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Kim HY, Jung YS, Park W, Choi YJ, Kim JY. Can medication-related osteonecrosis of the jaw be attributed to specific microorganisms through oral microbiota analyses? A preliminary study. BMC Oral Health 2024; 24:160. [PMID: 38302952 PMCID: PMC10832156 DOI: 10.1186/s12903-024-03945-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/27/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Medication-related osteonecrosis of the jaw (MRONJ) can cause significant pain and loss of aesthetics and function if not treated properly. However, diagnosis still relies on detailed intraoral examinations and imaging. Prognosis varies even among patients with similar stages or conditions of MRONJ, emphasizing the need for a deeper understanding of its complex mechanisms. Thus, this study aimed to identify the oral microbiota of patients with MRONJ. METHODS This single-center prospective cohort study included patients with confirmed MRONJ who visited the Department of Oral and Maxillofacial Surgery at Yonsei University Dental Hospital between 2021 and 2022. Oral swab samples were collected from the affected and unaffected sides of each patient. The composition and enumeration of the microbial communities were analyzed, and the diversity was compared to verify ecological changes in the groups using a next-generation sequencing-based 16S metagenomic analysis. A statistical analysis was performed using Wilcoxon signed-rank test with SPSS version 22, and values of P less than 0.05 were considered statistically significant. RESULTS The final study sample included 12 patients. The mean age was 82.67 ± 5.73 (range, 72-90) years. Changes in microbial composition were observed at different taxonomic levels (phylum, genus, and species). The identified microorganisms were commonly associated with periodontitis, gingival disease, and endodontic infection, suggesting a multifactorial etiology of MRONJ. CONCLUSIONS Although this study is based on a small number of cases, it shows that MRONJ is not caused by a specific microorganism but can rather be caused by a variety of factors. By addressing these findings in large-scale studies, the significance of oral microbiome in pathogenesis can be further elucidated and can facilitate the development of effective therapeutic interventions for patients with MRONJ.
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Affiliation(s)
- Heon-Young Kim
- Department of Oral and Maxillofacial Surgery, Ewha Womans University Medical Centre, Seoul, Republic of Korea
| | - Young-Soo Jung
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Wonse Park
- Department of Advanced General Dentistry, Yonsei University College of Dentistry, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea
| | - Yoon Jeong Choi
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Jun-Young Kim
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Republic of Korea.
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Sans-Serramitjana E, Obreque M, Muñoz F, Zaror C, Mora MDLL, Viñas M, Betancourt P. Antimicrobial Activity of Selenium Nanoparticles (SeNPs) against Potentially Pathogenic Oral Microorganisms: A Scoping Review. Pharmaceutics 2023; 15:2253. [PMID: 37765222 PMCID: PMC10537110 DOI: 10.3390/pharmaceutics15092253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Biofilms are responsible for the most prevalent oral infections such as caries, periodontal disease, and pulp and periapical lesions, which affect the quality of life of people. Antibiotics have been widely used to treat these conditions as therapeutic and prophylactic compounds. However, due to the emergence of microbial resistance to antibiotics, there is an urgent need to develop and evaluate new antimicrobial agents. This scoping review offers an extensive and detailed synthesis of the potential role of selenium nanoparticles (SeNPs) in combating oral pathogens responsible for causing infectious diseases. A systematic search was conducted up until May 2022, encompassing the MEDLINE, Embase, Scopus, and Lilacs databases. We included studies focused on evaluating the antimicrobial efficacy of SeNPs on planktonic and biofilm forms and their side effects in in vitro studies. The selection process and data extraction were carried out by two researchers independently. A qualitative synthesis of the results was performed. A total of twenty-two articles were considered eligible for this scoping review. Most of the studies reported relevant antimicrobial efficacy against C. albicans, S. mutans, E. faecalis, and P. gingivalis, as well as effective antioxidant activity and limited toxicity. Further research is mandatory to critically assess the effectiveness of this alternative treatment in ex vivo and in vivo settings, with detailed information about SeNPs concentrations employed, their physicochemical properties, and the experimental conditions to provide enough evidence to address the construction and development of well-designed and safe protocols.
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Affiliation(s)
- Eulàlia Sans-Serramitjana
- Center of Plant, Soil Interaction and Natural Resources Biotechnology, Scientific and Biotechnological Bioresource Nucleus (BIOREN-UFRO), Universidad de La Frontera, Temuco 4811230, Chile;
| | - Macarena Obreque
- Center for Research in Dental Sciences (CICO), Endodontic Laboratory, Faculty of Dentistry, Universidad de La Frontera, Temuco 4811230, Chile; (M.O.); (F.M.)
| | - Fernanda Muñoz
- Center for Research in Dental Sciences (CICO), Endodontic Laboratory, Faculty of Dentistry, Universidad de La Frontera, Temuco 4811230, Chile; (M.O.); (F.M.)
| | - Carlos Zaror
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Manuel Montt #112, Temuco 4811230, Chile;
- Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco 4811230, Chile
| | - María de La Luz Mora
- Center of Plant, Soil Interaction and Natural Resources Biotechnology, Scientific and Biotechnological Bioresource Nucleus (BIOREN-UFRO), Universidad de La Frontera, Temuco 4811230, Chile;
| | - Miguel Viñas
- Laboratory of Molecular Microbiology & Antimicrobials, Department of Pathology & Experimental Therapeutics, Faculty of Medicine & Health Sciences, University of Barcelona, 08907 Barcelona, Spain;
| | - Pablo Betancourt
- Center for Research in Dental Sciences (CICO), Endodontic Laboratory, Faculty of Dentistry, Universidad de La Frontera, Temuco 4811230, Chile; (M.O.); (F.M.)
- Department of Integral Adultos, Faculty of Dentistry, Universidad de La Frontera, Temuco 4811230, Chile
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Tetradis S, Allen MR, Ruggiero SL. Pathophysiology of Medication-Related Osteonecrosis of the Jaw-A Minireview. JBMR Plus 2023; 7:e10785. [PMID: 37614299 PMCID: PMC10443081 DOI: 10.1002/jbm4.10785] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 08/25/2023] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious adverse effect of antiresorptive medications administered for control of osseous malignancy, osteoporosis, or other bone metabolic diseases. Despite being reported in the literature two decades ago, MRONJ etiology, pathophysiology, and progression remain largely unknown, and current nonoperative or operative treatment strategies are mostly empirical. Several hypotheses that attempt to explain the mechanisms of MRONJ pathogenesis have been proposed. However, none of these hypotheses alone is able to capture the complex mechanistic underpinnings of the disease. In this minireview, we aim to highlight key findings from clinical and translational studies and propose a unifying model for the pathogenesis and progression of MRONJ. We also identify aspects of the disease process that require further investigation and suggest areas for future research efforts toward calibrating methodologic approaches and validating experimental findings. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Sotirios Tetradis
- Division of Diagnostic and Surgical SciencesUCLA School of DentistryLos AngelesCAUSA
| | - Matthew R. Allen
- Department of Anatomy, Cell Biology & PhysiologyIndiana University School of MedicineIndianapolisINUSA
| | - Salvatore L. Ruggiero
- New York Center for Orthognathic and Maxillofacial SurgeryLake SuccessNYUSA
- Department Oral and Maxillofacial SurgeryStony Brook School of Dental MedicineStony BrookNYUSA
- Division of Oral and Maxillofacial SurgeryHofstra‐Northwell School of MedicineHempsteadNYUSA
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Yan K, Auger S, Diaz A, Naman J, Vemulapalli R, Hasina R, Izumchenko E, Shogan B, Agrawal N. Microbial Changes Associated With Oral Cavity Cancer Progression. Otolaryngol Head Neck Surg 2023; 168:1443-1452. [PMID: 36939272 PMCID: PMC10213157 DOI: 10.1002/ohn.211] [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: 06/25/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To examine the oral microbiome in the context of oral cavity squamous cell carcinoma. STUDY DESIGN Basic science research. SETTING Academic medical center. METHODS Oral swabs were collected from patients presenting to the operating room for management of oral cavity squamous cell carcinoma and from age- and sex-matched control patients receiving surgery for unrelated benign conditions. 16S ribosomal RNA (rRNA) sequencing was performed on genetic material obtained from swabs. A bacterial rRNA gene library was created and sequence reads were sorted into taxonomic units. RESULTS Thirty-one control patients (17 males) and 35 cancer patients (21 males) were enrolled. Ages ranged from 23 to 89 (median 63) for control patients and 35 to 86 (median 66) for cancer patients. Sixty-one percent of control patients and 63% of cancer patients were smokers. 16S analyses demonstrated a significant decrease in Streptococcus genera in oral cancer patients (34.11% vs 21.74% of the population, p = .04). Increases in Fusobacterium, Peptostreptococcus, Parvimonas, and Neisseria were also found. The abundance of these bacteria correlated with tumor T-stage. CONCLUSION 16S rRNA sequencing demonstrated changes in bacterial populations in oral cavity cancer and its progression compared to noncancer controls. We found increases in bacteria genera that correspond with tumor stage-Fusobacteria, Peptostreptococcus, Parvimonas, Neisseria, and Treponema. These data suggest that oral cancer creates an environment to facilitate foreign bacterial growth, rather than implicating a specific bacterial species in carcinogenesis. These bacteria can be employed as a potential marker for tumor progression or interrogated to better characterize the tumor microenvironment.
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Affiliation(s)
- Kenneth Yan
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Samuel Auger
- Department of Surgery, Section of Otolaryngology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Ashley Diaz
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Julia Naman
- Department of Surgery, Section of Otolaryngology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Ramya Vemulapalli
- Department of Surgery, Section of Otolaryngology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Rifat Hasina
- Department of Surgery, Section of Otolaryngology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Evgeny Izumchenko
- Department of Medicine, Section of Hematology and Oncology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Benjamin Shogan
- Department of Medicine, Section of Hematology and Oncology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology, University of Chicago Medicine, Chicago, Illinois, USA
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Chowdhry A, Kapoor P, Bhargava D, Bagga DK. Exploring the oral microbiome: an updated multidisciplinary oral healthcare perspective. Discoveries (Craiova) 2023; 11:e165. [PMID: 37554313 PMCID: PMC10406501 DOI: 10.15190/d.2023.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/08/2023] [Accepted: 06/27/2023] [Indexed: 08/10/2023] Open
Abstract
The oral cavity is home to diverse microbial content, collectively called as the oral microbiome. The latest technological advancements have unraveled the intricacies of the oral microbiome. It can be of great importance for oral health care givers to know the fundamentals and latest developments in the field of the oral microbiome, as oral dysbiosis is associated with many common diseases frequently seen and managed by them. These diseases include dental caries, periodontitis, mucosal diseases (such as oral leukoplakia, oral lichen planus, and systemic lupus erythematosus), oral cancers, and even co-infections related to the current COVID-19 pandemic. The emergence of new genomic and molecular biology methodologies has been pivotal for understanding the role of the human microbiome in health and disease. The current review compiles oral microbiome in health and disease with a multidisciplinary dental approach. The insight into the oral microbiome, which is provided dental specialty wise in the current article will initiate and guide researchers of various disciplines in developing microbiome-based therapeutic or prophylactic management strategies, managing public health challenges by microbiome-based boarder interventions and divert resources for preserving and achieving a balanced oral microbiome.
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Affiliation(s)
- Aman Chowdhry
- School of Dental Sciences, Sharda University, Greater Noida (UP), India
- Department of Oral Pathology & Microbiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Priyanka Kapoor
- School of Dental Sciences, Sharda University, Greater Noida (UP), India
- Department of Orthodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Deepak Bhargava
- Department of Oral Pathology and Microbiology, School of Dental Sciences, Sharda University, Greater Noida (UP), India
| | - Dinesh Kumar Bagga
- Department of Orthodontics, School of Dental Sciences, Sharda University, Greater Noida (UP), India
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Significance of medication discontinuation on bisphosphonate-related jaw osteonecrosis in a rat model. Sci Rep 2022; 12:21449. [PMID: 36509781 PMCID: PMC9744902 DOI: 10.1038/s41598-022-25347-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
Bisphosphonate (BP) discontinuation has been advised as a measure to prevent the incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ), however, its efficacy remains controversial. This study aimed to analyze the efficacy of BP discontinuation in reducing BRONJ severity following tooth extraction in a rat model. Thirty-four male Sprague-Dawley rats were divided into two BRONJ model categories: oral administration (PO) of alendronate (1 mg/kg) for 3 and 8 weeks and intraperitoneal (IP) injection of pamidronate (3 mg/kg) and dexamethasone (1 mg/kg) for 20 days. The PO model was divided into five groups (a control group without BPs and four experimental groups with 1-week discontinuation). The IP model was divided into two groups consisting of group I (without discontinuation) and group II (1-week discontinuation). One molar from both sides of the mandible was extracted. After extraction, the PO models were sacrificed at 3 and 5 weeks, and the IP models were sacrificed either immediately or at 2, 4, 6, and 8 weeks. Micro-CT showed non-significant differences among PO groups but significant differences were observed between IP groups. Most bone remodeling parameters within group I of the IP model differed significantly (p-value < 0.05). Histologically, group I showed a significantly higher percentage of necrotic bone than group II (51.93 ± 12.75%, p < 0.05) and a higher number of detached osteoclasts in TRAP staining. With discontinuation of medication for at least 1 week in rats, the effects of BPs on alveolar bone are suppressed and bone turnover and osteoclast functions are restored.
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Arnal Etienne A, van Maanen A, Van Eeckhout P, Magremanne M. Actinomycosis and osteonecrosis of the jaw: Every why hides a why. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e749-e756. [PMID: 35640875 DOI: 10.1016/j.jormas.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 04/10/2022] [Accepted: 05/27/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Andrea Arnal Etienne
- Department of oral and maxillo-facial surgery, Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, 10, avenue Hippocrate, 1200 Brussels, Belgium.
| | - Aline van Maanen
- Statistical support unit, Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, 10, avenue Hippocrate, 1200 Brussels, Belgium; Institut Roi Albert II, Cancérologie et Hématologie, Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, 10, avenue Hippocrate, 1200 Brussels, Belgium
| | - Pascal Van Eeckhout
- Department of pathology, Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, 10, avenue Hippocrate, 1200 Brussels, Belgium; Institut Roi Albert II, Cancérologie et Hématologie, Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, 10, avenue Hippocrate, 1200 Brussels, Belgium
| | - Michèle Magremanne
- Department of oral and maxillo-facial surgery, Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, 10, avenue Hippocrate, 1200 Brussels, Belgium; Institut Roi Albert II, Cancérologie et Hématologie, Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, 10, avenue Hippocrate, 1200 Brussels, Belgium
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Guo Y, Xu F, Thomas SC, Zhang Y, Paul B, Sakilam S, Chae S, Li P, Almeter C, Kamer AR, Arora P, Graves DT, Saxena D, Li X. Targeting the succinate receptor effectively inhibits periodontitis. Cell Rep 2022; 40:111389. [PMID: 36130514 PMCID: PMC9533417 DOI: 10.1016/j.celrep.2022.111389] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/06/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
Periodontal disease (PD) is one of the most common inflammatory diseases in humans and is initiated by an oral microbial dysbiosis that stimulates inflammation and bone loss. Here, we report an abnormal elevation of succinate in the subgingival plaque of subjects with severe PD. Succinate activates succinate receptor-1 (SUCNR1) and stimulates inflammation. We detected SUCNR1 expression in the human and mouse periodontium and hypothesize that succinate activates SUCNR1 to accelerate periodontitis through the inflammatory response. Administration of exogenous succinate enhanced periodontal disease, whereas SUCNR1 knockout mice were protected from inflammation, oral dysbiosis, and subsequent periodontal bone loss in two different models of periodontitis. Therapeutic studies demonstrated that a SUCNR1 antagonist inhibited inflammatory events and osteoclastogenesis in vitro and reduced periodontal bone loss in vivo. Our study reveals succinate’s effect on periodontitis pathogenesis and provides a topical treatment for this disease. Periodontitis is the most prevalent adult oral disease. Guo et al. show elevation of succinate in periodontitis, which aggravates the disease through the succinate receptor (SUCNR1). They developed a gel formulation of a small compound specifically blocking SUCNR1 to prevent and treat periodontitis by inhibiting dysbiosis, inflammation, and bone loss.
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Affiliation(s)
- Yuqi Guo
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY 10010, USA
| | - Fangxi Xu
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY 10010, USA
| | - Scott C Thomas
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY 10010, USA
| | - Yanli Zhang
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY 10010, USA
| | - Bidisha Paul
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY 10010, USA
| | - Satish Sakilam
- Department of Chemistry, New York University, New York, NY 10003, USA
| | - Sungpil Chae
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY 10010, USA
| | - Patty Li
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY 10010, USA
| | - Caleb Almeter
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY 10010, USA
| | - Angela R Kamer
- Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, NY 10010, USA
| | - Paramjit Arora
- Department of Chemistry, New York University, New York, NY 10003, USA
| | - Dana T Graves
- Department of Periodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, PA 19104, USA
| | - Deepak Saxena
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY 10010, USA; Department of Surgery, New York University Grossman School of Medicine, New York, NY 10016, USA.
| | - Xin Li
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY 10010, USA; Department of Urology, New York University Grossman School of Medicine, New York, NY 10016, USA; Perlmutter Cancer Institute, New York University Langone Medical Center, New York, NY 10016, USA.
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Kuroshima S, Al‐Omari FA, Sasaki M, Sawase T. Medication‐related osteonecrosis of the jaw: A literature review and update. Genesis 2022; 60:e23500. [DOI: 10.1002/dvg.23500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Shinichiro Kuroshima
- Department of Applied Prosthodontics Graduate School of Biomedical Sciences, Nagasaki University Nagasaki Japan
| | - Farah A. Al‐Omari
- Department of Applied Prosthodontics Graduate School of Biomedical Sciences, Nagasaki University Nagasaki Japan
| | - Muneteru Sasaki
- Department of Applied Prosthodontics Graduate School of Biomedical Sciences, Nagasaki University Nagasaki Japan
| | - Takashi Sawase
- Department of Applied Prosthodontics Graduate School of Biomedical Sciences, Nagasaki University Nagasaki Japan
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Kemp APT, Ferreira VHC, Mobile RZ, Brandão TB, Sassi LM, Zarpellon A, Braz-Silva PH, Schussel JL. Risk factors for medication-related osteonecrosis of the jaw and salivary IL-6 IN cancer patients. Braz J Otorhinolaryngol 2022; 88:683-690. [PMID: 33189595 PMCID: PMC9483935 DOI: 10.1016/j.bjorl.2020.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/10/2020] [Accepted: 09/14/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction Medication-related osteonecrosis of the jaws is a severe complication of the use of antiresorptive and antiangiogenic therapy, with limited treatment options and great impact on patient’s quality pf life. Objective The aim of this study was to assess the risk factors associated with medication-related osteonecrosis of the jaws in oncologic patients undergoing bisphosphonate treatment. In addition, salivary levels of interleukin-6, IL-6, were measured to investigate their association with severity and risk of medication-related osteonecrosis of the jaws. Methods Case-control study with 74 patients with bone metastases from solid tumors and multiple myeloma was included. Patients were divided into three groups: 1) those undergoing bisphosphonate treatment with medication-related osteonecrosis of the jaws; 2) those undergoing bisphosphonate without medication-related osteonecrosis of the jaws; and 3) those with bisphosphonate pretreatment. The demographic and medical data of the patients were collected to assess risk. The clinical evaluation was performed to diagnose medication-related osteonecrosis of the jaws and unstimulated saliva was collected for quantification of IL-6. Results As result, it was observed that patients diagnosed with medication-related osteonecrosis of the jaws were submitted to higher number of bisphosphonate doses (p = 0.001) and monthly infusion protocol (p = 0.044; OR = 7.75). Patients who did not have routine followup with specialized dentists during therapy with bisphosphonate and smoking were associated with medication-related osteonecrosis of the jaws (p = 0.019; OR = 8.25 and p = 0.031; OR = 9.37 respectively). Group 1 had a higher frequency of treatment with chemotherapy and corticosteroids concomitant with bisphosphonate, and surgical dental procedures (p = 0.129). Salivary IL-6 levels showed no statistically significant difference between the groups (p = 0.571) or association with medication-related osteonecrosis of the jaws severity (p = 0.923). Conclusion A higher number of bisphosphonate cycles, monthly infusion protocol, no dental follow-up for oral health maintenance and smoking were associated with medication-related osteonecrosis of the jaws. Specialized dental follow up during bisphosphonate treatment has been shown to be an important factor in preventing this complication.
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Affiliation(s)
- Aristilia Pricila Tahara Kemp
- Universidade Federal do Paraná, Programa de Pós-Graduação em Odontologia, Departamento de Estomatologia, Curitiba, PR, Brazil; Instituto do Câncer do Estado de São Paulo, Serviço de Odontologia, São Paulo, SP, Brazil
| | - Vitor Hugo Candido Ferreira
- Universidade Federal do Paraná, Programa de Pós-Graduação em Odontologia, Departamento de Estomatologia, Curitiba, PR, Brazil
| | - Rafael Zancan Mobile
- Universidade Federal do Paraná, Programa de Pós-Graduação em Odontologia, Departamento de Estomatologia, Curitiba, PR, Brazil
| | - Thais Bianca Brandão
- Instituto do Câncer do Estado de São Paulo, Serviço de Odontologia, São Paulo, SP, Brazil
| | - Laurindo Moacir Sassi
- Hospital Erasto Gaerner, Departamento de Cirurgia Bucomaxilofacial, Curitiba, PR, Brazil
| | - Amanda Zarpellon
- Universidade de São Paulo, Faculdade de Odontologia, Divisão de Patologia Geral, Departamento de Estomatologia, São Paulo, SP, Brazil
| | - Paulo Henrique Braz-Silva
- Universidade de São Paulo, Faculdade de Odontologia, Divisão de Patologia Geral, Departamento de Estomatologia, São Paulo, SP, Brazil; Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Virologia, São Paulo, SP, Brazil
| | - Juliana Lucena Schussel
- Universidade Federal do Paraná, Programa de Pós-Graduação em Odontologia, Departamento de Estomatologia, Curitiba, PR, Brazil.
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11
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Wu S, Li F, Tan J, Ye X, Le Y, Liu N, Everts V, Wan Q. Porphyromonas gingivalis Induces Bisphosphonate-Related Osteonecrosis of the Femur in Mice. Front Cell Infect Microbiol 2022; 12:886411. [PMID: 35811676 PMCID: PMC9256925 DOI: 10.3389/fcimb.2022.886411] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/25/2022] [Indexed: 11/15/2022] Open
Abstract
One of the most prominent characteristics of bisphosphonate-related osteonecrosis of the jaw(BRONJ) is its site-specificity. Osteonecrosis tends to occur specifically in maxillofacial bones, in spite of a systemic administration of the medicine. Previous studies suggested rich blood supply and fast bone turnover might be reasons for BRONJ. Yet, a sound scientific basis explaining its occurrence is still lacking. The present study aimed to explore the role of Porphyromonas gingivalis (P. gingivalis), an important oral pathogen, on the site-specificity of bisphosphonate-induced osteonecrosis and to elucidate its underlying mechanism. Mice were intraperitoneally injected with zoledronic acid (ZA) or saline for 3 weeks. In the third week, the right mandibular first molars were extracted and circular bone defects with a diameter of 1 mm were created in right femurs. After the operation, drug administration was continued, and P. gingivalis suspension was applied to the oral cavities and femur defects. The mice were killed after four or eight weeks postoperatively. The right mandibles and femurs were harvested for micro-CT and histological analyses. A poor healing of bone defects of both jaws and femurs was noted in mice injected with both ZA and P. gingivalis. Micro-CT analysis showed a decreased bone volume, and histological staining showed an increased number of empty osteocyte lacunae, a decreased collagen regeneration, an increased inflammatory infiltration and a decreased number of osteoclasts. In addition, the left femurs were collected for isolation of osteoclast precursors (OCPs). The osteoclastogenesis potential of OCPs was analyzed in vitro. OCPs extracted from mice of ZA-treated groups were shown to have a lower osteoclast differentiation potential and the expression level of related genes and proteins was declined. In conclusion, we established a mouse model of bisphosphonate-related osteonecrosis of both the jaw and femur. P. gingivalis could inhibit the healing of femur defects under the administration of ZA. These findings suggest that P. gingivalis in the oral cavity might be one of the steering compounds for BRONJ to occur.
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Affiliation(s)
- Shuxuan Wu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology [Hubei-Ministry of Science and Technology(MOST)] and Key Laboratory of Oral Biomedicine, Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Feng Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology [Hubei-Ministry of Science and Technology(MOST)] and Key Laboratory of Oral Biomedicine, Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jingjing Tan
- The State Key Laboratory Breeding Base of Basic Science of Stomatology [Hubei-Ministry of Science and Technology(MOST)] and Key Laboratory of Oral Biomedicine, Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xiaoling Ye
- The State Key Laboratory Breeding Base of Basic Science of Stomatology [Hubei-Ministry of Science and Technology(MOST)] and Key Laboratory of Oral Biomedicine, Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Stomatology, Shenzhen Yantian District People’s Hospital, Shenzhen, China
| | - Yushi Le
- The State Key Laboratory Breeding Base of Basic Science of Stomatology [Hubei-Ministry of Science and Technology(MOST)] and Key Laboratory of Oral Biomedicine, Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Nianke Liu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology [Hubei-Ministry of Science and Technology(MOST)] and Key Laboratory of Oral Biomedicine, Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Vincent Everts
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
- Department of Anatomy, Dental Faculty, Chulalongkorn University, Bangkok, Thailand
| | - Qilong Wan
- The State Key Laboratory Breeding Base of Basic Science of Stomatology [Hubei-Ministry of Science and Technology(MOST)] and Key Laboratory of Oral Biomedicine, Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthognathic & Cleft Lip and Palate Plastic Surgery, Hospital of Stomatology, Wuhan University, Wuhan, China
- *Correspondence: Qilong Wan,
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12
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Huang YF, Lin KC, Liu SP, Chang CT, Muo CH, Chang PJ, Tsai CH, Wu CZ. The association between the severity of periodontitis and osteonecrosis of the jaw in patients with different cancer locations: a nationwide population-based study. Clin Oral Investig 2022; 26:3843-3852. [PMID: 35482084 DOI: 10.1007/s00784-021-04175-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/31/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine the relation between the severity of periodontitis and osteonecrosis of the jaw (ONJ) occurrence among different cancer locations and estimate the effect of dental care on ONJ prevention in cancer patients. MATERIALS AND METHODS This population-based cross-sectional study was conducted through the Longitudinal Health Insurance Database, Taiwan. Patients with malignancies were collected and subdivided into groups according to their different cancer locations, the severity of periodontitis, and dental care. Multivariable logistic regression analysis was performed to assess the associations between ONJ and ONJ-related factors. RESULTS A total of 8,234 ONJ patients and 32,912 control patients were investigated. Lip, oral cavity, and pharynx malignancies had the highest ONJ risk among all cancer locations (OR from 3.07 to 9.56, P < 0.01). There is a linear relationship between different severities of periodontitis and ONJ. Patients with radiotherapy and severe periodontitis had the highest ONJ risk (adjusted OR, 9.56; 95% CI, 5.34-17.1). Patients with good dental care had a lower ONJ risk. CONCLUSIONS The periodontal condition and cancer location showed a significant impact on the risk of developing ONJ after adjusting for bisphosphonate use. Good dental care could decrease the risk of ONJ in cancer patients. The severity of periodontitis might be a target to predict the potency of ONJ. CLINICAL RELEVANCE Dentists must be vigilant about the increased risk of ONJ in cancer patients with periodontitis, especially in the head and neck cancer population. Good dental care is advised for cancer patients with severe periodontitis.
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Affiliation(s)
- Yi-Fang Huang
- Department of General Dentistry, Chang Gung Memorial Hospital, Linkou, 33305, Taiwan
- School of Dentistry, College of Oral Medicine, Taipei Medical University, No. 250, Wu-Hsing St., Xinyi Dist, Taipei, 11031, Taiwan
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan
| | - Kuan-Chou Lin
- School of Dentistry, College of Oral Medicine, Taipei Medical University, No. 250, Wu-Hsing St., Xinyi Dist, Taipei, 11031, Taiwan
- Department of Oral and Maxillofacial Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, 11696, Taiwan
| | - Shih-Ping Liu
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, 40402, Taiwan
- Center for Neuropsychiatry, China Medical University Hospital, Taichung, 40402, Taiwan
- Department of Social Work, Asia University, Taichung, 41354, Taiwan
| | - Chung-Ta Chang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, No. 250, Wu-Hsing St., Xinyi Dist, Taipei, 11031, Taiwan
- Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, 22056, Taiwan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan, 32003, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, 40402, Taiwan
| | - Po-Jen Chang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, No. 250, Wu-Hsing St., Xinyi Dist, Taipei, 11031, Taiwan
| | - Chun-Hao Tsai
- Graduate Institute of Clinical Medicine, China Medical University, Taichung, 40402, Taiwan
- Department of Orthopedics, China Medical University Hospital, Taichung, 40402, Taiwan
| | - Ching-Zong Wu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, No. 250, Wu-Hsing St., Xinyi Dist, Taipei, 11031, Taiwan.
- Department of Dentistry, Taipei Medical University Hospital, Taipei, 11031, Taiwan.
- Department of Dentistry, Lotung Poh-Ai Hospital, Yilan, 26546, Taiwan.
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13
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Bullock G, Miller CA, McKechnie A, Hearnden V. A Review Into the Effects of Pamidronic Acid and Zoledronic Acid on the Oral Mucosa in Medication-Related Osteonecrosis of the Jaw. FRONTIERS IN ORAL HEALTH 2022; 2:822411. [PMID: 35224540 PMCID: PMC8865370 DOI: 10.3389/froh.2021.822411] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/17/2021] [Indexed: 01/02/2023] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a growing problem without an effective treatment, presenting as necrotic bone sections exposed via lesions in the overlying soft tissue. There is currently a lack of clarity on how the factors involved in MRONJ development and progression contribute to disease prognosis and outcomes. Bisphosphonates (BPs), the most common cause of MRONJ, affect bone remodeling, angiogenesis, infection, inflammation and soft tissue toxicity, all of which contribute to MRONJ development. This article reviews the cellular mechanisms through which BPs contribute to MRONJ pathology, with a focus on the effects on cells of the oral mucosa. BPs have been shown to reduce cell viability, reduce proliferation, and increase apoptosis in oral keratinocytes and fibroblasts. BPs have also been demonstrated to reduce epithelial thickness and prevent epithelial formation in three-dimensional tissue engineered models of the oral mucosa. This combination of factors demonstrates how BPs lead to the reduced wound healing seen in MRONJ and begins to uncover the mechanisms through which these effects occur. The evidence presented here supports identification of targets which can be used to develop novel treatment strategies to promote soft tissue wound healing and restore mucosal coverage of exposed bone in MRONJ.
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Affiliation(s)
- George Bullock
- Department of Materials Science and Engineering, Kroto Research Institute, The University of Sheffield, Sheffield, United Kingdom
- School of Clinical Dentistry, The University of Sheffield, Sheffield, United Kingdom
| | - Cheryl A. Miller
- School of Clinical Dentistry, The University of Sheffield, Sheffield, United Kingdom
- *Correspondence: Cheryl A. Miller
| | | | - Vanessa Hearnden
- Department of Materials Science and Engineering, Kroto Research Institute, The University of Sheffield, Sheffield, United Kingdom
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14
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Sharma D, Hamlet S, Vaquette C, Petcu EB, Ramamurthy P, Ivanovski S. Local delivery of hydrogel encapsulated vascular endothelial growth factor for the prevention of medication-related osteonecrosis of the jaw. Sci Rep 2021; 11:23371. [PMID: 34862395 PMCID: PMC8642483 DOI: 10.1038/s41598-021-02637-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
The anti-angiogenic effects of bisphosphonates have been hypothesized as one of the major etiologic factors in the development of medication-related osteonecrosis of the jaw (MRONJ), a severe debilitating condition with limited treatment options. This study evaluated the potential of a gelatine-hyaluronic acid hydrogel loaded with the angiogenic growth factor, vascular endothelial growth factor (VEGF), as a local delivery system to aid in maintaining vascularization in a bisphosphonate-treated (Zoledronic Acid) rodent maxillary extraction defect. Healing was assessed four weeks after implantation of the VEGF-hydrogel into extraction sockets. Gross examination and histological assessment showed that total osteonecrosis and inflammatory infiltrate was significantly reduced in the presence of VEGF. Also, total vascularity and specifically neovascularization, was significantly improved in animals that received VEGF hydrogel. Gene expression of vascular, inflammatory and bone specific markers within the defect area were also significantly altered in the presence of VEGF. Furthermore, plasma cytokine levels were assessed to determine the systemic effect of locally delivered VEGF and showed similar outcomes. In conclusion, the use of locally delivered VEGF within healing extraction sockets assists bone healing and prevents MRONJ via a pro-angiogenic and immunomodulatory mechanism.
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Affiliation(s)
- Dileep Sharma
- College of Medicine and Dentistry, James Cook University, Cairns Campus, PO Box 6811, Cairns, 4870, Australia. .,Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia.
| | - Stephen Hamlet
- Menzies Health Institute Queensland, School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Gold Coast, 4222, Australia
| | - Cedryck Vaquette
- School of Dentistry, Faculty of Health and Behavioral Sciences, The University of Queensland, Herston Campus, Brisbane, 4006, Australia
| | - Eugen Bogdan Petcu
- New York Institute of Technology College of Osteopathic Medicine (NYIT), Old Westbury, NY, 11545, USA.,School of Dentistry and Oral Health, Griffith University, Gold Coast, Australia
| | - Poornima Ramamurthy
- College of Medicine and Dentistry, James Cook University, Cairns Campus, PO Box 6811, Cairns, 4870, Australia
| | - Saso Ivanovski
- School of Dentistry, Faculty of Health and Behavioral Sciences, The University of Queensland, Herston Campus, Brisbane, 4006, Australia.
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15
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Li N, Fu L, Li Z, Ke Y, Wang Y, Wu J, Yu J. The Role of Immune Microenvironment in Maxillofacial Bone Homeostasis. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.780973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Maxillofacial bone defects are common medical problems caused by congenital defects, necrosis, trauma, tumor, inflammation, and fractures non-union. Maxillofacial bone defects often need bone graft, which has many difficulties, such as limited autogenous bone supply and donor site morbidity. Bone tissue engineering is a promising strategy to overcome the above-mentioned problems. Osteoimmunology is the inter-discipline that focuses on the relationship between the skeletal and immune systems. The immune microenvironment plays a crucial role in bone healing, tissue repair and regeneration in maxillofacial region. Recent studies have revealed the vital role of immune microenvironment and bone homeostasis. In this study, we analyzed the complex interaction between immune microenvironment and bone regeneration process in oral and maxillofacial region, which will be important to improve the clinical outcome of the bone injury treatment.
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16
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Matrix-Bound Zolzoledronate Enhances the Biofilm Colonization of Hydroxyapatite: Effects on Osteonecrosis. Antibiotics (Basel) 2021; 10:antibiotics10111380. [PMID: 34827318 PMCID: PMC8615173 DOI: 10.3390/antibiotics10111380] [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: 09/28/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/27/2022] Open
Abstract
(1) Background: The aim of this study was to test whether matrix-bound zoledronate (zol) molecules enhanced the oral biofilm colonization of a mineralized matrix, rendering the alveolar bone more susceptible to medication-related osteonecrosis of the jaw (MRONJ) following invasive dental procedures. (2) Methods: We tested the effect of matrix-bound zol on the growth and attachment of Porphyromonas gingivalis (Pg), Fusobacterium nucleatum (Fn) and Actinomyces israelii (Ai), and whether the nitrogen-containing component of zol contributed to such effect. The role of oral bacteria in the induction of osteonecrosis was then tested using an extra-oral bone defect model. (3) Results: The attachment of biofilm to hydroxyapatite discs increased when the discs were pre-treated with zol. Bacterial proliferation was not affected. Matrix-bound zol was more potent than non-nitrogen-containing etidronate in enhancing the colonization. Stimulation was dampened by pre-treating the bacteria with histidine. The delivery of oral biofilm to a tibial defect caused osteonecrosis in zol-treated rats. (4) Conclusions: We conclude that matrix-bound zol enhances the oral biofilm colonization of hydroxyapatite. This enhancement depended on the presence of the nitrogen-containing group. The oral biofilm rendered the extra-oral bone susceptible to medication-related osteonecrosis, suggesting that it has an important role in the induction of MRONJ.
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17
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Castillo EJ, Messer JG, Abraham AM, Jiron JM, Alekseyenko AV, Israel R, Thomas S, Gonzalez-Perez GM, Croft S, Gohel A, Bhattacharyya I, Yarrow JF, Novince CM, Kimmel DB, Aguirre JI. Preventing or controlling periodontitis reduces the occurrence of osteonecrosis of the jaw (ONJ) in rice rats (Oryzomys palustris). Bone 2021; 145:115866. [PMID: 33515777 PMCID: PMC8265021 DOI: 10.1016/j.bone.2021.115866] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/08/2021] [Accepted: 01/24/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Osteonecrosis of the jaw (ONJ) is an adverse event that requires association of both systemic risk factors, such as powerful anti-resorptives (pARs; e.g. zoledronic acid [ZOL]), and local oral risk factors (e.g. tooth extraction, periodontitis). Whereas optimal oral health prior to initiate pARs is recognized as critically important for minimizing ONJ risk, the efficacy of preventive/maintenance measures in patients who are taking pARs is understudied. Rice rats fed a standard diet (STD), rich in insoluble fiber, develop localized periodontitis. STD-rats with localized periodontitis treated with ZOL for 18-24 wk develop ONJ. Hence, we hypothesized that controlling/preventing localized periodontitis in the ZOL-treated rats, reduces ONJ occurrence. METHODS We used two approaches to attempt reducing periodontitis prevalence: 1) periodontal cleaning (PC); and 2) replacing the STD-diet with a nutritionally-equivalent diet high in soluble fiber (SF). 75 four-week-old male rats were weight-randomized into five groups (n = 15) in a 24-week experiment. Three groups ate the STD-diet and two the high SF-diet. STD-diet groups received intravenous (IV) vehicle (VEH) q4wks (STD + VEH), 80 μg/kg ZOL q4wks IV (STD + ZOL), or ZOL plus PC q2wks (STD + ZOL + PC). The SF-diet groups received VEH (SF + VEH) or ZOL (SF + ZOL). Jaws were processed for histopathology and evaluated for ONJ prevalence and tissue-level periodontitis. RESULTS 1) 40% of STD + VEH rats developed maxillary localized periodontitis with no ONJ; 2) 50% of STD + ZOL rats developed ONJ; 3) 7% of STD + ZOL + PC rats developed ONJ (p < 0.01 vs. STD + ZOL); and 4) one SF + ZOL rat developed localized periodontitis, and no SF + VEH or SF + ZOL rats developed ONJ (p < 0.001 vs. STD + ZOL). CONCLUSIONS 1) Periodontal cleaning in ZOL-treated rats decreases localized periodontitis severity and reduces ONJ prevalence; and 2) feeding a SF-diet to ZOL-treated rats reduces both incidence of localized periodontitis and ONJ. Our data indicates strong oral microbial community shifts according to oral health condition and trends in the shifts associated with diet.
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Affiliation(s)
- E J Castillo
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - J G Messer
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America
| | - A M Abraham
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America
| | - J M Jiron
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - A V Alekseyenko
- Department of Oral Health Sciences, Medical University of South Carolina College of Dental Medicine, Charleston, SC, United States of America; Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States of America; Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States of America.
| | - R Israel
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - S Thomas
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - G M Gonzalez-Perez
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - S Croft
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - A Gohel
- Department of Oral & Maxillofacial Diagnostic Sciences, College of Dentistry, UF, United States of America.
| | - I Bhattacharyya
- Department of Oral & Maxillofacial Diagnostic Sciences, College of Dentistry, UF, United States of America.
| | - J F Yarrow
- VA Medical Center, Research Service, Gainesville, FL, United States of America; Division of Endocrinology, Diabetes, and Metabolism, UF College of Medicine, Gainesville, FL, United States of America.
| | - C M Novince
- Department of Oral Health Sciences, Medical University of South Carolina College of Dental Medicine, Charleston, SC, United States of America.
| | - D B Kimmel
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America
| | - J I Aguirre
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
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18
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Zhang W, Gao L, Ren W, Li S, Zheng J, Li S, Jiang C, Yang S, Zhi K. The Role of the Immune Response in the Development of Medication-Related Osteonecrosis of the Jaw. Front Immunol 2021; 12:606043. [PMID: 33717086 PMCID: PMC7947359 DOI: 10.3389/fimmu.2021.606043] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/03/2021] [Indexed: 12/22/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious adverse drug effect. There are multiple hypotheses to explain the development of MRONJ. Reduced bone remodeling and infection or inflammation are considered central to the pathogenesis of MRONJ. In recent years, increasing evidence has shown that bisphosphonates (BPs)-mediated immunity dysfunction is associated with the pathophysiology of MRONJ. In a healthy state, mucosal immunity provides the first line of protection against pathogens and oral mucosal immune cells defense against potentially invading pathogens by mediating the generation of protective immunoinflammatory responses. In addition, the immune system takes part in the process of bone remodeling and tissue repair. However, the treatment of BPs disturbs the mucosal and osteo immune homeostasis and thus impairs the body's ability to resist infection and repair from injury, thereby adding to the development of MRONJ. Here, we present the current knowledge about immunity dysfunction to shed light on the role of local immune disorder in the development of MRONJ.
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Affiliation(s)
- Weidong Zhang
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.,School of Stomatology of Qingdao University, Qingdao, China
| | - Ling Gao
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.,Key Laboratory of Oral Clinical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenhao Ren
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shaoming Li
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jingjing Zheng
- Key Laboratory of Oral Clinical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China.,Department of Endodontics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shasha Li
- Department of Stomatology, Binzhou People'Hospital, Binzhou, China
| | - Chunmiao Jiang
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shuying Yang
- Department of Anatomy and Cell Biology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Keqian Zhi
- Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.,Key Laboratory of Oral Clinical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
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19
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Concentration of Penicillin G in Jawbone Affected by Antiresorptive Agent-Related Osteonecrosis Following a Single Preoperative Dose. Antibiotics (Basel) 2020; 10:antibiotics10010017. [PMID: 33375399 PMCID: PMC7824264 DOI: 10.3390/antibiotics10010017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to evaluate the concentration of penicillin G in bone affected by antiresorptive agent-related osteonecrosis of the jaw (ARONJ) following a single preoperative dose of 10 million international units (6000 mg). ARONJ is a major concern in patients administered antiresorptive agents for conditions associated with pathologically increased bone resorption. Antibiotic therapy is a key component of most treatment approaches for ARONJ and penicillin based regimens, providing a cost effective therapy option with a favorable side effect profile, are administered most frequently. In this study, high performance liquid chromatography with tandem mass spectrometry (HPLC-MS/MS) was applied to evaluate penicillin G concentration in serum and bone samples of 19 patients suffering from ARONJ and undergoing surgical treatment under perioperative intravenous (IV) antibiotic therapy. Penicillin G bone concentrations were above the limit of detection (0.1 μg/g bone tissue) in 16 out of 19 samples, with a median concentration of 2.7 μg/g (range 0.1–8.8 μg/g). Penicillin G concentrations in intraoperative serum samples were above the limit of detection in all serum samples, with a median concentration of 116 μg/mL (range 1–232 μg/mL). Thus, considering bacteria frequently found in ARONJ lesions, penicillin G at levels providing adequate antimicrobial activity was detected in the serum and 16 out of 19 osteonecrotic lesions of patients suffering from ARONJ.
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20
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Giudice A, Antonelli A, Chiarella E, Baudi F, Barni T, Di Vito A. The Case of Medication-Related Osteonecrosis of the Jaw Addressed from a Pathogenic Point of View. Innovative Therapeutic Strategies: Focus on the Most Recent Discoveries on Oral Mesenchymal Stem Cell-Derived Exosomes. Pharmaceuticals (Basel) 2020; 13:ph13120423. [PMID: 33255626 PMCID: PMC7760182 DOI: 10.3390/ph13120423] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023] Open
Abstract
Bisphosphonates-related osteonecrosis of the jaw (BRONJ) was firstly reported by Marx in 2003. Since 2014, the term medication-related osteonecrosis of the jaw (MRONJ) is recommended by the American Association of Oral and Maxillofacial Surgeons (AAOMS). Development of MRONJ has been associated to the assumption of bisphosphonates but many MRONJ-promoting factors have been identified. A strong involvement of immunity components has been suggested. Therapeutic intervention includes surgical and non-surgical treatments, as well as regenerative medicine procedures for the replacement of the lost tissues. The literature confirms that the combination of mesenchymal stem cells (MSCs), biomaterials and local biomolecules can support the regeneration/repair of different structures. In this review, we report the major open topics in the pathogenesis of MRONJ. Then, we introduce the oral tissues recognized as sources of MSCs, summing up in functional terms what is known about the exosomes release in physiological and pathological conditions.
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Affiliation(s)
- Amerigo Giudice
- Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (A.G.); (A.A.)
| | - Alessandro Antonelli
- Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (A.G.); (A.A.)
| | - Emanuela Chiarella
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (E.C.); (F.B.); (T.B.)
| | - Francesco Baudi
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (E.C.); (F.B.); (T.B.)
| | - Tullio Barni
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (E.C.); (F.B.); (T.B.)
| | - Anna Di Vito
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy; (E.C.); (F.B.); (T.B.)
- Correspondence:
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21
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Li Q, Pu Y, Lu H, Zhao N, Wang Y, Guo Y, Guo C. Porphyromonas, Treponema, and Mogibacterium promote IL8/IFNγ/TNFα-based pro-inflammation in patients with medication-related osteonecrosis of the jaw. J Oral Microbiol 2020; 13:1851112. [PMID: 33391627 PMCID: PMC7717612 DOI: 10.1080/20002297.2020.1851112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective: Refractory infection is an important factor affecting the progression of medication-related osteonecrosis of the jaw (MRONJ) from clinical stage I to stage II/III. The aim of this study was to explore the distribution of bacteria and their association with the inflammatory pathway of stage II/III MRONJ. Materials and Methods: Nine specimens of fresh inflammation tissue, located next to the necrotic bone or sequestrum, were collected from MRONJ patients. Nine specimens from normal oral mucosa were collected from healthy patients. The 16S rRNA gene sequencing method was used to determine the distribution characteristics of the bacterial colony. The protein microarray analysis was used to detect the expression of inflammatory cytokines. Results: The average relative abundance of Bacteroidetes, Spirochaetes, Synergistetes, and Tenericutes was higher, while Proteobacteria and Actinobacteria were lower in the MRONJ group. Most pro-inflammatory cytokines were up-regulated in the MRONJ group; yet, only IFNγ, TNFα, and IL8 showed statistical differences (P < 0.05). Porphyromonas and Treponema were positively correlated with IL8, and Mogibacterium was positively correlated with IFNγ and TNFα. Conclusions: IL8/IFNγ/TNFα pro-inflammatory effect caused by Porphyromonas, Treponema, and Mogibacterium may be the leading cause of advancing MRONJ and thus may be used as a new target for infection control.
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Affiliation(s)
- Qingxiang Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China.,National Clinical Research Center for Oral Diseases, Beijing, PR China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, PR China.,Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - Yinfei Pu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China.,National Clinical Research Center for Oral Diseases, Beijing, PR China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, PR China.,Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, PR China.,The Second Outpatient Department, Peking University School and Hospital of Stomatology, Beijing, PR China.,Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, PR China
| | - Han Lu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China.,National Clinical Research Center for Oral Diseases, Beijing, PR China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, PR China.,Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - Ning Zhao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China.,National Clinical Research Center for Oral Diseases, Beijing, PR China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, PR China.,Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - Yifei Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China.,National Clinical Research Center for Oral Diseases, Beijing, PR China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, PR China.,Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - Yuxing Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China.,National Clinical Research Center for Oral Diseases, Beijing, PR China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, PR China.,Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - Chuanbin Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China.,National Clinical Research Center for Oral Diseases, Beijing, PR China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, PR China.,Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, PR China
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22
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Wan JT, Sheeley DM, Somerman MJ, Lee JS. Mitigating osteonecrosis of the jaw (ONJ) through preventive dental care and understanding of risk factors. Bone Res 2020; 8:14. [PMID: 32195012 PMCID: PMC7064532 DOI: 10.1038/s41413-020-0088-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/31/2019] [Accepted: 01/13/2020] [Indexed: 02/06/2023] Open
Abstract
It is well established that alterations in phosphate metabolism have a profound effect on hard and soft tissues of the oral cavity. The present-day clinical form of osteonecrosis of the jaw (ONJ) was preceded by phosphorus necrosis of the jaw, ca. 1860. The subsequent removal of yellow phosphorus from matches in the early 20th century saw a parallel decline in "phossy jaw" until the early 2000s, when similar reports of unusual jaw bone necrosis began to appear in the literature describing jaw necrosis in patients undergoing chemotherapy and concomitant steroid and bisphosphonate treatment. Today, the potential side effect of ONJ associated with medications that block osteoclast activity (antiresorptive) is well known, though the mechanism remains unclear and the management and outcomes are often unsatisfactory. Much of the existing literature has focused on the continuing concerns of appropriate use of bisphosphonates and other antiresorptive medications, the incomplete or underdeveloped research on ONJ, and the use of drugs with anabolic potential for treatment of osteoporosis. While recognizing that ONJ is a rare occurrence and ONJ-associated medications play an important role in fracture risk reduction in osteoporotic patients, evidence to date suggests that health care providers can lower the risk further by dental evaluations and care prior to initiating antiresorptive therapies and by monitoring dental health during and after treatment. This review describes the current clinical management guidelines for ONJ, the critical role of dental-medical management in mitigating risks, and the current understanding of the effects of predominantly osteoclast-modulating drugs on bone homeostasis.
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Affiliation(s)
- Jason T. Wan
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD USA
| | - Douglas M. Sheeley
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD USA
| | - Martha J. Somerman
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD USA
- Laboratory for Oral Connective Tissue Biology, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD USA
| | - Janice S. Lee
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD USA
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23
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Li M, Yu Y, Shi Y, Zhou Y, Zhang W, Hua H, Ge J, Zhang Z, Ye D, Yang C, Wang S. Decreased Osteogenic Ability of Periodontal Ligament Stem Cells Leading to Impaired Periodontal Tissue Repair in BRONJ Patients. Stem Cells Dev 2020; 29:156-168. [PMID: 31801410 DOI: 10.1089/scd.2019.0151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a severe adverse reaction, which results in progressive bone destruction in the maxillofacial region of patients. To date, the pathological mechanisms remain largely unclear. Recently, we found that BRONJ patient had significantly deep periodontal pockets and severe periodontal bone defects before the exposed necrotic bone. Human periodontal ligament stem cells (hPDLSCs) play key roles in physiological maintenance and regeneration of periodontal tissues. However, the activities of hPDLSCs derived from BRONJ lesions and the role of hPDLSCs in BRONJ periodontal defect repair remain poorly understood. The aim of the present study was to elucidate the role of hPDLSCs in BRONJ. In this study, we found that the capacities of cell proliferation, adhesion, and migration of hPDLSCs derived from BRONJ lesions (BRONJ-hPDLSCs) were significantly decreased compared with control-hPDLSCs. BRONJ-hPDLSCs underwent early apoptosis compared with control-hPDLSCs. Importantly, we first demonstrated that BRONJ-hPDLSCs exhibited impaired osteogenic differentiation abilities in ectopic osteogenesis of nude mice. The above results suggested that the impaired BRONJ-hPDLSCs may be an important factor in deficient periodontal repair of BRONJ lesions and provide new insight into the underlying mechanism of BRONJ.
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Affiliation(s)
- Mengyu Li
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center of Oral Disease, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yejia Yu
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center of Oral Disease, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yueqi Shi
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center of Oral Disease, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yuqiong Zhou
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center of Oral Disease, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Wenjie Zhang
- Department of Prosthodontics, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongfei Hua
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center of Oral Disease, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jing Ge
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center of Oral Disease, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Zhiyuan Zhang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center of Oral Disease, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Dongxia Ye
- Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Chi Yang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center of Oral Disease, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Shaoyi Wang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center of Oral Disease, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
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24
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Elsayed R, Kurago Z, Cutler CW, Arce RM, Gerber J, Celis E, Sultan H, Elashiry M, Meghil M, Sun C, Auersvald CM, Awad ME, Zeitoun R, Elsayed R, Eldin M Elshikh M, Isales C, Elsalanty ME. Role of dendritic cell-mediated immune response in oral homeostasis: A new mechanism of osteonecrosis of the jaw. FASEB J 2020; 34:2595-2608. [PMID: 31919918 DOI: 10.1096/fj.201901819rr] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/25/2019] [Accepted: 12/05/2019] [Indexed: 11/11/2022]
Abstract
Dendritic cells are an important link between innate and adaptive immune response. The role of dendritic cells in bone homeostasis, however, is not understood. Osteoporosis medications that inhibit osteoclasts have been associated with osteonecrosis, a condition limited to the jawbone, thus called medication-related osteonecrosis of the jaw. We propose that disruption of the local immune response renders the oral microenvironment conducive to osteonecrosis. We tested whether zoledronate (Zol) treatment impaired dendritic cell (DC) functions and increased bacterial load in alveolar bone in vivo and whether DC inhibition alone predisposed the animals to osteonecrosis. We also analyzed the role of Zol in impairment of differentiation and function of migratory and tissue-resident DCs, promoting disruption of T-cell activation in vitro. Results demonstrated a Zol induced impairment in DC functions and an increased bacterial load in the oral cavity. DC-deficient mice were predisposed to osteonecrosis following dental extraction. Zol treatment of DCs in vitro caused an impairment in immune functions including differentiation, maturation, migration, antigen presentation, and T-cell activation. We conclude that the mechanism of Zol-induced osteonecrosis of the jaw involves disruption of DC immune functions required to clear bacterial infection and activate T cell effector response.
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Affiliation(s)
- Ranya Elsayed
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Zoya Kurago
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA.,Biochemistry and Molecular Biology, Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Christopher W Cutler
- Department of Periodontics, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Roger M Arce
- Department of Periodontics, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Jennifer Gerber
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Esteban Celis
- Biochemistry and Molecular Biology, Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Hussein Sultan
- Department of Pathology and Immunology, School of Medicine, Washington University, St. Louis, MO, USA
| | - Mahmoud Elashiry
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA.,Department of Periodontics, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Mohamed Meghil
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA.,Department of Periodontics, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Christina Sun
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Caroline M Auersvald
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Mohamed E Awad
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Rana Zeitoun
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Riham Elsayed
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - Mohey Eldin M Elshikh
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, London, UK
| | - Carlos Isales
- Department of neuroscience and regenerative medicine, Augusta University, Augusta, GA, USA
| | - Mohammed E Elsalanty
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA
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25
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Effect of Periapical Diseases in Development of MRONJ in Immunocompromised Mouse Model. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1271492. [PMID: 31662968 PMCID: PMC6778953 DOI: 10.1155/2019/1271492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/01/2019] [Indexed: 11/17/2022]
Abstract
Objectives This study aimed to assess the effect of zoledronic acid on an immunocompromised mice model with periapical disease. Materials and Methods Thirty C57BL/6N mice were randomly divided into three groups (N = 10). All animals were subjected to bilateral ovariectomy (OVX) and then treated with saline (Veh), zoledronic acid (ZA), or concomitant zoledronic acid and dexamethasone (ZA/Dx) for 12 weeks. Eight weeks after starting drug administration, pulpal exposure was conducted on the lower left first molar. Four weeks after pulpal exposure, all mice were sacrificed and the mandibles were collected for radiological and histological examinations. Results Microcomputed tomography (μ-CT) examination showed significantly reduced periapical bone resorption in the ZA/Dx group and decreased periodontal bone resorption in both ZA and ZA/Dx groups. Higher bone mineral density (BMD) and strengthened microstructure were found in ZA and ZA/Dx groups. More empty lacunae were found in ZA and ZA/Dx groups. Conclusions Apical periodontitis aggravates MRONJ under immunocompromised circumstances. Concurrent use of ZA and steroids inhibits alveolar bone resorption but increases the risk of developing MRONJ.
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26
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Hidaka K, Mikuni-Takagaki Y, Wada-Takahashi S, Saita M, Kawamata R, Sato T, Kawata A, Miyamoto C, Maehata Y, Watabe H, Tani-Ishii N, Hamada N, Takahashi SS, Deguchi S, Takeuchi R. Low-Intensity Pulsed Ultrasound Prevents Development of Bisphosphonate-Related Osteonecrosis of the Jaw-Like Pathophysiology in a Rat Model. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1721-1732. [PMID: 31006496 DOI: 10.1016/j.ultrasmedbio.2019.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/21/2018] [Accepted: 02/15/2019] [Indexed: 06/09/2023]
Abstract
We developed a rat model of bisphosphonate-related osteonecrosis of the jaw (BRONJ) by removing a maxillary molar tooth (M1) from ovariectomized rats after treatment with alendronate. To mimic periodontitis, some of the rats were administered Porphyromonas gingivalis (p. gingivalis) at the M1 site every 2 to 3 d for 2 wk. Rats pretreated with alendronate plus p. gingivalis showed delayed healing of socket epithelia, periosteal reaction of alveolar bone formation and lower bone mineral density in the alveolus above adjacent M2 teeth. These abnormalities were prevented by tooth socket exposure to 20 min/d low-intensity pulsed ultrasound (LIPUS), which restored diminished expression of RANKL, Bcl-2, IL-6, Hsp70, NF-κB and TNF-α messenger ribonucleic acids in remote bone marrow, suggesting LIPUS prevented development of BRONJ-like pathophysiology in rat by inducing systemic responses for regeneration, in addition to accelerating local healing. Non-invasive treatment by LIPUS, as well as low-level laser therapy, may be useful for medication-related osteonecrosis of the jaw patients.
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Affiliation(s)
- Kouki Hidaka
- Department of Oral Science, Kanagawa Dental University Graduate School of Dentistry, Yokosuka, Japan; Department of Oral Interdisciplinary Medicine, Kanagawa Dental University Graduate School of Dentistry, Yokosuka, Japan
| | - Yuko Mikuni-Takagaki
- Department of Oral Science, Kanagawa Dental University Graduate School of Dentistry, Yokosuka, Japan.
| | - Satoko Wada-Takahashi
- Department of Oral Science, Kanagawa Dental University Graduate School of Dentistry, Yokosuka, Japan
| | - Makiko Saita
- Department of Oral Interdisciplinary Medicine, Kanagawa Dental University Graduate School of Dentistry, Yokosuka, Japan
| | - Ryota Kawamata
- Department of Dentomaxillofacial Diagnosis and Treatment, Kanagawa Dental University Graduate School of Dentistry, Yokosuka, Japan
| | - Takenori Sato
- Department of Oral Science, Kanagawa Dental University Graduate School of Dentistry, Yokosuka, Japan
| | - Akira Kawata
- Department of Oral Science, Kanagawa Dental University Graduate School of Dentistry, Yokosuka, Japan
| | - Chihiro Miyamoto
- Department of Oral Science, Kanagawa Dental University Graduate School of Dentistry, Yokosuka, Japan
| | - Yojiro Maehata
- Department of Oral Science, Kanagawa Dental University Graduate School of Dentistry, Yokosuka, Japan
| | - Hirotaka Watabe
- Department of Oral Interdisciplinary Medicine, Kanagawa Dental University Graduate School of Dentistry, Yokosuka, Japan
| | - Nobuyuki Tani-Ishii
- Department of Oral Interdisciplinary Medicine, Kanagawa Dental University Graduate School of Dentistry, Yokosuka, Japan
| | - Nobushiro Hamada
- Department of Oral Science, Kanagawa Dental University Graduate School of Dentistry, Yokosuka, Japan
| | - Shun-Suke Takahashi
- Department of Oral Science, Kanagawa Dental University Graduate School of Dentistry, Yokosuka, Japan
| | - Shinji Deguchi
- Kanagawa Dental University Graduate School of Dentistry, Yokosuka, Japan
| | - Ryohei Takeuchi
- Department of Oral Science, Kanagawa Dental University Graduate School of Dentistry, Yokosuka, Japan; Joint Surgery Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
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27
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Ruggiero S, Saxena D, Tetradis S, Aghaloo T, Ioannidou E. Task Force on Design and Analysis in Oral Health Research: Medication-Related Osteonecrosis of the Jaw. JDR Clin Trans Res 2019; 3:222-225. [PMID: 30938596 DOI: 10.1177/2380084418770662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Knowledge Transfer Statement: This article discusses the proceedings of the conference organized by the Task Force on Design and Analysis in Oral Health Research on the understanding of the translational evidence on the etiology and pathogenesis of medication-related osteonecrosis of the jaw as well as the clinical protocols on patient management.
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Affiliation(s)
- S Ruggiero
- 1 New York Center for Orthognathic and Maxillofacial Surgery, New York, NY, USA.,2 Stony Brook School of Dental Medicine, Stony Brook, NY, USA.,3 School of Medicine, Hofstra-Northwell Health, Hempstead, NY, USA
| | - D Saxena
- 4 Department of Basic Sciences and Craniofacial Biology College of Dentistry, New York University, New York, NY, USA
| | - S Tetradis
- 5 School of Dentistry, University of California at Los Angeles, CA, USA
| | - T Aghaloo
- 6 Section of Oral and Maxillofacial Surgery, School of Dentistry, University of California at Los Angeles, CA, USA
| | - E Ioannidou
- 7 Division of Periodontology, UConn Health, Farmington, CT, USA.,8 Task Force on Design and Analysis in Oral Health Research, Princeton, NJ, USA
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28
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Akashi M, Kusumoto J, Takeda D, Shigeta T, Hasegawa T, Komori T. A literature review of perioperative antibiotic administration in surgery for medication-related osteonecrosis of the jaw. Oral Maxillofac Surg 2018; 22:369-378. [PMID: 30327979 DOI: 10.1007/s10006-018-0732-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/09/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Few studies exist that focus on the details of perioperative antibiotic administration for surgery to treat medication-related osteonecrosis of the jaw (MRONJ). The regime and duration of perioperative antibiotics applied in published studies were reviewed to clarify appropriate perioperative antibiotic use in MRONJ surgery. METHODS A literature search was conducted using the MEDLINE database via PubMed. RESULTS The search resulted in 453 hits on PubMed. After reading the downloaded full-text articles, 17 articles met the inclusion and exclusion criteria. The most common perioperative antibiotic used for MRONJ surgery was a combination of penicillin-based antibiotics and β-lactamase inhibitor (52.9%), and the second most common regime was penicillin-based antibiotics with metronidazole (17.6%). The duration of administration was 2 weeks postoperatively in nine studies, whereas four studies applied long-term administration (2-6 weeks postoperatively). CONCLUSIONS Oral and maxillofacial surgeons mostly prefer penicillin-based antibiotics plus β-lactamase inhibitor or metronidazole for MRONJ surgery. The duration of administration of these medications may be based on empirical experience.
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Affiliation(s)
- Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Junya Kusumoto
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, 439 Honmachi, Kakogawa-cho, Kakogawa, 675-8611, Japan
| | - Daisuke Takeda
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takashi Shigeta
- Department of Oral and Maxillofacial Surgery, Hyogo Cancer Center, 13-70 Kitaouji-cho, Akashi, 673-0021, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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29
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Abstract
PURPOSE OF REVIEW Osteonecrosis of the jaw (ONJ) is a rare and severe necrotic bone disease reflecting a compromise in the body's osseous healing mechanisms and unique to the craniofacial region. Antiresorptive and antiangiogenic medications have been suggested to be associated with the occurrence of ONJ; yet, the pathophysiology of this disease has not been fully elucidated. This article raises the current theories underlying the pathophysiology of ONJ. RECENT FINDINGS The proposed mechanisms highlight the unique localization of ONJ. The evidence-based mechanisms of ONJ pathogenesis include disturbed bone remodeling, inflammation or infection, altered immunity, soft tissue toxicity, and angiogenesis inhibition. The role of dental infections and the oral microbiome is central to ONJ, and systemic conditions such as rheumatoid arthritis and diabetes mellitus contribute through their impact on immune resiliency. Current experimental studies on mechanisms of ONJ are summarized. The definitive pathophysiology is as yet unclear. Recent studies are beginning to clarify the relative importance of the proposed mechanisms. A better understanding of osteoimmunology and the relationship of angiogenesis to the development of ONJ is needed along with detailed studies of the impact of drug holidays on the clinical condition of ONJ.
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Affiliation(s)
- J Chang
- Department of Periodontology, University of Florida College of Dentistry, Gainesville, FL, 32610, USA
| | - A E Hakam
- Department of Periodontology, University of Florida College of Dentistry, Gainesville, FL, 32610, USA
| | - L K McCauley
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, 1011 North University Ave, Ann Arbor, MI, 48109, USA.
- Department of Pathology, Medical School, University of Michigan, Ann Arbor, MI, USA.
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30
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Zirk M, Wenzel C, Buller J, Zöller JE, Zinser M, Peters F. Microbial diversity in infections of patients with medication-related osteonecrosis of the jaw. Clin Oral Investig 2018; 23:2143-2151. [PMID: 30276516 DOI: 10.1007/s00784-018-2655-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 09/20/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES A central role of infections in the treatment of MRONJ patients is widely accepted. An investigation of the MRONJ lesions' biofilms as potential pathogens seems logical. MATERIALS AND METHODS We investigated the clinical data of our MRONJ patients who received surgery in advanced stage of the disease. Special attention was granted to the local colonizers harvested from osseous MRONJ specimens and submucosal putrid infections. RESULTS Eleven out of 71 patients presented a spontaneous onset of the disease and for 60 out of 71 patients a trigger was detected. Breast cancer (29.6%) and prostate cancer (22.5%) were the most frequent underlying disease for prescription of an antiresorptive therapy, mostly zoledronate. Submucosal soft tissue biofilms significantly differed from biofilms harvested from the MRONJ lesions bottom, yet the most frequent bacteria were equally present in both groups: Streptococcus species (spp.), Prevotella spp., Actinomyces spp., Veillonella spp., and Parvimonas micra. The cephalosporins, cefuroxime and cefotaxime, and ß-lactam antibiotics with ß-lactamase inhibitor revealed the greatest susceptibility for the detected bacteria. CONCLUSION The bacteria from the submucosal areas and the bottom of the infected bone presented comparable susceptibility to the common antibiotics regimes. Streptococcus spp., Prevotella spp., and Veillonella spp. present a high abundance in MRONJ lesions beside Actinomyces spp. The MRONJ lesions bottom is in many cases not infected by Actinomyces spp. CLINICAL RELEVANCE The removal of the necrotic bone reduces the variety of bacteria found in MRONJ lesions, in particular at the bottom of the lesion.
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Affiliation(s)
- Matthias Zirk
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Kerpener Strasse, 62 50931, Cologne, Germany.
| | - Charlotte Wenzel
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Kerpener Strasse, 62 50931, Cologne, Germany
| | - Johannes Buller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Kerpener Strasse, 62 50931, Cologne, Germany
| | - Joachim E Zöller
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Kerpener Strasse, 62 50931, Cologne, Germany
| | - Max Zinser
- Department for Oral and Craniomaxillofacial and Plastic Surgery, University of Cologne, Kerpener Strasse, 62 50931, Cologne, Germany
| | - Franziska Peters
- Department of Dermatology, University of Cologne, Cologne, Germany.,Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany
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Lee W. Microbiome in oral and maxillofacial surgery. J Korean Assoc Oral Maxillofac Surg 2018; 44:41-42. [PMID: 29732307 PMCID: PMC5932269 DOI: 10.5125/jkaoms.2018.44.2.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Won Lee
- Department of Dentistry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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32
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Pushalkar S, Hundeyin M, Daley D, Zambirinis CP, Kurz E, Mishra A, Mohan N, Aykut B, Usyk M, Torres LE, Werba G, Zhang K, Guo Y, Li Q, Akkad N, Lall S, Wadowski B, Gutierrez J, Kochen Rossi JA, Herzog JW, Diskin B, Torres-Hernandez A, Leinwand J, Wang W, Taunk PS, Savadkar S, Janal M, Saxena A, Li X, Cohen D, Sartor RB, Saxena D, Miller G. The Pancreatic Cancer Microbiome Promotes Oncogenesis by Induction of Innate and Adaptive Immune Suppression. Cancer Discov 2018; 8:403-416. [PMID: 29567829 PMCID: PMC6225783 DOI: 10.1158/2159-8290.cd-17-1134] [Citation(s) in RCA: 763] [Impact Index Per Article: 127.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/03/2018] [Accepted: 02/07/2018] [Indexed: 12/17/2022]
Abstract
We found that the cancerous pancreas harbors a markedly more abundant microbiome compared with normal pancreas in both mice and humans, and select bacteria are differentially increased in the tumorous pancreas compared with gut. Ablation of the microbiome protects against preinvasive and invasive pancreatic ductal adenocarcinoma (PDA), whereas transfer of bacteria from PDA-bearing hosts, but not controls, reverses tumor protection. Bacterial ablation was associated with immunogenic reprogramming of the PDA tumor microenvironment, including a reduction in myeloid-derived suppressor cells and an increase in M1 macrophage differentiation, promoting TH1 differentiation of CD4+ T cells and CD8+ T-cell activation. Bacterial ablation also enabled efficacy for checkpoint-targeted immunotherapy by upregulating PD-1 expression. Mechanistically, the PDA microbiome generated a tolerogenic immune program by differentially activating select Toll-like receptors in monocytic cells. These data suggest that endogenous microbiota promote the crippling immune-suppression characteristic of PDA and that the microbiome has potential as a therapeutic target in the modulation of disease progression.Significance: We found that a distinct and abundant microbiome drives suppressive monocytic cellular differentiation in pancreatic cancer via selective Toll-like receptor ligation leading to T-cell anergy. Targeting the microbiome protects against oncogenesis, reverses intratumoral immune tolerance, and enables efficacy for checkpoint-based immunotherapy. These data have implications for understanding immune suppression in pancreatic cancer and its reversal in the clinic. Cancer Discov; 8(4); 403-16. ©2018 AACR.See related commentary by Riquelme et al., p. 386This article is highlighted in the In This Issue feature, p. 371.
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Affiliation(s)
- Smruti Pushalkar
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York
| | - Mautin Hundeyin
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Donnele Daley
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Constantinos P Zambirinis
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Emma Kurz
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Ankita Mishra
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Navyatha Mohan
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Berk Aykut
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Mykhaylo Usyk
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York
| | - Luisana E Torres
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Gregor Werba
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Kevin Zhang
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York
| | - Yuqi Guo
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York
| | - Qianhao Li
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York
| | - Neha Akkad
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Sarah Lall
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Benjamin Wadowski
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Johana Gutierrez
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Juan Andres Kochen Rossi
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Jeremy W Herzog
- National Gnotobiotic Rodent Research Center, University of North Carolina, Chapel Hill, North Carolina
| | - Brian Diskin
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Alejandro Torres-Hernandez
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Josh Leinwand
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Wei Wang
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Pardeep S Taunk
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Shivraj Savadkar
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - Malvin Janal
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York
| | - Anjana Saxena
- Department of Epidemiology and Health Promotion, NYU College of Dentistry, New York, New York
| | - Xin Li
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York
| | - Deirdre Cohen
- Department of Biology, Brooklyn College and the Graduate Center (CUNY), Brooklyn, New York, New York
| | - R Balfour Sartor
- National Gnotobiotic Rodent Research Center, University of North Carolina, Chapel Hill, North Carolina
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Deepak Saxena
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York.
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York
| | - George Miller
- S. Arthur Localio Laboratory, Department of Surgery, New York University School of Medicine, New York, New York.
- Department of Medicine, Microbiology, and Immunology, University of North Carolina, Chapel Hill, North Carolina
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Eleutherakis-Papaiakovou E, Bamias A. Antiresorptive treatment-associated ONJ. Eur J Cancer Care (Engl) 2017; 26. [PMID: 29063702 DOI: 10.1111/ecc.12787] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 01/22/2023]
Abstract
Osteonecrosis of the jaw (ONJ) is a severe complication of therapy with antiresorptive agents (e.g. bisphosphonates and denosumab), which are used to manage bone metastases from cancer, to reduce the incidence of skeletal-related events. Available data indicate that 0-27, 5% of patients exposed to antiresorptive agents may develop ONJ, depending on the number of infusions and the duration of therapy. Besides antiresorptive therapy, a number of risk factors for osteonecrosis have been identified. Oral surgical procedures, tooth extractions and infection to the jawbones are considered the main risk factors for developing ONJ, when receiving antiresorptive therapy. However, a growing number of patients develop ONJ without apparent risk factors, raising concern for other predisposing factors. Jaw bone necrosis may be irreversible, resulting in a chronic disease with negative impact on the quality of patients' lives. The role of risk reduction strategies like meticulous dental screening and optimal oral hygiene is fundamental for preventing development of ONJ. ONJ is usually treated conservatively to relieve the symptoms and manage jaw bone necrosis. In certain cases, surgical intervention is required. Future research should emphasize individual predisposition to ONJ, more effective preventive measures and more efficient therapeutic procedures.
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Affiliation(s)
- Evangelos Eleutherakis-Papaiakovou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece.,Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - Aristotelis Bamias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece.,Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
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Ermer MA, Kottmann SC, Otten JE, Wittmer A, Poxleitner P, Pelz K. In Vitro Investigation of the Antimicrobial Effect of Three Bisphosphonates Against Different Bacterial Strains. J Oral Maxillofac Surg 2017; 76:553-560. [PMID: 28916324 DOI: 10.1016/j.joms.2017.08.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE Since the first descriptions of medication-related osteonecrosis of the jaw (MRONJ) in 2003, the pathogenesis has remained unanswered. Recent histomorphometric studies have found several microorganisms, including Actinomyces, Bacillus, Fusobacterium, Staphylococcus, Streptococcus, Selenomonas, Treponema, and Candida albicans in necrotic bone. Polymerase chain reaction studies have recently confirmed the occurrence of 48 genera. Only a few studies have examined the antimicrobial effect of bisphosphonates (BPs). The influence of bacterial growth on the etiology remains unclear. The aim of the present study was the in vitro investigation of the antimicrobial effect of 3 BPs against different bacterial strains. MATERIALS AND METHODS The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of 48 strains from 40 species were determined in microdilution assays against pamidronic, ibandronic, and zoledronic acid. RESULTS Growth of gram-positive oral microbiota, which account for most microorganisms in MRONJ, was present for 2 of 22 species; 6 of 26 gram-negative species and 9 of 13 anaerobes were inhibited. The MIC values were compared with the BP bone concentrations from previous reports. Of the 48 strains, 9 had an MIC or MBC less than the bone concentrations. CONCLUSIONS The results of the present study have demonstrated that BPs have an inhibitory effect on selected bacterial species and might inhibit the growth of some relevant pathogens in osteonecrosis. However, most of the species tested were unaffected at the concentration levels assumed present in the human jawbone. The clinical relevance of these in vitro data will better be clarified with reliable data on the BP concentrations in the human jawbone. The present study has provided a first approach toward the assessment of the interaction of oral bacteria and BPs.
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Affiliation(s)
- Michael A Ermer
- Consultant, Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany.
| | - Simon C Kottmann
- Private Practitioner, Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Jörg-Elard Otten
- Professor, Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Annette Wittmer
- Medical Technical Assistant, Department of Hygiene and Microbiology, Albert-Ludwigs-Universität, Freiburg, Freiburg, Germany
| | - Philipp Poxleitner
- Resident, Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Klaus Pelz
- Consultant, Department of Hygiene and Microbiology, Albert-Ludwigs-Universität, Freiburg, Freiburg, Germany
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Kim SM, Eo MY, Cho YJ, Kim YS, Lee SK. Wound healing protein profiles in the postoperative exudate of bisphosphonate-related osteonecrosis of mandible. Eur Arch Otorhinolaryngol 2017. [PMID: 28647850 DOI: 10.1007/s00405-017-4657-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Recurrent bacterial infections in cases of bisphosphonate-related osteonecrosis of jaw (BRONJ) frequently occur. Therefore, BRONJ are usually treated by radical saucerization followed by intensive antibiotic medications without bisphosphonate therapy. The postoperative exudate (POE) from BRONJ lesions may directly indicate the inflammatory status of osteomyelitis in patients, but so far, the POE has rarely been examined for its expression of various cytokines and wound healing proteins. A total of 27 cases of BRONJ, which involved the mandible, were selected and their individual POE collected 6 h, 1 day, and 2 days after surgical intervention was analyzed by immunoprecipitation high performance liquid chromatography (IP-HPLC). The different protein expressions in the BRONJ POE were compared with findings from ten cases of chronic mandibular osteomyelitis (CMO) exudate as the control group. For the protein expressions for inflammation, osteogenesis, and angiogenesis, in the 6 h POE sample, the BRONJ exudate exhibited more expression of IL-10, IL-28, OPG, and osteocalcin, but less expression of TNFα and LL-37 than the control. In the 1 day POE sample, the BRONJ exudate showed more expression of TNFα, IL-6, 8, 12, 28, α1-antitrypsin, VEGF-A, and VEGF-C, but less expression of CD68, lysozyme, bFGF, RANKL, bFGF, and ALP than the control. In the 2 day POE sample, the BRONJ exudate consistently showed more expression of LL-37, β-defensin-1, and VEGF-A than the control. The present BRONJ POE revealed the rapid progress of bony wound healing through increased molecular signaling for inflammation, angiogenesis, and osteogenesis compared to the control. Therefore, it was suggested that the POE obtained from the postoperative bony lesions should be collected and analyzed by the IP-HPLC method to predict the prognosis of seriously complicated inflammatory bony diseases such as BRONJ.
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Affiliation(s)
- Soung Min Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Mi Young Eo
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Yun Ju Cho
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Yeon Sook Kim
- Department of Dental Hygiene, College of Health Sciences, Cheongju University, Cheongju, South Korea
| | - Suk Keun Lee
- Department of Oral Pathology, College of Dentistry, Gangneung-Wonju National University, 123 Chibyun-dong, Gangneung, South Korea.
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Panya S, Fliefel R, Probst F, Tröltzsch M, Ehrenfeld M, Schubert S, Otto S. Role of microbiological culture and polymerase chain reaction (PCR) of actinomyces in medication-related osteonecrosis of the jaw (MRONJ). J Craniomaxillofac Surg 2017; 45:357-363. [PMID: 28162845 DOI: 10.1016/j.jcms.2017.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 12/21/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022] Open
Abstract
We hypothesized that local infection plays a critical role in the pathogenesis of medication-related osteonecrosis of the jaw (MRONJ). Recent developments in molecular methods have revolutionized new approaches for the rapid detection of microorganisms including those difficult to culture. The aim of our study is to identify the bacterial profiles in MRONJ by microbiological culture and polymerase chain reactions (PCR). A retrospective analysis was performed on MRONJ patients from 2008 to 2014. The bacterial profile from MRONJ bone samples was determined using microbiological culture and PCR. Ninety five patients fulfilled the inclusion criteria with mean age of 69.85 ± 8.71 years. A female predilection was detected. The mandible was more commonly affected than maxilla. Tooth extraction was the frequent triggering factor. Breast cancer was the primary cause for administration and intravenous bisphosphonates were the most commonly administrated antiresorptive drugs. The majority of patients were classified as stage 2. Posterior teeth were most commonly affected. Based on bone culture results, the most common microorganism were both actinomyces and mixed flora. PCR confirmed the presence of actinomyces in 55 patients. Our data suggest that PCR might be an innovative method for detection of microorganisms difficult to culture using traditional microbiological techniques.
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Affiliation(s)
- Sappasith Panya
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität, Lindwurmstrasse 2a, 80337, Munich, Germany. Head: Prof. Dr. Med. Dr. Med. Dent
| | - Riham Fliefel
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität, Lindwurmstrasse 2a, 80337, Munich, Germany. Head: Prof. Dr. Med. Dr. Med. Dent; Experimental Surgery and Regenerative Medicine, Ludwig-Maximilians-Universität, Nussbaumstrasse 20, 80336, Munich, Germany. Head: Prof. Dr. Med. Wolfgang Böcker; Department of Oral and Maxillofacial Surgery, Alexandria-University, Champollion Street, Azarita, Alexandria, Egypt. Head: Prof. Dr. Maged Fahmy
| | - Florian Probst
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität, Lindwurmstrasse 2a, 80337, Munich, Germany. Head: Prof. Dr. Med. Dr. Med. Dent
| | - Matthias Tröltzsch
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität, Lindwurmstrasse 2a, 80337, Munich, Germany. Head: Prof. Dr. Med. Dr. Med. Dent
| | - Michael Ehrenfeld
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität, Lindwurmstrasse 2a, 80337, Munich, Germany. Head: Prof. Dr. Med. Dr. Med. Dent
| | - Sören Schubert
- Department of Bacteriology, Ludwig-Maximilians-Universität, Marchioninistrasse 17, 81377, Munich, Germany. Head: Prof. Dr. Med. Sebastian Suerbaum
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-Universität, Lindwurmstrasse 2a, 80337, Munich, Germany. Head: Prof. Dr. Med. Dr. Med. Dent.
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Abstract
Younger patients are affected more often by osteonecrosis than by osteoarthritis, and osteonecrosis has significantly greater long-term morbidity. Corticosteroids are the most common cause of nontraumatic osteonecrosis. The femoral head is the most common site of osteonecrosis. In rare instances, osteonecrosis of the jaw has been associated with bisphosphonate exposure. This phenomenon is more common with repeated intravenous infusions of bisphosphonates. Case reports of osteonecrosis of the jaw in association with other medications, such as denosumab, have been reported. The final common pathway in the pathogenesis of osteonecrosis is disruption of blood supply to a segment of bone. Abnormalities in lipid metabolism, bone homeostasis, regulation of apoptosis, coagulopathies, innate immunity, and oxidative stress may play a role in the pathogenesis of osteonecrosis. Epigenetics may alter the predisposition to develop osteonecrosis. MRI is currently the optimal test for early diagnosis and identification of the extent of osteonecrosis. Nonsurgical treatment of osteonecrosis does not change the natural history of the disease. Although surgical treatment of femoral head osteonecrosis has many variations, most symptomatic patients eventually require total hip arthroplasty. Knowledge of risk factors and early detection are crucial to the successful management of osteonecrosis. Because of the lack of successful treatment options, new modes of management focus on the prevention of osteonecrosis.
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Zheng X, Mo A, Wang Y, Guo Y, Wu Y, Yuan Q. Effect of FK-506 (tacrolimus) therapy on bone healing of titanium implants: a histometric and biomechanical study in mice. Eur J Oral Sci 2016; 125:28-33. [PMID: 27935130 DOI: 10.1111/eos.12320] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Xiaofei Zheng
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
- Dental Implant Center; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Anchun Mo
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
- Dental Implant Center; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Yuan Wang
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
- Dental Implant Center; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Yuchen Guo
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
- Dental Implant Center; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Yunshu Wu
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
- Dental Implant Center; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Quan Yuan
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
- Dental Implant Center; West China Hospital of Stomatology; Sichuan University; Chengdu China
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Hallmer F, Bjørnland T, Andersson G, Becktor JP, Kristoffersen AK, Enersen M. Bacterial diversity in medication-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:436-444. [PMID: 28159588 DOI: 10.1016/j.oooo.2016.11.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/17/2016] [Accepted: 11/25/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim was to study the association between microflora and medication-related osteonecrosis of the jaw (MRONJ) by using culture-independent molecular techniques to detect bacteria in necrotic bone lesions. STUDY DESIGN Included were 18 consecutive patients with MRONJ, 10 with osteoporosis and 8 cancer patients. Bone biopsies were retrieved from the center of the necrotic bone and from visually healthy bone, and 16 S rRNA gene fragments from bacterial DNA were amplified with polymerase chain reaction. RESULTS The study revealed a diversity of bacteria represented by 16 S rRNA sequences in all the necrotic bone samples and in 60% of the visually healthy bone. Eight dominating taxa groups were identified at the genus level: Porphyromonas, Lactobacillus, Tannerella, Prevotella, Actinomyces, Treponema, Streptococcus, and Fusobacterium. CONCLUSIONS The necrotic bone lesions contained mainly anaerobic bacteria, representative of periodontal microflora, suggesting that a periodontal infection in combination with antiresorptive treatment could initiate osteonecrosis.
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Affiliation(s)
- Fredrik Hallmer
- Consultant, Department of Oral and Maxillofacial Surgery, Skåne University Hospital, Lund, Sweden; Department of Oral and Maxillofacial Surgery, Malmö University, Faculty of Odontology, Malmö, Sweden.
| | - Tore Bjørnland
- Professor and Chairman, Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Gunilla Andersson
- Associate Professor, Department of Oral and Maxillofacial Surgery, Malmö University, Faculty of Odontology, Malmö, Sweden
| | - Jonas P Becktor
- Associate Professor and Head, Department of Oral and Maxillofacial Surgery Malmö University, Faculty of Odontology, Malmö, Sweden
| | - Anne K Kristoffersen
- Senior Engineer, Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Morten Enersen
- Associate Professor, Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
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40
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Jabbour Z, do Nascimento C, El-Hakim M, Henderson JE, de Albuquerque RF. Profile of bacteria colonizing the exposed bone of patients with anti-osteoclastic drug-related osteonecrosis of the jaws. Can J Microbiol 2016; 62:772-80. [PMID: 27419922 DOI: 10.1139/cjm-2016-0212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Microbial etiology for anti-osteoclastic drug-related osteonecrosis of the jaw (ARONJ) was suggested. This study investigates any link between bacteria colonizing ARONJ sites and other oral cavity sites. Microbiota samples of 10 ARONJ patients were collected from the exposed bone, adjacent teeth, contralateral teeth, and tongue. DNA checkerboard hybridization was used for microbiota analysis with 43 genomic DNA probes prepared from human oral bacterial (38) and candida (5) species, using Socransky's bacterial complexes as a guide. The frequency and the mean proportion of each bacterial species were used. Eikenella corrodens, Streptococcus constellatus, and Fusobacterium nucleatum were dominant in the ARONJ sites and detected in most teeth samples. Staphylococcus aureus was also dominant in the ARONJ sites and tongue. Significant correlations were found between the mean proportions of bacterial species colonizing adjacent teeth, contralateral teeth, and tongue (p < 0.001, R(2) > 0.69). No significant correlation (p > 0.05, R(2) < 0.025) was found between bacteria colonizing ARONJ sites and other evaluated sites. Within the study limitations, it was concluded that the primary sources of microorganisms colonizing ARONJ sites could be other sites such as teeth and tongue. The microbial profile of the necrotic bone is predominantly colonized with bacteria from Socransky's green and orange complexes, as well as with species associated with bone infections.
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Affiliation(s)
- Zaher Jabbour
- a Division of Restorative Dentistry, Faculty of Dentistry, McGill University, Montréal, Quebec, Canada.,d Bone Engineering Labs, Research Institute, McGill University Health Center, Montréal, Quebec, Canada
| | - Cássio do Nascimento
- b Department of Dental Materials and Prosthodontics, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
| | - Michel El-Hakim
- c Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, McGill University, Montréal, Quebec, Canada
| | - Janet E Henderson
- d Bone Engineering Labs, Research Institute, McGill University Health Center, Montréal, Quebec, Canada.,e Department of Medicine and Surgery, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | - Rubens F de Albuquerque
- b Department of Dental Materials and Prosthodontics, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
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Çapar GD, Sapmaz-Metin M, Kütan E, Tomruk CO, Yalcin GM, Er N, Ozfidan GK. Preventive effect of doxycycline sponge against bisphosphonate-related osteonecrosis of the jaws: an animal study. BIOTECHNOL BIOTEC EQ 2016. [DOI: 10.1080/13102818.2016.1174078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Gonca Duygu Çapar
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Trakya University, Edirne, Turkey
| | - Melike Sapmaz-Metin
- Health Services Vocational College, Department of Histology and Embryology, Trakya University, Edirne, Turkey
| | - Esma Kütan
- Faculty of Dentistry, Department of Implantology, Yeditepe University, Istanbul, Turkey
| | - Ceyda Ozcakir Tomruk
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Yeditepe University, Istanbul, Turkey
| | - Gül Merve Yalcin
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Okan University, Istanbul, Turkey
| | - Nilay Er
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Trakya University, Edirne, Turkey
| | - Gulnur Kizilay Ozfidan
- Faculty of Medicine, Department of Histology and Embryology, Trakya University, Edirne, Turkey
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Aghaloo T, Hazboun R, Tetradis S. Pathophysiology of Osteonecrosis of the Jaws. Oral Maxillofac Surg Clin North Am 2015; 27:489-96. [PMID: 26412796 DOI: 10.1016/j.coms.2015.06.001] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Osteonecrosis of the jaw (ONJ) is a multifactorial disease in patients with primary or metastatic bone malignancy or osteoporosis undergoing systemic antiresorptive therapy, where pathophysiology has not yet been fully determined. The staging of ONJ is based on severity of symptoms and extent of clinical and radiographic findings. Treatment strategies range from conservative local wound care to aggressive resective surgery of all necrotic bone. The first ONJ cases were reported in 2003 and 2004, and although significant progress has been made in our understanding of the disease, much more work needs to be done to completely explain its pathophysiology.
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Affiliation(s)
- Tara Aghaloo
- Section of Oral and Maxillofacial Surgery, Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, 10833 Le Conte Ave., Los Angeles, CA 90095-1668, USA.
| | - Renna Hazboun
- Section of Special Patient Care, Division of Advanced Prosthodontics and Section of Restorative Dentistry, Division of Regenerative and Constitutive Sciences, UCLA School of Dentistry, 10833 Le Conte Ave., Los Angeles, CA 90095-1668, USA
| | - Sotirios Tetradis
- Section of Oral and Maxillofacial Radiology, Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, 10833 Le Conte Ave., Los Angeles, CA 90095-1668, USA; Molecular Biology Institute, UCLA, Los Angeles, CA 90095, USA
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Kalyan S, Wang J, Quabius ES, Huck J, Wiltfang J, Baines JF, Kabelitz D. Systemic immunity shapes the oral microbiome and susceptibility to bisphosphonate-associated osteonecrosis of the jaw. J Transl Med 2015; 13:212. [PMID: 26141514 PMCID: PMC4490596 DOI: 10.1186/s12967-015-0568-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/09/2015] [Indexed: 12/22/2022] Open
Abstract
Background Osteonecrosis of the jaw (ONJ) is a rare but serious adverse drug effect linked to long-term and/or high-dose exposure to nitrogen-bisphosphonates (N-BP), the standard of care for the treatment of bone fragility disorders. The mechanism leading to bisphosphonate-associated ONJ (BAONJ) is unclear and optimal treatment strategies are lacking. Recent evidence suggests that BAONJ may be linked to drug-induced immune dysfunction, possibly associated with increased susceptibility to infections in the oral cavity. The objective of this investigation was to comprehensively assess the relationship linking immune function, N-BP exposure, the oral microbiome and ONJ susceptibility. Methods Leukocyte gene expression of factors important for immunity, wound healing and barrier function were assessed by real-time quantitative PCR and the oral microbiome was characterized by 454 pyrosequencing of the 16S rRNA gene in 93 subjects stratified by N-BP exposure and a history of ONJ. Results There were marked differences in the systemic expression of genes regulating immune and barrier functions including RANK (p = 0.007), aryl hydrocarbon receptor (AHR, p < 0.001), and FGF9 (p < 0.001), which were collectively up-regulated in individuals exposed to N-BP without ONJ relative to treatment controls. In contrast, the expression levels of these same genes were significantly down-regulated in those who had experienced BAONJ. Surprisingly, the oral microbiome composition was not directly linked to either BAONJ or N-BP exposure, rather the systemic leukocyte expression levels of RANK, TNFA and AHR each explained 9% (p = 0.04), 12% (p = 0.01), and 7% (p = 0.03) of the oral bacterial beta diversity. Conclusions The oral microbiome is unlikely causative of ONJ, rather individuals with BAONJ lacked immune resiliency which impaired their capacity to respond adequately to the immunological stress of N-BP treatment. This may be the common factor linking N-BP and anti-RANK agents to ONJ in at-risk individuals. Preventive and/or therapeutic strategies should target the wound healing deficits present in those with ONJ. Electronic supplementary material The online version of this article (doi:10.1186/s12967-015-0568-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shirin Kalyan
- Institute of Immunology, Christian-Albrechts University Kiel, Arnold-Heller-Strasse 3, Bldg. 17, 24105, Kiel, Germany.
| | - Jun Wang
- Max Planck Institute for Evolutionary Biology, August-Thienemann-Str. 2, 24306, Plön, Germany. .,Institute for Experimental Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, Bldg. 17, 24105, Kiel, Germany.
| | - Elgar Susanne Quabius
- Institute of Immunology, Christian-Albrechts University Kiel, Arnold-Heller-Strasse 3, Bldg. 17, 24105, Kiel, Germany. .,Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts University Kiel, Arnold-Heller-Str. 3, Bldg. 27, 24105, Kiel, Germany.
| | - Jörn Huck
- Department of Oral and Maxillofacial Surgery, Christian-Albrechts University Kiel, Arnold-Heller-Str. 3, Bldg. 26, 24105, Kiel, Germany.
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, Christian-Albrechts University Kiel, Arnold-Heller-Str. 3, Bldg. 26, 24105, Kiel, Germany.
| | - John F Baines
- Max Planck Institute for Evolutionary Biology, August-Thienemann-Str. 2, 24306, Plön, Germany. .,Institute for Experimental Medicine, Christian-Albrechts-University of Kiel, Arnold-Heller-Str. 3, Bldg. 17, 24105, Kiel, Germany.
| | - Dieter Kabelitz
- Institute of Immunology, Christian-Albrechts University Kiel, Arnold-Heller-Strasse 3, Bldg. 17, 24105, Kiel, Germany.
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Jiang WX, Hu YJ, Gao L, He ZY, Zhu CL, Ma R, Huang ZW. The impact of various time intervals on the supragingival plaque dynamic core microbiome. PLoS One 2015; 10:e0124631. [PMID: 25942317 PMCID: PMC4420457 DOI: 10.1371/journal.pone.0124631] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 03/16/2015] [Indexed: 01/09/2023] Open
Abstract
Objective The aim of this study was to examine the influence of various time intervals on the composition of the supragingival plaque microbiome, especially the dynamic core microbiome, and to find a suitable observation interval for further studies on oral microbiota. Methods and Materials Eight qualified volunteers whose respective age ranges from 25 to 28 years participated in the present study. The supragingival plaque was collected from the buccogingival surface of the maxillary first molar at eight time slots with different intervals (day 0, 1 day, 3 days, 1 week, 2 weeks, 3 weeks, 1 month, and 3 months). Bioinformatic analyses was performed based on 16S rDNA pyrosequencing (454 sequencing platform) targeting at the hypervariable V4–V5 region, in order to assess the diversity and variation of the supragingival plaque microbiome. Results A total of 359,565 qualified reads for 64 samples were generated for subsequent analyses, which represents 8,452 operational taxonomic units identified at 3% dissimilarity. The dynamic core microbiome detected in the current study included five phyla, 12 genera and 13 species. At the genus level, the relative abundance of bacterial communities under the “1 day,” “1 month,” and “3 months” intervals was clustered into sub-category. At the species level, the number of overlapping species remained stable between the “1 month” and “3 months” intervals, whereas the number of dynamic core species became stable within only 1 week. Conclusions This study emphasized the impact of different time intervals (days, weeks and months) on the composition, commonality and diversity of the supragingival microbiome. The analyses found that for various types of studies, the time interval of a month is more suitable for observing the general composition of the supragingival microbiome, and that a week is better for observing the dynamic core microbiome.
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Affiliation(s)
- Wen-xin Jiang
- Department of Endodontics, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yue-jian Hu
- Department of Endodontics, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Li Gao
- Department of Endodontics, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Zhi-yan He
- Department of Endodontics, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Cai-lian Zhu
- Department of Endodontics, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Rui Ma
- Department of Endodontics, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Zheng-wei Huang
- Department of Endodontics, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
- * E-mail:
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