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Silva PGDB, Neto RADLP, Lima LA, Lemos JVM, Rodrigues MIDQ, Alves APNN, Dantas TS, Lima RA. Photodynamic therapy and photobiomodulation therapy in zoledronic acid-induced osteonecrosis in rats. Photodiagnosis Photodyn Ther 2022; 38:102889. [PMID: 35489689 DOI: 10.1016/j.pdpdt.2022.102889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/07/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study investigated the effect of antimicrobial photodynamic therapy (PDT), using methylene blue (MBO) and photobiomodulation therapy (PT), on the alveolar bone of rats submitted to bisphosphonate-induced osteonecrosis of the maxillaries (OMB) model using zoledronic acid (ZA). METHODS Sixty rats divided into six groups were used: SALINE, PDT, ZA, ZA+PDT, ZA+PT, and ZA+MBO. Three weekly administrations (Days 0, 7, and 14) of ZA 0.20 mg/kg or saline solution were performed. After one month (Day 42), the exodontia of the left lower first molars were performed. An additional dose of ZA was administered at Day 49. PDT was performed on days 42, 45, 49, and 54. One month after exodontia (Day 70), the animals were euthanized to obtain samples for imaging and microscopic analysis. ANOVA/Bonferroni tests were used for statistical analysis. RESULTS The ZA+PDT group showed a significantly lower percentage of apoptotic osteocytes than the ZA group (p<0.001). The ZA+MBO, ZA+PT, and PDT groups significantly reduced the number of mononuclear cells compared to the ZA group (p<0.001). The ZA+PT and ZA+PDT groups showed a significant reduction in the number of CD 68+ (p<0.001) and CD3+ (p=0.002) cells compared to the ZA group. The number of cells expressing INF-y had a significant reduction in the groups co-treated with PT and PDT compared to the ZA group (p<0.001). CONCLUSIONS We conclude that PDT and PT attenuated the severity of OMB and the inflammatory process due to a reduction of macrophages, T lymphocytes, and cytokines that stimulate the activity of these cells.
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Affiliation(s)
- Paulo Goberlânio de Barros Silva
- Department of Dentistry, Laboratory of Oral Pathology, Unichristus, Fortaleza, Ceará, Brazil; Department of Clinical Dentistry, Division of Oral Pathology, School of Pharmacy, Dentistry and Nursing, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | | | - Laís Aragão Lima
- Department of Dentistry, Laboratory of Oral Pathology, Unichristus, Fortaleza, Ceará, Brazil; Department of Clinical Dentistry, Division of Oral Pathology, School of Pharmacy, Dentistry and Nursing, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - José Vitor Mota Lemos
- Department of Dentistry, Laboratory of Oral Pathology, Unichristus, Fortaleza, Ceará, Brazil; Department of Clinical Dentistry, Division of Oral Pathology, School of Pharmacy, Dentistry and Nursing, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Maria Imaculada De Queiroz Rodrigues
- Department of Clinical Dentistry, Division of Oral Pathology, School of Pharmacy, Dentistry and Nursing, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Ana Paula Negreiros Nunes Alves
- Department of Clinical Dentistry, Division of Oral Pathology, School of Pharmacy, Dentistry and Nursing, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Thinali Sousa Dantas
- Department of Dentistry, Laboratory of Oral Pathology, Unichristus, Fortaleza, Ceará, Brazil; Department of Clinical Dentistry, Division of Oral Pathology, School of Pharmacy, Dentistry and Nursing, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Ramille Araújo Lima
- Department of Dentistry, Laboratory of Oral Pathology, Unichristus, Fortaleza, Ceará, Brazil.
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Aguirre JI, Castillo EJ, Kimmel DB. Preclinical models of medication-related osteonecrosis of the jaw (MRONJ). Bone 2021; 153:116184. [PMID: 34520898 PMCID: PMC8743993 DOI: 10.1016/j.bone.2021.116184] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/15/2021] [Accepted: 09/07/2021] [Indexed: 01/20/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe adverse event affecting patients with cancer and patients with osteoporosis who have been treated with powerful antiresorptives (pARs) or angiogenesis inhibitors (AgIs). pARs, including nitrogen-containing bisphosphonates (N-BPs; e.g., zoledronic acid, alendronate) and anti-RANKL antibodies (e.g., denosumab), are used to manage bone metastases in patients with cancer or to prevent fragility fractures in patients with osteoporosis. Though significant advances have been made in understanding MRONJ, its pathophysiology is still not fully elucidated. Multiple species have been used in preclinical MRONJ research, including the rat, mouse, rice rat, rabbit, dog, sheep, and pig. Animal research has contributed immensely to advancing the MRONJ field, particularly, but not limited to, in developing models and investigating risk factors that were first observed in humans. MRONJ models have been developed using clinically relevant doses of systemic risk factors, like N-BPs, anti-RANKL antibodies, or AgIs. Specific local oral risk factors first noted in humans, including tooth extraction and inflammatory dental disease (e.g., periodontitis, periapical infection, etc.), were then added. Research in rodents, particularly the rat, and, to some extent, the mouse, across multiple laboratories, has contributed to establishing multiple relevant and complementary preclinical models. Models in larger species produced accurate clinical and histopathologic outcomes suggesting a potential role for confirming specific crucial findings from rodent research. We view the current state of animal models for MRONJ as good. The rodent models are now reliable enough to produce large numbers of MRONJ cases that could be applied in experiments testing treatment modalities. The course of MRONJ, including stage 0 MRONJ, is characterized well enough that basic studies of the molecular or enzyme-level findings in different MRONJ stages are possible. This review provides a current overview of the existing models of MRONJ, their more significant features and findings, and important instances of their application in preclinical research.
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Affiliation(s)
- J I Aguirre
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - E J Castillo
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - D B Kimmel
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America
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Isaias PHC, Silva PGDB, do Nascimento IV, Verde MEQL, Moreira MDS, Alves APNN, Sousa FB, Pereira KMA, Mota MRL. Effect of continuous and intermittent sodium alendronate oral dosing on post-extraction alveoli healing in rats. Arch Oral Biol 2021; 132:105291. [PMID: 34700193 DOI: 10.1016/j.archoralbio.2021.105291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/06/2021] [Accepted: 10/13/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This study aimed to compare alveolar healing after tooth extraction in two experimental rat models using continuous or discontinuous dosing of sodium alendronate (ALN). DESIGN Forty-eight male Wistar rats were divided into eight experimental groups (n = 6/group) and administered ALN (2.5, 5.0, or 7.5 mg/kg) by gavage, weekly, either intermittently or following a continuous regimen (2.5, 5.0, or 7.5 mg/kg) before tooth extraction. The positive control rats were administered zoledronic acid (ZA; 0.2 mg/kg, intravenous), whereas negative control rats received sterile saline (0.9% NaCl, gavage). RESULTS Only the ZA-treated animals showed a larger radiolucent extraction site area compared to the saline group (p = 0.007). Small areas of bone tissue filling the alveoli were visualized in the 7.5 mg/kg continuous ALN group and compared with the saline group (p < 0.001). Increased amounts of empty osteocyte lacunae (p < 0.001) and osteoclasts with signs of apoptosis (p = 0.004) were observed in the continuous ALN groups (2.5, 5.0, and 7.5 mg/kg) compared with the saline group. Increased immunolabeling for TNF-α was observed in the 7.5 mg/kg discontinuous ALN group and all continuous ALN groups compared with the saline group (p < 0.001). The number of tartrate-resistant acid phosphatase (TRAP)-positive osteoclasts was higher in the two continuous ALN groups (5.0 and 7.5 mg/kg) than in the saline group (p < 0.001). CONCLUSIONS Continuous administration of ALN impaired post-extraction alveolar bone healing in rats; however, discontinuation of ALN administration before tooth extraction allowed for adequate post-dental extraction alveolar healing.
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Affiliation(s)
- Pedro Henrique Chaves Isaias
- Department of Dental Clinic, Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil.
| | - Paulo Goberlânio de Barros Silva
- Department of Dental Clinic, Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil; Ceará Oncology School, Ceará Cancer Institute, Hospital Haroldo Juaçaba, Fortaleza, Ceará, Brazil.
| | - Isabelly Vidal do Nascimento
- Department of Dental Clinic, Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil.
| | - Maria Elisa Quezado Lima Verde
- Department of Dental Clinic, Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil.
| | - Manuela da Silva Moreira
- Department of Dental Clinic, Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil.
| | - Ana Paula Negreiros Nunes Alves
- Department of Dental Clinic, Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil.
| | - Fabrício Bitu Sousa
- Department of Dental Clinic, Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil.
| | - Karuza Maria Alves Pereira
- Department of Dental Clinic, Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Morphology, School Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil.
| | - Mário Rogério Lima Mota
- Department of Dental Clinic, Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil.
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Preidl RHM, Amann K, Weber M, Schiller M, Ringler M, Ries J, Neukam FW, Kesting M, Geppert CI, Wehrhan F. Lineage-associated connexin 43 expression in bisphosphonate-exposed rat bones. J Craniomaxillofac Surg 2021; 49:738-747. [PMID: 33642117 DOI: 10.1016/j.jcms.2021.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 11/19/2020] [Accepted: 02/14/2021] [Indexed: 10/22/2022] Open
Abstract
Expression of signaling proteins in bone cells depends on their embryological mesoderm-derived (e.g. tibia) or cranial neural crest (CNC)-derived (e.g. jaw) origin. Connexin 43 (Cx43) is a gap junction protein that plays an essential role in the mode of action of bisphosphonates (BP). This study aimed to investigate Cx43 expression and the influence of BP application on mesoderm- and CNC-derived bone. Using a rat model, molar extraction and tibia osteotomy with (Group 4) or without (Group 3) previous BP application was performed. Untreated (Group 1) and animals selectively treated with BPs (Group 2) served as controls. Cx43 expression was immunohistochemically determined 12 and 16 weeks postoperatively via a labeling index. Cx43 expression in CNC-derived bone was significantly higher compared with mesodermal bone. BP application decreased Cx43 expression; however, detected expression levels were still higher in jawbone (Group 2 tibia vs jaw: 5.83 ± 5.06 vs 23.52 ± 6.42; p = 0.007). During bone healing after surgical intervention (Group 3) there were no expression differences between tibia and jawbone. BP treatment prior to surgery resulted in significantly lower Cx43 expression in CNC-derived compared with tibia bone (Group 4 tibia vs jaw: 56.84 ± 15.57 vs 16.40 ± 5.66; p < 0.01). Increased Cx43 expression in jaw compared with tibia bone is in line with their embryological origins. A significant Cx43 suppression in jawbone after BP application and surgery might contribute to the selectively altered osseous turnover and development of MRONJ in CNC-derived bone.
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Affiliation(s)
- Raimund H M Preidl
- Resident, Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glückstraße 11, 91056, Erlangen, Germany.
| | - Kerstin Amann
- Head of Nephropathology, University of Erlangen-Nuremberg, Glückstraße 11, 91056, Erlangen, Germany
| | - Manuel Weber
- Resident, Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glückstraße 11, 91056, Erlangen, Germany
| | - Martin Schiller
- Doctoral Students, Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glückstraße 11, 91056, Erlangen, Germany
| | - Manuela Ringler
- Doctoral Students, Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glückstraße 11, 91056, Erlangen, Germany
| | - Jutta Ries
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glückstraße 11, 91056, Erlangen, Germany
| | - Friedrich W Neukam
- Former Head of Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glückstraße 11, 91056, Erlangen, Germany
| | - Marco Kesting
- Head of Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glückstraße 11, 91056, Erlangen, Germany
| | - Carol-Immanuel Geppert
- Specialist in Pathology, University of Erlangen-Nuremberg, Glückstraße 11, 91056, Erlangen, Germany
| | - Falk Wehrhan
- Specialist in Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glückstraße 11, 91056, Erlangen, Germany
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Mergoni G, Vescovi P, Passerini P, Maestri R, Corradi D, Sala R, Govoni P. Effects of zoledronic acid and dexamethasone on early phases of socket healing after tooth extraction in rats: A preliminary macroscopic and microscopic quantitative study. Med Oral Patol Oral Cir Bucal 2019; 24:e339-e345. [PMID: 31011145 PMCID: PMC6530960 DOI: 10.4317/medoral.22883] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/22/2019] [Indexed: 01/11/2023] Open
Abstract
Background The exact pathogenesis of medication-related osteonecrosis of the jaw (MRONJ) is still unknown. The aim of this paper was to investigate the effects of zoledronic acid and dexamethasone on the early phases of socket healing in rats subjected to tooth extractions. Material and Methods Thirty male Sprague-Dawley rats were divided into 2 groups: pharmacologically treated group (T, n=20) and non-pharmacologically treated group (C, n=10). T group rats received 0.1 mg/Kg of zoledronic acid (ZOL) and 1 mg/Kg of dexamethasone (DEX) three times a week for 10 consecutive weeks. C group rats were infused with vehicle. After 9 weeks from the first infusion, first maxillary molars were extracted in each of the rats. Quantitative macroscopic and microscopic analysis was performed to evaluate socket healing 8 days after extraction. Results Pharmacologically treated rats showed significant inhibition of bone remodeling. Connective tissue/alveolar bone ratio, osteoclast number and woven bone deposition were significantly reduced in group T compared to group C. Conversely, the proportion of necrotic bone was higher in group T compared to group C (0.8% and 0.3%, respectively. P=0.031). ZOL plus DEX do not cause gross effects on socket healing at a macroscopic level. Conclusions Our findings confirmed that exposure to ZOL plus DEX impairs alveolar wound repair. Inhibition of osteoclastic resorption of socket walls after tooth extraction and the inability to dispose of the necrotic bone may be considered the initial steps of MRONJ onset. Key words:Medication-related osteonecrosis of the jaw, zoledronic acid, dexamethasone, tooth extraction, rat.
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Affiliation(s)
- G Mergoni
- Centro Universitario di Odontoiatria Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy Via Gramsci 14, Parma, Italy, 43100,
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