Neuropathic pain in the orofacial region: The role of pain history. A retrospective study

INTRODUCTION

Orofacial neuropathic pain is often difficult to treat, mostly because of still unclear underlying mechanisms. The occurrence of such neuropathic pain varies depending on different factors, of which preexisting preoperative pain seems to be of high importance. The aim of this study was thus to test the hypothesis that prior history of pain could indeed be considered a risk factor for the development of orofacial neuropathic pain in the same region.

METHODS

The study was performed in the dental department of the Groupe Hospitalier Pitié-Salpêtrière (GHPS) in Paris, France. We investigated the presence of prior inflammatory pain before development of orofacial neuropathic pain in 56 patients. For each patient file, the following items were collected: age, gender; medical history; diagnosis; description of the pain (at time of consultation); presence or absence of prior dental treatment; date and type of dental treatment received.

RESULTS

41 patients (73%) of orofacial neuropathic pain patients had a history of pain compatible with an inflammatory condition; 4% (n=2) did not report any prior pain and 23% (n=13) could not remember. Among the patients with documented history of pain prior to neuropathy, 88% (n=36) received surgical treatment; 61%, (n=25) endodontic treatment and 22%, (n=9) restorative treatment. All eventually received endodontic treatment or tooth extraction. These dental treatments are compatible with the hypothesis of prior inflammatory pain in these patients.

CONCLUSION

These results support the hypothesis that prior inflammatory pain could favor the development of orofacial neuropathic pain. Prevention and treatment of inflammatory trigeminal pain may therefore play a key role in preventing future neuropathic pain development.

Hedgehog Pathway-Mediated Vascular Alterations Following Trigeminal Nerve Injury

Whereas neurovascular interactions in spinal neuropathic pain models have been well characterized, little attention has been given to such neurovascular interactions in orofacial neuropathic pain models. This study investigated in male Sprague-Dawley rats the vascular changes following chronic constriction injury (CCI) of the infraorbital nerve (IoN), a broadly validated preclinical model of orofacial neuropathic pain. Following IoN-CCI, an early downregulation of tight junction proteins Claudin-1 and Claudin-5 was observed within the endoneurium and perineurium, associated with increased local accumulation of sodium fluorescein (NaFlu) within the IoN parenchyma, as compared with sham animals. These events were evidence of local blood-nerve barrier disruption and increased vascular permeability. A significant upregulation of immunocytes (CD3, CD11b) and innate immunity (TLR2, TLR4) mRNA markers was also observed, suggestive of increased local inflammation. Finally, a significant downregulation of Hedgehog pathway readouts Patched-1 and Gli-1 was observed within the IoN after CCI and local injections of cyclopamine, a Hedgehog pathway inhibitor, replicated in naïve rats the molecular, vascular, and behavioral changes observed following IoN-CCI. These results suggest a major role of Hedgehog pathway inhibition in mediating local increased endoneurial and perineurial vascular permeability following trigeminal nerve injury, thus facilitating immunocytes infiltration, neuroinflammation development, and neuropathic pain-like aversive behavior.

Implication of the chemokine CCL2 in trigeminal nociception and traumatic neuropathic orofacial pain

BACKGROUND

Chemokine (C-C motif) ligand 2 (CCL2) participates in different mechanisms contributing to the spinal cord inflammation and pain development after sciatic nerve injury. Recent data also support its role in orofacial thermal hypersensitivity, although its implication in different phases of trigeminal pain emergence is unclear. We assessed the importance of CCL2 signalling in biochemical and behavioural alterations during the early and late stages following chronic constriction injury of infraorbital nerve (ION-CCI), a model of peripheral traumatic trigeminal pain.

METHODS

After evaluating the consequences of CCL2 intracisternal injection in naïve rats, we determined the expression changes for CCL2, inflammatory and glia activation markers in the somatosensory trigeminal complex (STC) and trigeminal ganglia (TG) after ION-CCI. The role of CCL2 signalling was assessed using pre-emptive or 'curative' intracisternal treatment with specific CCL2 receptor antagonist - INCB3344.

RESULTS

Exogenous CCL2 evoked spontaneous behaviour reminiscent of orofacial pain and marked mechanical hypersensitivity, associated with increased expression of proinflammatory cytokines and glial markers in STC and TG. CCL2-evoked changes were prevented by the co-administration of INCB3344. Two weeks after ION-CCI, mRNA for CCL2, glial and inflammatory markers were up-regulated, and CCL2-immunoreactivity accumulated in central and ganglionic tissues. At this time, repeated intracisternal administration of INCB3344 did not attenuate the ION-CCI-associated behavioural nor biochemical changes. By contrast, pre-emptive INCB3344 treatment delayed the emergence of trigeminal mechanical allodynia and associated biochemical alterations.

CONCLUSIONS

Our data suggest that CCL2 is involved principally in the early events accompanying the ION lesion rather than in long-term alterations and the maintenance of trigeminal mechanical hypersensitivity.

Dental Afferents Project onto Gustatory Neurons in the Nucleus of the Solitary Tract

The aim of this study was to investigate the inferior alveolar nerve (IAN) and chorda tympani (CT) projections onto gustatory neurons of the nucleus of the solitary tract (NST) in the rat by immunochemical and electrophysiological techniques. IAN afferents were retrogradely labeled. NST neurons were labeled either by retrograde tracer injection into the parabrachial nucleus (PBN) or by c-Fos mapping after CT activation. NST neurons responding to tastant stimulation were recorded in vivo before and after electrical stimulation of the IAN. Results from the immunolabeling approach showed IAN boutons “en passant” apposed to retrogradely labeled neurons from PBN and to CT-activated neurons in the NST. Recordings of single NST neurons showed that the electrical stimulation of the IAN significantly decreased CT gustatory responses. Analysis of these data provides an anatomical and physiological basis to support trigeminal dental and gustatory interactions within the brainstem.

[Prevalence of fixed prosthesis-related periodontitis in Senegal]

The purpose of this study was to determine radiographically the prevalence of periapical periodontitis in teeth restored with crown in a Senegalese population. Full mouth periapical radiographs were obtained from 208 consecutive adult patients (6234 teeth) presenting as new patients to the Dental Service of the University. The presence of crown restorations, the periapical status and technical quality of root fillings associated were evaluated. 7.69% (n = 16) of patients had at least one tooth that was crowned. The total number of crowns assessed was 0.95% (n = 59). The molars were the teeth most crowned 40.67% (n = 24) followed by anterior teeth 30.50% (n = 18) and premolars 28.81% (n = 17). All the crowned teeth had previous root canal treatment of which only 16.94% (n = 10) were acceptable. 53 % (n = 32) of the teeth had apical periodontitis (PAI > 2). Unacceptable root fillings were associated with a higher prevalence of periapical disease (p < 0.05). Crown with a post extending more than 4 millimetres from the apex were associated with more periapical lesions 64.28% (p < 0.05). The results indicate a low prevalence of crowned teeth, an absence of vital preparation, a high prevalence of radiographic periapical disease and unacceptable root fillings associated.

[Radiographic study of the canal anatomy of mandibular premolars in a Senegalese population]

AIM

The purpose of this study was to assess the canal anatomy of mandiblar premolars in Senegalese population.

MATERIALS AND METHODS

Retroalveolar radiographs of mandibular premolars of 208 patients in Senegal were obtained. Two experienced practitioners using a long cone tube and the parallel plane technique with angulators took the radiographs. The canal morphology of each tooth was determined in terms of the number of canals radiologically visible to the apex. Any anatomic structure emanating from the pulp chamber or the principal canal to the apex and measuring more than 3 millimetres was considered to be a supplementary canal.

RESULTS

For the 208 patients studied, 412 first premolars were present and 4 were absent.Among the 412 teeth, 335 (81.3%) had a single canal, 62 (15.1%) 2 canals, and 17 (3.6%) 3 canals. For the second premolars 408 were present. Of the 408 teeth, 352 (86%) had one canal, 49 (12%) 2 canals, and 8 (2%) 3 canals.

CONCLUSION

The prevalence of two or more canals in premolar mandibular from Senegalese patients was similar to that found in the others ethnic population.

Use of chromosomal integron arrays as a phylogenetic typing system for Vibrio cholerae pandemic strains

Approximately 200 serogroups of Vibrio cholerae exist, with only two, O1 and O139, responsible for epidemic and pandemic cholera. Strains from these serogroups have evolved from a common progenitor, with lateral gene transfer largely driving their emergence. These strains are so closely related that separation using single- or multi-locus phylogeny has proven difficult. V. cholerae strains contain a genetic system called the integron that is located in the chromosome and that can integrate and excise DNA elements called mobile gene cassettes (MGCs) by site-specific recombination. Large arrays of MGCs are found in V. cholerae strains. For instance, the O1 El Tor strain N16961 contains 179 MGCs. Since integron arrays are dynamic through recombination and excision of MGCs, it was hypothesized that the MGC composition in a given V. cholerae pandemic strain would be useful as a phylogenetic typing system. To address this, a PCR-based method was used to rapidly characterize the MGC composition of V. cholerae arrays. The results showed that the MGC composition of pandemic V. cholerae cassette arrays is relatively conserved, providing further evidence that these strains have evolved from a common progenitor. Comparison of MGC composition between the V. cholerae pandemic strains was also able to resolve the evolution of O139 from a subgroup of O1 El Tor. This level of differentiation of closely related V. cholerae isolates was more sensitive than conventional single-gene phylogeny or multi-locus sequence analysis. Using this method, novel MGCs from an O1 classical strain and an Argentinian O139 isolate were also identified, and a major deletion in the MGC array in all pandemic O139 strains and a subset of O1 El Tor strains was identified. Analysis of sequenced V. cholerae integron arrays showed that their evolution can proceed by rearrangements and deletions/insertions of large portions of MGCs in addition to the insertion or excision of single MGCs.

Prevalence and technical quality of root fillings in Dakar, Senegal

AIM

To examine the prevalence and technical quality of root fillings and the periapical status of root-filled teeth in a subpopulation of Dakar, Senegal.

METHODOLOGY

Full-mouth periapical radiographs were obtained from 208 consecutive adults presenting as new patients to the Dental Service of the University. The occurrence and technical quality of root fillings were assessed for each root according to the apical extent of the root fillings and its density. The periapical status was evaluated using the Periapical Index Scoring System with a PAI > 2 indicating periapical disease. The presence of coronal restorations and posts was also noted. Statistical analysis was performed with the chi-square test with a significance level set at P < 0.05%.

RESULTS

Of the 6234 teeth examined, 2.6% were root filled. A PAI > 2 was associated with 56.1% of the filled roots. Only 17.7% of the root fillings were technically acceptable and 26.2% of these were associated with a PAI > 2. In roots with unacceptable root fillings, 62.5% had a PAI > 2. Unacceptable root fillings were associated with a higher prevalence of periapical disease (P < 0.001). A post was seen in 18.9% of the filled roots with 66.2% associated with a PAI > 2. A permanent coronal restoration was present in 78.5% of the filled roots, of which 50.7% had a PAI > 2 vs 75.7% for no permanent restoration. At least one periapical lesion was seen in 59.6% of the subjects.

CONCLUSION

The results indicate a low prevalence of teeth with radiographic periapical disease, a low prevalence of root-filled teeth and a high prevalence of unacceptable root fillings.

Phase I/II study of neoadjuvant bevacizumab with radiation therapy and 5-fluorouracil in patients with rectal cancer: initial results

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Background: A phase I/II study of neoadjuvant bevacizumab with 5-fluorouracil and radiation therapy in patients with locally advanced rectal cancer was undertaken to determine whether inhibition of VEGF is safe and has clinical benefits by enhancing chemo- radiation therapy. Methods: 22 patients with endoscopic ultrasound or surface coil MRI staged T3/T4 non-metastatic rectal cancer were enrolled from 2001–2006. All patients completed 4 cycles of neoadjuvant therapy including: 1) bevacizumab infusion (5 or 10 mg/kg) on day 1 of each cycle; 2) peripheral venous infusion 5-FU (225 mg/m2/24 hours) administration each treatment week of cycles 2 - 4; 3) external beam irradiation delivery (50.4 Gy in 28 fractions over 5.5 weeks); and 4) surgery 7 to 9 weeks after completion of all neoadjuvant therapy. Correlative studies were undertaken before and during the trial. We collected serial tumor biopsies, PET-FDG scans, and analyzed blood and urine for potential biomarkers. Results: Mean pre-therapy tumor size was 4.7 cm (2–9 cm). Post-treatment surgical specimens usually had well-demarcated shallow ulcerations with a mean diameter of 2.4 cm (0.7–6 cm). In response to the neoadjuvant regimen, all patients had significantly (p<0.01) decreased FDG-uptake by PET. Histologic examination showed no residual primary cancer in 5 patients (ypT0). Of 17 patients with residual disease, microscopic disease usually occurred as malignant glands embedded in fibrosis (ypT1 in 3 patients, ypT2 in 4 patients, ypT3 in 10 patients). Downstaging was seen in 12/22 tumors. 8 patients had microscopic nodal metastases. Bevacizumab alone and combined treatment were both associated with increased plasma VEGF and PlGF levels in 18/18 patients (P<0.01 at all 4 timepoints compared to baseline). Viable CECs were decreased by VEGF blockade at day 3 (P<0.01 compared to baseline), and peak CEC levels during treatment was correlated with histologic tumor response (2.77 [1.18–3.18] for T3 patients, n=9 versus 1.14 [0.82–1.53] for T0-T2 patients, n=12; p=0.05). Conclusions: Addition of bevacizumab at a dose of 5 mg/kg to standard chemo-radiation is safe in patients with locally advanced rectal cancer. Bevacizumab is active and the combined regimen yields promising results.

[Table: see text]

How big is the iceberg of which organellar genes in nuclear genomes are but the tip?

As more and more complete bacterial and archaeal genome sequences become available, the role of lateral gene transfer (LGT) in shaping them becomes more and more clear. Over the long term, it may be the dominant force, affecting most genes in most prokaryotes. We review the history of LGT, suggesting reasons why its prevalence and impact were so long dismissed. We discuss various methods purporting to measure the extent of LGT, and evidence for and against the notion that there is a core of never-exchanged genes shared by all genomes, from which we can deduce the "true" organismal tree. We also consider evidence for, and implications of, LGT between prokaryotes and phagocytic eukaryotes.

Activation of brain stem neurons by irritant chemical stimulation of the throat assessed by c-fos immunohistochemistry

The method of c-fos immunohistochemistry was used to identify the brain stem distribution of neurons activated following irritant chemical stimulation of the laryngopharyngeal mucosa. In pentobarbital-anesthetized rats, either water (control), nicotine (600 mM, 1 ml) or capsaicin (330 microM, 1 ml) was applied to the pharynx via a cannula placed posterior to the soft palate. Following nicotine and capsaicin, there was a significant increase in fos-like immunoreactivity (FLI) compared with controls in the following areas: nucleus of the solitary tract from the level of the pyramidal decussation caudally to the level of the area postrema rostrally; dorsomedial aspect of trigeminal subnucleus caudalis (Vc); and paratrigeminal islands interspersed in the spinal trigeminal tract. There was significantly more FLI in Vc and paratrigeminal nuclei following capsaicin than following nicotine, while the reverse was true for NTS. In addition, there was a significant increase in FLI in area postrema and the ventrolateral medullary region dorsal to the lateral reticular nucleus following nicotine but not capsaicin. The distributions of FLI in NTS, area postrema, Vc, and paratrigeminal nuclei are consistent with prior anatomical tract-tracing studies and suggest roles for these brain stem regions in mediating sensory and reflex responses to irritant chemical stimulation of the upper respiratory mucosa.

Effects of excitatory amino acid receptor antagonists on pulpal blood flow of the rat mandibular incisor

Pulpal blood flow (PBF) changes have been monitored by laser Doppler flowmetry on rat mandibular incisors. Electrical stimulation (10 sec, 50 microA, 2 ms, 20 Hz) of one incisor induced a blood flow decrease followed by a blood flow increase. The effect of intravenous administration of antagonists of ionotropic glutamate receptors (iGluRs) and antagonists of metabotropic glutamate receptors (mGluRs) was compared with that of those obtained from animals treated with the vehicle alone. No long-term effect on basal PBF was observed, except a remaining increase of 34.5% (p < 0.05, n = 5) for ketamine (10 mg/kg), an iGluR antagonist, and of 37% (p < 0.05, n = 5) for MCPG (7.5 mg/kg), an mGluR antagonist. In animals treated with iGluR antagonists, acute changes in PBF after stimulation were not significantly different from those observed with vehicle. In animals treated with mGluR antagonists, the blood flow decrease was significantly enhanced in amplitude and duration for MCPG (7.5 mg/kg), respectively, +73% and +92% (p < 0.05, n = 5). These results suggest that Group I mGluRs participate in the regulation of the immediate pulpal blood flow decrease induced by electrical stimulation of the lower incisor in the rat.

Solid stress facilitates spheroid formation: potential involvement of hyaluronan

When neoplastic cells grow in confined spaces in vivo, they exert a finite force on the surrounding tissue resulting in the generation of solid stress. By growing multicellular spheroids in agarose gels of defined mechanical properties, we have recently shown that solid stress inhibits the growth of spheroids and that this growth-inhibiting stress ranges from 45 to 120 mmHg. Here we show that solid stress facilitates the formation of spheroids in the highly metastatic Dunning R3327 rat prostate carcinoma AT3.1 cells, which predominantly do not grow as spheroids in free suspension. The maximum size and the growth rate of the resulting spheroids decreased with increasing stress. Relieving solid stress by enzymatic digestion of gels resulted in gradual loss of spheroidal morphology in 8 days. In contrast, the low metastatic variant AT2.1 cells, which grow as spheroids in free suspension as well as in the gels, maintained their spheroidal morphology even after stress removal. Histological examination revealed that most cells in AT2.1 spheroids are in close apposition whereas a regular matrix separates the cells in the AT3.1 gel spheroids. Staining with the hyaluronan binding protein revealed that the matrix between AT3.1 cells in agarose contained hyaluronan, while AT3.1 cells had negligible or no hyaluronan when grown in free suspension. Hyaluronan was found to be present in both free suspensions and agarose gel spheroids of AT2.1. We suggest that cell-cell adhesion may be adequate for spheroid formation, whereas solid stress may be required to form spheroids when cell-matrix adhesion is predominant. These findings have significant implications for tumour growth, invasion and metastasis.

Radiographic evaluation of the prevalence and technical quality of root canal treatment in a French subpopulation

AIM

This study was undertaken to examine the prevalence and technical quality of root fillings and the periapical status of endodontically treated teeth in a French subpopulation.

METHODOLOGY

Full-mouth periapical radiographs were obtained from 208 consecutive adult patients seeking care within the dental service provided by the Hôtel-Dieu in Paris. The occurrence and technical quality of root fillings were assessed for each root according to the position and the density of the obturation. The periapical status was evaluated using the Periapical Index Scoring System. The type of coronal restoration and the presence of posts were also noted.

RESULTS

Of the 8743 roots included in the survey, 23% were root-filled. An acceptable standard of treatment was found in 21% of roots with 16% of these cases associated with signs of periapical disease. In roots with unacceptable root-fillings, 27% had periapical pathology. A post was seen in 26% of the root-filled canals, with 29% of these cases associated with periapical pathology. An intracoronal restoration existed in 30% of the filled roots, of which 22% exhibited a periapical lesion. An extra-coronal restoration was present in 60% of the filled roots, of which 24% had radiographic signs of periapical pathology. The remaining 10% of filled roots that had no coronal restoration were associated with periapical pathology in 33% of cases. At least one periapical lesion was seen in 63% of the patients.

CONCLUSION

The results demonstrate a high prevalence of root-filled teeth and poor technical quality of treatment. Roots presenting with acceptable root fillings were associated with a lower prevalence of periapical pathology (P < 0.001). Posts in roots were associated with periapical pathology significantly more than in roots without posts (P < 0.001).

LYVE-1 is not restricted to the lymph vessels: expression in normal liver blood sinusoids and down-regulation in human liver cancer and cirrhosis

Lymphatic vessel endothelial hyaluronan receptor (LYVE)-1 is thought to be restricted to lymph vessels and has been used as such to show that tumor lymphangiogenesis occurs on overexpression of lymphangiogenic factors in mouse tumor models. However, these studies have not yet been corroborated in human tumors. Here we show, first, that LYVE-1 is not exclusive to the lymph vessels. Indeed, LYVE-1 is also present in normal hepatic blood sinusoidal endothelial cells in mice and humans. Surprisingly, LYVE-1 is absent from the angiogenic blood vessels of human liver tumors and only weakly present in the microcirculation of regenerative hepatic nodules in cirrhosis, though both vessels are largely derived from the liver sinusoids. Second, we propose a novel approach to identify lymphatics in human and murine liver. By combining LYVE-1 and Prox 1 (a transcription factor) immunohistochemistry, we demonstrate that lymphatics are abundant in cirrhosis. In contrast, in human hepatocellular carcinoma and liver metastases, they are restricted to the tumor margin and surrounding liver. The absence of intratumor lymphatics in hepatocellular carcinomas and liver metastases may impair molecular and cellular transport in these tumors. Finally, the presence of LYVE-1 in liver sinusoidal endothelia suggests that LYVE-1 has functions beyond the lymph vascular system.

Defining the core of nontransferable prokaryotic genes: the euryarchaeal core

If lateral gene transfer (LGT) has affected all genes over the course of prokaryotic evolution, reconstruction of organismal phylogeny is compromised. However, if a core of genes is immune to transfer, then the evolutionary history of that core might be our most reliable guide to the evolution of organisms. Such a core should be preferentially included in the subset of genes shared by all organisms, but where universally conserved genes have been analyzed, there is too little phylogenetic signal to allow determination of whether or not they indeed have the same history (Hansmann and Martin 2000; Teichmann and Mitchison 1999). Here we look at a more restricted set, 521 homologous genes (COGs) simultaneously present in four sequenced euryarchaeal genomes. Although there is overall little robust phylogenetic signal in this data set, there is, among well-supported trees, strong representation of all three possible four-taxon topologies. "Informational" genes seem no less subject to LGT than are "operational genes," within the euryarchaeotes. We conclude that (i) even in this collection of conserved genes there has been extensive LGT (orthologous gene replacement) and (ii) the notion that there is a core of nontransferable genes (the "core hypothesis") has not been proven and may be unprovable.

Decorin inhibits endothelial migration and tube-like structure formation: role of thrombospondin-1

Interactions between endothelial cell receptors and the extracellular matrix (ECM) play a critical, yet poorly understood role in angiogenesis. Based on the anti-adhesive role of decorin, we hypothesized that decorin binding to ECM molecules such as thrombospondin-1 (TSP-1) plays a regulatory role in endothelial tube-like structure (TLS) formation. To test this hypothesis, endothelial cells were plated on TSP-1, decorin, or mixed substrates of TSP-1 plus decorin. TLS formation was induced by applying type I collagen on the confluent endothelial monolayer. Cartilage decorin inhibited the formation of TLSs in a concentration-dependent manner. On substrates of high decorin concentrations (2.5 and 5.0 microg/cm(2)) the reduction in TLSs was due either to a reduction in the number of adhering cells or to decreased cell migration. At low decorin concentrations (0.05 and 0.25 microg/cm(2)) the reduction in TLSs was independent of the number of attached cells. Time-lapse video microscopy revealed that decorin substrates facilitated homotypic aggregation and isolated cord formation at the expense of endothelial migration and TLS formation. Consistent with the reduced migration, endothelial cells formed fewer vinculin-positive focal adhesions and actin-stress fibers on decorin substrates. Endothelial migration and TLS formation were also significantly inhibited by skin decorin and the protein core of cartilage decorin. The inhibition of TLS formation by the protein core of cartilage decorin was potentiated by TSP-1. These findings suggest that decorin alone or in combination with TSP-1 interferes with the activation of endothelial cell receptors by ECM molecules, thus blocking intracellular signals that induce cytoskeletal reorganization, migration, and TLS formation.

Bacterial origin for the isoprenoid biosynthesis enzyme HMG-CoA reductase of the archaeal orders Thermoplasmatales and Archaeoglobales

The enzyme 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA reductase or HMGR) fulfills an essential role in archaea, as it is required for the synthesis of isoprenoid ethers, the main component of archaeal cell membranes. There are two clearly homologous but structurally different classes of the enzyme, one found mainly in eukaryotes and archaea (class 1), and the other found in bacteria (class 2). This feature facilitated the identification of several cases of interdomain lateral gene transfer (LGT), in particular, the bacterial origin for the HMGR gene from the archaeon Archaeoglobus fulgidus. In order to investigate if this LGT event was recent and limited in its scope or had a broad and long-term impact on the recipient and its related lineages, the HMGR gene was amplified and sequenced from a variety of archaea. The survey covered close relatives of A. fulgidus, the only archaeon known prior to this study to possess a bacterial-like HMGR; representatives of each main euryarchaeal group were also inspected. All culturable members of the archaeal group Archaeoglobales were found to display an HMGR very similar to the enzyme of the bacterium Pseudomonas mevalonii. Surprisingly, two species of the genus Thermoplasma also harbor an HMGR of bacterial origin highly similar to the enzymes found in the Archaeoglobales. Phylogenetic analyses of the HMGR gene and comparisons to reference phylogenies from other genes confirm a common bacterial origin for the HMGRs of Thermoplasmatales and Archaeoglobales. The most likely explanation of these results includes an initial bacteria-to-archaea transfer, followed by a another event between archaea. Their presence in two divergent archaeal lineages suggests an important adaptive role for these laterally transferred genes.

Microbial genomes: dealing with diversity

We have now complete genome sequences of several pairs of closely related prokaryotes (conspecific strains or congeneric species). Surprisingly, even strains of the same species can differ by as much as 20% in gene content. Conceptual and methodological approaches for dealing with such diversity are now being developed, and should transform microbial genomics.

Role of tumor-host interactions in interstitial diffusion of macromolecules: cranial vs. subcutaneous tumors

The large size of many novel therapeutics impairs their transport through the tumor extracellular matrix and thus limits their therapeutic effectiveness. We propose that extracellular matrix composition, structure, and distribution determine the transport properties in tumors. Furthermore, because the characteristics of the extracellular matrix largely depend on the tumor-host interactions, we postulate that diffusion of macromolecules will vary with tumor type as well as anatomical location. Diffusion coefficients of macromolecules and liposomes in tumors growing in cranial windows (CWs) and dorsal chambers (DCs) were measured by fluorescence recovery after photobleaching. For the same tumor types, diffusion of large molecules was significantly faster in CW than in DC tumors. The greater diffusional hindrance in DC tumors was correlated with higher levels of collagen type I and its organization into fibrils. For molecules with diameters comparable to the interfibrillar space the diffusion was 5- to 10-fold slower in DC than in CW tumors. The slower diffusion in DC tumors was associated with a higher density of host stromal cells that synthesize and organize collagen type I. Our results point to the necessity of developing site-specific drug carriers to improve the delivery of molecular medicine to solid tumors.

Effects of BP 2-94, a selective H(3)-receptor agonist, on blood flow and vascular permeability of the rat mandibular incisor pulp

Pulpal blood-flow changes were monitored by laser Doppler flowmetry after electrical stimulation of the mandibular incisor. Stimuli of 10 s (50 microA, 2 ms, 20 Hz) were applied to the incisors of untreated animals and longer stimulations (5 min) were applied in animals treated with the alpha-blocker phenoxybenzamine. Changes in vascular permeability in the dental pulp were measured by Evans blue extravasation following resection of the superior cervical ganglion. In these groups, a selective agonist of H(3) receptors, BP2-94 (1.5 and 15 mg/kg), and an H(3)-antagonist ciproxifan (1 mg/kg) were administered. The effects of these drugs were compared with those obtained from animals treated only with the vehicle (methylcellulose 1%). Basal pulpal blood-flow was not affected significantly by BP2-94 or ciproxifan. The vasoconstriction induced in the group of intact rats by electrical stimulation of 10 s is decreased in amplitude and duration at the higher dose of BP2-94 by 58 and 40%, respectively (P<0.05, n=5). In the sympathectomized animals, plasma extravasation was significantly increased at 15 mg/kg BP2-94 (+100%, P<0.01, n=5). These results suggest that H(3) receptors may participate in the regulation of changes in vessel contraction and permeability provoked by electrical stimulation of the dental pulp. However, the non-selective effects of the H(3) agonists reacting on adrenergic sites and H(1) receptors could explain a part of the results.

Vascular endothelial growth factor receptor-2-blocking antibody potentiates radiation-induced long-term control of human tumor xenografts

Antiangiogenic therapy can enhance radiation-induced tumor growth inhibition. However, the effects of combined antiangiogenic and radiation therapy on long-term tumor control and normal tissue response have not been reported. We treated mice bearing two different human tumor xenografts with anti-vascular endothelial growth factor receptor-2 antibody (DC101) and five dose fractions of local radiation and followed them for at least 6 months. DC101 significantly decreased the dose of radiation necessary to control 50% of tumors locally. The decrease was 1.7- and 1.3-fold for the moderately radiosensitive small cell lung carcinoma 54A and the highly radioresistant glioblastoma multiforme U87, respectively. In contrast to tumors, no increase in skin radiation reaction by the antibody was detected. Surprisingly, 44% of mice bearing 54A tumor developed clear ascites after DC101 treatment at its highest dose; this was fatal to 20% of mice. This adverse effect was seen only in mice that received whole-body irradiation 1 day before tumor implantation. The encouraging results on two human tumor xenografts suggest that vascular endothelial growth factor receptor-2 blockade merits further investigation to assess its potential as an enhancer of radiation therapy in the clinic.

Anti-Vascular endothelial growth factor treatment augments tumor radiation response under normoxic or hypoxic conditions

Recent studies in experimental animals have shown that combining antiangiogenic therapy with radiation can enhance tumor response. Whether this enhancement is mainly attributable to angiogenesis inhibition, endothelial cell radiosensitivity, tumor cell apoptosis, or a decrease in the number of hypoxic cells (improved oxygenation) is not known. We designed this study to discern the role of tumor oxygenation. We chose an anti-vascular endothelial growth factor (anti-VEGF) monoclonal antibody (mAb) which has a known target, human VEGF. We also measured interstitial fluid pressure (IFP) to test the hypothesis that the decreased vascular permeability induced by the anti-VEGF mAb can lower IFP. The effect of anti-VEGF mAb on vascular density, partial oxygen tension (pO2), and apoptosis was also measured. Athymic NCr/Sed nu/nu mice bearing 6-mm xenograft of the human glioblastoma multiforme (U87), or colon adenocarcinoma (LS174T) were treated with anti-VEGF mAb injected i.p. on alternate days for a total of six injections at a dosage of 100 microg/injection/mouse. For combined anti-VEGF and radiation, single radiation doses were given under normal blood flow (20 and 30 Gy) or clamped hypoxic conditions (30 and 40 Gy) 24 h after the sixth injection of mAb. The inhibition of the growth of U87 and LS174T tumors by the anti-VEGF mAb was associated with a significant reduction in tumor vascular density and a relatively small increase in the number of apoptotic cells. Compared with size-matched controls, IFP decreased by 74% in LS174T, and 73% in U87 in mice treated with anti-VEGF mAb. After antibody treatment PO2 increased significantly in U87, but did not change in LS174T tumors. Combined treatment induced in U87 tumors a tumor-growth delay (TGD) which was greater than additive; in LS174T except for the 40-Gy hypoxic group, the effect was only additive. In both U87 and LS174T the TGD induced by the antibody was independent of oxygen levels in the tumor at the time of radiation. The fact that the increase in TGD occurred under both normoxic and hypoxic conditions suggests that anti-VEGF mAb treatment can compensate for the resistance to radiation induced by hypoxia.

Oncotic pressure in solid tumors is elevated

Oncotic and hydrostatic pressure differences control the movement of fluid and large molecules across the microvascular wall of normal and tumor tissues. Recent studies have shown that the interstitial fluid pressure in tumors is elevated and is approximately equal to the microvascular pressure. Whereas oncotic pressure in blood plasma of various species is known, no data are available on the oncotic pressure in the interstitial space of tumors. We hypothesize that because of the leaky nature of tumor vessels, oncotic pressure in tumor interstitium should be close to that in plasma. To this end, we first developed a chronic wick method for the direct measurement of oncotic pressures in the interstitial fluid of tumors grown in mice. We found interstitial oncotic pressures in four human tumor xenografts to be higher than in s.c. tissue and comparable to that in plasma [rhabdomyosarcoma (RD), 24.2+/-4.7; squamous cell carcinoma (FaDu), 19.9+/-1.9; small cell lung carcinoma (54A), 21.1+/-2.8; colon adenocarcinoma (LIS174T), 16.7+/-3.0 mm Hg; s.c. tissue, 8.2+/-2.3; plasma, 20.0+/-1.6 mm Hg]. These results support our hypothesis that the oncotic pressure difference across the tumor microvascular wall is low. The high oncotic pressure in tumors is consistent with the elevated interstitial fluid pressure, and it contributes to the suboptimal delivery of large therapeutic agents to neoplastic cells.

The role of lateral gene transfer in the evolution of isoprenoid biosynthesis pathways

Lateral gene transfer (LGT) is a major force in microbial genome evolution. Here, we present an overview of lateral transfers affecting genes involved in isopentenyl diphosphate (IPP) synthesis. Two alternative metabolic pathways can synthesize this universal precursor of isoprenoids, the 1-deoxy-D-xylulose 5-phosphate (DOXP) pathway and the mevalonate (MVA) pathway. We have surveyed recent genomic data and the biochemical literature to determine the distribution of the genes composing these pathways within the bacterial domain. The scattered distribution observed is incompatible with a simple scheme of vertical transmission. LGT (among and between bacteria, archaea and eukaryotes) more parsimoniously explains many features of this pattern. This alternative scenario is supported by phylogenetic analyses, which unambiguously confirm several cases of lateral transfer. Available biochemical data allow the formulation of hypotheses about selective pressures favouring transfer. The phylogenetic diversity of the organisms involved and the range of possible causes and effects of these transfer events make the IPP biosynthetic pathways an ideal system for studying the evolutionary role of LGT.

Odorant and pheromone binding by aphrodisin, a hamster aphrodisiac protein

Aphrodisin is a soluble glycoprotein of hamster vaginal discharges, which stimulates male copulatory behavior. Natural aphrodisin was purified and its post-translational modifications characterized by MALDI-MS peptide mapping. To evaluate its ability to bind small volatile ligands, the aphrodisiac protein was expressed in the yeast Pichia pastoris as two major isoforms differing in their glycosylation degree, but close in conformation to the natural protein. Dimeric recombinant aphrodisins were equally able to efficiently bind odors (2-isobutyl-3-methoxypyrazine and methyl thiobutyrate) and a pheromone (dimethyl disulfide), suggesting that they could act as pheromone carriers instead of, or in addition to, direct vomeronasal neuron receptor activators.

Utilization of gutta-percha for retrograde root fillings

Just as gutta-percha used with a root canal sealer is a recommended material for orthograde root fillings, it could similarly be the material of choice for retrograde fillings. Unfortunately, clinical accessibility and visibility do not always facilitate such a technique. The aim of this article is to present a new technique which enables retrograde fillings to be achieved with gutta-percha and a sealer. After the apex had been resected, a hole was drilled perpendicular to the plane of section of the apex about 1 mm coronally. The bucco-lingual depth required to reach the main canal was calculated. The cavity was then dried, coated with the sealer, and obturated with gutta-percha in accordance with thermo-mechanical compaction techniques. After excess filling material had been removed, the gutta-percha was cold burnished and the angles of the root were smoothed. Clinical cases illustrating healing of the periapical tissues are shown.

Persistent pain related to root canal filling and apical fenestration: a case report

Endodontic treatments may give rise to persistent pain whose origin is sometimes difficult to determine. Although it is unusual, pain may occur due to apical fenestrations following endodontic treatment. If this occurs, the solution is surgical intervention. This surgical procedure consists of raising a flap to expose the fenestration, followed by curettage of any overextended canal filling materials that may be potentially irritating to the underlying mucosa, remodeling of the apex, and its repositioning below the level of the cortical bone. A case is described that illustrates this clinical situation. The case also demonstrates information that can be obtained from tomodensitometric films.

Mechanics of interstitial-lymphatic fluid transport: theoretical foundation and experimental validation

Interstitial fluid movement is intrinsically linked to lymphatic drainage. However, their relationship is poorly understood, and associated pathologies are mostly untreatable. In this work we test the hypothesis that bulk tissue fluid movement can be evaluated in situ and described by a linear biphasic theory which integrates the regulatory function of the lymphatics with the mechanical stresses of the tissue. To accomplish this, we develop a novel experimental and theoretical model using the skin of the mouse tail. We then use the model to demonstrate how interstitial-lymphatic fluid movement depends on a balance between the elasticity, hydraulic conductivity, and lymphatic conductance as well as to demonstrate how chronic swelling (edema) alters the equipoise between tissue fluid balance parameters. Specifically, tissue fluid equilibrium is perturbed with a continuous interstitial infusion of saline into the tip of the tail. The resulting gradients in tissue stress are measured in terms of interstitial fluid pressure using a servo-null system. These measurements are then fit to the theory to provide in vivo estimates of the tissue hydraulic conductivity, elastic modulus, and overall resistance to lymphatic drainage. Additional experiments are performed on edematous tails to show that although chronic swelling causes an increase in the hydraulic conductivity, its greatly increased distensibility (due to matrix remodeling) dampens the driving forces for fluid movement and leads to fluid stagnation. This model is useful for examining potential treatments for edema and lymphatic disorders as well as substances which may alter tissue fluid balance and/or lymphatic drainage.

Tumor-host interactions in the gallbladder suppress distal angiogenesis and tumor growth: involvement of transforming growth factor beta1

Angiogenesis inhibitors produced by a primary tumor can create a systemic anti-angiogenic environment and maintain metastatic tumor cells in a state of dormancy. We show here that the gallbladder microenvironment modulates the production of transforming growth factor (TGF)-beta1, a multifunctional cytokine that functions as an endogenous anti-angiogenic and anti-tumor factor in a cranial window preparation. We found that a wide variety of human gallbladder tumors express TGF-beta1 irrespective of histologic type. We implanted a gel impregnated with basic fibroblast growth factor or Mz-ChA-2 tumor in the cranial windows of mice without tumors or mice with subcutaneous or gallbladder tumors to study angiogenesis and tumor growth at a secondary site. Angiogenesis, leukocyte-endothelial interaction in vessels and tumor growth in the cranial window were substantially inhibited in mice with gallbladder tumors. The concentration of TGF-beta1 in the plasma of mice with gallbladder tumors was 300% higher than that in the plasma of mice without tumors or with subcutaneous tumors. In contrast, there was no difference in the plasma levels of other anti- and pro-angiogenic factors. Treatment with neutralizing antibody against TGF-beta1 reversed both angiogenesis suppression and inhibition of leukocyte rolling induced by gallbladder tumors. TGF-beta1 also inhibited Mz-ChA-2 tumor cell proliferation. Our results indicate that the production of anti-angiogenesis/proliferation factors is regulated by tumor-host interactions.

Taxane-induced apoptosis decompresses blood vessels and lowers interstitial fluid pressure in solid tumors: clinical implications

Elevated tumor interstitial fluid pressure (IFP) is partly responsible for the poor penetration and distribution of therapeutic agents in solid tumors. The etiology of tumor interstitial hypertension is poorly understood. We have postulated that the solid stress generated by tumor cells growing in a confined space compresses blood vessels and increases tumor microvascular pressure and IFP. To test the hypothesis that neoplastic cell loss would decompress blood vessels and lower IFP, we induced apoptosis in tumors with paclitaxel and docetaxel. Taxanes inhibited the growth of the murine mammary carcinoma (MCa-IV) and of the human soft tissue sarcoma (HSTS-26T). Taxanes induced apoptosis and reduced the density of intact neoplastic cells in both MCa-IV and HSTS-26T. To determine whether neoplastic cell loss decompressed blood vessels, we measured the diameter of tumor vessels in HSTS-26T tumors implanted in transparent dorsal skin fold chambers. At 48 and 96 h after paclitaxel, the diameter of tumor vessels was significantly increased. The increase in vascular diameters was associated with reductions in microvascular pressure and IFP. The changes in neoplastic cell density and IFP were also correlated. In the human glioblastoma U87, which is resistant to paclitaxel, the IFP and cellular density were not modified by paclitaxel treatment. Collectively, these results support the hypothesis that solid stress generated by neoplastic cell proliferation increases vascular resistance and IFP. The increase in vessel diameter induced by paclitaxel and docetaxel suggests that taxanes could improve tumor response by increasing the vascular surface area for delivery of therapeutic agents.

The control of haemorrhage at the operative site during periradicular surgery

CLINICAL TECHNIQUE: Effective apical sealing in endodontic surgery requires a dry root-end cavity to insert the filling material. A number of procedures for controlling haemorrhage have been described in the literature. An improvement of these techniques is proposed in this paper: by using a mixture of surgical wax and fibres of calcium alginate. This device, easy to place, sterile and non-toxic, permits placement of a root-end filling under more favourable conditions.

Enhancement of fluid filtration across tumor vessels: implication for delivery of macromolecules

Cancer therapies using genes and other macromolecules might realize their full clinical potential if they could be delivered to tumor tissue in optimal quantities. Unfortunately, the compromised circulation within tumors poses a formidable resistance to adequate and uniform penetration of these agents. Previously, we have proposed elevated interstitial fluid pressure (IFP) as a major physiological barrier to delivery of macromolecules. Here we postulate that modulation of tumor microvascular pressure (MVP) and associated changes in IFP would enhance macromolecular delivery into a solid tumor. To test our hypothesis, we altered tumor MVP by either periodic injection or continuous infusion of angiotensin II (AII) and measured the resulting changes in IFP and uptake of macromolecules. We used the nicotinyl hydrazine derivative of human polyclonal IgG (HYNIC-IgG) as a nonspecific macromolecule and CC49 antibody as a specific macromolecule. We found that both chronic and periodic modulation of tumor MVP enhances transvascular fluid filtration, leading to a 40% increase in total uptake of the specific antibody within 4 hr of its administration. Conversely, neither continuous nor periodic infusion of AII induced any increase in uptake of nonspecific antibodies. Strategies to improve delivery of macromolecules and limitations of this approach are identified.

Intratumoral infusion of fluid: estimation of hydraulic conductivity and implications for the delivery of therapeutic agents

We have developed a new technique to measure in vivo tumour tissue fluid transport parameters (hydraulic conductivity and compliance) that influence the systemic and intratumoral delivery of therapeutic agents. An infusion needle approximating a point source was constructed to produce a radially symmetrical fluid source in the centre of human tumours in immunodeficient mice. At constant flow, the pressure gradient generated in the tumour by the infusion of fluid (Evans blue-albumin in saline) was measured as a function of the radial position with micropipettes connected to a servo-null system. To evaluate whether the fluid infused was reabsorbed by blood vessels, infusions were also performed after circulatory arrest. In the colon adenocarcinoma LS174T with a spherically symmetrical distribution of Evans blue-albumin, the median hydraulic conductivity in vivo and after circulatory arrest at a flow rate of 0.1 microl min(-1) was, respectively, 1.7x10(-7) and 2.3x10(-7) cm2 mmHg(-1) s. Compliance estimates were 35 microl mmHg(-1) in vivo, and 100 microl mmHg(-1) after circulatory arrest. In the sarcoma HSTS 26T, hydraulic conductivity and compliance were not calculated because of the asymmetric distribution of the fluid infused. The technique will be helpful in identifying strategies to improve the intratumoral and systemic delivery of gene targeting vectors and other therapeutic agents.

A photoelastimetric analysis of stress induced by root-end resection

The aim of this study was to place into perspective some factors that played an important role in the healing of periapical lesions after surgical endodontic procedures. Root-ends were sectioned at different angulations on models and analyzed by photoelastimetry. Results showed that a section of the root-end through a plane perpendicular to the long axis of the tooth offers a better distribution of the stresses exerted on the apical region that the use of an inclined plane. The biological implications of these results have led the authors to propose a plan of resection that is perpendicular to the long axis of the tooth instead of the inclined plane commonly used.

A teaching model for endodontic surgery

It is often difficult to achieve realistic simulation in teaching endodontic surgery. There is relatively little material available to students other than animal tissue or human cadavers. We propose a working model for the teaching of this discipline, constructed from casts of a natural skull which reproduce anatomical features such as gingiva, maxillary sinus, or mandibular canal, for example. This model, made of polyurethane resin containing mineral particles, which closely simulates the radiological and tactile differences of the relative densities of spongy bone, cortical bone and teeth, permits close simulation of the conditions under which endodontic surgery may be performed.

Surgical treatment of a lateroradicular lesion on an invaginated lateral incisor (dens in dente)

The complex anatomy of invaginated teeth makes their endodontic treatment difficult. The case described here reports the successful management of an invaginated tooth presenting with a lateroradicular lesion. After the root was surgically exposed and the radicular defect was cleaned, gutta percha was sealed with a zinc oxide eugenol cement, heat-compacted under 5 degrees, and then cold-burnished. The osseous cavity was filled with Biocorail. Radiographs at 1 month and 5 years show periapical healing with osseous formation. This procedure, resulting in minimal loss of hard tissues, permitted retention of the tooth.

Surgical treatment of a periradicular lesion on an invaginated maxillary lateral incisor (dens in dente)

The complex anatomy of invaginated teeth make their root canal treatment difficult. Moreover, this treatment may compromise the future of the tooth if it is destined to support a post-retained coronal restoration. This case reports the successful surgical root canal treatment of an invaginated tooth using a retrograde filling with gutta-percha. After surgical exposure of the root-end and cleaning of the root canal, the gutta-percha was compacted in the root canal which had been coated previously with a zinc oxide-eugenol cement. The gutta-percha was then cold-burnished. Periapical radiographic examination after 1, 2, 3, 6 and 12 months showed periapical healing with osseous formation. This procedure, resulting in minimal loss of hard tissues, permitted subsequent restoration of the tooth.