Possible implications of Ni(II) on oral IL-1β-induced inflammatory processes

Use of liquid-based cytology samples reveals genomic instability and cell death in patients undergoing orthodontic treatment

PURPOSE

To examine the use of liquid-based exfoliative cytology to determine the presence of genomic instability and cell death in the oral mucosa of patients with orthodontic appliances.

METHODS

Fifty-four oral mucosa samples were collected from 18 patients and divided into three stages: T0, before fixation of orthodontic appliances; T1, 25 days after appliance fixation; T2, 90 days after appliance fixation. All samples were Papanicolaou-stained and observed by microscopy (1,000 cells/sample) to ascertain the frequency of micronucleated cells (MN) and nuclear abnormalities (nuclear buds (NB), binucleated (BN), condensed chromatin (CC), karyorrhexis (KR), and karyolysis (KL)). Differences were analyzed statistically using the Mann-Whitney, Wilcoxon, Kruskal-Wallis and chi-squared tests.

RESULTS

After placement of orthodontic appliances, significant differences were observed for genomic instability biomarkers (MN and NB) and cell death (CC, KR and KL) (P < 0.05). Female patients and older patients exhibited a higher frequency of MN.

CONCLUSION

Liquid-based cytology has revealed that orthodontic appliances induce genomic instability and cell death in epithelial tissue of the oral mucosa, facilitating sample preservation and yielding more than one preparation per sample. Future studies should investigate whether such cell damage can be reversed through cell repair or whether cell alterations evolve and lead to disease.

In Vitro Ion Release of Wires in Removable Orthodontic Appliances

Various orthodontic wire compositions and configurations are present on the market for removable appliances; however, there have still been only few studies focusing on the effect of resin color and additives such as glitter on corrosion of metallic wires under different conditions. Thus, the aim of the study was to compare concentrations of released ions (aluminium, chromium, nickel) in a corrosive medium under three different conditions: non-loaded wires, loaded wires, and non-loaded wires treated with Kukis^® cleaning tablets. Six different wires made of three types of steel alloy were embedded in PMMA resin leaving one centimetre of each wire emerging from the resin to come into contact with the corrosive medium. Glitter particles were added to half of the produced test specimens. For the unloaded test series, five specimens of each group were covered in a petri dish with 50 mL of corrosive medium (pH 2.3) following EN-ISO 10271 for seven days at 37 °C. The wires for the mechanically loaded test specimens overlapped the resin by 5 cm and were clamped into a time-switched electric drive for a defined period of time before the samples were taken after a testing time of 7 days. In the third group, unloaded test specimens were transferred from their petri dishes into the prepared Kukis^® solution every 24 h before being stored in the corrosive medium. Inductively coupled plasma mass spectrometry (ICP-MS) was used to quantify the specific ions in the corrosive solution. Statistical analysis showed that the mechanical loading of all wires could significantly raise the diffusion of ions into the corrosive medium. The colour of the resin did not affect the concentration of the released ions. The Kukis^® cleaning tabs could not lower the corrosion of the tested metals, as some of the wires were corroded even more using the brace cleanser. Glitter-containing test specimens showed significantly higher amounts of aluminium. Mechanical loading as well as the presence of glitter particles in the resin significantly affected ion concentrations.

Identification of the Potential Biomarkers Involved in the Human Oral Mucosal Wound Healing: A Bioinformatic Study

Objective. To identify the key genetic and epigenetic mechanisms involved in the wound healing process after injury of the oral mucosa. Materials and Methods. Gene expression profiling datasets pertaining to rapid wound healing of oral mucosa were identified using the Gene Expression Omnibus (GEO) database. Differential gene expression analysis was performed to identify differentially expressed genes (DEGs) during oral mucosal wound healing. Next, functional enrichment analysis was performed to identify the biological processes (BPs) and signaling pathways relevant to these DEGs. A protein-protein interaction (PPI) network was constructed to identify hub DEGs. Interaction networks were constructed for both miRNA-target DEGs and DEGs-transcription factors. A DEGs-chemical compound interaction network and a miRNA-small molecular interaction network were also constructed. Results. DEGs were found significantly enriched in several signaling pathways including arachidonic acid metabolism, cell cycle, p53, and ECM-receptor interaction. Hub genes, GABARAPL1, GABARAPL2, HDAC5, MAP1LC3A, AURKA, and PLK1, were identified via PPI network analysis. Two miRNAs, miR-34a-5p and miR-335-5p, were identified as pivotal players in the miRNA-target DEGs network. Four transcription factors FOS, PLAU, BCL6, and RORA were found to play key roles in the TFs-DEGs interaction network. Several chemical compounds including Valproic acid, Doxorubicin, Nickel, and tretinoin and small molecular drugs including atorvastatin, 17β-estradiol, curcumin, and vitamin D3 were noted to influence oral mucosa regeneration by regulating the expression of healing-associated DEGs/miRNAs. Conclusion. Genetic and epigenetic mechanisms and specific drugs were identified as significant molecular mechanisms and entities relevant to oral mucosal healing. These may be valuable potential targets for experimental research.

Evaluation of the release of nickel and titanium under orthodontic treatment

The metal alloys used in dentistry are made mainly of nickel (Ni), titanium (Ti), and other elements such as molybdenum (Mo), zirconium (Zr), iron (Fe), tin (Sn), chrome (Cr), carbon (C), copper (Cu) and niobium (Nb) which can release metal ions in unstable environments. The aim of this work was determine the salivary pH before and during orthodontic treatment; evaluate the release of metal ions, mainly Ni and Ti, in urine and saliva using Inductively Coupled Plasma Optical Emission Spectroscopy (ICP-OES); and evaluate the corrosion using Scanning Electronic Microscopy (SEM). In this study, we selected 35 individuals under orthodontic treatment, from whom saliva and urine samples were collected in 3 stages: (a) basal, (b) at 3 and (c) 6 months after the placement of the fixed appliances. SEM analyzed the Ni-Ti (0.016″) and stainless steel (SS) (0.016 × 0.022″) archs after 1 month of being in contact with the oral cavity. Statistical analysis was performed with Stata using the ANOVA model of repeated measures with a p < 0.05. A statistically significant difference in the concentration of Ni in saliva were found between 3 and 6 months of intervention and Ti in urine was found 3 and 6 months.

Quantification of matrix metalloproteinases MMP-8 and MMP-9 in gingival overgrowth

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Protein dot-blot method is suitable to compare expression levels of MMP-8 and MMP-9 in gums.

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The relative levels of MMP-8 and MMP-9 in mild and moderate gingival overgrowth were measured.

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Biological variability among individuals did not affect assay development.

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The protein dot blot was fast, highly sensitive, repeatable and economic.

Background

Matrix metalloproteinases (MMPs) are proteolytic enzymes involved in extracellular matrix remodeling of all body tissues, including oral tissues such as gingival tissue. Expression levels of MMPs are widely studied as important biomarkers for explaining the biochemical mechanisms and evolution of many oral diseases.

Objective

Demonstrate the sensitivity, reproducibility, repeatability, and robustness of the dot blot assay for the relative quantification of MMP-8 and MMP-9 expression levels in patients with GO associated with orthodontic treatment.

Methods

A validated dot blot assay was used to compare the relative expression levels of MMP-8 and MMP-9 in gingival samples. Methodological variability, reproducibility, sensitivity and robustness were determined with the use of control samples from healthy donors (G1). Next, expression levels were measured in gingival tissue from patients with mild and moderate gingival overgrowth associated with orthodontic treatment (G3 and G4) and patients without gingival overgrowth but with a history of using orthodontic appliances (G2).

Results

Dot blot assay demonstrated that MMP-8 and MMP-9 expression levels were higher in patients with gingival overgrowth and distinguished those with moderate clinical grade (G4) from those with mild overgrowth (G3). In addition, patients with a history of orthodontic treatment showed similar expression levels to the control group two years after removing orthodontic appliances.

Conclusions

With the assay used, we were able to detect differences in MMP-8 and MMP-9 expression in patients with different levels of severity of gingival overgrowth. Dot blot could be used to measure MMPs during the onset and progression of gingival overgrowth.

Predicting patient exposure to nickel released from cardiovascular devices using multi-scale modeling

Many cardiovascular device alloys contain nickel, which if released in sufficient quantities, can lead to adverse health effects. However, in-vivo nickel release from implanted devices and subsequent biodistribution of nickel ions to local tissues and systemic circulation are not well understood. To address this uncertainty, we have developed a multi-scale (material, tissue, and system) biokinetic model. The model links nickel release from an implanted cardiovascular device to concentrations in peri-implant tissue, as well as in serum and urine, which can be readily monitored. The model was parameterized for a specific cardiovascular implant, nitinol septal occluders, using in-vitro nickel release test results, studies of ex-vivo uptake into heart tissue, and in-vivo and clinical measurements from the literature. Our results show that the model accurately predicts nickel concentrations in peri-implant tissue in an animal model and in serum and urine of septal occluder patients. The congruity of the model with these data suggests it may provide useful insight to establish nickel exposure limits and interpret biomonitoring data. Finally, we use the model to predict local and systemic nickel exposure due to passive release from nitinol devices produced using a wide range of manufacturing processes, as well as general relationships between release rate and exposure. These relationships suggest that peri-implant tissue and serum levels of nickel will remain below 5 μg/g and 10 μg/l, respectively, in patients who have received implanted nitinol cardiovascular devices provided the rate of nickel release per device surface area does not exceed 0.074 μg/(cm² d) and is less than 32 μg/d in total.

STATEMENT OF SIGNIFICANCE

The uncertainty in whether in-vitro tests used to evaluate metal ion release from medical products are representative of clinical environments is one of the largest roadblocks to establishing the associated patient risk. We have developed and validated a multi-scale biokinetic model linking nickel release from cardiovascular devices in-vivo to both peri-implant and systemic levels. By providing clinically relevant exposure estimates, the model vastly improves the evaluation of risk posed to patients by the nickel contained within these devices. Our model is the first to address the potential for local and systemic metal ion exposure due to a medical device and can serve as a basis for future efforts aimed at other metal ions and biomedical products.

Nickel-free vs conventional braces for patients allergic to nickel: Gingival and blood parameters during and after treatment

INTRODUCTION

Allergic and inflammatory reactions have commonly been associated with the release of metal ions during orthodontic treatment. Our objective was to evaluate prospectively gingival and blood status in patients allergic to nickel.

METHODS

Allergy to nickel was diagnosed using a patch test. Two groups were established: conventional braces (n = 21) and nickel-free braces (n = 21). The gingival index was used to determine gingival status before treatment, periodically for 12 months (evaluations every 3 months), and 1 month after the removal of the braces. Blood status was evaluated with a complete blood count, including the quantification of nickel and immunoglobin E before treatment, during treatment, and 1 month after removal of the braces. The data were analyzed using Mann-Whitney, Student t, Wilcoxon, repeated measures analysis of variance, Friedman, and chi-square tests. Either the Pearson or the Spearman correlation coefficients were calculated, when appropriate.

RESULTS

The number of basophils increased significantly among the evaluations in both groups (conventional, P = 0.002; nickel-free, P = 0.001), whereas the number of eosinophils and the immunoglobin E levels decreased significantly in the conventional group (P = 0.004). Plasma nickel levels were increased before and during treatment, and decreased 1 month after removing the braces in both groups, but the differences were significant only in the nickel-free group (P = 0.002). No correlations were found between the concentrations of nickel and immunoglobin E, basophils, or eosinophils, or between the gingival index and either bands or segmented neutrophils (P ≥ 0.05).

CONCLUSIONS

Patients treated with nickel-free braces had better gingival health and smaller blood changes than did those treated with conventional braces. All abnormalities tended to be eliminated after the removal of the braces.

Genome-wide transcriptome induced by nickel in human monocytes

Nickel-containing alloys are frequently used in the biomedical field, although, owing to corrosive processes metal ion leaching is inevitable. Due to nickel ion (Ni(2+)) leaching several adverse effects are described in the literature. However, only a few studies evaluated the genetic profile of Ni(2+) in human cells which is of great importance since nickel-induced effects differ between humans and mice as a result of species-specific receptor variability. Thus, we investigated gene expression induced by Ni(2+)in human monocytes using a transcriptome-wide approach determining new target genes implicated in nickel-induced pathologies. Monocytes were isolated from healthy volunteers of Central European origin using stringent inclusion criteria. Cells were challenged with different Ni(2+) concentrations. Array-based gene expression analysis was performed comprising more than 47,000 transcripts followed by pathway analyses. Transcriptional data were validated by protein and cell surface markers. Ni(2+) significantly influenced the expression of 1385 transcripts in a dose-dependent manner. Apart from known targets (CCL20↑, PTGS2↑, MTs↑, SLCs↑), we identified new candidates implicated in Ni(2+)-elicited processes (various microRNAs↑, INSIG1↑, NAMPT↑, MS4A6A↓, DHRS9↓). Several of these transcripts correspond to immunity, inflammation and were shown to be involved in cellular reactions related to hypersensitivity, cancer, colitis, and encephalitis. Moreover, 459 canonical pathways/signaling, 500 pathologies and 2687 upstream regulators were detected. Protein results validated our findings. To our knowledge, the present systematic transcriptome-wide expression study is the first which explored Ni(2+)-elicited cell responses in human primary monocytes identifying new target genes, pathways and upstream regulators of relevance to diagnostic and therapeutic strategies.

STATEMENT OF SIGNIFICANCE

Nickel is widely applied in the biomedical field, although several adverse effects are documented in the literature due to nickel ion (Ni(2+)) leaching. In humans, allergic reactions like contact dermatitis are the most common adverse effect to Ni(2+), whereas serious concerns relate to possible systemic and carcinogenic activities. Using a systematic genome-wide transcriptional approach in human primary monocytes unveil new target genes, pathways and upstream regulators implicated in nickel-elicited immune response which are of significance to diagnostic and therapeutic strategies. This approach provides new information of how host-derived immune response contributes to the interaction with antigens and supports the interplay between metal ions and systemic diseases.