Hydroxyapatite grafting promotes new bone formation and osseointegration of smooth titanium implants

Titanium is the ideal metal for intra-osseous dental implants. It permits the natural formation of an oxide layer on its surface and thereby it prevents the release of potentially toxic molecules. New formation of bone around implants, partially placed into the bone marrow cavity, is a gradual process that runs from the endosteum to the surface of the implant. Deposition of hydroxyapatite crystals on collagen type I fibrils is initiated by acidic proteins and leads to bone mineralization. This study analyzed the effects of hydroxyapatite upon peri-implant bone formation after insertion of smooth titanium implants. Screw-shaped smooth titanium implants of 3.75 mm thickness and 8.5 mm length were inserted into the metaphysis of rabbit tibia, either together with bovine hydroxyapatite into the right tibia or in controls without hydroxyapatite into the left tibia. Polyfluorochrome tracers (alizarin complex, calcein, tetracycline) were injected subcutaneously at different time intervals after implantation to evaluate the time frame of bone new formation over a period of 8 weeks. All samples were processed for histology and analyzed by fluorescence and polarizing microscopy. Our results showed a higher quantity of mature type I collagen fibers around implants and an acceleration of bone formation in the presence of hydroxyapatite. Mainly immature organic matrix was formed at the surface of implants in controls. The presence of hydroxyapatite seems to promote the maturation of collagen fibers surrounding the titanium implants and to support osteoconduction. Moreover, new formation of bone was faster in all samples where implants were inserted together with hydroxyapatite.

Requirements and infection prophylaxis for internally cooled implant drills

Implant site preparation is crucially important to long-term success. Heat generation during drilling is unfavourable, since bone is relatively susceptible to heat, depending on its vascularisation and microstructure. Numerous factors such as drilling pressure, number of revolutions, drill design, wear and material, drilling depth and cooling influence heat generation. Internally cooled drills are, therefore, increasingly used, even though the improved cooling effect compared to conventional externally cooled drills is controversial. Internally cooled drills may have the disadvantage of a germ reservoir developing in the cooling channel. This study aimed to examine the effects of disinfection and sterilisation of internally cooled drills. After contamination of the cooling channel with suitable bioindicators (Enterococcus faecium, ATCC 6057 and spores of Bacillus stearothermophilus, ATCC 7953), the drills were disinfected (disinfection solution ID 220, Dürr Dental) and autoclaved (Webeco, E5S90, 134 degrees C, 2.6 bar, 5 min). Disinfection was not completely effective except after pre-cleaning. By means of sterilisation all spores of Bacillus stearothermophilus were completely killed. Internally cooled drills can be successfully disinfected by means of this hygienic procedure routinely used in dental practice and no source of infection is created.

[Retrospective survey of the management of patients treated for acute myocardial infarction in Provence-Alpes-Côte d'Azur]

OBJECTIVE

The aim of the study is to assess the characteristics, outcomes and factors associated with delay of reperfusion therapy in patients with myocardial infarction in the Provence Alpes Côte d'Azur (PACA).

METHODS

This retrospective study included all patients hospitalized with myocardial infarction in the PACA between January and June 2000. Myocardial infarction patients were identified using the Programme de Médicalisation des Systèmes d'Information. Univariate and multivariate analysis were performed.

RESULTS

A total of 2049 patients were admitted in 74 hospitals. Mean patient age was 68.9. Treatment consisted of coronary angioplasty alone in 53.3% of cases, thrombolysis alone in 4.5% and angioplasty after thrombolysis in 7.7%. The complication rate was 27.4% and mortality was 9.5%. The median time from first awareness of symptoms to the first action taken by the patient (1) was 1 hour 30 minutes. The time from the first action taken by the patient to revascularisation (2) was 3 hours 30 minutes. The time between the first awareness and revascularisation (3) was 8 hours 45 minutes. Multivariate analysis showed that the following factors were associated with increased delay: (1). no prior myocardial infarction, occurrence of symptoms at home. (2). age > 65 years, absence of chest pain, consultation with a physician before hospitalization, non-medical transport, transfer from one hospital to another, treatment by angioplasty alone. (3). age > 65 years, absence of chest pain, consultation with a physician before hospitalization, non-medical transport, treatment by angioplasty alone.

CONCLUSIONS

Alerting emergency services more quickly would shorten treatment delay not only by ensuring quicker transport to a properly equipped hospital but also by allowing prompt pre-hospital thrombolytic therapy.

Bone healing after the inferior alveolar nerve lateralization: A histologic study in rabbits (Oryctolagus cuniculus)

PURPOSE

The purpose of this article is to evaluate the bone healing around 2 different dental implant surfaces after the lateralization surgery of the inferior alveolar nerve (IAN) during an 8-week healing period in rabbits, and to check if there is any interaction between the implants and the nerve.

MATERIALS AND METHODS

The IAN lateralization was performed in an experimental rabbit model. Eight adult female rabbits (Oryctolagus cuniculus) underwent the surgical procedure, and 1 implant was placed on each side of the mandible while the nerve was lateralized. On both sides, the nerve was repositioned directly in contact with the implant surface. With the intention of obtaining comparative results, smooth titanium implants were installed on the right side, and blasted Al2O3 ones were placed on the left. During the healing period, bone tracers were administered subcutaneously to check different periods of bone ingrowth.

RESULTS

Histologic section, regardless of the studied surface, showed bone remodeling around the nerve, without contact between the nerve and the implanted surface. The bone blocks containing implants were histomorphometrically examined through computerized analysis, and the results obtained showed that the bone remodeling around the nerve occurred during the first weeks of healing. Through analysis of variance, the blasted Al2O3 implants showed at least 2.5-fold greater bone neoformation compared with the smooth titanium implants.

CONCLUSIONS

Our results showed that there was no significant difference in the healing process concerning the nerve between the 2 studied surfaces. No interaction was detected between the nerve and the implants.

Plasma hormones and metabolites in Piedmontese cows during late pregnancy: relationships with calf birth weight

Relationships among plasma hormonal and metabolic variables in the last trimester of gestation in 59 Piedmontese dams (n = 15 heifers, n = 44 cows) and the calf birth weight (BWT) class of their offspring were investigated in seven herds. The BWT data were categorized as follows: > 50 kg (BWT-A), 46 to 50 kg (BWT-B), 41 to 45 kg (BWT-C), and < 41 kg (BWT-D). Blood samples were collected at 33, 36, and 39 wk of gestation. Packed cell volume (PCV) and plasma concentrations of insulin, estrone sulfate (E1SO4), NEFA, and creatinine were determined and correlated to BWT class. Creatinine: E1SO4 ratio also was calculated. Duration of gestation was greater for dams producing a BWT-A calf than for the other BWT classes, and calf BWT was heavier (P < 0.001) for calves in the BWT-A vs. BWT-D class. The heaviest calf in BWT-A was associated with the highest calving difficulty score. Insulin and PCV values were not affected by week of gestation, whereas plasma E1SO4, NEFA, and creatinine content increased (P < 0.001) and creatinine:E1SO4 decreased (P < 0.001) during late gestation. Calf BWT class did not affect PCV value. Plasma E1SO4 concentrations were lower (P < 0.01) in BWT-D dams than the other dams, showing the greatest difference at 39 wk of gestation. At 36 and 39 wk of gestation, dams bearing BWT-C and BWT-D calves had a higher (P < 0.01) plasma insulin concentration than those bearing BWT-A and BWT-B calves. Plasma NEFA concentrations at 39 wk of gestation were higher (P < 0.05) in dams of calf BWT-A than in the other dams. We conclude that plasma E1SO4 level is a variable that can be used to monitor problems related to a small size calf. Conversely, the forthcoming birth of a calf with a heavy BW seems to be preceded by a pronounced increase in plasma NEFA level in the dam just a few days before calving.

Bone regeneration in rabbit sinus lifting associated with bovine BMP

Autogenous bone is considered the optimal grafting material for sinus lifting, although its harvesting causes great patient discomfort. Various approaches have been taken in order to obtain sinus lifting with preexisting tissue. However, because of the unsuitability of such tissue, additional materials have been required. Alternatively, biomaterials from humans or other animals are used. In this study, the efficacy of using morphogenetic bovine bone protein (BMPb) to augment the maxillary sinus floor was examined. Four grafting materials were employed: lyophilized bovine bone powder, absorbable collagen flakes, natural hydroxylapatite, and synthetic hydroxylapatite. Two groups of rabbits were studied. In one group, graft material only was used. In the other, graft material was combined with 0.5 mg BMPb. During 8 weeks of observation, polyfluorochrome tracers were injected in subcutaneous tissue to evaluate new bone- deposition periods. Following sacrifice, the samples were examined under fluorescent and light microscopes. Results indicated 33.34% more newly formed bone in BMPb animals than in controls. Graft-material resorption increased, but natural HA showed no significant alterations. The results show that the use of BMPb, although providing osteoinduction, might not promote sufficient bone formation. Nonetheless, this material could provide an alternative to autogenous grafts, thereby avoiding patient discomfort.

The effects of bovine BMP associated to HA in maxillary sinus lifting in rabbits

This study examines the efficacy of using bone morphogenetic protein of bovine origin associated with other biomaterials in maxillary sinus floor augmentation procedures in rabbits (Oryctolagus cuniculus). Various approaches have been attempted to obtain sinus lifting with pre-existing tissue, but all of them have been considered inadequate, because such tissue offers very low bio-quality, requiring additional materials to stimulate bone neo-formation. For this purpose, autogenous bone is considered to be the best grafting material, but harvesting it results in great discomfort for the patient. Biomaterials from human beings or other animals are used as a substitute. In this study, four different grafting materials were used: lyophilized bovine bone powder, absorbable collagen flakes, natural hydroxyapatite (nHA) and synthetic hydroxyapatite (sHA), in nine animals divided into two groups: (A) control group (left sinus)--using just graft material, and (B) BMP group (right sinus)--using graft material with 0.5 mg bovine bone morphogenetic protein (BMPb). The observation periods were of 8 and 12 weeks duration and sequential bone neo-formation polyfluorochrome tracers (alizarin complex, calcein, and tetracycline) were subcutaneously injected, to evaluate the periods of new bone deposition. After the animals were sacrificed, the material was obtained and examined under a fluorescent microscope and also activated by UV light and the conclusion reached that the newly formed bone increase was of 33.34% when compared to the control group at 8 weeks At 12 weeks, the bone deposition in the "BMP" group was not significant while in the "control" group there was continuous growth. This difference showed that the BMP stimulated bone formation during the early periods of healing (8 weeks), although it altered the normal cycle of bone deposition over the longer period (12 weeks). The graft material showed increasing reabsorption, but the natural HA did not show significant alterations. The results of this new animal model indicated that the BMPb used, although facilitating osteoinduction, might not be sufficient to promote qualitative and quantitative bone neo-formation, which could guarantee better prognoses. The BMPb material studied may possibly become an alternative to autogenous grafts causing less discomfort for the patient.

5'-aminoimidazole-4-carboxamide riboside induces apoptosis in human neuroblastoma cells

5'-Aminoimidazole-4-carboxamide riboside (AICA riboside) has been previously shown to be toxic to two neuronal cell models [Neuroreport 11 (2000) 1827]. In this paper we demonstrate that AICA riboside promotes apoptosis in undifferentiated human neuroblastoma cells (SH-SY5Y), inducing a raise in caspase-3 activity. In order to exert its effect on viability, AICA riboside must enter the cells and be phosphorylated to the ribotide, since both a nucleoside transport inhibitor, and an inhibitor of adenosine kinase produce an enhancement of the viability of AICA riboside-treated cells. Short-term incubations (2 h) with AICA riboside result in five-fold increase in the activity of AMP-dependent protein kinase (AMPK). However, the activity of AMPK is not significantly affected at prolonged incubations (48 h), when the apoptotic effect of AICA riboside is evident. The results demonstrate that when the cell line is induced to differentiate both toward a cholinergic phenotype (with retinoic acid) or a noradrenergic phenotype (with phorbol esters), the toxic effect is significantly reduced, and in the case of the noradrenergic phenotype differentiation, the riboside is completely ineffective in promoting apoptosis. This reduction of effect correlates with an overexpression of Bcl-2 during differentiation. AICA riboside, derived from the hydrolysis of the ribotide, an intermediate of purine de novo synthesis, is absent in normal healthy cells; however it may accumulate in those individuals in which an inborn error of purine metabolism causes an increase in the rate of de novo synthesis and/or an overexpression of cytosolic 5'-nucleotidase, that appears to be the enzyme responsible for AICA ribotide hydrolysis. In fact, 5'-nucleotidase activity has been shown to increase in patients affected by Lesch-Nyhan syndrome in which both acceleration of de novo synthesis and accumulation of AICA ribotide has been described, and also in other neurological disorders of unknown etiology. Our results raise the intriguing clue that the neurotoxic effect of AICA riboside on the developing brain might contribute to the neurological manifestations of syndromes related to purine dismetabolisms.

Catabolism of exogenous deoxyinosine in cultured epithelial amniotic cells

Uptake and catabolism of purine nucleosides have been commonly considered as means to salvage the purine ring for nucleic acid synthesis, usually neglecting the destiny of the pentose moiety. With the aim to ascertain if deoxyribose derived from exogenous DNA can be utilised as a carbon and energy source, we studied the catabolism of exogenous deoxyinosine in a cell line derived from human amnion epithelium (WISH). Intact WISH cells catabolise deoxyinosine by conversion into hypoxanthine. The nucleoside enters the cell through a nitrobenzylthioinosine-insensitive equilibrative transport. Deoxyinosine undergoes a phosphorolytic cleavage inside the cell. The purine base diffuses back to the external medium, while the phosphorylated pentose moiety can be further catabolised to glycolysis and citric acid cycle intermediates. Our results indicate that the catabolism of the deoxynucleoside can be considered mainly as a means to meet the carbon and energy requirements of growing cells.

Bovine cytosolic 5'-nucleotidase acts through the formation of an aspartate 52-phosphoenzyme intermediate

Cytosolic 5'-nucleotidase/phosphotransferase (cN-II), specific for purine monophosphates and their deoxyderivatives, acts through the formation of a phosphoenzyme intermediate. Phosphate may either be released leading to 5'-mononucleotide hydrolysis or be transferred to an appropriate nucleoside acceptor, giving rise to a mononucleotide interconversion. Chemical reagents specifically modifying aspartate and glutamate residues inhibit the enzyme, and this inhibition is partially prevented by cN-II substrates and physiological inhibitors. Peptide mapping experiments with the phosphoenzyme previously treated with tritiated borohydride allowed isolation of a radiolabeled peptide. Sequence analysis demonstrated that radioactivity was associated with a hydroxymethyl derivative that resulted from reduction of the Asp-52-phosphate intermediate. Site-directed mutagenesis experiments confirmed the essential role of Asp-52 in the catalytic machinery of the enzyme and suggested also that Asp-54 assists in the formation of the acyl phosphate species. From sequence alignments we conclude that cytosolic 5'-nucleotidase, along with other nucleotidases, belong to a large superfamily of hydrolases with different substrate specificities and functional roles.

Cytosolic 5'-nucleotidase hyperactivity in erythrocytes of Lesch-Nyhan syndrome patients

Lesch-Nyhan syndrome is a metabolic-neurological syndrome caused by the X-linked deficiency of the purine salvage enzyme hypoxanthine-guanine phosphoribosyltransferase (HGPRT). Metabolic consequences of HGPRT deficiency have been clarified, but the connection with the neurological manifestations is still unknown. Much effort has been directed to finding other alterations in purine nucleotides in different cells of Lesch-Nyhan patients. A peculiar finding was the measure of appreciable amount of Z-nucleotides in red cells. We found significantly higher IMP-GMP-specific 5'-nucleotidase activity in the erythrocytes of seven patients with Lesch-Nyhan syndrome than in healthy controls. The same alteration was found in one individual with partial HGPRT deficiency displaying a severe neurological syndrome, and in two slightly hyperuricemic patients with a psychomotor delay. Since ZMP was a good substrate of 5'-nucleotidase producing Z-riboside, we incubated murine and human cultured neuronal cells with this nucleoside and found that it is toxic for our models, promoting apoptosis. This finding suggests an involvement of the toxicity of the Z-riboside in the pathogenesis of neurological disorders in Lesch-Nyhan syndrome and possibly in other pediatric neurological syndromes of uncertain origin.

Identification, separation and characterisation of two forms of cytosolic 5'-nucleotidase/nucleoside phosphotransferase in calf thymus

Cytosolic 5'-nucleotidase, acting preferentially on IMP, GMP and their deoxyderivatives, endowed with phosphotransferase activity, is a widespread enzyme responsible for the regulation of intracellular IMP and GMP concentrations and the phosphorylation of purine nucleoside pro-drugs. The enzyme activity is stimulated by ATP, ADP and 2,3-bisphosphoglycerate (BPG), and is inhibited by phosphate. Calf thymus possesses two active proteins with a different electrophoretic mobility. In this report we show that the two forms can be separated by ADP-agarose affinity chromatography. Whereas form A binds weakly to the column, form B is tightly bound and is released by the addition of ADP into the elution buffer. The two enzyme forms differ in terms of electrophoretic, chromatographic behaviour and regulatory characteristics. Form B, as already described for the enzyme purified from the same source (Pesi et al., 1996, Biochim Biophys Acta 294, 191-194), exhibits three different sites for the three activators with a synergistic effect between ADP and BPG. Form A has a high affinity regulatory site for BPG, while ADP and ATP appear to share the same low affinity site and no synergistic effect is observed.

Bovine cytosolic IMP/GMP-specific 5'-nucleotidase: cloning and expression of active enzyme in Escherichia coli

A cDNA coding for bovine cytosolic IMP/GMP-specific 5'-nucleotidase endowed with phosphotransferase activity was cloned from calf thymus RNA, by 5' and 3' rapid amplification of cDNA ends protocols (5' and 3' RACE). Two products were isolated: a 5' RACE 1.6 kb fragment and a 3' RACE 2.0 kb fragment, with an overlapping region of 505 bp, leading to a total length of approx. 2951 bp. The similarity in the coding region to that of the human 5'-nucleotidase cDNA sequence [Oka, Matsumoto, Hosokawa and Inoue (1994) Biochem. Biophys. Res. Commun. 205, 917-922], indirectly identified as a 5'-nucleotidase, was 94% and the deduced amino acid sequences were 99.5% identical. The bovine cDNA sequence included the sequences codifying for six peptides obtained from 5'-nucleotidase/phosphotransferase purified from calf thymus. Northern blots of human mRNA species from different tissues showed a 3.6 kb mRNA expressed at equal levels in most tissues. The cDNA was cloned into a pET-28c expression vector and the protein obtained after induction had a molecular mass of 61 kDa under SDS/PAGE. It exhibited both 5'-nucleotidase and phosphotransferase activity, as well as immunological and kinetic properties similar to those of the enzyme purified from calf thymus. This is the first time that a fully active recombinant 5'nucleotidase has been described.

The bifunctional cytosolic 5'-nucleotidase: regulation of the phosphotransferase and nucleotidase activities

The cytosolic 5'-nucleotidase specific for IMP, GMP, and their deoxyderivatives has been purified approximately 1000 times from calf thymus. The enzyme, in the presence of a suitable nucleoside, can act as a phosphotransferase, catalyzing the transfer of the phosphate moiety from a nucleoside monophosphate donor to a nucleoside acceptor, thus operating as an interconverting activity. This phosphorylating activity has drawn the attention of several research groups because the cytosolic 5'-nucleotidase represents the only cellular enzyme able to phosphorylate inosine and guanosine analogs, which are not substrates of known cellular nucleoside kinases. In this paper, we report the kinetic parameters of the bifunctional enzyme and its response to variations in adenylate energy charge. The results seem to indicate that in the presence of physiological concentrations of ATP and phosphate, the enzyme behaves mainly as a phosphotransferase, its activity being dependent only on the availability of a suitable nucleoside.