Using Spatial Transcriptomics to Identify a Diagnostic Molecular Signature Associated with Reversible Dental Pulpitis

Area of Science:

• Endodontics
• Molecular Biology
• Dental Research

Background:

• Current endodontic diagnostics rely on subjective measures, often misclassifying pulp inflammation.
• This leads to unnecessary tooth devitalization and missed opportunities for conservative treatment.
• Understanding pulp biology is crucial for accurate diagnosis and maintaining tooth vitality.

Purpose of the Study:

• To investigate transcriptomic profiles of dental pulpitis.
• To identify distinct inflammation subtypes beyond reversible/irreversible classifications.
• To refine diagnostic approaches for pulpitis and improve case selection for vital pulp therapy.

Main Methods:

• Spatial transcriptomics (Visium-CytAssist-V2) analyzed four dental pulp tissues.
• Cell deconvolution and differential gene expression identified transcriptomic signatures.
• Analysis focused on healthy pulp, reversible pulpitis, and irreversible pulpitis, particularly coronal regions near caries.

Main Results:

• Irreversible pulpitis shared molecular features with reversible pulpitis, including immune-fibroblast ratios and neuroinflammation pathways.
• Upregulated genes in irreversible pulpitis suggest immune signaling, cell migration, and tissue repair.
• Specific gene expression patterns (e.g., increased PTN, CXCL14; decreased ENG, SELE) may indicate residual healing potential.

Conclusions:

• A distinct transcriptomic profile associated with pulp healing was identified.
• Findings support a nuanced diagnostic approach focusing on immune-fibroblast dynamics.
• This research has implications for enhancing pulp preservation via vital pulp therapy.