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郭 玉, 张 建, 王 佃, 郭 传. [Analysis of pathological characteristics of medication-related osteonecrosis of the jaw and discussion of clinical treatment strategies based on the pathological analysis results]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54:1190-1195. [PMID: 36533354 PMCID: PMC9761830 DOI: 10.19723/j.issn.1671-167x.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To summarize the pathological characteristics of medication-related osteonecrosis of the jaw (MRONJ) specimens after jaw curettage or jaw osteotomy treatment and to comprehensively analyze the relationship between the different pathological features, treatment methods, and treatment effects to provide new ideas for effective treatment of MRONJ in clinical work. METHODS The clinical and pathological data were collected from 23 patients with MRONJ who were treated with curettage (18 patients) and jaw osteotomy (5 patients) at the Department of Oral and Maxillofacial Surgery of Peking University Hospital of Stomatology between June 2014 and December 2015. The pathological characteristics of MRONJ were summarized and analyzed with treatment effects based on various surgical treatment methods. The diagnostic criteria and disease staging of MRONJ were determined according to the 2014 American Association of Oral and Maxillofacial Surgeon's Position Paper. RESULTS In this study, 5 patients have treated with jaw segmental osteotomy, and all of them were in stage Ⅲ; the other 18 patients were treated with jaw curettage, including 5 patients in stage Ⅱ and 13 patients in stage Ⅲ. The pathological features of MRONJ in five cases of jaw segmental osteotomy were divided into three adjacent regions from shallow to deep: inflammation region (IR), sclerosis region (SR), and bone remodeling layer (BRL). Moreover, three types of pathological features of specimens from traditional curettage were defined as type 1 (IR), type 2 (IR + SR), and type 3 (IR + SR + BRL). The pathological features of the patients treated with jaw curettage were: type Ⅰ, 38.9% (7/18); type Ⅱ, 44.4% (8/18); type Ⅲ, 16.7% (3/18). Complete healing was achieved in 5 patients treated with jaw segmental osteo-tomy. Moreover, 2 cases with type Ⅰ, 1 case with type Ⅱ, and 1 with type Ⅲ completely healed after jaw curettage, while 5 cases with type Ⅰ, 7 cases with type Ⅱ, and 2 cases with type Ⅲ experienced recurrence after surgery. CONCLUSION Pathological features of continuous regions of inflammation, sclerosis, and bone remodeling layer were identified from shallow to deep, based on the microscopic observation of jaw segmental osteotomy samples. Insufficient removal of the sclerotic region during jaw curettage that blocks the required blood, nutritional factors, and mesenchymal stem cells seems to be a common cause for failed treatment of MRONJ after curettage surgery.
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Affiliation(s)
- 玉兴 郭
- 北京大学口腔医学院·口腔医院口腔颌面外科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,国家卫生健康委员会口腔医学计算机应用工程技术研究中心,国家药品监督管理局口腔生物材料重点实验室,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
| | - 建运 张
- 北京大学口腔医学院·口腔医院口腔病理科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,国家卫生健康委员会口腔医学计算机应用工程技术研究中心,国家药品监督管理局口腔生物材料重点实验室,北京 100081Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
| | - 佃灿 王
- 北京大学口腔医学院·口腔医院口腔颌面外科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,国家卫生健康委员会口腔医学计算机应用工程技术研究中心,国家药品监督管理局口腔生物材料重点实验室,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
| | - 传瑸 郭
- 北京大学口腔医学院·口腔医院口腔颌面外科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,国家卫生健康委员会口腔医学计算机应用工程技术研究中心,国家药品监督管理局口腔生物材料重点实验室,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
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Lorenzo-Pouso AI, Bravo SB, Carballo J, Del Pilar Chantada-Vázquez M, Bagán J, Bagán L, Chamorro-Petronacci CM, Conde-Amboage M, López-López R, García-García A, Pérez-Sayáns M. Quantitative proteomics in medication-related osteonecrosis of the jaw: a proof-of-concept study. Oral Dis 2022. [PMID: 35377498 DOI: 10.1111/odi.14201] [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] [Received: 02/17/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Medication-related osteonecrosis of the jaw (MRONJ) is a paradoxical effect associated with bone modifying agents (BMAs) and other drugs. Currently no valuable diagnostic or prognosis biomarkers exist. This goal of this research was to study MRONJ related salivary proteome. MATERIALS AND METHODS This case-control aimed to study salivary proteome in MRONJ versus control groups i) formed from BMAs consumers and ii) healthy individuals to unravel biomarkers. 38 samples of unstimulated whole saliva (18 MRONJ patients, 10 BMA consumers, and 10 healthy controls) were collected. Proteomic analysis by SWATH-MS coupled to bioinformatics analysis was executed. RESULTS 586 proteins were identified, 175 proteins showed significant differences among MRONJ versus controls. SWATH-MS revealed differentially expressed proteins among three groups, which have never isolated. These proteins had distinct roles including cell envelope organization, positive regulation of vesicle fusion, positive regulation of receptor binding, or regulation of low-density lipoprotein particle clearance. Integrative analysis prioritised 3 proteins (MMP9, AACT and HBD). Under receiver operating characteristic analysis, this panel discriminated MRONJ with a sensitivity of 90% and a specificity of 78.9%. CONCLUSION These findings may inform of a novel biomarker panel for MRONJ prediction or diagnosis. Nonetheless, further research is needed to validate this panel.
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Affiliation(s)
- Alejandro I Lorenzo-Pouso
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, University of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Spain
| | - Susana B Bravo
- Proteomic Unit, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, Spain
| | - Javier Carballo
- Department of Food Technology, Faculty of Sciences, University of Vigo-Ourense Campus, Spain
| | - María Del Pilar Chantada-Vázquez
- Proteomic Unit, Health Research Institute of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago de Compostela, Spain
| | - José Bagán
- Department of Stomatology and Maxillofacial Surgery, University General Hospital of Valencia, Spain
| | - Leticia Bagán
- Department of Stomatology and Maxillofacial Surgery, University General Hospital of Valencia, Spain
| | - Cintia M Chamorro-Petronacci
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, University of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Spain
| | - Mercedes Conde-Amboage
- Models of Optimization, Decision, Statistics and Applications Reseach Group (MODESTYA), Department of Statistics, Mathematical Analysis and Optimization, University of Santiago de Compostela, Spain
| | - Rafael López-López
- Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago (IDIS), University Hospital Complex of Santiago de Compostela (SERGAS), Spain
| | - Abel García-García
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, University of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Spain
| | - Mario Pérez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, University of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Spain
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Kozutsumi R, Kuroshima S, Kaneko H, Sasaki M, Ishisaki A, Sawase T. Zoledronic Acid Deteriorates Soft and Hard Tissue Healing of Murine Tooth Extraction Sockets in a Dose-Dependent Manner. Calcif Tissue Int 2022; 110:104-116. [PMID: 34363509 DOI: 10.1007/s00223-021-00890-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/05/2021] [Indexed: 12/24/2022]
Abstract
The pathophysiology, histopathology, and immunopathology of bisphosphonate-related osteonecrosis of the jaw (BRONJ) Stage 0 remain unclear. The aim of this study was to investigate the effects of high-dose bisphosphonates on tooth extraction socket healing by creating a murine model of BRONJ Stage 0-like lesions using 8-week-old female C57BL/6J mice. Zoledronic acid (Zol) was administered subcutaneously twice a week for 7 weeks at doses of 0.1 mg/kg/week (moderate dose; Zol-M), 0.5 mg/kg/week (high dose; Zol-H1), and 1.0 mg/kg/week (higher dose; Zol-H2). Saline was used as a control (VC). Both maxillary first molars were extracted 3 weeks after drug treatment. Maxillae, long bones, and sera were collected 4 weeks post-extraction (n = 7 mice/group). Microcomputed tomography, histological, immunohistochemical, and ELISA analyses were performed. A ceiling effect for Zol was noted at the Zol-H1 dose. Osseous healing of extraction sites was significantly impaired with increased necrotic bone and the number of empty lacunae in a Zol dose-dependent manner. Zol significantly decreased epithelial thickness, due to a decrease in thickness of the stratum spinosum, in both Zol-H1 and Zol-H2. Both Zol-H1 and Zol-H2 significantly suppressed the distribution of F4/80+ macrophages in the connective tissue of tooth extraction sockets, although gross healing appeared to be normal. Intriguingly, both Zol-H1 and Zol-H2 significantly increased the numbers of TRAP+ mononuclear cells and detached osteoclasts in the connective tissue and bone marrow of extraction sites compared to VC and Zol-M, correlated with serum TRAcP5b levels. The created murine model of BRONJ Stage 0-like lesions becoming more severe in a dose-dependent manner may help to understand the pathophysiology and histopathology of BRONJ Stage 0 in humans.
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Affiliation(s)
- Ryohei Kozutsumi
- Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8588, Japan
| | - Shinichiro Kuroshima
- Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8588, Japan.
| | - Haruka Kaneko
- Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8588, Japan
| | - Muneteru Sasaki
- Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8588, Japan
| | - Akira Ishisaki
- Division of Cellular Biosignal Sciences, Department of Biochemistry, Iwate Medical University, Shiwa-gun, Iwate, 028-3694, Japan
| | - Takashi Sawase
- Department of Applied Prosthodontics, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8588, Japan
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Effects of Soft Tissue Closure on Medication-Related Osteonecrosis of the Jaw in a Rabbit Model with Tooth Extraction: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4166770. [PMID: 34957304 PMCID: PMC8694973 DOI: 10.1155/2021/4166770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/17/2021] [Accepted: 11/24/2021] [Indexed: 11/19/2022]
Abstract
Objectives The study investigated the effect of soft tissue closure after tooth extraction on the prevention of medication-related osteonecrosis of the jaw in a rabbit model. Materials and Methods Twenty female New Zealand white rabbits were randomly assigned into the experimental group administrated with zoledronic acid (ZA) and control groups treated with saline. Bilateral lower premolar extraction was performed 4 weeks after ZA/saline administration. Immediately after extraction, the wound on the right mandible was closed by suture while the other side was left open. Animals were sacrificed 4 weeks and 8 weeks after tooth extraction. Fluorochrome labeling solutions were injected subcutaneously to evaluate the bone growth rates. The mandibles were harvested and subjected for microcomputed tomography, confocal microscope, and histomorphological examinations. Results All extraction sites healed well without any signs of infection. Trabecular thickness (Tb.Th) was significantly higher in the ZA-treated group than in the control group at both week 4 and week 8, while no significant difference was detected in the rest of the assessed parameters. The bone growth rate in mandibles showed gradual reduction in the ZA-treated group. Histological analysis showed that at week 8, the animals in the ZA-treated group had significantly higher incidence of osteonecrosis than that in the control group, while no significance was revealed between the sutured and nonsutured side. Conclusions ZA treatment significantly reduces bone growth rates but does not reveal a significant effect on bone mineral density and bone microarchitecture. Soft tissue closure of the extraction socket does not reduce the incidence of ONJ in the ZA-treated rabbit model.
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Aguirre JI, Castillo EJ, Kimmel DB. Preclinical models of medication-related osteonecrosis of the jaw (MRONJ). Bone 2021; 153:116184. [PMID: 34520898 PMCID: PMC8743993 DOI: 10.1016/j.bone.2021.116184] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/15/2021] [Accepted: 09/07/2021] [Indexed: 01/20/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe adverse event affecting patients with cancer and patients with osteoporosis who have been treated with powerful antiresorptives (pARs) or angiogenesis inhibitors (AgIs). pARs, including nitrogen-containing bisphosphonates (N-BPs; e.g., zoledronic acid, alendronate) and anti-RANKL antibodies (e.g., denosumab), are used to manage bone metastases in patients with cancer or to prevent fragility fractures in patients with osteoporosis. Though significant advances have been made in understanding MRONJ, its pathophysiology is still not fully elucidated. Multiple species have been used in preclinical MRONJ research, including the rat, mouse, rice rat, rabbit, dog, sheep, and pig. Animal research has contributed immensely to advancing the MRONJ field, particularly, but not limited to, in developing models and investigating risk factors that were first observed in humans. MRONJ models have been developed using clinically relevant doses of systemic risk factors, like N-BPs, anti-RANKL antibodies, or AgIs. Specific local oral risk factors first noted in humans, including tooth extraction and inflammatory dental disease (e.g., periodontitis, periapical infection, etc.), were then added. Research in rodents, particularly the rat, and, to some extent, the mouse, across multiple laboratories, has contributed to establishing multiple relevant and complementary preclinical models. Models in larger species produced accurate clinical and histopathologic outcomes suggesting a potential role for confirming specific crucial findings from rodent research. We view the current state of animal models for MRONJ as good. The rodent models are now reliable enough to produce large numbers of MRONJ cases that could be applied in experiments testing treatment modalities. The course of MRONJ, including stage 0 MRONJ, is characterized well enough that basic studies of the molecular or enzyme-level findings in different MRONJ stages are possible. This review provides a current overview of the existing models of MRONJ, their more significant features and findings, and important instances of their application in preclinical research.
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Affiliation(s)
- J I Aguirre
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - E J Castillo
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - D B Kimmel
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America
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Medication-Related Osteonecrosis of the Jaw: A Critical Narrative Review. J Clin Med 2021; 10:jcm10194367. [PMID: 34640383 PMCID: PMC8509366 DOI: 10.3390/jcm10194367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Nearly two decades have passed since a paradoxical reaction in the orofacial region to some bone modifying agents and other drugs was recognized, namely medication-related osteonecrosis of the jaw (MRONJ). Purpose: The aim of this manuscript was to critically review published data on MRONJ to provide an update on key terminology, concepts, and current trends in terms of prevention and diagnosis. In addition, our objective was to examine and evaluate the therapeutic options available for MRONJ. Methods: The authors perused the most relevant literature relating to MRONJ through a search in textbooks and published articles included in several databases for the years 2003–2021. Results and conclusions: A comprehensive update of the current understanding of these matters was elaborated, addressing these topics and identifying relevant gaps of knowledge. This review describes our updated view of the previous thematic blocks, highlights our current clinical directions, and emphasizes controversial aspects and barriers that may lead to extending the accumulating body of evidence related to this severe treatment sequela.
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Rodríguez-Lozano FJ, Oñate-Sánchez R, Gonzálvez-García M, Vallés-Bergadá M, Martínez CM, Revilla-Nuin B, Guerrero-Gironés J, Moraleda JM, García-Bernal D. Allogeneic Bone Marrow Mesenchymal Stem Cell Transplantation in Tooth Extractions Sites Ameliorates the Incidence of Osteonecrotic Jaw-Like Lesions in Zoledronic Acid-Treated Rats. J Clin Med 2020; 9:jcm9061649. [PMID: 32486396 PMCID: PMC7355877 DOI: 10.3390/jcm9061649] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is defined as the exposed necrotic bone involving the maxillofacial structures in bisphosphonate treated patients, and the pathophysiology of this disease remains unclear. The aim of this study was to assess the effects of the allogeneic transplantation of bone marrow-derived mesenchymal stem cells (BM-MSCs) in a model of Wistar mice with induced MRONJ disease. BM-MSCs from five male Wistar rats were characterized and cultured on β-tricalcium phosphate (β-TCP) granules. Thirty female Wistar rats were injected intraperitoneally with zoledronic acid and afterwards upper jaw molars were extracted. The animals were randomized to receive: Group 1: 1 × 106 BM-MSCs/β-TCP construct in the alveolar socket; and Group 2: Saline solution/β-TCP construct. A clinical and histological analysis was performed. Nested polymerase chain reaction (PCR) was assessed to verify the presence of transplanted male rat cells in the female recipient jaws. Clinical and histological findings evidenced that none of the animals in Group 1 exhibited uncovered sockets or bone exposure associated to MRONJ, whereas we detected 33% of MRONJ cases in Group 2. In addition, male rat cells were detected in the maxillae site four weeks after transplantation in the BM-MSCs-group. Allogeneic BM-MSCs in extractions sites ameliorates MRONJ incidence in zoledronic acid-treated rats compared to non-MSC treatments.
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Affiliation(s)
- Francisco Javier Rodríguez-Lozano
- Special Care in Dentistry-Gerodontology Unit, Department of Dermatology, Stomatology, Radiology and Physical Medicine, Morales Meseguer Hospital, Faculty of Medicine, University of Murcia, 30008 Murcia, Spain; (R.O.-S.); (J.G.-G.)
- Research Group Cellular Therapy and Hematopoietic Transplant, Biomedical Research Institute, Virgen de la Arrixaca Clinical University Hospital, IMIB-Arrixaca, University of Murcia, Avenida Buenavista s/n, 30120 Murcia, Spain; (J.M.M.); (D.G.-B.)
- Correspondence: ; Tel.: +34-868889518
| | - Ricardo Oñate-Sánchez
- Special Care in Dentistry-Gerodontology Unit, Department of Dermatology, Stomatology, Radiology and Physical Medicine, Morales Meseguer Hospital, Faculty of Medicine, University of Murcia, 30008 Murcia, Spain; (R.O.-S.); (J.G.-G.)
| | | | - Marta Vallés-Bergadá
- Dental and Maxillofacial Surgery Unit, Quirónsalud Torrevieja, Partida de la Loma, s/n, 03184 Torrevieja, Alicante, Spain;
| | - Carlos M. Martínez
- Experimental Pathology Unit, Biomedical Research Institute of Murcia-Arrixaca, IMIB-Arrixaca, 30120 Murcia, Spain;
| | - Beatriz Revilla-Nuin
- Genomics Unit, Biomedical Research Institute of Murcia-Arrixaca, IMIB-Arrixaca, 30120 Murcia, Spain;
| | - Julia Guerrero-Gironés
- Special Care in Dentistry-Gerodontology Unit, Department of Dermatology, Stomatology, Radiology and Physical Medicine, Morales Meseguer Hospital, Faculty of Medicine, University of Murcia, 30008 Murcia, Spain; (R.O.-S.); (J.G.-G.)
| | - Jose M. Moraleda
- Research Group Cellular Therapy and Hematopoietic Transplant, Biomedical Research Institute, Virgen de la Arrixaca Clinical University Hospital, IMIB-Arrixaca, University of Murcia, Avenida Buenavista s/n, 30120 Murcia, Spain; (J.M.M.); (D.G.-B.)
- Internal Medicine Department, Faculty of Medicine, University of Murcia, 30120 Murcia, Spain
| | - David García-Bernal
- Research Group Cellular Therapy and Hematopoietic Transplant, Biomedical Research Institute, Virgen de la Arrixaca Clinical University Hospital, IMIB-Arrixaca, University of Murcia, Avenida Buenavista s/n, 30120 Murcia, Spain; (J.M.M.); (D.G.-B.)
- Internal Medicine Department, Faculty of Medicine, University of Murcia, 30120 Murcia, Spain
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Lorenzo‐Pouso AI, Pérez‐Sayáns M, Chamorro‐Petronacci C, Gándara‐Vila P, López‐Jornet P, Carballo J, García‐García A. Association between periodontitis and medication‐related osteonecrosis of the jaw: A systematic review and meta‐analysis. J Oral Pathol Med 2019; 49:190-200. [DOI: 10.1111/jop.12963] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/14/2019] [Accepted: 09/28/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Alejandro I. Lorenzo‐Pouso
- Faculty of Medicine and Dentistry Oral Medicine Oral Surgery and Implantology Unit Health Research Institute of Santiago de Compostela (IDIS) University of Santiago de Compostela Santiago de Compostela A Coruña Spain
| | - Mario Pérez‐Sayáns
- Faculty of Medicine and Dentistry Oral Medicine Oral Surgery and Implantology Unit Health Research Institute of Santiago de Compostela (IDIS) University of Santiago de Compostela Santiago de Compostela A Coruña Spain
| | - Cintia Chamorro‐Petronacci
- Faculty of Medicine and Dentistry Oral Medicine Oral Surgery and Implantology Unit Health Research Institute of Santiago de Compostela (IDIS) University of Santiago de Compostela Santiago de Compostela A Coruña Spain
| | - Pilar Gándara‐Vila
- Faculty of Medicine and Dentistry Oral Medicine Oral Surgery and Implantology Unit Health Research Institute of Santiago de Compostela (IDIS) University of Santiago de Compostela Santiago de Compostela A Coruña Spain
| | - Pía López‐Jornet
- Faculty of Medicine Department of Oral Medicine Regional Campus of International Excellence "Campus Mare Nostrum" University of Murcia Espinardo Murcia Spain
| | - Javier Carballo
- Faculty of Sciences Department of Food Technology University of Vigo‐Ourense Campus Ourense Spain
| | - Abel García‐García
- Faculty of Medicine and Dentistry Oral Medicine Oral Surgery and Implantology Unit Health Research Institute of Santiago de Compostela (IDIS) University of Santiago de Compostela Santiago de Compostela A Coruña Spain
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Erten Taysi A, Cevher E, Sessevmez M, Olgac V, Mert Taysi N, Atalay B. The efficacy of sustained-release chitosan microspheres containing recombinant human parathyroid hormone on MRONJ. Braz Oral Res 2019; 33:e086. [PMID: 31483052 DOI: 10.1590/1807-3107bor-2019.vol33.0086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 07/23/2019] [Indexed: 01/02/2023] Open
Abstract
Treatment of patients with bisphosphonate usage is a significant concern for oral surgeons because it interferes with jaw bone turnover and regeneration. In case of adverse effects manifesting related to bisphosphonate use, oral surgeons are usually treating and keep the patient's symptoms under control. In this study, we aimed to investigate a new treatment protocol for medication-related osteonecrosis of the jaw (MRONJ). This treatment protocol consisted of administering human parathyroid hormone (hPTH) loaded chitosan microspheres which were prepared by ionotropic gelation method or/and the prepared microspheres were suspended in a poloxamer gel. After in-vitro optimization studies, the efficacy of the chosen formulations was evaluated in-vivo studies. Zoledronic acid was administered daily to forty-eight adult female Sprague-Dawley rats, divided into four experimental groups, at a daily concentration of 0.11 mg/kg over three weeks to induce the MRONJ model. At the end of this period, maxillary left molar teeth were extracted. In the first group, the subjects received no treatment. In the negative control group, poloxamer hydrogel containing empty microspheres were immediately applied to the soft tissues surrounding the extraction socket. The treatment group-1 was treated with local injections of poloxamer hydrogel containing hPTH. The treatment group-2 was treated with a single local injection of poloxamer hydrogel containing hPTH-loaded chitosan microspheres. Both treatment groups received a total of 7 µg of hPTH at the end of the treatment protocol. Our study demonstrates successful attenuation of MRONJ through a local drug delivery system combined with hPTH, as opposed to previously attempted treatment strategies.
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Affiliation(s)
- Aysegul Erten Taysi
- Altinbas University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey
| | - Erdal Cevher
- Istanbul University, Faculty of Pharmacy, Department of Pharmaceutical Technology, Istanbul, Turkey
| | - Melike Sessevmez
- Istanbul University, Faculty of Pharmacy, Department of Pharmaceutical Technology, Istanbul, Turkey
| | - Vakur Olgac
- Istanbul University, Institute of Oncology, Department of Tumor Pathology and Cytology, Istanbul, Turkey
| | - Nuri Mert Taysi
- İstinye University, Vocational School of Health Care Services, Istanbul, Turkey
| | - Berkem Atalay
- Istanbul University-Cerrahpaşa, Vocational School of Health Care Services, Istanbul, Turkey
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10
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Cardoso AM, de Oliveira EG, Coradini K, Bruinsmann FA, Aguirre T, Lorenzoni R, Barcelos RCS, Roversi K, Rossato DR, Pohlmann AR, Guterres SS, Burger ME, Beck RCR. Chitosan hydrogels containing nanoencapsulated phenytoin for cutaneous use: Skin permeation/penetration and efficacy in wound healing. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 96:205-217. [DOI: 10.1016/j.msec.2018.11.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 09/27/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
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Liao MT, Chien WC, Wang JC, Chung CH, Chu SJ, Tsai SH. Increased risk of bisphosphonate-related osteonecrosis of the jaw in patients with Sjögren's syndrome: nationwide population-based cohort study. BMJ Open 2019; 9:e024655. [PMID: 30765404 PMCID: PMC6398708 DOI: 10.1136/bmjopen-2018-024655] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The aim of this study was to explore whether patients with Sjögren's syndrome (SS) were susceptible to bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) after tooth extraction in the entire population of Taiwan. DESIGN A nationwide population-based retrospective cohort study. SETTING Data were extracted from Taiwan's National Health Insurance Research Database (NHIRD). METHODOLOGY Medical conditions for both the study and control group were categorised using the International Classification of Diseases, 9th Revision. ORs and 95% CIs for associations between SS and osteonecrosis of the jaw (ONJ) were estimated using Cox regression. RESULTS Overall, 13 398 patients diagnosed with SS were identified from the NHIRD. An additional 53 592 matched patients formed the control group. At the 3-year follow-up, patients with SS started to exhibit a significantly increased cumulative risk of developing BRONJ compared with that of patients without SS (log rank test <0.001). At the end of the follow-up period, patients with SS exhibited a significantly increased incidence of ONJ compared with that of the controls (0.08%vs0.03%, p=0.017). The Cox regression model showed that patients with SS also exhibited a significantly increased risk of developing BRONJ compared with that of the patients without SS (adjusted HR=7.869, 95% CI 3.235 to 19.141, p<0.001). CONCLUSION Patients with SS exhibit an increased risk of developing BRONJ after tooth extraction. BPs should be used with caution in patients with SS.
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Affiliation(s)
- Min-Tser Liao
- Department of Pediatrics, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
- Department of Pediatrics, Tri-Service General Hospital, National Defense MedicalCenter, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Jen-Chun Wang
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Shi-Jye Chu
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Physiology and Biophysics, Graduate Institute of Physiology, NationalDefense Medical Center, Taipei, Taiwan.
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Holtmann H, Lommen J, Kübler NR, Sproll C, Rana M, Karschuck P, Depprich R. Pathogenesis of medication-related osteonecrosis of the jaw: a comparative study of in vivo and in vitro trials. J Int Med Res 2018; 46:4277-4296. [PMID: 30091399 PMCID: PMC6166332 DOI: 10.1177/0300060518788987] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/25/2018] [Indexed: 12/20/2022] Open
Abstract
Objective This study was performed to determine whether the results of prevailing in vivo and in vitro studies offer a reliable model for investigation of medication-related osteonecrosis of the jaw (MRONJ). Methods Embase, Medline, and the Cochrane Library were searched for articles published from September 2003 to June 2017 involving experimental approaches to the pathogenesis of MRONJ. In vivo and in vitro trials were analyzed with respect to the scientific question, study design, methodology, and results. Results Of 139 studies, 87, 46, and 6 conducted in vivo, in vitro, and both in vivo and in vitro experiments, respectively. Rats, mice, dogs, minipigs, sheep, and rabbits were the preferred animal models used. Osteoblasts, osteoclasts, fibroblasts, keratinocytes, macrophages, and human umbilical vein endothelial cells were the preferred cell types. Zoledronate, alendronate, ibandronate, and risedronate were the most frequent bisphosphonates used. MRONJ was most reliably induced in minipigs because of the close relationship with human bone physiology. In vitro studies showed that reduced viability, growth, and migration of cells in the bone and soft tissues were causative for MRONJ. Other than exposed jawbone after tooth extraction, no reliable cofactors were found. Conclusion The minipig is the most suitable animal model for MRONJ.
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Affiliation(s)
- Henrik Holtmann
- Department of Oral and Maxillofacial Surgery,
Plastic Surgery of the Head and Neck, Heinrich-Heine-University, Düsseldorf,
Germany
| | - Julian Lommen
- Department of Oral and Maxillofacial Surgery,
Plastic Surgery of the Head and Neck, Heinrich-Heine-University, Düsseldorf,
Germany
| | - Norbert R. Kübler
- Department of Oral and Maxillofacial Surgery,
Plastic Surgery of the Head and Neck, Heinrich-Heine-University, Düsseldorf,
Germany
| | - Christoph Sproll
- Department of Oral and Maxillofacial Surgery,
Plastic Surgery of the Head and Neck, Heinrich-Heine-University, Düsseldorf,
Germany
| | - Majeed Rana
- Department of Oral and Maxillofacial Surgery,
Plastic Surgery of the Head and Neck, Heinrich-Heine-University, Düsseldorf,
Germany
| | - Patrick Karschuck
- Department of Oral and Maxillofacial Surgery,
Plastic Surgery of the Head and Neck, Heinrich-Heine-University, Düsseldorf,
Germany
| | - Rita Depprich
- Department of Oral and Maxillofacial Surgery,
Plastic Surgery of the Head and Neck, Heinrich-Heine-University, Düsseldorf,
Germany
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13
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Lorenzo-Pouso AI, Pérez-Sayáns M, García A, Carballo J. Vitamin D supplementation: Hypothetical effect on medication-related osteonecrosis of the jaw. Med Hypotheses 2018; 116:79-83. [PMID: 29857915 DOI: 10.1016/j.mehy.2018.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/10/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
Vitamin D is an important nutrient for bone health and skeleton growth. Few foods are natural sources of this secosteroid; this is the reason why the consumption of vitamin D as a dietary supplement is becoming common in developed countries. For many years vitamin D has been considered crucial in the treatment and prevention of the Global Burden of Disease and in a reduction in mortality among elder people. Many health care providers prescribe these supplements in the management of osteoporosis and metabolic bone diseases; specifically in the primary prevention of fractures. Recently medication-related osteonecrosis of the jaw (MRONJ) has been reported as severe late sequelae of antiresorptive therapies (i.e., bisphosphonates and some monoclonal antibodies). Although MRONJ-related pathophysiology is not fully understood, there are three fundamental theories to explain it: (1) the inhibition of osteoclasts, (2) the inhibition of angiogenesis and (3) the processes of inflammation-infection. Recent advances in Vitamin D research have shown that this secosteroid can play a potential pivotal role in many of the different etiological pathways of MRONJ. Furthermore, there are a large number of co-morbidities between the deficit of this vitamin and other MRONJ concomitant outcomes. Our hypothesis argues that the low-risk and low-cost vitamin D dietary supplementation may prove to be suitable for use as a practical MRONJ prevention strategy. The described framework gives more insight into the study of disease mechanisms, search of potential biomarkers, and therapeutic targets in MRONJ.
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Affiliation(s)
- Alejandro I Lorenzo-Pouso
- Oral Medicine, Oral Surgery and Implantology Unit, School of Dentistry, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain; GI-1319 Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - Mario Pérez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit, School of Dentistry, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain; GI-1319 Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Abel García
- Oral Medicine, Oral Surgery and Implantology Unit, School of Dentistry, Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain; GI-1319 Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Javier Carballo
- Department of Food Technology, Faculty of Sciences, University of Vigo - Ourense Campus, Ourense, Spain
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Yang R, Tao Y, Wang C, Shuai Y, Jin L. Circulating microRNA Panel as a Novel Biomarker to Diagnose Bisphosphonate-Related Osteonecrosis of the Jaw. Int J Med Sci 2018; 15:1694-1701. [PMID: 30588193 PMCID: PMC6299413 DOI: 10.7150/ijms.27593] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/02/2018] [Indexed: 01/08/2023] Open
Abstract
There is no defined biomarker for BRONJ diagnosis with satisfactory performance in clinic. In this study, we established the BRONJ model and selected 7 microRNAs as candidate for BRONJ diagnosis from microRNA microarray reported by other research. Dysregulated microRNAs during BRONJ were detected and validated in two independent animal experiments using serum samples. In the first part, serum miR-21, miR-23a and miR-145 were significantly altered in between BRONJ and control group. And an Indice was constructed as -0.032+(0.154×miR-21)+(0.145×miR-23a)+(-0.700×miR-145) using logistic regression model to improve diagnostic performance. The performance of Indice to differentiate BRONJ subjects from control group was analyzed as AUC of 0.82 (95% CI, 0.72-0.92) or 0.85 (95% CI, 0.73-0.97) in the first or second part. Moreover, the predictive performance of Indice to discriminate BRONJ-1w and BRONJ-4w from control group was displayed as AUC of 0.65 (95% CI, 0.47-0.84) or 0.75 (95% CI, 0.60-0.91), which was better than individual circulating microRNAs. In addition, the expressions of candidate microRNAs were validated in human samples. Consequently, we investigated a combined Indice constructed with circulating microRNAs for BRONJ diagnosis and prediction.
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Affiliation(s)
- Rui Yang
- Department of Stomatology, PLA Army General Hospital, Beijing, 100000, People's Republic of China
| | - Yurong Tao
- Department of Gastroenterology, PLA Army General Hospital, Beijing, 100000, People's Republic of China
| | - Chao Wang
- Department of Stomatology, PLA Army General Hospital, Beijing, 100000, People's Republic of China
| | - Yi Shuai
- Department of Stomatology, Nanjing General Hospital of Nanjing Military Command, Nanjing, Jiangsu 210002, People's Republic of China
| | - Lei Jin
- Department of Stomatology, Nanjing General Hospital of Nanjing Military Command, Nanjing, Jiangsu 210002, People's Republic of China
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Kim KY, Zhang X, Cha IH. Identifying a combined biomarker for bisphosphonate-related osteonecrosis of the jaw. Clin Implant Dent Relat Res 2017; 20:191-198. [PMID: 29266738 DOI: 10.1111/cid.12569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/23/2017] [Accepted: 11/13/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND For this study, the aim was to identify combined biomarkers associated with bisphosphonate-related osteonecrosis of the jaw (BRONJ). MATERIALS AND METHODS Microarray data for GSE7116 were downloaded from the Gene Expression Omnibus database, which contains 26 samples, including without ONJ, and 5 healthy volunteers. The combined biomarkers were identified using principal component analysis, and the pathway enrichment analyses were performed using the DAVID online tool. RESULTS Two hundred differently expressed genes between groups were detected according to the significances. From functional annotation, Y-box binding protein 1 and heterogeneous nuclear ribonucleoprotein C were found to be included in the most significant 10 pathways. Ten combined gene sets were identified that were effective in classifying multiple myeloma (MM) with ONJ and MM without ONJ. CONCLUSION Identifying combined gene expression profiles is expected to contribute to more personalized management of BRONJ and to improve existing therapies, and it will be helpful in finding new therapies by identifying more predictive biomarkers.
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Affiliation(s)
- Ki-Yeol Kim
- Dental Education Research Center, BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Xianglan Zhang
- Department of Pathology, Yanbian University Medical College, Yanji City, Jilin Province, China
| | - In-Ho Cha
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea
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Role of Periapical Diseases in Medication-Related Osteonecrosis of the Jaws. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1560175. [PMID: 29109954 PMCID: PMC5646299 DOI: 10.1155/2017/1560175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/29/2017] [Indexed: 12/05/2022]
Abstract
Objective The present study aimed to investigate the role of periapical diseases in inducing medication-related osteonecrosis of the jaws (MRONJ) using an ovariectomized (OVX) mice model. Materials and Methods Twenty C57BL/6N female mice were randomly assigned to two groups. All mice were subjected to bilateral ovariectomy and then treated with oncologic dose of zoledronic acid (ZA) or vehicle for twelve weeks. Eight weeks after commence of drug administration, a pulpal exposure (PE) operation was performed on the first right lower molar to induce periapical periodontitis; the contralateral non-PE tooth was used as control. All animals were sacrificed four weeks after pulpal exposure, and the mandibles were harvested for radiological and histomorphometrical analysis. Results Micro computed tomography (μ-CT) examination demonstrated that periapical diseases significantly increased alveolar bone resorption, and the resorption was greatly attenuated by ZA treatment. Concurrent ZA therapy significantly increased bone density and histological osteocyte necrosis in the presence of periapical lesions. Conclusion ZA treatment reduced bone absorption resulting from periapical disease but increased the risk of developing MRONJ in the ovariectomized mouse model.
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Zandi M, Dehghan A, Mohammadi-Mofrad A, Amini P, Vahdatinia F. Short-term perioperative teriparatide therapy for the prevention of medication-related osteonecrosis of the jaw: A randomized, controlled preclinical study in rats. J Craniomaxillofac Surg 2016; 45:275-280. [PMID: 28087282 DOI: 10.1016/j.jcms.2016.12.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/18/2016] [Accepted: 12/08/2016] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Dentoalveolar procedures in patients receiving bisphosphonates and other antiresorptive agents are associated with an increased risk of medication-related osteonecrosis of the jaw (MRONJ). The aim of present study was to evaluate the effects of perioperative teriparatide (TPD) therapy in prevention of MRONJ. SUBJECTS AND METHODS Two protocols of TPD therapy were studied. For protocol A, 25 TPD-treated (AT) and 25 control (AC) rats received 5 weekly injection of 0.06 mg/kg zoledronate. At the end of week 5, extraction of bilateral mandibular first molars was performed for all rats, and 4-week TPD (20 μg/kg/day) and saline therapy was started for AT and AC rats, respectively. For protocol B, 25 TPD-treated (BT) and 25 control (BC) rats received 5 weekly injection of 0.06 mg/kg zoledronate. One week later, 4-week TPD and saline therapy was started for BT and BC rats, respectively. Both groups underwent tooth extraction at the end of week 7 of the experiment. All rats were sacrificed 8 weeks after tooth extraction and assessed clinically for bone exposure/fistula, and histologically for density of osteocytes in newly formed bone and empty osteocyte lacunae in alveolar bone. RESULTS Incidence of bone exposure/fistula and mean numbers of osteocytes and empty lacunae per 25 mm2 (at 400× magnification) were 20%, 15.36, and 2.63 in AT group; 78%, 5.78, and 6.81 in AC group; 14%, 16.94, and 2.08 in BT group; and 78%, 7.54, and 5.95 in BC group; respectively. The differences between AT and AC and between BT and BC were statistically significant (P < 0.001). However, no statistically significant difference between AT and BT and between AC and BC was found. CONCLUSION Four weeks of TPD therapy, beginning at the same day or 2 weeks before tooth extraction, had a potential role in prevention of ONJ.
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Affiliation(s)
- Mohammad Zandi
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. M. Zandi), Hamadan University of Medical Sciences, Hamadan, Iran; Dental Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Arash Dehghan
- Department of Pathology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amirhossein Mohammadi-Mofrad
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. M. Zandi), Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Payam Amini
- Department of Biostatistics, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farshid Vahdatinia
- Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
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Zandi M, Dehghan A, Janbaz P, Malekzadeh H, Amini P. The starting point for bisphosphonate-related osteonecrosis of the jaw: Alveolar bone or oral mucosa? A randomized, controlled experimental study. J Craniomaxillofac Surg 2016; 45:157-161. [PMID: 27919595 DOI: 10.1016/j.jcms.2016.10.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 09/20/2016] [Accepted: 10/25/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Although over a decade has passed since first introduction of BRONJ, the exact pathophysiology of this disease is still unclear. The present experimental study aimed to determine whether the oral mucosa or alveolar bone serves as the starting point for BRONJ development. SUBJECTS AND METHODS Sixty male Wistar rats were randomly assigned into study and control groups (each, n = 30), and received intraperitoneal injection of 0.06 mg/kg zoledronate and saline, respectively, once a week for 12 weeks. At the end of the week 4 of the experiment, all 60 rats underwent unilateral mandibular first molar extraction. A 4 mm defect was made in the contralateral canine alveolar mucosa. At the end of the experiment, rats were sacrificed, and the three areas of interest including extraction, soft tissue defect, and the non-intervention (canine area on the same side of extraction) sites were assessed clinically for presence of bone exposure/fistula, and histologically for status of bone remodeling (only at extraction site) and osteonecrosis. RESULTS In the study group, the frequency of bone exposure/fistula was 80%, 0%, and 0%; and the rate of histological bone necrosis was 83.3%, 20%, and 0%; at the extraction, soft tissue defect, and non-intervention sites, respectively. No clinical and histological sign of bone necrosis was found in the control group. Normal bone remodeling was observed in 0% and 100% of the extraction sockets in the study and control groups, respectively. CONCLUSION Injury to alveolar bone was a stronger trigger for BRONJ development compared to oral mucosal damages.
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Affiliation(s)
- Mohammad Zandi
- Department of Oral and Maxillofacial Surgery, Hamadan University of Medical Sciences, Hamadan, Iran; Dental Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Arash Dehghan
- Department of Pathology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Pejman Janbaz
- Department of Oral and Maxillofacial Surgery, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Hamid Malekzadeh
- Department of Oral and Maxillofacial Surgery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Payam Amini
- Department of Biostatistics, Hamadan University of Medical Sciences, Hamadan, Iran
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Arun MZ, Reel B, Sala-Newby GB, Bond M, Tsaousi A, Maskell P, Newby AC. Zoledronate upregulates MMP-9 and -13 in rat vascular smooth muscle cells by inducing oxidative stress. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:1453-60. [PMID: 27143852 PMCID: PMC4841407 DOI: 10.2147/dddt.s103124] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Bisphosphonates, including zoledronate, target osteoclasts and are widely used in the treatment of osteoporosis and other bone resorption diseases, despite side effects that include damaging the stomach epithelium. Beneficial and adverse effects on other organ systems, including the cardiovascular system, have also been described and could impact on the use of bisphosphonates as therapeutic agents. Vascular smooth muscle cells (VSMCs) are major constituents of the normal vascular wall and have a key role in intimal thickening and atherosclerosis, in part by secreting MMPs that remodel the extracellular matrix and cleave cell surface proteins or secreted mediators. In this study, we investigated the effects of zoledronate on MMP expression. Methods Rat VSMCs were stimulated by PDGF (50 ng/mL) plus TNF-α (10 ng/mL) or left unstimulated for a further 24 hours in serum-free medium. In other series of experiments, cells were pre-treated either with SC-514 (50 μM) or with apocynin (20 nM) for 2 hours, then zoledronate (100 μM) was added into 2% fetal calf serum containing medium for 24 hours. Results and discussion Using isolated rat VSMCs in culture, zoledronate (100 μM) increased MMP-9 and -13 mRNA expressions but inhibited MMP-2 expression. MMP-9 and MMP-13 up-regulation was shown to depend on the NF-κB pathway; and this was activated by zoledronate. Furthermore, zoledronate elevated the levels of reactive oxygen species detected by either dichlorofluorescein in isolated VSMCs or lucigenin enhanced chemiluminescence in rat aortic rings in vitro. Apocynin, an inhibitor of NADPH oxidase, reversed NF-κB activation and MMP-9 and MMP-13 up-regulation by zoledronate. Conclusion We conclude that zoledronate increases MMP-9 and MMP-13 expressions in rat VSMCs dependent upon stimulation of the NF-κB pathway by reactive oxygen species. Effects on MMP expression may contribute to the pharmacologic profile of bisphosphonates.
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Affiliation(s)
- Mehmet Zuhuri Arun
- Department of Pharmacology, Faculty of Pharmacy, Ege University, Izmir, Turkey
| | - Buket Reel
- Department of Pharmacology, Faculty of Pharmacy, Ege University, Izmir, Turkey
| | - Graciela B Sala-Newby
- Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Mark Bond
- Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Aikaterini Tsaousi
- Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Perry Maskell
- Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Andrew C Newby
- Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, UK
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In vitro comparison of new bisphosphonic acids and zoledronate effects on human gingival fibroblasts viability, inflammation and matrix turnover. Clin Oral Investig 2015; 20:2013-2021. [DOI: 10.1007/s00784-015-1690-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/09/2015] [Indexed: 01/08/2023]
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Barba-Recreo P, Del Castillo Pardo de Vera JL, Georgiev-Hristov T, Ruiz Bravo-Burguillos E, Abarrategi A, Burgueño M, García-Arranz M. Adipose-derived stem cells and platelet-rich plasma for preventive treatment of bisphosphonate-related osteonecrosis of the jaw in a murine model. J Craniomaxillofac Surg 2015; 43:1161-8. [PMID: 26027865 DOI: 10.1016/j.jcms.2015.04.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 04/02/2015] [Accepted: 04/30/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The main challenge in treating bisphosphonate-related osteonecrosis of the jaw (BRONJ) is the absence of an effective established treatment. We aimed to compare different potentially preventive treatments for BRONJ after dental extractions in zoledronic acid (ZA)-treated animals. We studied the local application of different combinations of adipose-derived stem cells (ASCs) with or without previous stimulation with bone morphogenetic protein 2 (BMP-2) and platelet-rich plasma (PRP) in rats. MATERIAL AND METHODS Fifty-six male Wistar rats were treated with ZA for 9 weeks. Dental extractions were performed in the eighth week, and the animals were divided into 4 groups. In group 1 (n = 14), alveolar coverage with mucoperiosteal flap was performed. In group 2 (n = 14), PRP was applied over the sockets and covered with the flap. In group 3 (n = 15), allogeneic ASCs with PRP were applied and covered with the flap. In group 4 (n = 13), animals were treated with ASCs cultured with BMP-2, PRP, and flap coverage. Histologic, fluorescence, and radiologic studies of the maxillae were performed. RESULTS ASC-treated animals showed lower frequency of osteonecrosis (14% vs 50%, p = 0.007) and greater bone turnover (p = 0.024) and osteoclast count (p = 0.045) than those not receiving the ASC treatment. CONCLUSIONS In this high-risk model, ASC-based treatments seem to prevent BRONJ more effectively than mucosal flap with or without PRP. The combination of ASCs and PRP appears to be synergistic, and the addition of BMP-2 could further improve the results.
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Affiliation(s)
- Paula Barba-Recreo
- Department of Oral and Maxillofacial Surgery (Head: Miguel Burgueño), Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
| | - Jose Luis Del Castillo Pardo de Vera
- Department of Oral and Maxillofacial Surgery (Head: Miguel Burgueño), Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Tihomir Georgiev-Hristov
- Cell Therapy Laboratory (Head: Damián García Olmo), Instituto de Investigación Sanitario Fundación Jiménez Díaz, Avda. Reyes Católicos 2, 28040 Madrid, Spain; Department of General Surgery, Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos 2, 28040 Madrid, Spain
| | | | - Ander Abarrategi
- Cellular Biotechnology Unit, Instituto de Salud Carlos III, Carretera Majadahonda-Pozuelo km 2.200, 28220 Majadahonda, Spain; Haematopoietic Stem Cell Laboratory, Cancer Research UK, 44 Lincoln's Inn Fields, London WC2A 3LY, United Kingdom
| | - Miguel Burgueño
- Department of Oral and Maxillofacial Surgery (Head: Miguel Burgueño), Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain; Department of Surgery, Faculty of Medicine, Universidad Autónoma de Madrid, C/ Arzobispo Morcillo s/n, 28029 Madrid, Spain
| | - Mariano García-Arranz
- Cell Therapy Laboratory (Head: Damián García Olmo), Instituto de Investigación Sanitario Fundación Jiménez Díaz, Avda. Reyes Católicos 2, 28040 Madrid, Spain; Department of Surgery, Faculty of Medicine, Universidad Autónoma de Madrid, C/ Arzobispo Morcillo s/n, 28029 Madrid, Spain
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Genetic investigation of bisphosphonate-related osteonecrosis of jaw (BRONJ) via whole exome sequencing and bioinformatics. PLoS One 2015; 10:e0118084. [PMID: 25668207 PMCID: PMC4337898 DOI: 10.1371/journal.pone.0118084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 01/04/2015] [Indexed: 11/26/2022] Open
Abstract
Complications associated with the use of bisphosphonate (BP) have risen over the
years due to an increase in the prescription of BP. BP-related osteonecrosis of jaw
(BRONJ), one of the complications linked to the consumption of BP, greatly affects
patients with minor dental trauma, incurring a long healing period. While BRONJ
afflicts only a minority of patients prescribed with BP, BRONJ is a multigenic
disease affected both by environmental and genetic factors having a distinctive
phenotype. This study aims to discover genetic biomarkers associated with BRONJ via
whole exome sequencing (WES) followed by statistical analysis. Sixteen individuals
who had been prescribed with bisphosphonate medication and diagnosed as BRONJ were
chosen and each individual’s saliva sample was collected for WES. 126
randomized subsamples from the GSK project representing 109 male and 17 female
Koreans were used as a control data set. Fisher’s exact test was carried out
to assess the significance of genetic variants in BRONJ patients. Gene set enrichment
analysis (GSEA) (DAVID Bioinformatics Resource 6.7) was used to perform a cluster
analysis of variants found from Fisher‘s exact test. The results from this
study suggest that BRONJ-inducing factors are genetically associated and BRONJ occurs
due to the malfunctioning of post-translational modification in osteoclast leading to
the impairment of cell morphology and adhesion.
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Barba-Recreo P, Del Castillo Pardo de Vera JL, García-Arranz M, Yébenes L, Burgueño M. Zoledronic acid – Related osteonecrosis of the jaws. Experimental model with dental extractions in rats. J Craniomaxillofac Surg 2014; 42:744-50. [DOI: 10.1016/j.jcms.2013.11.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 08/26/2013] [Accepted: 11/04/2013] [Indexed: 10/26/2022] Open
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Thumbigere-Math V, Michalowicz BS, de Jong EP, Griffin TJ, Basi DL, Hughes PJ, Tsai ML, Swenson KK, Rockwell L, Gopalakrishnan R. Salivary proteomics in bisphosphonate-related osteonecrosis of the jaw. Oral Dis 2013; 21:46-56. [PMID: 24286378 DOI: 10.1111/odi.12204] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 09/15/2013] [Accepted: 10/17/2013] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective of this study was to identify differentially expressed salivary proteins in bisphosphonate-related osteonecrosis of the jaw (BRONJ) patients that could serve as biomarkers for BRONJ diagnosis. SUBJECTS AND METHODS Whole saliva obtained from 20 BRONJ patients and 20 controls were pooled within groups. The samples were analyzed using iTRAQ-labeled two-dimensional liquid chromatography-tandem mass spectrometry. RESULTS Overall, 1340 proteins were identified. Of these, biomarker candidates were selected based on P-value (<0.001), changes in protein expression (≥1.5-fold increase or decrease), and unique peptides identified (≥2). Three comparisons made between BRONJ and control patients identified 200 proteins to be differentially expressed in BRONJ patients. A majority of these proteins were predicted to have a role in drug metabolism and immunological and dermatological diseases. Of all the differentially expressed proteins, we selected metalloproteinase-9 and desmoplakin for further validation. Immunoassays confirmed increased expression of metalloproteinase-9 in individual saliva (P = 0.048) and serum samples (P = 0.05) of BRONJ patients. Desmoplakin was undetectable in saliva. However, desmoplakin levels tended to be lower in BRONJ serum than controls (P = 0.157). CONCLUSIONS Multiple pathological reactions are involved in BRONJ development. One or more proteins identified by this study may prove to be useful biomarkers for BRONJ diagnosis. The role of metalloproteinase-9 and desmoplakin in BRONJ requires further investigation.
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Affiliation(s)
- V Thumbigere-Math
- Division of Periodontology, University of Minnesota School of Dentistry, Minneapolis, MN, USA
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Okamoto Y, Hirota M, Monden Y, Murata S, Koyama C, Mitsudo K, Iwai T, Ishikawa Y, Tohnai I. High-dose zoledronic acid narrows the periodontal space in rats. Int J Oral Maxillofac Surg 2012; 42:627-31. [PMID: 23245701 DOI: 10.1016/j.ijom.2012.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Revised: 08/20/2012] [Accepted: 11/13/2012] [Indexed: 11/27/2022]
Abstract
The aim of this experiment was to evaluate the histological effects of zoledronic acid on the periodontal space in rats. 40 male Wistar rats were divided into three zoledronic acid groups and a control group. Zoledronic acid was injected subcutaneously at doses of 10, 50, or 500 μg/kg once a week for 3 weeks. The rats were killed 1 or 9 weeks after the last injection. Histological examination of the periodontal space around the incisor tooth revealed that zoledronic acid did not inhibit tooth development. In the rats killed 1 week after treatment discontinuation, the periodontal space gradually narrowed in response to increasing zoledronic acid doses, and the changes were statistically significant according to ANOVA but not according to ANOVA with post hoc tests. The changes persisted in the high-dose zoledronic acid group despite zoledronic acid discontinuation, with significant differences identified by ANOVA and ANOVA with post hoc tests. Therefore, although zoledronic acid had an insignificant effect on tooth development, it had a significant effect on the periodontal space when high doses were administered. The results of this experiment may provide useful information for future investigations on the role of zoledronic acid in the osteonecrosis of the jaw.
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Affiliation(s)
- Y Okamoto
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
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26
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Current World Literature. Curr Opin Support Palliat Care 2012; 6:402-16. [DOI: 10.1097/spc.0b013e3283573126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zoledronate inhibits ischemia-induced neovascularization by impairing the mobilization and function of endothelial progenitor cells. PLoS One 2012; 7:e41065. [PMID: 22848429 PMCID: PMC3405104 DOI: 10.1371/journal.pone.0041065] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 06/17/2012] [Indexed: 02/03/2023] Open
Abstract
Background Bisphosphonates are a class of pharmacologic compounds that are commonly used to treat postmenopausal osteoporosis and malignant osteolytic processes. Studies have shown that bone marrow-derived endothelial progenitor cells (EPCs) play a significant role in postnatal neovascularization. Whether the nitrogen-containing bisphosphonate zoledronate inhibits ischemia-induced neovascularization by modulating EPC functions remains unclear. Methodology/Principal Findings Unilateral hindlimb ischemia was surgically induced in wild-type mice after 2 weeks of treatment with vehicle or zoledronate (low-dose: 30 μg/kg; high-dose: 100 μg/kg). Doppler perfusion imaging demonstrated that the ischemic limb/normal side blood perfusion ratio was significantly lower in wild-type mice treated with low-dose zoledronate and in mice treated with high-dose zoledronate than in controls 4 weeks after ischemic surgery (control vs. low-dose vs. high-dose: 87±7% vs. *61±18% vs. **49±17%, *p<0.01, **p<0.005 compared to control). Capillary densities were also significantly lower in mice treated with low-dose zoledronate and in mice treated with high-dose zoledronate than in control mice. Flow cytometry analysis showed impaired mobilization of EPC-like cells (Sca-1+/Flk-1+) after surgical induction of ischemia in mice treated with zoledronate but normal levels of mobilization in mice treated with vehicle. In addition, ischemic tissue from mice that received zoledronate treatment exhibited significantly lower levels of the active form of MMP-9, lower levels of VEGF, and lower levels of phosphorylated eNOS and phosphorylated Akt than ischemic tissue from mice that received vehicle. Results of the in vitro studies showed that incubation with zoledronate inhibited the viability, migration, and tube-forming capacities of EPC. Conclusions/Significance Zoledronate inhibited ischemia-induced neovascularization by impairing EPC mobilization and angiogenic functions. These findings suggest that administration of zoledronate should be withheld in patients with ischemic events such as acute limb ischemia.
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Feng J, McDaniel JS, Chuang HH, Huang O, Rakian A, Xu X, Steffensen B, Donly KJ, MacDougall M, Chen S. Binding of amelogenin to MMP-9 and their co-expression in developing mouse teeth. J Mol Histol 2012; 43:473-85. [PMID: 22648084 PMCID: PMC3460178 DOI: 10.1007/s10735-012-9423-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 04/29/2012] [Indexed: 12/02/2022]
Abstract
Amelogenin is the most abundant matrix protein in enamel. Proper amelogenin processing by proteinases is necessary for its biological functions during amelogenesis. Matrix metalloproteinase 9 (MMP-9) is responsible for the turnover of matrix components. The relationship between MMP-9 and amelogenin during tooth development remains unknown. We tested the hypothesis that MMP-9 binds to amelogenin and they are co-expressed in ameloblasts during amelogenesis. We evaluated the distribution of both proteins in the mouse teeth using immunohistochemistry and confocal microscopy. At postnatal day 2, the spatial distribution of amelogenin and MMP-9 was co-localized in preameloblasts, secretory ameloblasts, enamel matrix and odontoblasts. At the late stages of mouse tooth development, expression patterns of amelogenin and MMP-9 were similar to that seen in postnatal day 2. Their co-expression was further confirmed by RT-PCR, Western blot and enzymatic zymography analyses in enamel organ epithelial and odontoblast-like cells. Immunoprecipitation assay revealed that MMP-9 binds to amelogenin. The MMP-9 cleavage sites in amelogenin proteins across species were found using bio-informative software program. Analyses of these data suggest that MMP-9 may be involved in controlling amelogenin processing and enamel formation.
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Affiliation(s)
- Junsheng Feng
- Department of Developmental Dentistry, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA
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