Immunohistochemical Evaluation of EMT-related Adhesion  Markers in Odontogenic Lesions: Implications for Tissue  Integrity and Tumor Behavior

Farid Museyibov; Sevda Guliyeva; Zeyneb Veliyeva; Gumru Jafarova; Sevda Aliyeva; Sevinj Shahmemmedova; Benay Yildirim

doi:10.31557/apjcb.2026.11.1.125-131

Authors

Farid Museyibov Research Center, Azerbaijan Medical University, Baku, Azerbaijan.
Sevda Guliyeva Research Center, Azerbaijan Medical University, Baku, Azerbaijan.
Zeyneb Veliyeva Research Center, Azerbaijan Medical University, Baku, Azerbaijan.
Gumru Jafarova
Sevda Aliyeva Department of Normal Physiology, Azerbaijan Medical University, Baku, Azerbaijan.
Sevinj Shahmemmedova Research Center, Azerbaijan Medical University, Baku, Azerbaijan.
Benay Yildirim Department of Oral Pathology at Ankara Gazi University, Ankara, Turkey.

DOI:

https://doi.org/10.31557/apjcb.2026.11.1.125-131

Keywords:

ameloblastoma, keratocystic odontogenic tumor, orthokeratinizing odontogenic keratocyst, epithelial–mesenchymal transition, immunohistochemistry

Abstract

Background: Epithelial–mesenchymal transition (EMT) is increasingly recognized as an important contributor to the invasive behavior of odontogenic tumors. However, comparative analyses of EMT-associated biomarkers across different odontogenic lesions remain limited. A clearer understanding of EMT-related alterations may help differentiate lesion biology and improve diagnostic interpretation.

Aim: To evaluate and compare the expression profiles of key EMT-related markers Twist, Snail, E-cadherin, and integrin-β1 in ameloblastoma (ABL), keratocystic odontogenic tumor (KOT), orthokeratinizing odontogenic keratocyst (OOK), and dental follicle (DF) tissues.

Methods: Seventy cases were analyzed: 21 ABL, 31 KOT, 8 OOK, and 10 DF. All samples underwent histopathological reevaluation followed by standardized immunohistochemical staining. Staining intensity, percentage of positive cells, and H-scores were independently assessed by two blinded pathologists. Statistical analyses included Mann–Whitney U and Kruskal–Wallis tests; significant Kruskal–Wallis results were followed by Dunn–Bonferroni post hoc comparisons. Effect sizes were calculated (r for Mann–Whitney, η² for Kruskal–Wallis). Data were reported as median (IQR) or mean ± SD, depending on distribution characteristics.

Results: ABL exhibited the highest frequency of Snail positivity (42.9%) together with marked reductions in E-cadherin and integrin-β1 expression, consistent with EMT-associated alterations. Snail expression was significantly higher in ABL than in both KOT and OOK (p < 0.01). E-cadherin and integrin-β1 levels were significantly lower in ABL and KOT compared with DF (p < 0.05). Twist expression did not differ significantly among lesion types (p > 0.05). No significant differences were found between solid and unicystic ABL subtypes.

Conclusion: EMT-related markers demonstrate distinct expression patterns across odontogenic lesions. Twist shows limited discriminatory value, whereas the combined profile of elevated Snail and reduced adhesion molecules (E-cadherin, integrin-β1) more reliably reflects EMT activity in ameloblastoma. These findings underscore the heterogeneous nature of EMT involvement and highlight the need for further molecular and functional studies clarifying its mechanistic contribution to odontogenic tumor behavior.