Iloprost up-regulates vascular endothelial growth factor expression in human dental pulp cells in vitro and enhances pulpal blood flow in vivo

Regenerative endodontic therapy: From laboratory bench to clinical practice

BACKGROUND

Maintaining the vitality and functionality of dental pulp is paramount for tooth integrity, longevity, and homeostasis. Aiming to treat irreversible pulpitis and necrosis, there has been a paradigm shift from conventional root canal treatment towards regenerative endodontic therapy.

AIM OF REVIEW

This extensive and multipart review presents crucial laboratory and practical issues related to pulp-dentin complex regeneration aimed towards advancing clinical translation of regenerative endodontic therapy and enhancing human life quality.

KEY SCIENTIFIC CONCEPTS OF REVIEW

In this multipart review paper, we first present a panorama of emerging potential tissue engineering strategies for pulp-dentin complex regeneration from cell transplantation and cell homing perspectives, emphasizing the critical regenerative components of stem cells, biomaterials, and conducive microenvironments. Then, this review provides details about current clinically practiced pulp regenerative/reparative approaches, including direct pulp capping and root revascularization, with a specific focus on the remaining hurdles and bright prospects in developing such therapies. Next, special attention was devoted to discussing the innovative biomimetic perspectives opened in establishing functional tissues by employing exosomes and cell aggregates, which will benefit the clinical translation of dental pulp engineering protocols. Finally, we summarize careful consideration that should be given to basic research and clinical applications of regenerative endodontics. In particular, this review article highlights significant challenges associated with residual infection and inflammation and identifies future insightful directions in creating antibacterial and immunomodulatory microenvironments so that clinicians and researchers can comprehensively understand crucial clinical aspects of regenerative endodontic procedures.

Asiaticoside-Loaded Nanosponges Hydrogel Has an Anti-inflammatory Effect and Promotes Human Dental Pulp Regeneration

INTRODUCTION

Asiaticoside (AS) demonstrated potential in wound healing and anti-inflammation. However, its therapeutic applications are limited due to poor solubility and low bioavailability, which make it difficult to use as dental pulp capping agent. The nanosponges (Ns) are nanosized carriers capable of carrying small drug molecules. We proposed a method to encapsulate AS in Ns (asiaticoside-loaded nanosponges) and incorporate it into hydrogel (asiaticoside-loaded nanosponges hydrogel [AS/Ns-gel]).

METHODS

Using different concentrations of polymer and carbopol four different fractions of asiaticoside-loaded nanosponges (N1-N4) and AS/Ns-gel (G1-G4) were prepared. The optimal fraction was determined by characterizing physiochemical properties and in vitro release kinetics. An in vitro model of inflammatory human dental pulp cells (hDPCs) was induced using a cytokine cocktail and/or lipopolysaccharide prior to application of AS/Ns-gel. Messenger ribonucleic acid (mRNA) and protein expression of inflammatory cytokines were measured. To assess the wound healing potential of AS/Ns-gel, an in vitro scratch test was performed.

RESULTS

N1/G3 AS/Ns-gel exhibited the most optimized and uniform particle size distribution, with good solubility, sustained AS release, and effective encapsulation. In an in vitro study of hDPCs pretreated with lipopolysaccharide or cytokine cocktail, the AS/Ns-gel downregulated interleukin 6 and interleukin 8 mRNA expression while upregulating interleukin 10 expression. Reverse transcription quantitative polymerase chain reaction and western blot analysis revealed a time-dependent increase in transforming growth factor β1, collagen type 1 and matrix metalloproteinase 9 mRNA/protein levels. Additionally, AS/Ns-gel accelerated hDPCs migration.

CONCLUSIONS

We successfully developed an AS/Ns-gel that reduced the expression of inflammatory cytokines in an inflamed pulp model in vitro. AS-loaded hydrogels have sustained release properties, promote cell proliferation and cell migration, thus suggesting its potential to be used in regenerative endodontic therapy.

Anti-inflammatory effects of the prostacyclin analogue iloprost in an in vitro model of inflamed human dental pulp cells

Iloprost's anti-inflammatory effects on human dental pulp stem cells (HDPCs) are currently unknown. We hypothesized that iloprost could downregulate the expression of inflammatory-related genes and protein in an inflamed HDPC in vitro model. To induce inflammation, the HDPCs were treated with a cocktail of interleukin-1 beta, interferon-gamma, and tumour necrosis alpha, at a ratio of 1:10:100. Iloprost (10-6  M) was then added or not to the cultures. Interleukin-6 (IL-6) and interleukin-12 (IL-12) mRNA expression were assessed by real-time polymerase chain reaction. IL-6 protein expression was assessed by enzyme-linked immunosorbent assay. The results were analysed using one-way ANOVA or the Kruskal-Wallis test. The cytokine cocktail induced more robust IL-6 expression than LPS treatment. Iloprost slightly, yet significantly, downregulated IL-6 and IL-12 mRNA expression. These findings suggest that iloprost might be used as a beneficial component in vital pulp therapy.

Wnt3a promotes odonto/osteogenic differentiation in vitro and tertiary dentin formation in a rat model

AIM

To investigate the effect of Wnt3a on odonto/osteogenic differentiation of stem cells isolated from human exfoliated deciduous teeth (SHEDs) and reparative dentine formation in a rat model.

METHODOLOGY

Stem cells isolated from human exfoliated deciduous teeth were cultured in media with Wnt3a (50-200 ng/ml). Wnt activation was confirmed by β-catenin immunocytochemistry. Colony-forming unit assay (normalized percentage area), osteogenic gene expression analysis by real-time polymerase chain reaction and mineralization assays measured by the absorption at 540 nm were performed. Tertiary dentine formation in vivo was evaluated using 8-week-old, male Wistar rats. Cavities with pinpoint pulp exposure by a sharp instrument were prepared at the mesial surface of the first molars. Teeth were divided into (n = 6): (1) distilled water (negative control), (2) phosphate-buffered saline (PBS), (3) lithium chloride in DI (20 μM), and (4) Wnt3a in PBS (200 ng/ml). Collagen sponge was used as a scaffold. The cavity was sealed with glass ionomer restoration. Four weeks later, animals were euthanized by sodium pentobarbital (120 mg/kg body weight). Hard tissue formation was evaluated using micro-computerized tomography. Sixty consecutive slides from the initial plane were analysed and calculated as bone/dentine volume per total tissue volume. Paraffin sections (2 μm) were stained with haematoxylin and eosin and Masson's trichrome for morphological evaluation. Data are presented as the mean ± standard error. Mann-Whitney U test was used for two-group comparison. Kruskal Wallis followed by pairwise comparison was employed for three or more group comparisons. Statistical analysis was performed using GraphPad Prism 7. Differences were considered significant at p < .05.

RESULTS

Wnt3a decreased SHEDs colony formation and increased OSX, BMP2, and DMP1 expression, corresponding to an increase in mineralization. Additionally, a significant increase in dentine/bone volume per total tissue volume was observed in Wnt3a treated defects. Dentine bridge formation at the exposure sites treated with Wnt3a demonstrated, while fibrous tissues were observed in the control.

CONCLUSIONS

Wnt3a suppressed proliferation, increased osteogenic differentiation of SHEDs and promotes tertiary dentine formation. Wnt3a could be utilized as biological molecule for vital pulp therapy.

The prostacyclin analogue iloprost promotes cementum formation and collagen reattachment of replanted molars and upregulates mineralization by human periodontal ligament cells

OBJECTIVES

This study evaluated the use of the prostacyclin analogue, iloprost, as a root surface treatment agent in promoting acellular cementum(AC) formation and collagen reattachment following tooth replantation in vivo. In addition, its effect on human periodontal ligament cell(hPDLC) mineralization was assessed in vitro.

METHODS

First molars of 8-weeks-old Wistar rats were extracted. In one group, the root surfaces were treated with Hank's Balanced Salt Solution(HBSS) and the other group's root surfaces were treated with 10^-6 M iloprost before re-plantation. At day 30, maxillae were prepared for microCT and histomorphometric analysis. The effect of iloprost on mineralization by hPDLCs were analyzed by mineralized nodule formation and qPCR at 7 and 14 days.

RESULTS

MicroCT demonstrated a significant higher bone-volume in the iloprost-groups, whereas the HBSS-groups had extensive bone and root resorption. Histologic analysis revealed deposition of a thick AC layer along the root in iloprost-group with well-organized PDL fibers inserted into the cementum. The HBSS-group demonstrated more osteoclasts than the iloprost-group. In vitro, iloprost-treated hPDLCs had a significantly increased RUNX2, OSX, BSP, and ALP gene expression that coincided with an increased deposition of mineralized nodules. These effects were abrogated by a PGI₂-receptor inhibitor.

CONCLUSION

Our results revealed that iloprost promoted PDL regeneration in replanted molars. Furthermore, resorption of the roots was decreased, whereas AC deposition was stimulated. Iloprost-treatment increased hPDLC mineralization and was mediated by PGI₂-receptor activation. These observations indicate that iloprost may be a promising root surface treatment agent.

The additive effect of iloprost on the biological properties of Mineral trioxide aggregate on mesenchymal stem cells

Background/purpose

Iloprost has been proposed as a potential biomaterial owing to angiogenic and odontogenic properties. However, the liquid form can limit its use during clinical applications. Mineral trioxide aggregate (MTA) has been used for various dental applications in which cell–material interaction is essential. This study aimed to investigate additive effects of iloprost on the biological properties of MTA on the viability, attachment, migration and differentiation of human mesenchymal stem cells (hMSCs).

Materials and methods

Standardized human dentin disks were prepared. MTA was prepared by mixing distilled water or iloprost solution, and the lumen of the disks was filled with MTA or MTA-iloprost. hMSCs on disk alone and hMSCs on culture plates were used as controls. Cell viability and attachment were measured after 1, 7 and 14 days using AlamarBlue assay and scanning electron microscopy (SEM). Cell migration in MTA or MTA-iloprost extracts was determined using a wound-healing model.

Osteogenic differentiation was evaluated by real-time reverse transcriptase polymerase chain reaction for alkaline phosphatase (ALP), bone sialoprotein (BSP), osteocalcin (OCN), and osteopontin (OSP) gene expressions after 7 and 14 days of osteogenic induction.

Results

Cells on MTA-iloprost surface showed similar viability with MTA at 1 and 14 days but enhanced cellular viability and cell spreading compared to MTA at 7 days (p < 0.05). Cell migration was similar by MTA-iloprost and MTA extracts (p > 0.05). MTAiloprost significantly upregulated BSP, OCN and OSP expressions compared to MTA (p < 0.05).

Conclusion

The addition of iloprost to MTA improved the initial cell viability and osteogenic potential of hMSCs.

Pulpal Response to the Combined Use of Mineral Trioxide Aggregate and Iloprost for Direct Pulp Capping

Purpose: The present study aims to assess the combined effects of mineral trioxide aggregate (MTA) and iloprost when used as a pulp capping material on pulpal inflammation and tertiary dentin formation compared with MTA and iloprost alone in rat molar teeth. Methods: Eighty maxillary first molar rat teeth were exposed and capped with iloprost solution, MTA, or MTA mixed with iloprost (MTA-iloprost). The cavities were then filled with resin-modified glass ionomer. The cavity was restored with glass ionomer without the use of pulp capping agent in the control group. The rats were sacrificed after one and four weeks. Block sections of the molar specimens were prepared and subjected to hematoxylin and eosin staining for evaluation. Statistical analysis was done using the Kruskal–Wallis test, followed by Dunnett’s test. Results: At week one, the control group showed significantly more severe pulpal inflammatory reactions than the iloprost (p = 0.00), MTA (p = 0.04), and MTA-iloprost (p = 0.00) groups. Hard tissue formation was commonly found in the iloprost, MTA, and MTA-iloprost groups. After four weeks, pulpal tissue degeneration was observed in the control group. Complete hard tissue barriers were found in 50%, 72.7%, and 77.8% of the specimens in iloprost, MTA, and MTA-iloprost groups, respectively, with no significant differences among the experimental groups. The dentinal tubule patterns were mostly regular in the MTA-iloprost group and irregular in the iloprost and MTA groups. Conclusions: The application of iloprost, MTA, and MTA-iloprost as a pulp capping material resulted in similar pulpal responses in the mechanically exposed pulp of rat molars. Therefore, mixing MTA with iloprost might not be clinically significant.

Stem Cell-based Dental Pulp Regeneration: Insights From Signaling Pathways

Deep caries, trauma, and severe periodontitis result in pulpitis, pulp necrosis, and eventually pulp loss. However, no clinical therapy can regenerate lost pulp. A novel pulp regeneration strategy for clinical application is urgently needed. Signaling transduction plays an essential role in regulating the regenerative potentials of dental stem cells. Cytokines or growth factors, such as stromal cell-derived factor (SDF), fibroblast growth factor (FGF), bone morphogenetic protein (BMP), vascular endothelial growth factor (VEGF), WNT, can promote the migration, proliferation, odontogenic differentiation, pro-angiogenesis, and pro-neurogenesis potentials of dental stem cells respectively. Using the methods of signaling modulation including growth factors delivery, genetic modification, and physical stimulation has been applied in multiple preclinical studies of pulp regeneration based on cell transplantation or cell homing. Transplanting dental stem cells and growth factors encapsulated into scaffold regenerated vascularized pulp-like tissue in the root canal. Also, injecting a flowable scaffold only with chemokines recruited endogenous stem/progenitor cells for pulp regeneration. Notably, dental pulp regeneration has gradually developed into the clinical phase. These findings enlightened us on a novel strategy for structural and functional pulp regeneration through elaborate modulation of signaling transduction spatially and temporally via clinically applicable growth factors delivery. But challenges, such as the adverse effects of unphysiological signaling activation, the controlled drug release system, and the safety of gene modulation, are necessary to be tested in future works for promoting the clinical translation of pulp regeneration.

Exploring the molecular disorder and dysfunction mechanism of human dental pulp cells under hypoxia by comprehensive multivariate analysis

Dental pulp cells (DPCs) are multipotent cells, which can differentiate into various tissues and have the potential to treat many diseases. However, little is known about the molecular disorder mechanism. To explore the mechanism of molecular disorders and dysfunction of DPCs under hypoxia, we investigated the molecular effects of two hypoxic time lengths on DPCs. Differential analysis, protein interaction network (PPI), enrichment analysis and coupling analysis were further synthesized to identify human dental pulp cell dysfunction modules under hypoxic conditions. Based on the module aggregation of 579 genes, 13 dental pulp cell dysfunction modules were obtained. Importantly, we found that up to 12 modules were significantly involved in positive regulation of neurogenesis, positive regulation of nervous system development. Based on the predictive analysis of regulators, we identified a series of ncRNAs (including CRNDE, MALAT1, microRNA-140-5p, microRNA-300 and microRNA-30a-5p) and transcription factors (including E2F1). Based on the comprehensive functional module analysis, we identified the dysfunction module of human dental pulp cells (HDPCs) under hypoxia. The results suggest that nerve regulation plays an important role in regulating the dysfunction module of DPCs. These prominent pivotal regulators in the module were used as an important part of the molecular disorders of DPCs, may be an important part of the subnetwork of the manipulation module and affect the molecular dysregulation mechanism of DPCs. This study provides new directions and potential targets for further research.

Clinical and histopathological characterization of root resorption in replanted teeth: Two case reports

RATIONALE

The frequency of tooth avulsion is on the rise due to increasing rates of maxillofacial trauma. Avulsed teeth present with varying degrees of root resorption, and are generally asymptomatic; therefore, they often go undiagnosed. The etiopathogenesis of root resorption in replanted teeth following avulsion remains unclear.

PATIENT CONCERNS

In case 1, the left upper lateral incisor became loose after 10 years of replantation. In case 2, the patient underwent tooth replantation after external root canal treatment due to tooth dislocation caused by trauma 8 years ago.

DIAGNOSIS

According to the medical history, clinical manifestations and imaging studies of the 2 patients, root resorption after replantation was diagnosed.

INTERVENTIONS

The teeth extraction was given to one patient. Besides the histological examination of extracted teeth was performed.

OUTCOMES

Teeth that underwent pulp treatment presented with external resorption. On the other hand, the tooth that had received no pulp treatment showed both external and internal resorption; residual vital pulp tissue was detected within the pulp cavity.

LESSONS

The dental pulp tissues may be involved in the initiation or development of internal resorption. Trauma to the periodontal ligament might play a major role in external resorption, whereas internal tooth resorption may be caused as a result of injury to the residual pulp tissue. Thus, the effective management of these tissues during the treatment of replanted teeth is essential.

Iloprost Induces Dental Pulp Angiogenesis in a Growth Factor-free 3-Dimensional Organ Culture System

INTRODUCTION

Angiogenesis is a key determinant in dental pulp regeneration. Iloprost is a synthetic prostacyclin that promotes angiogenesis. A three-dimensional culture that mimics the in vivo condition has been used in tissue engineering. This study investigated the effect of iloprost on promoting dental pulp angiogenesis by using the tooth slice organ culture system.

METHODS

Tooth slices with intact pulp tissue were cut from molars extracted from 12 patients. Dental pulp tissue viability was determined by live/dead staining. The tooth slices were cultured with iloprost for 1 or 3 days. The microvessel density and expression of vascular endothelial growth factor were determined by immunohistochemical staining. Collagen density was determined by using Masson trichrome and immunofluorescent staining.

RESULTS

The pulp tissue in the tooth slices remained viable when cultured in serum-free medium. Iloprost increased the microvessel density as shown by a higher number of von Willebrand factor-positive cells. A significant increase in vascular endothelial growth factor expression was observed in the tooth slices cultured with iloprost. Iloprost stimulated collagen deposition, and this effect was abolished after inhibition of protein kinase A activity.

CONCLUSIONS

Human tooth slices provide a valuable and easy-to-obtain model to investigate the effect of bioactive molecules used in dental pulp regeneration. This study showed for the first time that tooth slices could be kept viable under serum-free conditions for up to 3 days. Iloprost promoted angiogenesis, increased new vessel formation, and induced collagen deposition. This study proposes the clinical value of iloprost as a drug for inducing angiogenesis that can increase the success of pulp regeneration.

1-methylnicotinamide and its structural analog 1,4-dimethylpyridine for the prevention of cancer metastasis

Background

1-methylnicotinamide (1-MNA), an endogenous metabolite of nicotinamide, has recently gained interest due to its anti-inflammatory and anti-thrombotic activities linked to the COX-2/PGI₂ pathway. Given the previously reported anti-metastatic activity of prostacyclin (PGI₂), we aimed to assess the effects of 1-MNA and its structurally related analog, 1,4-dimethylpyridine (1,4-DMP), in the prevention of cancer metastasis.

Methods

All the studies on the anti-tumor and anti-metastatic activity of 1-MNA and 1,4-DMP were conducted using the model of murine mammary gland cancer (4T1) transplanted either orthotopically or intravenously into female BALB/c mouse. Additionally, the effect of the investigated molecules on cancer cell-induced angiogenesis was estimated using the matrigel plug assay utilizing 4T1 cells as a source of pro-angiogenic factors.

Results

Neither 1-MNA nor 1,4-DMP, when given in a monotherapy of metastatic cancer, influenced the growth of 4T1 primary tumors transplanted orthotopically; however, both compounds tended to inhibit 4T1 metastases formation in lungs of mice that were orthotopically or intravenously inoculated with 4T1 or 4T1-luc2-tdTomato cells, respectively. Additionally, while 1-MNA enhanced tumor vasculature formation and markedly increased PGI₂ generation, 1,4-DMP did not have such an effect. The anti-metastatic activity of 1-MNA and 1,4-DMP was further confirmed when both agents were applied with a cytostatic drug in a combined treatment of 4T1 murine mammary gland cancer what resulted in up to 80 % diminution of lung metastases formation.

Conclusions

The results of the studies presented below indicate that 1-MNA and its structural analog 1,4-DMP prevent metastasis and might be beneficially implemented into the treatment of metastatic breast cancer to ensure a comprehensive strategy of metastasis control.

Electronic supplementary material

The online version of this article (doi:10.1186/s13046-016-0389-9) contains supplementary material, which is available to authorized users.

Role of angiogenesis in endodontics: contributions of stem cells and proangiogenic and antiangiogenic factors to dental pulp regeneration

INTRODUCTION

Dental pulp regeneration is a part of regenerative endodontics, which includes isolation, propagation, and re-transplantation of stem cells inside the prepared root canal space. The formation of new blood vessels through angiogenesis is mandatory to increase the survival rate of re-transplanted tissues. Angiogenesis is defined as the formation of new blood vessels from preexisting capillaries, which has great importance in pulp regeneration and homeostasis. Here the contribution of human dental pulp stem cells and proangiogenic and antiangiogenic factors to angiogenesis process and regeneration of dental pulp is reviewed.

METHODS

A search was performed on the role of angiogenesis in dental pulp regeneration from January 2005 through April 2014. The recent aspects of the relationship between angiogenesis, human dental pulp stem cells, and proangiogenic and antiangiogenic factors in regeneration of dental pulp were assessed.

RESULTS

Many studies have indicated an intimate relationship between angiogenesis and dental pulp regeneration. The contribution of stem cells and mechanical and chemical factors to dental pulp regeneration has been previously discussed.

CONCLUSIONS

Angiogenesis is an indispensable process during dental pulp regeneration. The survival of inflamed vital pulp and engineered transplanted pulp tissue are closely linked to the process of angiogenesis at sites of application. However, the detailed regulatory mechanisms involved in initiation and progression of angiogenesis in pulp tissue require investigation.