Guided Surgery with 3D Printed Device: A Case Report

Dental surgeons need in-depth knowledge of the bone tissue status and gingival morphology of atrophic maxillae. The aim of this study is to describe preoperative virtual planning of placement of 5 implants and to compare the plan with the actual surgical results. Three-dimensional (3D) planning of rehabilitation using software programs enables surgical guides to be specially designed for the implant site and manufactured using 3D printing. A patient with 5 teeth missing was selected for this study. The patient's maxillary region was scanned with cone-beam computed tomography (CBCT), and a cast model was produced. After virtual planning using ImplantViewer, 5 implants were placed using a printed surgical guide. Two weeks after the surgical procedure, the patient underwent another CBCT scan of the maxilla. Statistically significant differences were detected between the virtually planned positions and the actual positions of the implants, with a mean deviation of 0.36 mm in the cervical region and 0.7 mm in the apical region. The surgical technique used enables more accurate procedures compared with the conventional technique. Implants can be better positioned, with a high level of predictability, reducing both operating time and patient discomfort.

Analysis of Trauma Intensity during Surgical Bone Procedures Using NF-κB Expression Levels as a Stress Sensor: An Experimental Study in a Wistar Rat Model

Aim and objectives: It is well known that the transcription factor NF-κB regulates multiple aspects of innate and adaptive immune functions and functions as a pivotal mediator of inflammatory responses. In the present study, we evaluated the trauma generated (inflammatory reaction) after osteotomy bone surgical procedures and placement of implants in the femoral cortical bone of Wistar rats. Surgical stress was evaluated measuring the release and activation of the NF-κB factor. Materials and Methods: Rats were divided into four groups (n = 10) and submitted to different surgical treatments: Control Group (G1 group), only bone perforation was performed without irrigation; Implant Group (G2 group), a titanium implant was inserted after bone perforation without irrigation; Irrigated Group (G3 group) perforations were performed with intense irrigation; and Vitaminic Compound Group (G4 group) surgical perforation was performed without irrigation and a vitaminic compound containing the principal ions present in the natural bone structure was used to fill the bone defect. All animals were euthanized six hours after the surgical procedure and NF-κB levels were determined through immunohistochemical stain followed by direct counting of labeled and unlabeled osteocytes. Results: Among different treated groups, the overall mean of the NF-κB positive cell count in all positions were higher for G1 group (33.4 ± 2.45 cells). NF-κB values were lower in the G2 group (28.9 ± 2.70 cells), whereas in the G3 group (24.3 ± 2.72 cells) as well as in G4 group still lesser NF-κB positive cells were counted (26.5 ± 2.60 cells). Conclusions: The results here presented suggest that maneuvers performed during osteotomy procedures can significantly affect inflammation levels. The NF-κB activation during the surgical procedures can be minimized and/or controlled thought the adequate irrigation or application of adequate substances.

Amorphous calcium phosphate (ACP) in tissue repair process

Synthetic biomaterials submitted to new structural technologies have become ideal for the recovery of traumatized bone tissues and some bone substitutes such as bioactive glass, β-Tricalcium phosphate (β-TCP) and amorphous calcium phosphate (ACP) are being used in areas of tissue defects. For this study, ACP was produced in the form of fibers and then submitted to cytotoxicity testing. A sample of ACP was inserted into the mandibular region of a patient with a lost implant so after removal and curettage, the remaining bone site was filled with the ACP biomaterial. Preliminary cytotoxicity test was negative. After 15 weeks of healing, a titanium implant was inserted at the site. Clinical and radiographic follow-up was conducted for 12 months and sequential radiographic analyses revealed tissue formation resembling spongy bone. Images under immunohistochemistry demonstrated efficient deposition and osteoconduction of the newly deposited tissue. Residual portion of the CaO:P₂ O₅ outer layers served as a substrate for osteoid matrix deposition, aiding growth, and the results of fiber absorption favored maturation of the new bone tissue.

Hydroxyapatite Dome for Bone Neoformation in Rabbit Tibia

PURPOSE

To evaluate supracortical bone neoformation with the use of hydroxyapatite (HA) hollow domes specially manufactured for osteogenesis promotion.

MATERIALS AND METHODS

Nine New Zealand rabbits were selected and 18 domes were placed, divided into three groups according to the filler: control (blood clot), vitamin complex, and particulate β-tricalcium phosphate (β-TCP). The healing period was 8 weeks, hence fluorescent markers were applied. After healing, the samples were embedded in resin to prepare slides for light and fluorescence microscopic evaluation of the amount of neoformed bone tissue. Energy dispersive spectroscopy was also used for chemical analysis of the material inside the domes.

RESULTS

The quality of neoformed bone tissue with active bone remodeling areas was observed. As a filler, β-TCP showed higher bone formation (14.1%), better quality of neoformed bone tissue with organized structures, and an area of mineralized tissue in the dome. Bone neoformation inside the dome filled with blood clot confirmed the osteoconductive property of HA, as indicated by the migration of osteogenic cells from the blood clot, without the action of another biomaterial (mean area of bone formation for blood clot filler = 7.5%). Bone neoformation was not favored in samples filled with vitamin complex because of the difficulty of blood penetration through the material.

CONCLUSION

HA domes performed well as a scaffold for bone neoformation over the cortical bone of rabbits, and this is based on maintenance of good stability and good integration with bone tissue. β-TCP presented higher values of neoformed bone area compared with the blood clot. HA domes have osteoconductive properties, especially when filled with blood clot, because of the migration of osteogenic cells without action of any other biomaterial. In domes filled with vitamin complex, no bone formation was noted because of the absence of resorption.

Evaluating Nuclear Factor NF-κB Activation following Bone Trauma: A Pilot Study in a Wistar Rats Model

The present study investigated the moment of peak NF-kB activation and its dissipation in the cortical bone in the femur of Wistar rat stimulated by surgical trauma. Sixty-five Wistar rats were divided into 13 groups (n = 5 per group): eight experimental groups (expG 1–8) divided based on the euthanasia time point (zero, 1 h, 2 h, 4 h, 6 h, 8 h, 12 h and 24 h) and five sham control groups (conG 1–5) killed at zero, 1 h, 2 h, 4 h and 6 h, respectively. A 1.8-mm-diameter defect was generated 0.5 mm from the femur proximal joint using a round bur to induce the surgical trauma. Overall, the activation peak of NF-κB in the cortical bone was 6 h (expG5 group) independent of the evaluated position; this peak was significantly different compared to those in the other groups (p < 0.05). The surgical trauma resulted in a spread of immune markings throughout the cortical bone with an accentuation in the knee region. The present study provides the first evidence that the NF-κB activation peak was established after 6 hours in the cortical bone of Wistar rats. The signs from a surgical trauma can span the entire cortical bone and are not limited to the damaged region.

Cell proliferation and drug sensitivity of human glioblastoma cells are altered by the stable modulation of cytosolic 5'-nucleotidase II

Cytosolic 5'-nucleotidase II (cN-II) has been reported to be involved in cell survival, nucleotide metabolism and in the cellular response to anticancer drugs. With the aim to further evaluate the role of this enzyme in cell biology, we stably modulated its expression the human glioblastoma cell ADF in which the transient inhibition of cN-II has been shown to induce cell death. Stable cell lines were obtained both with inhibition, obtained with plasmids coding cN-II-targeting short hairpin RNA, and stimulation, obtained with plasmids coding Green Fluorescence Protein (GFP)-fused wild type cN-II or a GFP-fused hyperactive mutant (GFP-cN-II-R367Q), of cN-II expression. Silenced cells displayed a decreased proliferation rate while the over expressing cell lines displayed an increased proliferation rate as evidenced by impedance measurement using the xCELLigence device. The expression of nucleotide metabolism relevant genes was only slightly different between cell lines, suggesting a compensatory mechanism in transfected cells. Cells with decreased cN-II expression were resistant to the nucleoside analog fludarabine confirming the involvement of cN-II in the metabolism of this drug. Finally, we observed sensitivity to cisplatin in cN-II silenced cells and resistance to this same drug in cN-II over-expressing cells indicating an involvement of cN-II in the mechanism of action of platinum derivatives, and most probably in DNA repair. In summary, our findings confirm some previous data on the role of cN-II in the sensitivity of cancer cells to cancer drugs, and suggest its involvement in other cellular phenomenon such as cell proliferation.

An alternative to nerve repair using an antioxidant compound: a histological study in rats

The fascicular composition and organisation of the inferior alveolar nerve (IAN) were determined to confirm the microarchitecture of the IAN bundles into each of the mandibular teeth, including the composition of the mental nerve. The aim of this study was to evaluate peripheral nerve repair after the application of an antioxidant compound to the damaged nerve tissue to elevate the concentration and bioavailability of elements capable of favouring tissue repair. Twenty-five Wistar rats were divided into groups: The Control 1 (Ctl 1) (n = 5) animals had the ischiatic nerve exposed with no suture injury and were sacrificed at 30 days post-operatively. The Control 2 (Ctl 2) (n = 10) animals had the ischiatic nerve exposed, and the nerve was injured using suture in three distinct regions. In the experimental (Exp) animals (n = 10), an antioxidant organic compound was applied to the nerve injury site. The animals with nerve injury (Ctl2 and Exp group) were sacrificed at 15 and 30 days post-operatively. The histological analysis showed less degeneration in the Exp group at 15 and 30 days post-operatively. Nerve neoformation forming a connection between the distal and proximal suture sites was observed in the experimental group. This study presented an alternative to nerve repair using an antioxidant compound.

Biologic response to titanium implants with laser-treated surfaces

PURPOSE

To examine the biologic response to titanium implant surfaces treated with a neodymium:yttrium-aluminum-garnet laser.

MATERIALS AND METHODS

Sixty mini-implants made of grade 2 titanium were placed in the femora of 30 Wistar rats. Thirty implants had a machined surface and the other 30 had surfaces that were roughened by laser treatment. The animals were subdivided into three groups according to bone repair periods of 15, 30, and 60 days. The samples were observed under light and electron scanning microscopes and analyzed with the Student t test.

RESULTS

Formation of new bone trabeculae toward the surface was apparent for the laser-treated implants at 15 days. Thin layers of bone matrix in intimate contact with the surface in the area of the central screw threads were observed, indicating high biocompatibility. Similar results were seen with machined implants after 30 days. A significant difference in bone formation was observed between the implant types at 15 days.

CONCLUSION

Bone-to-implant contact was better on the surfaces subjected to laser treatment than on the machined titanium implants. The development of new laser treatments, which promote alterations in the surface energy as well as in the macro- and microstructures of titanium, may lead to improved bone-to-implant contact and thus better outcomes.

On the physiological role of cytosolic 5'-nucleotidase II (cN-II): pathological and therapeutical implications

Among the members of the 5'-nucleotidase family, there is only one membrane-bound ectosolic isoenzyme. This esterase prefers AMP as substrate but can hydrolyze a number of purine and pyrimidine phosphorylated compounds, indicating that no evolutive pressure to develop a more restricted specificity was exerted on this enzyme. On the contrary, five cytosolic isoforms have been evolved, probably by convergent evolution, showing different and restricted substrate specificity. The different isoforms have different level of expression and distribution in organs of vertebrates. The cytosolic nucleotidase specific for IMP and GMP (cN-II), is an enzyme allosterically regulated, structurally strongly conserved and expressed at a low but constant level in all organs and tissues in vertebrates. As far as we know, alteration of cN-II expression is limited to pathological conditions. In this review, we report the results of the modulation of cN-II specific activity exerted by silencing or hyperexpression in different cell types, in the attempt to better understand its role and implications in pathology and therapy.

Japanese encephalitis virus RNA detected in Culex pipiens mosquitoes in Italy

Mosquitoes collected in northern Italy were screened for flavivirus RNA. Positive amplicons were sequenced and found most similar to insect flavivirus (ISF), Usutu virus (USUV) and surprisingly also to Japanese encephalitis virus (JEV). The sequence (167 bp), obtained from one pool of Culex pipiens, was found identical to JEV strains from bats in China. Unfortunately additional sequence data or virus isolations were not obtained in this study. Confirmation of potential introduction of JEV to Italy and other European countries is urgently needed.

Comparative animal study on hard tissue integration and bone formation of different Nobel Biocare implants

Dental implantation aims at optimal and long-term hard tissue integration. Beside primary stability, loading time and other factors, e.g. the surface of the endosteal part of the implant, is a matter of special importance. In this animal trial, hard tissue integration of two different implant types was studied using radiological, histological and histomorphometric analysis. Two different implants with an oxidized surface (TiUnite; Nobel Biocare AB, Goteborg, Sweden, NobelReplace Tapered Groovy 4.3 x 10 mm and Replace Select Tapered 4.3 x 10 mm) were inserted into the right and left mandibles of 10 German domestic pigs between canine and premolar and immediately provided with a ceramic crown. The primary implant stability was determined using resonance frequency analysis. After 70 days, the test animals were killed and specimens were collected for histological and histomorphometric examination. All implants showed good primary stability after surgery. Histological and histomorphometrical analysis revealed no significant differences in the bone apposition. The immediate loading of the different implant types don't have any negative effects on the bone apposition in the period of 70 days. The long-term effects of immediate loading of these types of implant requires further studies.

Soft tissue integration in the neck area of titanium implants--an animal trial

Dental implant materials are required to enable good apposition of bone and soft tissues. They must show sufficient resistance to chemical, physical and biological stress in the oral cavity to achieve good long-term outcomes. A critical issue is the apposition of the soft tissues, as they have provided a quasi-physiological closure of oral cavity. The present experiment was performed to study the peri-implant tissue response to non-submerged (1-stage) implant installation procedures. Two different implants types (NobelBiocare, NobelReplace Tapered Groovy 4.3 x 10 mm and Replace Select Tapered TiU RP 4.3 x 10mm) were inserted into the right and left sides of 8 domestic pigs (Sus scrofa domestica) mandibles, between canines and premolars and immediately provided with a ceramic crown. Primary implant stability was determined using ressonance frequency analysis. Soft tissue parameters were assessed: sulcus depth (SDI) and junctional epithelium (JE). Following 70 days of healing, jaw sections were processed for histology and histomorphometric examination. Undecalcified histological sections demonstrated osseointegration with direct bone contact. The soft tissue parameters revealed no significant differences between the two implant types. The peri-implant soft tissues appear to behave similarly in both implant types.

Alveolar ridge sockets preservation with bone grafting--review

INTRODUCTION

Alveolar bone seems to play a key role in providing support to the teeth, which are anchored to the bone by desmodontal fibers. The progressive alveolar bone resorption process occurs due to a loss of anatomic, biologic and mechanical factors. Mechanical stimulation of alveolar bone during mastication is crucial in keeping the teeth and underlying bone healthy. Tooth extraction leads to typical bone deficiency of ridge width and height of alveolar crest and reduces the possibility of placing screw titanium implants. When tooth extraction is necessary, trauma should be minimized during the procedure and bone preservation should receive careful attention. The literature has shown that early bone loss can be significantly reduced by socket grafting. The process of socket grafting requires an understanding of wound healing and an appreciation of the biological properties of the products available for socket grafting. Augmentative measures may, thus, be required to guarantee optimal prosthetic replacement of the lost tissue. Success or failure of augmentation procedures is dependent on revascularization and remodelling of the grafted bone into a vital, load bearing bone. In contrast to a visible three-dimensional change, the concept of remodelling refers to the internal turnover of bone, which is a coupled process where osteoclastic resorption and osteoblastic formation are more or less balanced. To restore alveolar bone loss and support efficient placement of dental implants, many different bone substitute such as autografts, allografts, xenografts, synthetic biomaterials and osteoactive agents have been proposed. In order to avoid harvesting an autograft, and thereby eliminating additional surgical procedures and risks, bone grafting materials and substitutes are alternative filler materials to be used for ridge augmentation.

PURPOSE

To present a literature review about biomaterials applicable in alveolar ridge sockets preservation to future implants insertion.

CONCLUSION

The maintenance of the dental alveolar bone after extraction depend on the attentive surgery procedure and the use of materials capable to maintain the prior space and be helpful in bone tissue healing.

Morphological and clinical considerations of first and second permanent molar eruption disorders

Tooth eruption is a complex biological process which starts from the site of development in the jaw bone until the teeth reach their final functional position in the chewing plane. Various factors can disturb this process. Besides mechanical obstacles on the eruption path, a pathological position or axial orientation of the tooth germ, morphological aberrations of the tooth or pathological alterations of the periodontium, primary disorders of the eruption mechanism may lead to complete or partial retention of the tooth in the jaw bone. These morphological features bear upon the prognosis of orthodontic correction which is dependent upon the underlying cause. First and second molars are rarely affected by eruption disorders, with a prevalence of 0.01 to 0.08 per cent, however, marked consequences for function such as posterior open bite or elongation of the antagonists may result. Following an overview of pathogenetic factors of tooth eruption disorders, selected cases of impacted first and second permanent molars are presented with respect to their morphological causes.

Problems of supernumerary teeth, hyperdontia or dentes supernumerarii

Supernumerary teeth are extra teeth or toothlike structures which may have either erupted or unerupted in addition to the 20 deciduous teeth and the 32 permanent teeth. This article provides an overview of frequency, distribution and classification of supernumerary teeth. The etiology of supernumerary teeth is still unknown, yet various theories have been presented based on epidemiological studies. Four clinical cases representing the possible manifestations of supernumerary teeth are discussed.

Hydroxyapatite grafting promotes new bone formation and osseointegration of smooth titanium implants

Titanium is the ideal metal for intra-osseous dental implants. It permits the natural formation of an oxide layer on its surface and thereby it prevents the release of potentially toxic molecules. New formation of bone around implants, partially placed into the bone marrow cavity, is a gradual process that runs from the endosteum to the surface of the implant. Deposition of hydroxyapatite crystals on collagen type I fibrils is initiated by acidic proteins and leads to bone mineralization. This study analyzed the effects of hydroxyapatite upon peri-implant bone formation after insertion of smooth titanium implants. Screw-shaped smooth titanium implants of 3.75 mm thickness and 8.5 mm length were inserted into the metaphysis of rabbit tibia, either together with bovine hydroxyapatite into the right tibia or in controls without hydroxyapatite into the left tibia. Polyfluorochrome tracers (alizarin complex, calcein, tetracycline) were injected subcutaneously at different time intervals after implantation to evaluate the time frame of bone new formation over a period of 8 weeks. All samples were processed for histology and analyzed by fluorescence and polarizing microscopy. Our results showed a higher quantity of mature type I collagen fibers around implants and an acceleration of bone formation in the presence of hydroxyapatite. Mainly immature organic matrix was formed at the surface of implants in controls. The presence of hydroxyapatite seems to promote the maturation of collagen fibers surrounding the titanium implants and to support osteoconduction. Moreover, new formation of bone was faster in all samples where implants were inserted together with hydroxyapatite.

Requirements and infection prophylaxis for internally cooled implant drills

Implant site preparation is crucially important to long-term success. Heat generation during drilling is unfavourable, since bone is relatively susceptible to heat, depending on its vascularisation and microstructure. Numerous factors such as drilling pressure, number of revolutions, drill design, wear and material, drilling depth and cooling influence heat generation. Internally cooled drills are, therefore, increasingly used, even though the improved cooling effect compared to conventional externally cooled drills is controversial. Internally cooled drills may have the disadvantage of a germ reservoir developing in the cooling channel. This study aimed to examine the effects of disinfection and sterilisation of internally cooled drills. After contamination of the cooling channel with suitable bioindicators (Enterococcus faecium, ATCC 6057 and spores of Bacillus stearothermophilus, ATCC 7953), the drills were disinfected (disinfection solution ID 220, Dürr Dental) and autoclaved (Webeco, E5S90, 134 degrees C, 2.6 bar, 5 min). Disinfection was not completely effective except after pre-cleaning. By means of sterilisation all spores of Bacillus stearothermophilus were completely killed. Internally cooled drills can be successfully disinfected by means of this hygienic procedure routinely used in dental practice and no source of infection is created.

[Retrospective survey of the management of patients treated for acute myocardial infarction in Provence-Alpes-Côte d'Azur]

OBJECTIVE

The aim of the study is to assess the characteristics, outcomes and factors associated with delay of reperfusion therapy in patients with myocardial infarction in the Provence Alpes Côte d'Azur (PACA).

METHODS

This retrospective study included all patients hospitalized with myocardial infarction in the PACA between January and June 2000. Myocardial infarction patients were identified using the Programme de Médicalisation des Systèmes d'Information. Univariate and multivariate analysis were performed.

RESULTS

A total of 2049 patients were admitted in 74 hospitals. Mean patient age was 68.9. Treatment consisted of coronary angioplasty alone in 53.3% of cases, thrombolysis alone in 4.5% and angioplasty after thrombolysis in 7.7%. The complication rate was 27.4% and mortality was 9.5%. The median time from first awareness of symptoms to the first action taken by the patient (1) was 1 hour 30 minutes. The time from the first action taken by the patient to revascularisation (2) was 3 hours 30 minutes. The time between the first awareness and revascularisation (3) was 8 hours 45 minutes. Multivariate analysis showed that the following factors were associated with increased delay: (1). no prior myocardial infarction, occurrence of symptoms at home. (2). age > 65 years, absence of chest pain, consultation with a physician before hospitalization, non-medical transport, transfer from one hospital to another, treatment by angioplasty alone. (3). age > 65 years, absence of chest pain, consultation with a physician before hospitalization, non-medical transport, treatment by angioplasty alone.

CONCLUSIONS

Alerting emergency services more quickly would shorten treatment delay not only by ensuring quicker transport to a properly equipped hospital but also by allowing prompt pre-hospital thrombolytic therapy.

Bone healing after the inferior alveolar nerve lateralization: A histologic study in rabbits (Oryctolagus cuniculus)

PURPOSE

The purpose of this article is to evaluate the bone healing around 2 different dental implant surfaces after the lateralization surgery of the inferior alveolar nerve (IAN) during an 8-week healing period in rabbits, and to check if there is any interaction between the implants and the nerve.

MATERIALS AND METHODS

The IAN lateralization was performed in an experimental rabbit model. Eight adult female rabbits (Oryctolagus cuniculus) underwent the surgical procedure, and 1 implant was placed on each side of the mandible while the nerve was lateralized. On both sides, the nerve was repositioned directly in contact with the implant surface. With the intention of obtaining comparative results, smooth titanium implants were installed on the right side, and blasted Al2O3 ones were placed on the left. During the healing period, bone tracers were administered subcutaneously to check different periods of bone ingrowth.

RESULTS

Histologic section, regardless of the studied surface, showed bone remodeling around the nerve, without contact between the nerve and the implanted surface. The bone blocks containing implants were histomorphometrically examined through computerized analysis, and the results obtained showed that the bone remodeling around the nerve occurred during the first weeks of healing. Through analysis of variance, the blasted Al2O3 implants showed at least 2.5-fold greater bone neoformation compared with the smooth titanium implants.

CONCLUSIONS

Our results showed that there was no significant difference in the healing process concerning the nerve between the 2 studied surfaces. No interaction was detected between the nerve and the implants.

Plasma hormones and metabolites in Piedmontese cows during late pregnancy: relationships with calf birth weight

Relationships among plasma hormonal and metabolic variables in the last trimester of gestation in 59 Piedmontese dams (n = 15 heifers, n = 44 cows) and the calf birth weight (BWT) class of their offspring were investigated in seven herds. The BWT data were categorized as follows: > 50 kg (BWT-A), 46 to 50 kg (BWT-B), 41 to 45 kg (BWT-C), and < 41 kg (BWT-D). Blood samples were collected at 33, 36, and 39 wk of gestation. Packed cell volume (PCV) and plasma concentrations of insulin, estrone sulfate (E1SO4), NEFA, and creatinine were determined and correlated to BWT class. Creatinine: E1SO4 ratio also was calculated. Duration of gestation was greater for dams producing a BWT-A calf than for the other BWT classes, and calf BWT was heavier (P < 0.001) for calves in the BWT-A vs. BWT-D class. The heaviest calf in BWT-A was associated with the highest calving difficulty score. Insulin and PCV values were not affected by week of gestation, whereas plasma E1SO4, NEFA, and creatinine content increased (P < 0.001) and creatinine:E1SO4 decreased (P < 0.001) during late gestation. Calf BWT class did not affect PCV value. Plasma E1SO4 concentrations were lower (P < 0.01) in BWT-D dams than the other dams, showing the greatest difference at 39 wk of gestation. At 36 and 39 wk of gestation, dams bearing BWT-C and BWT-D calves had a higher (P < 0.01) plasma insulin concentration than those bearing BWT-A and BWT-B calves. Plasma NEFA concentrations at 39 wk of gestation were higher (P < 0.05) in dams of calf BWT-A than in the other dams. We conclude that plasma E1SO4 level is a variable that can be used to monitor problems related to a small size calf. Conversely, the forthcoming birth of a calf with a heavy BW seems to be preceded by a pronounced increase in plasma NEFA level in the dam just a few days before calving.

Bone regeneration in rabbit sinus lifting associated with bovine BMP

Autogenous bone is considered the optimal grafting material for sinus lifting, although its harvesting causes great patient discomfort. Various approaches have been taken in order to obtain sinus lifting with preexisting tissue. However, because of the unsuitability of such tissue, additional materials have been required. Alternatively, biomaterials from humans or other animals are used. In this study, the efficacy of using morphogenetic bovine bone protein (BMPb) to augment the maxillary sinus floor was examined. Four grafting materials were employed: lyophilized bovine bone powder, absorbable collagen flakes, natural hydroxylapatite, and synthetic hydroxylapatite. Two groups of rabbits were studied. In one group, graft material only was used. In the other, graft material was combined with 0.5 mg BMPb. During 8 weeks of observation, polyfluorochrome tracers were injected in subcutaneous tissue to evaluate new bone- deposition periods. Following sacrifice, the samples were examined under fluorescent and light microscopes. Results indicated 33.34% more newly formed bone in BMPb animals than in controls. Graft-material resorption increased, but natural HA showed no significant alterations. The results show that the use of BMPb, although providing osteoinduction, might not promote sufficient bone formation. Nonetheless, this material could provide an alternative to autogenous grafts, thereby avoiding patient discomfort.

The effects of bovine BMP associated to HA in maxillary sinus lifting in rabbits

This study examines the efficacy of using bone morphogenetic protein of bovine origin associated with other biomaterials in maxillary sinus floor augmentation procedures in rabbits (Oryctolagus cuniculus). Various approaches have been attempted to obtain sinus lifting with pre-existing tissue, but all of them have been considered inadequate, because such tissue offers very low bio-quality, requiring additional materials to stimulate bone neo-formation. For this purpose, autogenous bone is considered to be the best grafting material, but harvesting it results in great discomfort for the patient. Biomaterials from human beings or other animals are used as a substitute. In this study, four different grafting materials were used: lyophilized bovine bone powder, absorbable collagen flakes, natural hydroxyapatite (nHA) and synthetic hydroxyapatite (sHA), in nine animals divided into two groups: (A) control group (left sinus)--using just graft material, and (B) BMP group (right sinus)--using graft material with 0.5 mg bovine bone morphogenetic protein (BMPb). The observation periods were of 8 and 12 weeks duration and sequential bone neo-formation polyfluorochrome tracers (alizarin complex, calcein, and tetracycline) were subcutaneously injected, to evaluate the periods of new bone deposition. After the animals were sacrificed, the material was obtained and examined under a fluorescent microscope and also activated by UV light and the conclusion reached that the newly formed bone increase was of 33.34% when compared to the control group at 8 weeks At 12 weeks, the bone deposition in the "BMP" group was not significant while in the "control" group there was continuous growth. This difference showed that the BMP stimulated bone formation during the early periods of healing (8 weeks), although it altered the normal cycle of bone deposition over the longer period (12 weeks). The graft material showed increasing reabsorption, but the natural HA did not show significant alterations. The results of this new animal model indicated that the BMPb used, although facilitating osteoinduction, might not be sufficient to promote qualitative and quantitative bone neo-formation, which could guarantee better prognoses. The BMPb material studied may possibly become an alternative to autogenous grafts causing less discomfort for the patient.

5'-aminoimidazole-4-carboxamide riboside induces apoptosis in human neuroblastoma cells

5'-Aminoimidazole-4-carboxamide riboside (AICA riboside) has been previously shown to be toxic to two neuronal cell models [Neuroreport 11 (2000) 1827]. In this paper we demonstrate that AICA riboside promotes apoptosis in undifferentiated human neuroblastoma cells (SH-SY5Y), inducing a raise in caspase-3 activity. In order to exert its effect on viability, AICA riboside must enter the cells and be phosphorylated to the ribotide, since both a nucleoside transport inhibitor, and an inhibitor of adenosine kinase produce an enhancement of the viability of AICA riboside-treated cells. Short-term incubations (2 h) with AICA riboside result in five-fold increase in the activity of AMP-dependent protein kinase (AMPK). However, the activity of AMPK is not significantly affected at prolonged incubations (48 h), when the apoptotic effect of AICA riboside is evident. The results demonstrate that when the cell line is induced to differentiate both toward a cholinergic phenotype (with retinoic acid) or a noradrenergic phenotype (with phorbol esters), the toxic effect is significantly reduced, and in the case of the noradrenergic phenotype differentiation, the riboside is completely ineffective in promoting apoptosis. This reduction of effect correlates with an overexpression of Bcl-2 during differentiation. AICA riboside, derived from the hydrolysis of the ribotide, an intermediate of purine de novo synthesis, is absent in normal healthy cells; however it may accumulate in those individuals in which an inborn error of purine metabolism causes an increase in the rate of de novo synthesis and/or an overexpression of cytosolic 5'-nucleotidase, that appears to be the enzyme responsible for AICA ribotide hydrolysis. In fact, 5'-nucleotidase activity has been shown to increase in patients affected by Lesch-Nyhan syndrome in which both acceleration of de novo synthesis and accumulation of AICA ribotide has been described, and also in other neurological disorders of unknown etiology. Our results raise the intriguing clue that the neurotoxic effect of AICA riboside on the developing brain might contribute to the neurological manifestations of syndromes related to purine dismetabolisms.

Catabolism of exogenous deoxyinosine in cultured epithelial amniotic cells

Uptake and catabolism of purine nucleosides have been commonly considered as means to salvage the purine ring for nucleic acid synthesis, usually neglecting the destiny of the pentose moiety. With the aim to ascertain if deoxyribose derived from exogenous DNA can be utilised as a carbon and energy source, we studied the catabolism of exogenous deoxyinosine in a cell line derived from human amnion epithelium (WISH). Intact WISH cells catabolise deoxyinosine by conversion into hypoxanthine. The nucleoside enters the cell through a nitrobenzylthioinosine-insensitive equilibrative transport. Deoxyinosine undergoes a phosphorolytic cleavage inside the cell. The purine base diffuses back to the external medium, while the phosphorylated pentose moiety can be further catabolised to glycolysis and citric acid cycle intermediates. Our results indicate that the catabolism of the deoxynucleoside can be considered mainly as a means to meet the carbon and energy requirements of growing cells.

Bovine cytosolic 5'-nucleotidase acts through the formation of an aspartate 52-phosphoenzyme intermediate

Cytosolic 5'-nucleotidase/phosphotransferase (cN-II), specific for purine monophosphates and their deoxyderivatives, acts through the formation of a phosphoenzyme intermediate. Phosphate may either be released leading to 5'-mononucleotide hydrolysis or be transferred to an appropriate nucleoside acceptor, giving rise to a mononucleotide interconversion. Chemical reagents specifically modifying aspartate and glutamate residues inhibit the enzyme, and this inhibition is partially prevented by cN-II substrates and physiological inhibitors. Peptide mapping experiments with the phosphoenzyme previously treated with tritiated borohydride allowed isolation of a radiolabeled peptide. Sequence analysis demonstrated that radioactivity was associated with a hydroxymethyl derivative that resulted from reduction of the Asp-52-phosphate intermediate. Site-directed mutagenesis experiments confirmed the essential role of Asp-52 in the catalytic machinery of the enzyme and suggested also that Asp-54 assists in the formation of the acyl phosphate species. From sequence alignments we conclude that cytosolic 5'-nucleotidase, along with other nucleotidases, belong to a large superfamily of hydrolases with different substrate specificities and functional roles.

Cytosolic 5'-nucleotidase hyperactivity in erythrocytes of Lesch-Nyhan syndrome patients

Lesch-Nyhan syndrome is a metabolic-neurological syndrome caused by the X-linked deficiency of the purine salvage enzyme hypoxanthine-guanine phosphoribosyltransferase (HGPRT). Metabolic consequences of HGPRT deficiency have been clarified, but the connection with the neurological manifestations is still unknown. Much effort has been directed to finding other alterations in purine nucleotides in different cells of Lesch-Nyhan patients. A peculiar finding was the measure of appreciable amount of Z-nucleotides in red cells. We found significantly higher IMP-GMP-specific 5'-nucleotidase activity in the erythrocytes of seven patients with Lesch-Nyhan syndrome than in healthy controls. The same alteration was found in one individual with partial HGPRT deficiency displaying a severe neurological syndrome, and in two slightly hyperuricemic patients with a psychomotor delay. Since ZMP was a good substrate of 5'-nucleotidase producing Z-riboside, we incubated murine and human cultured neuronal cells with this nucleoside and found that it is toxic for our models, promoting apoptosis. This finding suggests an involvement of the toxicity of the Z-riboside in the pathogenesis of neurological disorders in Lesch-Nyhan syndrome and possibly in other pediatric neurological syndromes of uncertain origin.

Identification, separation and characterisation of two forms of cytosolic 5'-nucleotidase/nucleoside phosphotransferase in calf thymus

Cytosolic 5'-nucleotidase, acting preferentially on IMP, GMP and their deoxyderivatives, endowed with phosphotransferase activity, is a widespread enzyme responsible for the regulation of intracellular IMP and GMP concentrations and the phosphorylation of purine nucleoside pro-drugs. The enzyme activity is stimulated by ATP, ADP and 2,3-bisphosphoglycerate (BPG), and is inhibited by phosphate. Calf thymus possesses two active proteins with a different electrophoretic mobility. In this report we show that the two forms can be separated by ADP-agarose affinity chromatography. Whereas form A binds weakly to the column, form B is tightly bound and is released by the addition of ADP into the elution buffer. The two enzyme forms differ in terms of electrophoretic, chromatographic behaviour and regulatory characteristics. Form B, as already described for the enzyme purified from the same source (Pesi et al., 1996, Biochim Biophys Acta 294, 191-194), exhibits three different sites for the three activators with a synergistic effect between ADP and BPG. Form A has a high affinity regulatory site for BPG, while ADP and ATP appear to share the same low affinity site and no synergistic effect is observed.

Bovine cytosolic IMP/GMP-specific 5'-nucleotidase: cloning and expression of active enzyme in Escherichia coli

A cDNA coding for bovine cytosolic IMP/GMP-specific 5'-nucleotidase endowed with phosphotransferase activity was cloned from calf thymus RNA, by 5' and 3' rapid amplification of cDNA ends protocols (5' and 3' RACE). Two products were isolated: a 5' RACE 1.6 kb fragment and a 3' RACE 2.0 kb fragment, with an overlapping region of 505 bp, leading to a total length of approx. 2951 bp. The similarity in the coding region to that of the human 5'-nucleotidase cDNA sequence [Oka, Matsumoto, Hosokawa and Inoue (1994) Biochem. Biophys. Res. Commun. 205, 917-922], indirectly identified as a 5'-nucleotidase, was 94% and the deduced amino acid sequences were 99.5% identical. The bovine cDNA sequence included the sequences codifying for six peptides obtained from 5'-nucleotidase/phosphotransferase purified from calf thymus. Northern blots of human mRNA species from different tissues showed a 3.6 kb mRNA expressed at equal levels in most tissues. The cDNA was cloned into a pET-28c expression vector and the protein obtained after induction had a molecular mass of 61 kDa under SDS/PAGE. It exhibited both 5'-nucleotidase and phosphotransferase activity, as well as immunological and kinetic properties similar to those of the enzyme purified from calf thymus. This is the first time that a fully active recombinant 5'nucleotidase has been described.

The bifunctional cytosolic 5'-nucleotidase: regulation of the phosphotransferase and nucleotidase activities

The cytosolic 5'-nucleotidase specific for IMP, GMP, and their deoxyderivatives has been purified approximately 1000 times from calf thymus. The enzyme, in the presence of a suitable nucleoside, can act as a phosphotransferase, catalyzing the transfer of the phosphate moiety from a nucleoside monophosphate donor to a nucleoside acceptor, thus operating as an interconverting activity. This phosphorylating activity has drawn the attention of several research groups because the cytosolic 5'-nucleotidase represents the only cellular enzyme able to phosphorylate inosine and guanosine analogs, which are not substrates of known cellular nucleoside kinases. In this paper, we report the kinetic parameters of the bifunctional enzyme and its response to variations in adenylate energy charge. The results seem to indicate that in the presence of physiological concentrations of ATP and phosphate, the enzyme behaves mainly as a phosphotransferase, its activity being dependent only on the availability of a suitable nucleoside.