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Okawa H, Kondo T, Hokugo A, Cherian P, Campagna JJ, Lentini NA, Sung EC, Chiang S, Lin YL, Ebetino FH, John V, Sun S, McKenna CE, Nishimura I. Mechanism of bisphosphonate-related osteonecrosis of the jaw (BRONJ) revealed by targeted removal of legacy bisphosphonate from jawbone using competing inert hydroxymethylene diphosphonate. eLife 2022; 11:e76207. [PMID: 36017995 PMCID: PMC9489207 DOI: 10.7554/elife.76207] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) presents as a morbid jawbone lesion in patients exposed to a nitrogen-containing bisphosphonate (N-BP). Although it is rare, BRONJ has caused apprehension among patients and healthcare providers and decreased acceptance of this antiresorptive drug class to treat osteoporosis and metastatic osteolysis. We report here a novel method to elucidate the pathological mechanism of BRONJ by the selective removal of legacy N-BP from the jawbone using an intra-oral application of hydroxymethylene diphosphonate (HMDP) formulated in liposome-based deformable nanoscale vesicles (DNV). After maxillary tooth extraction, zoledronate-treated mice developed delayed gingival wound closure, delayed tooth extraction socket healing and increased jawbone osteonecrosis consistent with human BRONJ lesions. Single cell RNA sequencing of mouse gingival cells revealed oral barrier immune dysregulation and unresolved proinflammatory reaction. HMDP-DNV topical applications to nascent mouse BRONJ lesions resulted in accelerated gingival wound closure and bone socket healing as well as attenuation of osteonecrosis development. The gingival single cell RNA sequencing demonstrated resolution of chronic inflammation by increased anti-inflammatory signature gene expression of lymphocytes and myeloid-derived suppressor cells. This study suggests that BRONJ pathology is related to N-BP levels in jawbones and demonstrates the potential of HMDP-DNV as an effective BRONJ therapy.
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Affiliation(s)
- Hiroko Okawa
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative & Reconstructive Sciences, University of California, Los Angeles School of DentistryLos AngelesUnited States
- Division of Molecular & Regenerative Prosthodontics, Tohoku University Graduate School of DentistrySendaiJapan
| | - Takeru Kondo
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative & Reconstructive Sciences, University of California, Los Angeles School of DentistryLos AngelesUnited States
- Division of Molecular & Regenerative Prosthodontics, Tohoku University Graduate School of DentistrySendaiJapan
| | - Akishige Hokugo
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative & Reconstructive Sciences, University of California, Los Angeles School of DentistryLos AngelesUnited States
- Regenerative Bioengineering and Repair Laboratory, Division of Plastic and Reconstructive Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los AngelesLos AngelesUnited States
| | | | - Jesus J Campagna
- Department of Neurology, David Geffen School of Medicine at University of California, Los AngelesLos AngelesUnited States
| | - Nicholas A Lentini
- Department of Chemistry, University of Southern CaliforniaLos AngelesUnited States
| | - Eric C Sung
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative & Reconstructive Sciences, University of California, Los Angeles School of DentistryLos AngelesUnited States
| | - Samantha Chiang
- Division of Oral & Systemic Health Sciences, University of California, Los Angeles School of DentistryLos AngelesUnited States
| | - Yi-Ling Lin
- Section of Oral & Maxillofacial Pathology, University of California, Los Angeles School of DentistryLos AngelesUnited States
| | | | - Varghese John
- Department of Neurology, David Geffen School of Medicine at University of California, Los AngelesLos AngelesUnited States
| | - Shuting Sun
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative & Reconstructive Sciences, University of California, Los Angeles School of DentistryLos AngelesUnited States
- BioVinc, LLCPasadenaUnited States
| | - Charles E McKenna
- Department of Chemistry, University of Southern CaliforniaLos AngelesUnited States
| | - Ichiro Nishimura
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative & Reconstructive Sciences, University of California, Los Angeles School of DentistryLos AngelesUnited States
- Division of Oral & Systemic Health Sciences, University of California, Los Angeles School of DentistryLos AngelesUnited States
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Ferreira GZ, Bachesk AB, Bachesk AB, Farah GJ, Filho LI, Dos Santos Silva R, Poluha RL, Danieletto-Zanna CF, Gonçales ES. Oral Rehabilitation With Dental Implants and the Importance of a Preventive Evaluation for Osteonecrosis of the Jaws Associated With Medications. J ORAL IMPLANTOL 2020; 46:431-437. [PMID: 33031547 DOI: 10.1563/aaid-joi-d-19-00275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Osteonecrosis of the jaw is a possible oral complication resulting from antiresorptive therapies, such as bisphosphonates (Bfs). Although the etiology is not entirely clear, it has been shown to be dependent on several factors, with the traumatic stimulation caused by the placement of teeth implants indicated as one of the predisposing factors to this pathology. The indications and preventive methods for performing these procedures have been questioned, making it essential to determine the proper protocols. Thus, the present study aims to discuss the risks of the development of osteonecrosis in patients undergoing dental implant surgery who use Bfs as well as to discuss related local and systemic factors and possible methods for preventing this side effect. The study also aims to present a clinical case of an osteopenic patient who used Bfs and underwent rehabilitation through implants according to specific protocols, which resulted in successful treatment.
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Affiliation(s)
- Gustavo Zanna Ferreira
- Oral and Maxilofacial Surgery of Bauru School of Dentistry - FOB/USP and Oral Surgery, UniCesumar, Maringá Paraná, Brazil
| | | | | | - Gustavo Jacobucci Farah
- Oral and Maxillofacial Surgery, Department of Dentistry, State University of Maringá, Brazil
| | - Liogi Iwaki Filho
- Oral and Maxillofacial Surgery, Department of Dentistry, State University of Maringá, Brazil
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