Cytokines and
chemokines have a fundamental role in the maintenance of
inflammation and bone response, which culminate in the development of chronic periapical lesions. Regulatory (Treg) and Th17
cytokines play a key role in regulating the immune response involved in this process. The aim of this study was to investigate the role of Treg and Th17 cells in chronic inflammatory
periapical disease, by comparing the expression of the immunoregulatory mediators TGF-β,
IL-10, CCL4, and the proinflammatory
IL-17 and CCL20 in the periapical tissue of teeth with
pulp necrosis, with and without associated chronic lesions. Eighty-six periapical tissue samples were obtained from human teeth. The samples were divided into three groups:
pulp necrosis with a periapical lesion (n=26);
pulp necrosis without a periapical lesion (
n=30), and control (
n=30). All samples were submitted to histopathological analysis and
cytokine and
chemokine measurement through ELISA. Statistical analyses were done with Kruskal-Wallis and Mann-Whitney tests and Spearman correlation. The group with
pulp necrosis and a periapical lesion showed a higher expression of CCL4 and TGF-β in comparison with
pulp necrosis without a lesion. CCL20 was higher in the group with a periapical lesion when compared to the control. In all groups there was a weak positive correlation between IL-17/CCL20, IL-10/CCL4, and IL-17/TGF-β. Both types of
cytokines, pro-inflammatory and immunoregulatory, occur simultaneously in periapical tissue. However, a rise in immunosuppressive
cytokines and
chemokines (CCL4 and TGF-β) in periapical lesions suggests a role of these
cytokines in stable
periapical disease.