Estrogen receptors and growth response in cultured human periodontal ligament cells

Consideration of hormonal changes for orthodontic treatment during pregnancy and lactation - a review

Hormonal changes in pregnant and lactating women significantly affect bone metabolism and overall stress levels, positioning them as a unique group within the orthodontic population. Fluctuations in estrogen, progesterone, prolactin, and other hormones are closely linked to bone remodeling and the periodontal tissue's response to inflammation caused by dental plaque. Hormones such as thyrotropin, leptin, and melatonin also play crucial roles in pregnancy and bone remodeling, with potential implications for orthodontic tooth movement. Additionally, adverse personal behaviors and changes in dietary habits worsen periodontal conditions and complicate periodontal maintenance during orthodontic treatment. Notably, applying orthodontic force during pregnancy and lactation may trigger stress responses in the endocrine system, altering hormone levels. However, these changes do not appear to adversely affect the mother or fetus. This review comprehensively examines the interaction between hormone levels and orthodontic tooth movement in pregnant and lactating women, offering insights to guide clinical practice.

Periodontology and pregnancy: An overview of biomedical and epidemiological evidence

Women are particularly susceptible to developing gingival problems during pregnancy. In addition, periodontal disease in pregnant women may lead to adverse outcomes for both mother and infant, which have serious clinical and public health implications. Both scenarios have been extensively researched, helping to bring attention to pregnant women as an important and vulnerable population as it concerns periodontal health. The increase in gingival inflammation caused by hormonal changes in pregnant women is undisputed and has been studied and documented since the 1960s, although the exact etiology is not fully understood. The relationship between periodontal disease during pregnancy and adverse pregnancy outcomes is less substantiated, because of conflicting evidence. This review of the biomedical and epidemiologic literature provides an overview of both sides of this relationship and examines the potential mechanisms for developing periodontal disease during pregnancy and the proposed mechanisms by which periodontal disease leads to adverse pregnancy outcomes.

Does the rate of orthodontic tooth movement change during pregnancy and lactation? A systematic review of the evidence from animal studies

BACKGROUND

The changes in bone homeostasis observed during pregnancy and lactation could result in alterations in the rate of orthodontic tooth movement, but research in human subjects presents significant ethical and practical limitations. Our aim was to compare the amount of orthodontic tooth movement between pregnant/lactating or not animals.

METHODS

We searched without restrictions 8 databases and performed hand searching until July 2019 (PubMed, Central, Cochrane Database of Systematic Reviews, SCOPUS, Web of Science, Arab World Research Source, ClinicalTrials.gov , ProQuest Dissertations and Theses Global). We searched for studies comparing quantitatively the amount of orthodontic tooth movement between pregnant/lactating or not animals. Following retrieval and selection of studies, the collection of related data was performed and the risk of bias was assessed using the SYRCLE's Risk of Bias Tool. Exploratory synthesis was carried out using the random effects model.

RESULTS

Four studies were finally identified raising no specific concerns regarding bias. One study showed that lactation increased the rate of tooth movement by 50 % [p < 0.05]. Although an overall increase was noted in the pregnancy group as well, it did not reach statistical significance [3 studies, Weighted Mean Difference: 0.10; 95% Confidence Interval: - 0.04 - 0.24; p = 0.165].

CONCLUSIONS

The metabolic changes occurring during pregnancy and lactation may have an impact on the rate of tooth movement in animals. Although these animal experimental results should be approached cautiously, it could be safe practice to consider the impact of these physiological changes in the clinical setting.

REGISTRATION

PROSPERO (CRD42018118003).

Relationship between gingival inflammation and pregnancy

An increase in the prevalence and severity of gingival inflammation during pregnancy has been reported since the 1960s. Though the etiology is not fully known, it is believed that increasing plasma sex steroid hormone levels during pregnancy have a dramatic effect on the periodontium. Current works of research have shown that estrogen and progesterone increasing during pregnancy are supposed to be responsible for gingivitis progression. This review is focused not only on epidemiological studies, but also on the effects of progesterone and estrogen on the change of subgingival microbiota and immunologic physiological mediators in periodontal tissue (gingiva and periodontal ligament), which provides current information about the effects of pregnancy on gingival inflammation.

Oestrogen regulates proliferation, osteoblastic differentiation, collagen synthesis and periostin gene expression in human periodontal ligament cells through oestrogen receptor beta

OBJECTIVE

The present study was designed to examine how oestrogen regulates proliferation, osteoblastic differentiation, collagen synthesis and periostin gene expression in primary human periodontal ligament (hPDL) cells.

DESIGN

The short interfering RNA (siRNA) technique was used to inhibit oestrogen receptor beta (ERβ) expression hPDL cells. hPDL cell were isolated and fully characterized. A colorimetric assay was applied for the determination of alkaline phosphatase (ALP). An ELISA kit was used to detect osteocalcin (OCN) levels. Collagen synthesis was determined by measuring the incorporation of L-[3H] praline. RT-PCR was performed to detection of periostin mRNA relative gene expression.

RESULTS

ERβ mRNA was expressed in hPDL cells and significant inhibition of mRNA expression and ERβ mature protein of the ERβ was evident in the siRNA group. At 72h, there was a significant increase in non-transfected hPDL cell proliferation after estradiol stimulation. Addition of 17β-estradiol significantly enhanced ALP activity and production of OCN in non-transfected cells but had no effect on collagen synthesis. A clear increase in periostin mRNA expression levels was observed after incubating hPDL cells with estradiol. In hPDL-siERβ cells, the application of estradiol did not produce any evident differences in periostin mRNA expression

CONCLUSIONS

ERβ may play important roles in oestrogen-induced effects on hPDL cell proliferation, osteoblastic differentiation and expression of key molecules for the functional and structural integrity of the periodontium (i.e. periostin).

The human periodontal ligament cell: a fibroblast-like cell acting as an immune cell

BACKGROUND

Periodontal ligament cells are fibroblast-like cells characterized by collagen production but also possessing some osteoblastic features. In the light of numerous studies presented during recent times, which show that human periodontal ligament cells also produce cytokines and chemokines in response to inflammation promoters, it is reasonable to suggest that periodontal ligament cells play a role as promoters of periodontal inflammation through these mechanisms.

MATERIAL AND METHODS

The periodontal ligament, which harbours the periodontal ligament cells, is a part of the attachment apparatus comprised of periodontal ligament cells, extracellular matrix and fibres, attaching the root cement to the alveolar bone. Periodontal ligament cells are in close proximity to bacteria within the plaque and the pocket, and thus these cells are readily accessible to bacterial endotoxins and other promoters of inflammation.

RESULTS

Cytokines and chemokines, released by periodontal ligament cells upon stimulation with inflammation promoters, reach the blood vessels easily thanks to rich vascularization of the periodontium stimulating recruitment of white blood cells to the site of inflammation. In addition to classical inflammatory cells, such as leucocytes, macrophages and mast cells, the periodontal ligament cells also contribute to periodontal inflammation via their production and release of cytokines and chemokines.

CONCLUSION

Therefore, pharmacological treatment of periodontitis should aim to reduce the release of proinflammatory agents not only from classical inflammatory cells but also from periodontal ligament cells.

Demonstration of mitochondrial oestrogen receptor beta and oestrogen-induced attenuation of cytochrome c oxidase subunit I expression in human periodontal ligament cells

OBJECTIVE

Periodontal ligament (PDL) cells express oestrogen receptor beta (ERbeta) protein, but cellular functions regulated by ERbeta in these cells have not been identified. In this study we determine if ERbeta is localised to mitochondria and if oestrogen regulates mitochondrial function in human PDL cells obtained from teeth extracted for orthodontic reasons.

DESIGN

Subcellular distribution of ERbeta was determined by confocal microscopy of cells co-stained with ERbeta antibody and the mitochondrion-selective probe MitoTracker and by immunogold electron microscopy. Expression of the mitochondrial enzyme cytochrome c oxidase subunit I, involved in oxidative phosphorylation, was determined by Western blotting in cells treated with or without physiological concentrations of the endogenous oestrogen 17beta-oestradiol.

RESULTS

ERbeta immunoreactivity was observed both in the nuclei and the cytoplasm. MitoTracker-labelling was observed in the cytoplasm, especially in the perinuclear region, but not in the nuclei. Co-localisation of ERbeta and MitoTracker was observed in cells derived from both male and female subjects. Mitochondrial localisation of ERbeta was confirmed by immunogold electron microscopy. Cells treated with or without 17beta-oestradiol (100 nM) displayed an identical pattern of staining for mitochondria. Treatment with 100 nM 17beta-oestradiol attenuated cytochrome c oxidase subunit I expression by about 30%, while combined treatment with 17beta-oestradiol and the ER blocker ICI 182780 (10 microM) had no effect.

CONCLUSION

This study demonstrates mitochondrial localisation of ERbeta and oestrogen-induced decrease in the expression of cytochrome c oxidase subunit I in human PDL cells, suggesting that oestrogen probably via ERbeta influences mitochondrial function and PDL cell energy metabolism.

Alterations in the periodontium after ovariectomy in rats: the effects of a Japanese herbal medicine, Chujo-to

Ovariectomy-induced changes on the periodontium (gingiva, alveolar bone, and periodontal ligament) in rats and the preventive effects of a Japanese herbal medicine, Chujo-to, were studied for a period of 49 days. The rats were divided into five groups: sham-operated (sham), ovariectomized (OVX), OVX given Chujo-to, OVX given 17beta-oestradiol, and OVX given the vehicle for 17beta-oestradiol, respectively. After the test period, the bone mineral content (BMC) of the mandibular condyle in OVX rats was similar to those in both sham rats and the OVX rats treated with either Chujo-to or 17beta-oestradiol. However, the scanning electron microscopic (SEM) analyses revealed that the periodontal ligament of the OVX rats and the OVX rats treated with Chujo-to became more coarse than that of the sham rats or the rats treated with 17beta-oestradiol. The surface of the alveolar bone in the OVX rats appeared to contain numerous small granules, which were not present in the sham rats and the rats treated with either Chujo-to or 17beta-oestradiol. These results suggest that ovariectomy caused alterations in the peridontium, but Chujo-to had a preventive effect on the surface architecture of the alveolar bones.

Analysis of oestrogen receptor mRNA by reverse transcriptase-polymerase chain reaction in human periodontal ligament cells

Periodontal ligament (PDL) cells have osteoblast-like features and are capable of differentiating into osteogenic cells. As human osteoblasts express oestrogen receptor mRNA, it is possible that PDL cells do so also, but findings have been conflicting. To determine whether they do express oestrogen receptor mRNA, the reverse transcriptase-polymerase chain reaction was performed with two different primers. Cells were obtained from a healthy periodontal ligament of premolar extracted for orthodontic reasons. The human breast adenocarcinoma cell-line MCF7 was used as a positive control. Expression of oestrogen receptor mRNA was detected in PDL cells with one of the primers but with less intensity than in MCF7 cells. Southern hybridization confirmed these results. These findings suggest that PDL cells express oestrogen receptor mRNA at low levels.

Androgens modulate interleukin-6 production by gingival fibroblasts in vitro

BACKGROUND

Pregnancy and puberty gingivitis have been attributed to increased concentrations of circulating sex hormones. This inflammatory gingival condition is accompanied by the local production of cytokines. The aims of this in vitro study were to assess, in the presence or absence of testosterone (T) or dihydrotestosterone (DHT), the production of interleukin-6 (IL-6) by human gingival fibroblasts (hGF), and to evaluate the effects of flutamide (a common anti-androgen) in this system.

METHODS

The effects of the androgens, T and DHT, on IL-6 production were measured in vitro in serum-free, phenol red-free medium. Cells were incubated with or without androgens for 72 hours; the concentration of IL-6 secreted into the medium after an additional 24-hour challenge with IL-1beta plus hormones was estimated by radioimmunoassay. The reverse transcription polymerase chain reaction was used to examine hGF and periodontal ligament cells (PDL) for the presence of androgen receptor.

RESULTS

In serum-free medium, T and DHT at concentrations of 5 x 10(-8) to 10(-7)M significantly (P <0.05) inhibited IL-6 production by hGF. Flutamide, up to concentrations of 2 x 10(-5)M, did not reverse this inhibition. The androgen receptor was identified in both hGF and PDL.

CONCLUSIONS

We concluded that elevated levels of androgens, specifically testosterone and dihydrotestosterone, could affect the stromal cell response to an inflammatory challenge by downregulation of IL-6 production. This in vitro study lends support to the hypothesis that increased hormones during pregnancy or puberty could modulate the development of localized inflammation.

Influence of hormonal contraceptives on microbial flora of gingival sulcus

To determine a possible influence of two different hormonal contraceptives on bacterial microflora of gingival sulcus, subgingival plaque samples of 29 healthy women aged between 20 and 32 years were investigated bacteriologically before subjects took a contraceptive and 10 and 20 days after subjects started the medication. In 14 women, and oral contraceptive containing 0.02 mg ethinyl estradiol and 0.15 mg desogestrel (preparation A) was used, and 15 women took a contraceptive containing 0.03 mg ethinyl estradiol and 2.00 mg dienogest (preparation B) daily over 21 days. There were no changes in clinical parameters of the teeth investigated during 3 weeks of the study. The periodontopathogenic bacteria Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans were never detected throughout the study. On the other hand, the periodontopathogenic species Prevotella intermedia was found in plaque samples of 22 women. The content of this microorganism showed only a little change between the pretreatment period and plaque sampling after 10 days of contraceptive treatment, but a striking increase occurred after 20 days of contraceptive treatment, especially in the preparation A group. In this respect, there was a significant difference between preparations A and B.

Polymerase chain reaction analysis of oestrogen and androgen receptor expression in human gingival and periodontal tissue

Oestrogen and androgen receptors mediate the effects of their respective hormones by acting as ligand-activated transcription factors that control a wide range of biological processes. In order to determine whether periodontal and gingival tissues could respond to oestrogen and androgen, the specific and highly sensitive reverse-transcribed polymerase chain reaction (PT-PCR) was used to examine the presence of the mRNAs corresponding to these receptors. Expression of the androgen receptor was readily detected in periodontal and gingival tissue and in fibroblasts derived from these tissues, but transcripts for the oestrogen receptor were not detected in these samples. Moreover, treatment of the cultured fibroblasts with the oestrogen diethylstilbesterol (DES) or the androgen dihydrotestosterone (DHT) did not induce the expression of the oestrogen receptor mRNA; nor did the hormones modify the activity of the androgen receptor gene. These results suggest that, while periodontal and gingival tissues are not able to respond directly to oestrogen, they may nevertheless be highly sensitive to the anabolic effects of androgens.

Effects of sex hormones on protein and collagen content of the temporomandibular joint disc of the rat

PURPOSE

The effect of sex hormones on the protein and collagen content of the temporomandibular joint (TMJ) disc of adult male and female rats.

MATERIALS AND METHODS

One hundred forty-four Wistar rats were assigned to 14 groups of 12 each. Two groups, one female and one male, served as a control and received no treatment, and two other groups (one female and one male) received a sham gonadectomy and placebo hormone. The remaining 10 groups (five males and five females) received either orchiectomy or ovariectomy, followed by administration of estrogen, progesterone, combined estrogen and progesterone, or testosterone. The total protein and collagen content of the TMJ disc were determined using the calorimetric hydroxyproline method.

RESULTS

The collagen content of TMJ discs of control males was statistically greater than the collagen content of the control female rats. This difference disappeared after ovariectomy of females and orchiectomy of males. Also, there was a general trend for a decrease in collagen and protein content to be produced by estrogen, progesterone, and by estrogen combined with progesterone in castrated male and female rats, and by orchiectomy of male rats. There was also a trend toward an increase in collagen and protein content after ovariectomy in female rats and administration of testosterone to castrated male and female rats. However, the only statistically significant effect of the drugs tested was that of estrogen combined with progesterone in ovariectomized female rats (a lowering effect on the total protein) and of estrogen alone in orchiectomized male rats (a lowering effect on the collagen content).

CONCLUSION

Steroid sex hormones have an effect on the collagen and protein content of the TMJ disc of the rat as indicated by the difference in the values between control males and females and by the disappearance of this difference on castration of both male and female animals. This was also manifested by the significant effect of estradiol on collagen content of castrated males, by the effect of estrogen combined with progesterone on the protein content of castrated females.

Sex steroid hormones and cell dynamics in the periodontium

The biological changes that occur in tissues of the periodontium during puberty, the menstrual cycle, pregnancy, menopause, and oral contraceptive use have heightened interest in the relationship between sex steroid hormones and periodontal health. These clinical observations coupled with tissue specificity of hormone localization, identification of hormone receptors, as well as the metabolism of hormones have strongly suggested that periodontal tissues are targets for androgens, estrogens, and progestins. The etiologies of periodontal endocrinopathies are diverse; nonetheless, periodontal pathologies may be a consequence of the actions and interactions of sex steroid hormones on specific cells found in the periodontium.