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Oryniak D, Brown M, Cholakis L, Elgazzar R. Case Report: Development of medication-related osteonecrosis of the jaw in a patient on long-term infliximab therapy. FRONTIERS IN ORAL HEALTH 2024; 5:1427060. [PMID: 39045331 PMCID: PMC11263092 DOI: 10.3389/froh.2024.1427060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 06/21/2024] [Indexed: 07/25/2024] Open
Abstract
Medication-Related Osteonecrosis of the Jaw (MRONJ) is a challenging and evolving aspect of Oral and Maxillofacial Surgery. In recent years, several medications apart from those traditionally associated with MRONJ such as bisphosphates (BPs) and Denosumab (DMB) have been implicated in bony necrosis of the jaw. This aim of this report is to demonstrate a significant case of bone necrosis following dental extractions on a patient being treated with infliximab therapy for Crohn's disease. Several cases in literature have reported MRONJ associated with infliximab but very few patients have developed as significant a form of the disease as seen in this report. Previous investigators have proposed pathophysiological pathways via which TNF-α inhibitors such as infliximab have a causative mechanism for MRONJ. When osteoclastic activity is restricted via these pathways, bone healing is impaired and MRONJ can occur. However, it remains a diagnostic challenge to differentiate between antiresorptive MRONJ and chronic osteomyelitis with bone necrosis in patients with acquired immunodeficiency. This case aims to illustrate why the antiresorptive effects of TNF-α inhibitors need to be considered as a possible primary driver of bone necrosis in such patients.
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Affiliation(s)
| | | | | | - Reda Elgazzar
- Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB, Canada
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2
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Jiang A, Zhang Z, Qiu X, Guo Q. Medication-related osteonecrosis of the jaw (MRONJ): a review of pathogenesis hypothesis and therapy strategies. Arch Toxicol 2024; 98:689-708. [PMID: 38155341 DOI: 10.1007/s00204-023-03653-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/22/2023] [Indexed: 12/30/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ), a severe side effect caused by antiresorptive antiangiogenic medication, particularly bisphosphonates (BPs), has become a challenging disease with serious and profound effects on the physical and mental health of patients. Although it occurs with high frequency and is harmful, the exact mechanism of MRONJ remains unknown, and systematic and targeted approaches are still lacking. Maxillofacial surgeons focus on the etiology of osteonecrosis in the mandible and maxilla as well as the appropriate oral interventions for high-risk patients. Adequate nursing care and pharmacotherapy management are also crucial. This review provides a current overview of the clinicopathologic feature and research of MRONJ caused by BPs, with an emphasis on the potential mechanisms and current therapy and prevention strategies of the disease. We are of the opinion that an in-depth comprehension of the mechanisms underlying MRONJ will facilitate the development of more precise and efficacious therapeutic approaches, resulting in enhanced clinical outcomes for patients.
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Affiliation(s)
- Aiming Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, China
| | - Zhuoyuan Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, China
- Department of Head and Neck Cancer Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xutong Qiu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, China.
- Department of Head and Neck Cancer Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Qiang Guo
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, China.
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Majdi Abunemer R, Saifuddin Shaheen R, Abudullah Alghamdi R. Correlation of anti-TNF-a biological therapy with periodontal conditions and osteonecrosis in autoimmune patients: A systematic review. Saudi Dent J 2023; 35:785-796. [PMID: 38025596 PMCID: PMC10658390 DOI: 10.1016/j.sdentj.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 06/19/2023] [Accepted: 07/02/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives This systematic review aims to investigate the impact of tumor necrotic factor alpha inhibitors in suppressing bone resorption in periodontitis, and its potential to cause osteonecrosis. Extensive electronic research was conducted following the PRISMA guidelines, which connected various aspects of anti-TNF-a (anti-tumor necrosis factor-a) to periodontitis and osteonecrosis patients. Background TNF-a inhibitors are broadly indicated in the treatment of autoimmune patients with possible joint resorption and increased inflammatory processes such as rheumatoid arthritis and inflammatory bowel disease, where they reduce bone loss and certain mediators. As rheumatoid arthritis and periodontitis share many characteristics, these medications may also be helpful in the treatment of coexisting periodontitis. However, besides medical benefits, anti-TNF-a also exhibits several adverse effects, ranging from dizziness to tuberculosis. Osteonecrosis is considered a recent adverse impact. Methods An extensive electronic systematic review following the PRISMA guidelines was performed for English-language papers using the following databases as sources of information: PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Library Genesis, Worldwide Science, National Rheumatoid Arthritis Society (NRAS), and other related articles. This systematic review is registered on the PROSPERO platform under registration number CRD42022341753. Results Twenty articles were identified after the exclusion criteria were applied. These include systematic reviews, case reports, retrospective cohort studies, case report series, meta-analyses, clinical trials, randomised clinical trials, cross-sectional and longitudinal analyses, longitudinal observational studies, and prospective clinical trials. All these were included in the quantitative and qualitative analyses. Conclusions Anti-TNF-a drugs show promising results in treating patients with rheumatoid arthritis and periodontitis but could be considered a risk factor for osteonecrosis. Hence, patients receiving such medications should be closely monitored by the dentist and physician before, during, and after administration.
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Affiliation(s)
- Rana Majdi Abunemer
- Bachelor of Dental Surgery, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Rakan Saifuddin Shaheen
- Department of Periodontal Dentistry and Implantology, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
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Lens C, Berne JV, Politis C. The impact of gastrointestinal diseases on oral and maxillofacial surgery outcomes. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:577-583. [PMID: 37658034 DOI: 10.1016/j.oooo.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/19/2023] [Accepted: 05/10/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE We analyzed the complication rates and outcomes in patients with gastrointestinal disorders who had undergone maxillofacial surgery. STUDY DESIGN We retrospectively analyzed 289 patients with inflammatory bowel disease (IBD), 142 with gastroesophageal reflux disease (GERD), and 42 with celiac disease (452 total) who had undergone oral and/or maxillofacial surgery. We examined their characteristics, medications they had taken, surgeries they had undergone, and complications they had experienced. Based on the results of univariate analysis, we selected variables for multivariable logistic regression to identify independent predictors of postoperative complications. RESULTS We found a complication rate of 10% in patients with IBD, 6.9% in patients with GERD, and 9.5% in patients with celiac disease. Dentoalveolar treatment was significantly associated with an increased risk of postoperative complications in patients with IBD and GERD. CONCLUSIONS Oral and/or maxillofacial surgery is safe in most patients with IBD, GERD, and celiac disease. Preventive measures for postoperative complications should be considered in patients with IBD and GERD undergoing dentoalveolar treatment.
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Affiliation(s)
- Charlotte Lens
- Oral and Maxillo-facial Surgery-Imaging and Pathology Research Group, Department of Imaging and Pathology, Group Biomedical Sciences, Catholic University Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Jonas Ver Berne
- Oral and Maxillo-facial Surgery-Imaging and Pathology Research Group, Department of Imaging and Pathology, Group Biomedical Sciences, Catholic University Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- Oral and Maxillo-facial Surgery-Imaging and Pathology Research Group, Department of Imaging and Pathology, Group Biomedical Sciences, Catholic University Leuven, Leuven, Belgium; Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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Ghosh YA, Pullara J, Rattan R, Melville JC. Case report: golimumab-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:e149-e152. [PMID: 37661466 DOI: 10.1016/j.oooo.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/21/2023] [Accepted: 05/23/2023] [Indexed: 09/05/2023]
Abstract
Medication-related osteonecrosis of the jaw is an uncommon but highly morbid adverse event of certain medical therapies. Although classically induced by bisphosphonates, the recent advent of monoclonal antibodies is contributing to a rise in cases. In this case report, we present a rare case of golimumab-associated medication-related osteonecrosis of the jaw and discuss the possible mechanisms of pathogenesis.
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Affiliation(s)
- Yohaann A Ghosh
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia; Integrated Prosthetics and Reconstruction, Department of Head and Neck Surgery, Sydney, Australia
| | - Jonathon Pullara
- Bernard and Gloria Pepper Katz Department of Oral and Maxillofacial Surgery, the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rishabh Rattan
- Bernard and Gloria Pepper Katz Department of Oral and Maxillofacial Surgery, the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - James C Melville
- Bernard and Gloria Pepper Katz Department of Oral and Maxillofacial Surgery, the University of Texas Health Science Center at Houston, Houston, TX, USA.
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Wichelmann TA, Ahdi HS, Pandravada S, Ehrenpreis ED. A Summary of the Rare Reports of Osteonecrosis of the Jaw Associated With Tumor Necrosis-α Inhibitors in the United States Food and Drug Administration's Adverse Event Reporting System Database. J Oral Maxillofac Surg 2023; 81:1311-1318. [PMID: 37480941 DOI: 10.1016/j.joms.2023.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 06/23/2023] [Accepted: 06/24/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Recent case reports highlight an association between osteonecrosis of the jaw (ONJ) and antitumor necrosis factor (anti-TNF) medications. Our study reviewed and described reports of anti-TNF associated ONJ reported to the United States of America's Food and Drug Administration Adverse Event Reporting System to explore this potential adverse drug reaction further. METHODS Using the Food and Drug Administration Adverse Event Reporting System database, we identified reported cases of ONJ between 2010 and 2021. Cases were included in our study if they reported any prior or concomitant anti-TNF medication use. Additionally, only adults (age 18+) and reports from health-care professionals were included. Cases lacking subject age or gender were excluded. After duplicates were removed, a dataset was created and demographics were described including age, gender, and indication for use. Naranjo scoring was conducted to assess adverse drug reaction probability. Subject demographics were then separately described for cases without reported denosumab or bisphosphonate therapy history and compared to those with reported history or concomitant denosumab or bisphosphonate therapy. RESULTS Over twenty thousand cases of ONJ were reported. Forty-four potential cases (0.22%) of anti-TNF medication-associated ONJ were identified and reviewed. Of these, female gender comprised 77.3% (35 cases) and there was an average age of 61.3 years ± 13.7 years. Twenty cases (45.5%) had no prior/concomitant bisphosphonate or denosumab therapy. Of these, 55% (11 cases) were female and the average age was 54.5 ± 17.3 years. Rheumatoid arthritis was the most frequent indication for use (5 cases, 25%) followed by inflammatory bowel disease (IBD) and psoriatic arthritis (4 cases each, 20%) in this cohort. CONCLUSIONS Twenty potential cases of anti-TNF-associated ONJ without prior or concomitant medications known to be associated with ONJ were identified and described. Interestingly, male gender was more frequent and subjects were younger in these cases compared to those with prior/concomitant bisphosphonates or denosumab therapy. Naranjo scoring indicated a probable interaction for three cases. Further studies are needed to clarify the association of ONJ and anti-TNF therapy, including investigating potential mechanisms and reporting future cases with sufficient detail to assess possible confounding factors.
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Affiliation(s)
- Thomas Adam Wichelmann
- Chief Resident, Department of Internal Medicine, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Hardeep S Ahdi
- Resident, Department of Internal Medicine, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Sasirekha Pandravada
- Resident, Department of Internal Medicine, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Eli D Ehrenpreis
- Associate Director of Research and Scholarly Activity, Department of Internal Medicine, Advocate Lutheran General Hospital, Park Ridge, IL §E2Bio Life Sciences, Evanston, IL.
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Boston B, Ipe D, Capitanescu B, Gresita A, Hamlet S, Love R, Hadjiargyrou M, Huang CL, Nusem I, Miroiu RI, Popa-Wagner A, Warnke PHH, Petcu EB. Medication-related osteonecrosis of the jaw: A disease of significant importance for older patients. J Am Geriatr Soc 2023. [PMID: 37224415 DOI: 10.1111/jgs.18414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/12/2023] [Accepted: 03/24/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Medication-related osteonecrosis of the jaw (MRONJ) is clinically defined as a non-healing jawbone ulcerative-necrotic lesion appearing after dental therapy or minor trauma in patients treated previously with anti-resorptive, anti-angiogenic or immunomodulators. Older patients with osteoporosis and cancer receive these pharmacological agents regularly. As these patients are long-term survivors, efficient treatment is of paramount importance for their quality of life. METHODS Literature searches via PubMed were conducted to identify relevant MRONJ studies. Basic information on MRONJ classification, clinical features, and pathosphysiology is presented herein as well as various clinical studies dealing with MRONJ in patients with osteoporosis and cancer. Lastly, we discuss current managment of patients and new trends in treatment of MRONJ. RESULTS Although close follow-up and local hygiene have been advocated by some authors, severe forms of MRONJ are not responsive to conservative therapy. At present, there is no "gold standard" therapy for this condition. However, as the physiopathological basis of MRONJ is represented by the anti-angiogenic action of various pharmacological agents, new methods to increase and promote local angiogenesis and vascularization have recently been successfully tested in vitro, limited preclinical studies, and in a pilot clinical study. CONCLUSIONS It appears that the best method implies application on the lesion of endothelial progenitor cells as well as pro-angiogenic factors such as Vascular Endothelial Growth Factor (VEGF) and other related molecules. More recently, scaffolds in which these factors have been incorporated have shown positive results in limited trials. However, these studies must be replicated to include a large number of cases before any official therapeutic protocol is adopted.
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Affiliation(s)
- Bridget Boston
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Deepak Ipe
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Bogdan Capitanescu
- Department Anatomy, University of Medicine, and Pharmacy, Craiova, Romania
| | - Andrei Gresita
- Department of Biomedical Sciences, New York Institute of Technology, Old Westbury, New York, USA
| | - Stephen Hamlet
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Robert Love
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Michael Hadjiargyrou
- Department of Biological and Chemical Sciences, New York Institute of Technology, Old Westbury, New York, USA
| | - Chien-Ling Huang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Iulian Nusem
- Department of Orthopaedic Surgery, Logan Hospital, Meadowbrook, Queensland, Australia
- Queensland Bone Bank, Coopers Plains, Queensland, Australia
| | - Rodica Ileana Miroiu
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
| | - Aurel Popa-Wagner
- Experimental Research Center for Normal and Pathological Aging, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Patrick Hans-Heinrich Warnke
- Department of Oral and Maxillofacial Surgery, University of Kiel and Praxisklinik am Ballastkai, Flensburg, Germany
| | - Eugen Bogdan Petcu
- Griffith University School of Medicine and Dentistry, Gold Coast Campus, Parklands Drive, Griffith University, Nathan, Queensland, Australia
- Department of Biomedical Sciences, New York Institute of Technology, Old Westbury, New York, USA
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8
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Bozgeyik E, Ege B, Erdogmus Z, Bozgeyik I, Koparal M, Bayazit S, Kurt MY. Inflammation-associated long non-coding RNA signature in radicular cyst tissues. Pathol Res Pract 2023; 245:154456. [PMID: 37116367 DOI: 10.1016/j.prp.2023.154456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/30/2023]
Abstract
Radicular cysts are characterized by significant levels of changes in inflammatory biomarkers. Among them, interleukins and growth factors have been reported to be deregulated in radicular cyst tissues. Moreover, long non-coding RNAs are recently discovered non-coding RNA molecules that regulate various intracellular stimuli to keep homeostasis in balance. A growing body of evidence suggests that lncRNAs are significantly involved in the regulation of inflammation by targeting various inflammatory biomarkers. Accordingly, the present study was aimed to investigate the gene expression levels of inflammation-related lncRNAs in radicular cysts and show their possible roles in the development of radicular cysts. For the study, a total of 25 patients with a radiologically and pathologically confirmed radicular cyst were enrolled. For the determination of non-coding RNA expression levels, real-time qPCR was used. As a result of the current study, expression levels of PACER and THRIL were found to be significantly elevated in radicular cyst tissues compared to control tissue samples. However, MALAT1, ANRIL, and NEAT1 expression levels were not significantly altered in radicular cyst tissues compared to control tissue samples. In conclusion, long non-coding RNAs, PACER and THRIL, seem to have significant pathophysiological roles by acquiring molecular changes during inflammation and might be involved in the development and formation of radicular cysts.
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Affiliation(s)
- Esra Bozgeyik
- Department of Medical Services and Techniques, Vocational School of Health Services, Adiyaman University, Adiyaman, Turkey.
| | - Bilal Ege
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adiyaman University, Adiyaman, Turkey
| | - Zozan Erdogmus
- Oral and Maxillofacial Surgery Clinic, Diyarbakir Oral and Dental Health Center, Diyarbakir, Turkey
| | - Ibrahim Bozgeyik
- Department of Medical Biology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Mahmut Koparal
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adiyaman University, Adiyaman, Turkey
| | - Seyma Bayazit
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adiyaman University, Adiyaman, Turkey
| | - Muhammed Yusuf Kurt
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adiyaman University, Adiyaman, Turkey
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Dos Santos Nascimento IJ, da Silva-Júnior EF. TNF-α Inhibitors from Natural Compounds: An Overview, CADD Approaches, and their Exploration for Anti-inflammatory Agents. Comb Chem High Throughput Screen 2022; 25:2317-2340. [PMID: 34269666 DOI: 10.2174/1386207324666210715165943] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 02/07/2023]
Abstract
Inflammation is a natural process that occurs in the organism in response to harmful external agents. Despite being considered beneficial, exaggerated cases can cause severe problems for the body. The main inflammatory manifestations are pain, increased temperature, edema, decreased mobility, and quality of life for affected individuals. Diseases such as arthritis, cancer, allergies, infections, arteriosclerosis, neurodegenerative diseases, and metabolic problems are mainly characterized by an exaggerated inflammatory response. Inflammation is related to two categories of substances: pro- and anti-inflammatory mediators. Among the pro-inflammatory mediators is Tumor Necrosis Factor-α (TNF-α). It is associated with immune diseases, cancer, and psychiatric disorders which increase its excretion. Thus, it becomes a target widely used in discovering new antiinflammatory drugs. In this context, secondary metabolites biosynthesized by plants have been used for thousands of years and continue to be one of the primary sources of new drug scaffolds against inflammatory diseases. To decrease costs related to the drug discovery process, Computer-Aided Drug Design (CADD) techniques are broadly explored to increase the chances of success. In this review, the main natural compounds derived from alkaloids, flavonoids, terpene, and polyphenols as promising TNF-α inhibitors will be discussed. Finally, we applied a molecular modeling protocol involving all compounds described here, suggesting that their interactions with Tyr59, Tyr119, Tyr151, Leu57, and Gly121 residues are essential for the activity. Such findings can be useful for research groups worldwide to design new anti-inflammatory TNF-α inhibitors.
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Affiliation(s)
| | - Edeildo Ferreira da Silva-Júnior
- Institute of Chemistry and Biotechnology, Federal University of Alagoas, Maceió, Brazil.,Laboratory of Medicinal Chemistry, Pharmaceutical Sciences Institute, Federal University of Alagoas, Maceió, Brazil
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10
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Romanos GE, Vaglica M, Sculean A. Drug-associated bone resorption with potential dental and implant implications. Periodontol 2000 2022; 90:236-246. [PMID: 35916776 DOI: 10.1111/prd.12461] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Every year more and more innovative pharmacological agents are introduced medicine, to treat systemic diseases. Due to these rapid and recent advancements, many patients are receiving treatment with a high variety of drugs, such as selective serotonin reuptake inhibitors, bisphosphonates, tumor necrosis factor (TNF)-α inhibitors, cyclosporine, and steroids. Since implant and osseous surgery are common treatment modalities used, within dentistry, it is of critical important to acknowledge and discuss the potential effects of selective serotonin reuptake inhibitors, bisphosphonates, TNF-α inhibitors, cyclosporine, and steroids, on bone healing. The present paper discusses the possible detrimental ramifications and risks these drug classes may have on bone healing.
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Affiliation(s)
- Georgios E Romanos
- Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Michael Vaglica
- Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, Bern, Switzerland
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11
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Hajeri S, Alturkistany Y. Medication-related osteonecrosis of the jaw after dental clearance: Prevalence in an oncology center. Saudi Dent J 2022; 34:479-484. [PMID: 36092518 PMCID: PMC9453503 DOI: 10.1016/j.sdentj.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/01/2022] Open
Abstract
Objective Study design Results Conclusion
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12
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Differentially Expressed Genes Reveal the Biomarkers and Molecular Mechanism of Osteonecrosis. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8684137. [PMID: 35035862 PMCID: PMC8759865 DOI: 10.1155/2022/8684137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022]
Abstract
Osteonecrosis is one of the most refractory orthopedic diseases, which seriously threatens the health of old patients. High-throughput sequencing (HTS) and microarray analysis have confirmed as an effective way for investigating the pathological mechanism of disease. In this study, GSE7716, GSE74089, and GSE123568 were obtained from Gene Expression Omnibus (GEO) database and used to identify differentially expressed genes (DEGs) by R language. Subsequently, the DEGs were analyzed with Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment. Moreover, the protein-protein interaction (PPI) network of DEGs was analyzed by STRING database and Cytoscape. The results showed that 318 downregulated genes and 58 upregulated genes were observed in GSE7116; 690 downregulated genes and 1148 upregulated genes were screened from 34183 genes in GSE74089. The DEGs involved in progression of osteonecrosis involved inflammation, immunological rejection, and bacterial infection-related pathways. The GO enrichment showed that osteonecrosis was related with extracellular matrix, external encapsulating structure organization, skeletal system development, immune response activity, cell apoptosis, mononuclear cell differentiation, and serine/threonine kinase activity. Moreover, PPI network showed that the progression of osteonecrosis of the femoral head was related with CCND1, CDH1, ESR1, SPP1, LOX, JUN, ITGA, ABL1, and VEGF, and osteonecrosis of the jaw is related with ACTB, CXCR4, PTPRC, IL1B, CXCL8, TNF, JUN, PTGS2, FOS, and RHOA. In conclusion, this study identified the hub factors and pathways which might play important roles in progression of osteonecrosis and could be used as potential biomarkers for diagnosis and treatment of osteonecrosis.
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Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update. J Oral Maxillofac Surg 2022; 80:920-943. [PMID: 35300956 DOI: 10.1016/j.joms.2022.02.008] [Citation(s) in RCA: 293] [Impact Index Per Article: 146.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 12/13/2022]
Abstract
Strategies for management of patients with, or at risk for, medication-related osteonecrosis of the jaws (MRONJ) - formerly referred to as bisphosphonate-related osteonecrosis of the jaws (BRONJ)-were set forth in the American Association of Oral and Maxillofacial Surgeons (AAOMS) position papers in 2007, 2009 and 2014. The position papers were developed by a committee appointed by the AAOMS Board of Trustees and comprising clinicians with extensive experience in caring for these patients, as well as clinical and basic science researchers. The knowledge base and experience in addressing MRONJ continues to evolve and expand, necessitating modifications and refinements to the previous position papers. Three members of the AAOMS Committee on Oral, Head, and Neck Oncologic and Reconstructive Surgery (COHNORS) and three authors of the 2014 position paper were appointed to serve as a working group to analyze the current literature and revise the guidance as indicated to reflect current knowledge in this field. This update contains revisions to diagnosis and management strategies and highlights the current research status. AAOMS maintains that it is vitally important for this information to be disseminated to other relevant healthcare professionals and organizations.
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Affiliation(s)
- Salvatore L Ruggiero
- Clinical Professor, Division of Oral and Maxillofacial Surgery, Stony Brook School of Dental Medicine, Hofstra North Shore-LIJ School of Medicine, New York Center for Orthognathic and Maxillofacial Surgery, Lake Success, NY.
| | - Thomas B Dodson
- Professor and Chair, University of Washington School of Dentistry, Department of Oral and Maxillofacial Surgery, Seattle, Wash
| | - Tara Aghaloo
- Professor, Oral and Maxillofacial Surgery, UCLA School of Dentistry, Los Angeles, Calif
| | - Eric R Carlson
- Professor and Kelly L. Krahwinkel Endowed Chairman, Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
| | - Brent B Ward
- Chalmers J Lyons Professor of Oral and Maxillofacial Surgery, Associate Professor of Dentistry, Chair of the Department of Oral and Maxillofacial Surgery/Hospital Dentistry in the School of Dentistry and Associate Professor of Surgery for the Medical School, University of Michigan Hospital, Ann Arbor, Mich
| | - Deepak Kademani
- Chief of Staff North Memorial Health, Fellowship Director, Oral/Head and Neck Oncologic and Reconstructive Surgery Attending Surgeon, North Memorial Health and the University of Minnesota. Private practice, Minnesota Oral and Facial Surgery and Minnesota Head and Neck Surgery, Minneapolis, Minn
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Wu WJ, Xia CL, Ou SJ, Yang Y, Zhou XZ, Ma YF, Hou YL, Wang FZ, Yang QP, Qi Y, Xu CP. Prophylactic Effects of NFκB Essential Modulator–Binding Domain Peptides on Bone Infection: An Experimental Study in a Rabbit Model. J Inflamm Res 2022; 15:2745-2759. [PMID: 35509324 PMCID: PMC9059993 DOI: 10.2147/jir.s346627] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/16/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Methods Results Conclusion
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Affiliation(s)
- Wen-Jiao Wu
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People’s Republic of China
| | - Chang-Liang Xia
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People’s Republic of China
| | - Shuan-Ji Ou
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People’s Republic of China
| | - Yang Yang
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People’s Republic of China
| | - Xiao-Zhong Zhou
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People’s Republic of China
| | - Yun-Fei Ma
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Yi-Long Hou
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Fa-Zheng Wang
- Department of Orthopaedics, First People’s Hospital of Kashgar Prefecture, Kashgar, Xinjiang, People’s Republic of China
| | - Qing-Po Yang
- Department of Orthopaedics, First People’s Hospital of Kashgar Prefecture, Kashgar, Xinjiang, People’s Republic of China
| | - Yong Qi
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People’s Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
- Correspondence: Yong Qi; Chang-Peng Xu, Tel +86-20-8916-8085, Email ;
| | - Chang-Peng Xu
- Department of Orthopaedics, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People’s Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
- Correspondence: Yong Qi; Chang-Peng Xu, Tel +86-20-8916-8085, Email ;
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Medication-Related Osteonecrosis of the Jaw Associated in a Patient Treated With Etanercept. J Craniofac Surg 2022; 33:e694-e696. [PMID: 35184115 DOI: 10.1097/scs.0000000000008588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/31/2022] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT Medication-related osteonecrosis of the jaws (MRONJ) is defined as a pathologic condition affecting the maxillary and mandibular bones arising subsequently to pharmacological treatment with antiresorptive and antiangiogenic drugs.In this case report, the occurrence of MRONJ is described in a 66-year-old female patient affected by rheumatoid arthritis and treated with Etanercept, a Tumor Necrosis Factor (TNF)-α inhibitor. The patient developed a mandibular MRONJ following the extraction of teeth 3.4 and 3.5. The patient was then treated with conservative surgery of the necrotic bone. At 12-month follow-up complete resolution was observed. According to the data presented, the evaluation of the effects of new immunosuppressive biological therapies on the oral cavity appears of utmost importance in preventing the development of MRONJ. Although the risk related to TNF-α inhibitors has not been quantified yet, the clinician should be aware of the potential adverse effects on the oral cavity.
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Gareb B, Beugeling M, Posthumus S, Otten AT, Dijkstra G, Kosterink JG, Frijlink HW. Infliximab formulation strategy for a stable ileo-colonic targeted oral dosage form intended for the topical treatment of inflammatory bowel disease. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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17
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Kawahara M, Kuroshima S, Sawase T. Clinical considerations for medication-related osteonecrosis of the jaw: a comprehensive literature review. Int J Implant Dent 2021; 7:47. [PMID: 33987769 PMCID: PMC8119587 DOI: 10.1186/s40729-021-00323-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/17/2021] [Indexed: 12/16/2022] Open
Abstract
Background Medication-related osteonecrosis of the jaw (MRONJ), which was first reported as bisphosphonate-related osteonecrosis of the jaw (BRONJ) in bisphosphonate users, is a rare but severe soft and hard tissue disease induced by several types of medications. There has been a deluge of information about MRONJ, such as epidemiology, risk factors, clinical recommendations for dental treatment to prevent it, and treatment strategies in medication-prescribed users. The aim of this study was to comprehensively review recent articles and provide the current scientific information about MRONJ, especially clinical considerations or recommendations for dental treatment to prevent its occurrence. Materials and methods The current literature review was mainly based on 14 systematic reviews with or without meta-analysis, 4 position papers, 1 consensus statement, 1 clinical guideline, and 2 clinical reviews regarding MRONJ after a PubMed database and manual searches according to inclusion and exclusion criteria. Moreover, 53 articles were selected by manual search in regard to all references from selected articles and other articles identified on the PubMed search, irrespective of publication date, and inclusion and exclusion criteria. Results The incidence and prevalence of MRONJ are relatively low, although they are clearly higher in cancer patients receiving high-dose antiresorptive agents or angiogenesis inhibitors rather than osteoporosis patients receiving oral bisphosphonates or denosumab. There are many types of local, systemic, and other risk factors for the development of MRONJ. Clinical recommendations are provided for each clinical situation of patients to prevent MRONJ. There are also treatment strategies for MRONJ in each stage. Conclusions General dentists should perform appropriate dental treatment to prevent MRONJ in the patients prior to or when receiving medications that could induce MRONJ. Moreover, there are treatment strategies for MRONJ in each stage that oral surgeons could follow. Adequate and updated clinical information regarding MRONJ based on scientific data is required whenever possible.
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Affiliation(s)
- Mampei Kawahara
- Oral & Maxillofacial Implant Center, Nagasaki University Hospital, 852-8588, Nagasaki, Japan
| | - Shinichiro Kuroshima
- Oral & Maxillofacial Implant Center, Nagasaki University Hospital, 852-8588, Nagasaki, Japan. .,Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8588, Japan.
| | - Takashi Sawase
- Oral & Maxillofacial Implant Center, Nagasaki University Hospital, 852-8588, Nagasaki, Japan.,Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8588, Japan
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18
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Rosenberg SA, Migliorati C, Romanos GE. Is medication-related osteonecrosis of the jaw associated with tumor necrosis factor-α inhibition? Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 131:422-427. [PMID: 33408034 DOI: 10.1016/j.oooo.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/05/2020] [Accepted: 12/10/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This article reviews the literature and evidence of the association of medication-related osteonecrosis of the jaw with tumor necrosis factor-α inhibition. METHODS A systematic review was performed using electronic databases (PubMed, MEDLINE, and Embase) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Key terms were used in the search. No restrictions were placed on publication status. Selection criteria comprised all levels of available evidence. Articles in the English language were selected up to and including July 2020. Reference lists of relevant studies were searched for additional articles. Articles were selected on the basis of inclusion and exclusion criteria. Findings from eligible studies were extracted by one reviewer and confirmed by a second. Disagreements were settled through discussion. RESULTS The initial search of the key terms yielded 2107 articles. There were 1192 articles remaining after removal of duplicates and addition of 6 articles that were hand-selected from among reference lists of relevant studies. There were 12 eligible articles after screening. The full texts were read, and 5 articles were included on the basis of inclusion and exclusion criteria. CONCLUSIONS Further research is required to determine an association of medication-related osteonecrosis of the jaw and tumor necrosis factor-α inhibition.
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Affiliation(s)
- Stacy A Rosenberg
- Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Cesar Migliorati
- College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Georgios E Romanos
- Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA.
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Kün-Darbois JD, Fauvel F. Medication-related osteonecrosis and osteoradionecrosis of the jaws: Update and current management. Morphologie 2020; 105:170-187. [PMID: 33281055 DOI: 10.1016/j.morpho.2020.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 12/19/2022]
Abstract
Medication related osteonecrosis of the jaws (MRONJ) and osteoradionecrosis of the jaws (ORNJ) are two different diseases of quite similar appearance. MRONJ is mainly due to antiresorptive or antiangiogenic drug therapy and ORNJ to radiotherapy. The present work aimed at presenting and comparing the current knowledge on MRONJ and ORNJ. They both present as an exposure of necrotic bone and differ in some clinical or radiological characteristics, clinical course and mostly in treatment. They share similar risk factors. A tooth extraction is more frequently found as a triggering factor in MRONJ. The frequency of a maxillary localisation seems higher for MRONJ. On computed tomographic images, a periosteal reaction seems characteristic of MRONJ. More frequent pathological fractures seem to occur in ORNJ. It is mandatory, for ORNJ diagnosis, to exclude a residual or recurrent tumour using histological examination. Both MRONJ and ORNJ are challenging to treat and cannot be managed similarly. For both, it would still be worth to optimise awareness within the medical community, patients' oral hygiene and dental cares to improve their prevention and make their incidences decrease. Conservative therapy is more frequently achieved for MRONJ than ORNJ and surgical resection is more often performed for ORNJ. For both diseases, the last treatment possible in refractory cases is a surgical extensive resection with free flap reconstruction. A MRONJ classification is widely used today, whereas no consensus exists to date for ORNJ classification. We propose a classification that could play this role.
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Affiliation(s)
- J-D Kün-Darbois
- Department of oral and maxillofacial surgery, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex, France; Groupe études remodelage osseux et bioMatériaux, GEROM, SFR 4208, UNIV Angers, IRIS-IBS institut de biologie en Santé, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex, France.
| | - F Fauvel
- Department of oral and maxillofacial surgery, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France; Department of oral and maxillofacial surgery, CH de Saint-Nazaire, 11, boulevard Georges-Charpak, 44606 Saint-Nazaire cedex, France
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Watanabe R. High incidence of antiresorptive agent-related osteonecrosis of the jaw in patients with rheumatoid arthritis. J Bone Miner Metab 2020; 38:737-738. [PMID: 32274571 DOI: 10.1007/s00774-020-01103-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Ryu Watanabe
- Department of Rheumatology, Osaki Citizen Hospital, 3-8-1 Furukawa Honami, Osaki, Miyagi, 989-6183, Japan.
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21
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Sacco R, Ball R, Barry E, Akintola O. The role of illicit drugs in developing medication-related osteonecrosis (MRONJ): a systematic review. Br J Oral Maxillofac Surg 2020; 59:398-406. [PMID: 33789811 DOI: 10.1016/j.bjoms.2020.08.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 08/10/2020] [Indexed: 11/25/2022]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a challenging condition to treat. It has primarily been associated with anti-resorptive and anti-angiogenic drugs, which are increasingly being used to prevent adverse skeletally-related complications in patients with cancer and bone pathologies. Although these medications have been proven to cause osteonecrosis of the jaws (ONJ) there are also a number of other drugs that could potentially cause this condition. The aim of this systematic review is to ascertain whether there is an associated risk of osteonecrosis of the jaw (ONJ) in recreational drug users (RDU). Three authors independently searched PubMed, MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials for published reports of osteonecrosis of the jaw (ONJ) in recreational drug users (RDU) or illicit drug users (IDU) who had no history of treatment with anti-angiogenic or anti-resorptive agents. Only 30 studies were eligible for analysis, and all were independently assessed for risk of bias. There was a total of 101 patients with ONJ attributed solely to illicit drug consumption. The most common site of ONJ was the maxilla (n=54). The most common illicit drug related to ONJ was desmorphine, known as 'Krokodil', this was followed by cocaine, methamphetamine, anabolic steroids, and hydrocodone/acetaminophen. In 52 of the cases, the ONJ resolved following treatment, however, eight showed a recurrence. Although all the studies were judged to be at a high risk of bias, the limited data suggest that some patients are at risk of developing ONJ as a result of illicit drug usage. Studies of higher quality are needed to establish the relative risk of ONJ in this patient group.
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Affiliation(s)
- R Sacco
- Oral Surgery Department, King's College Hospital, London, SE5 9RW, UK; Oral Surgery Department, Barts and the London School of Medicine and Dentistry, London, E1 2AT, UK; Oral and Craniofacial Science, King's College London, London, WC2R 2LS, UK; Eastman Dental Institute - University College of London, London, WC1X 8LT, UK; Oral Surgery Department, Division of Dentistry, School of Medical Science - The University of Manchester, Manchester, M13 9PL, UK.
| | - R Ball
- Oral Surgery Department, King's College Hospital, London, SE5 9RW, UK
| | - E Barry
- Oral Surgery Department, King's College Hospital, London, SE5 9RW, UK
| | - O Akintola
- Oral Surgery Department, King's College Hospital, London, SE5 9RW, UK
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Ma X, Xia W, Zong Y, Jiang C, Shan H, Lin Y, Yin F, Wang N, Zhou L, Wen G, Zhou Z. Tumor necrosis factor-α promotes Staphylococcus aureus-induced osteomyelitis through downregulating endothelial nitric oxide synthase. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 54:1018-1027. [DOI: 10.1016/j.jmii.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/14/2020] [Accepted: 08/05/2020] [Indexed: 12/20/2022]
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Gareb B, Otten AT, Frijlink HW, Dijkstra G, Kosterink JGW. Review: Local Tumor Necrosis Factor-α Inhibition in Inflammatory Bowel Disease. Pharmaceutics 2020; 12:E539. [PMID: 32545207 PMCID: PMC7356880 DOI: 10.3390/pharmaceutics12060539] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/28/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023] Open
Abstract
Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) characterized by intestinal inflammation. Increased intestinal levels of the proinflammatory cytokine tumor necrosis factor-α (TNF-α) are associated with disease activity and severity. Anti-TNF-α therapy is administered systemically and efficacious in the treatment of IBD. However, systemic exposure is associated with adverse events that may impede therapeutic treatment. Clinical studies show that the efficacy correlates with immunological effects localized in the gastrointestinal tract (GIT) as opposed to systemic effects. These data suggest that site-specific TNF-α inhibition in IBD may be efficacious with fewer expected side effects related to systemic exposure. We therefore reviewed the available literature that investigated the efficacy or feasibility of local TNF-α inhibition in IBD. A literature search was performed on PubMed with given search terms and strategy. Of 8739 hits, 48 citations were included in this review. These studies ranged from animal studies to randomized placebo-controlled clinical trials. In these studies, local anti-TNF-α therapy was achieved with antibodies, antisense oligonucleotides (ASO), small interfering RNA (siRNA), microRNA (miRNA) and genetically modified organisms. This narrative review summarizes and discusses these approaches in view of the clinical relevance of local TNF-α inhibition in IBD.
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Affiliation(s)
- Bahez Gareb
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Department of Pharmaceutical Technology and Biopharmacy, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
- Martini Hospital Groningen, Department of Clinical Pharmacy and Toxicology, Van Swietenplein 1, 9728 NT Groningen, The Netherlands
| | - Antonius T. Otten
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (A.T.O.); (G.D.)
| | - Henderik W. Frijlink
- Department of Pharmaceutical Technology and Biopharmacy, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; (A.T.O.); (G.D.)
| | - Jos G. W. Kosterink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
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How nonbacterial osteomyelitis could be discriminated from tuberculosis in the early stages: the simple algorithm. Clin Rheumatol 2020; 39:3825-3832. [DOI: 10.1007/s10067-020-05174-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 12/19/2022]
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