Evaluation of the Effects of Photobiomodulation on Biomechanical Properties and Hounsfield Unit of Partial Osteotomy Healing in an Experimental Rat Model of Type I Diabetes and Osteoporosis

Comparative Investigation of Photobiomodulation in Diabetes-Impaired Alveolar Bone Healing: A Histomorphometrical and Molecular Study

Objective: Diabetes mellitus is increasing worldwide. Photobiomodulation (PBM) is proposed as a therapeutic method in various medical concerns. This study aimed to compare the effects of PBM at the wavelengths of 660, 808, or 660 + 808 nm on alveolar bone healing in diabetic rats. Methods: Bilateral maxillary first molars were extracted from diabetic Wistar rats (n = 36). Right-sided sockets were treated by an In-Ga-Al-P laser at 660 nm (7.2 J/cm2, 24 s; DM660), Ga-Al-As laser at 808 nm (7 J/cm2, 14 s; DM808), or a combination of these two sets (DM-dual) (n = 12). Left sides served as controls. On days 7 or 14, specimens were assigned for histomorphometric or real-time PCR analysis of runt-related transcription factor 2, osteocalcin, collagen I, and vascular endothelial growth factor expression. Results: Irradiated sockets of groups DM-808 and DM-dual showed a significant increase in bone tissue and blood vessel establishment as compared to DM-660. Further, group DM-dual exhibited the least amount of fibrotic tissue as compared to the other groups. Conclusions: Within our study limits, the present experiment suggested PBM at 808 nm, alone or combined with 660 nm irradiation, could promote alveolar bone healing, along with minimal fibrosis induction, in diabetic rats.

The Role of Silymarin in Mitigating Inflammation and Cognitive Impairment Induced by Ovariectomy in Wistar Rats

Background. Silymarin, a polyphenolic flavonoid found in milk thistle, has been used to treat liver and brain injuries in humans and animals. The study aims to investigate the protective effects of silymarin on spatial and passive avoidance memory, oxidative stress, and inflammatory factors in the brain and liver tissues of ovariectomized (OVX) Wistar rats. Methods. The study involved 30 female Wistar rats divided into control, sham, and three silymarin-treated groups. After ovariectomy, rats underwent CT scan, and some of them were administered silymarin via gavage for 2 months. Memory and learning were assessed using Morris water maze and shuttle box tests. Brain and liver tissues were analyzed for inflammatory factors (IL-1β, TNFα, and IL-6) and oxidative stress markers (CAT, SOD, and MDA) after sacrifice. Results. Silymarin improved spatial memory and fear learning compared to the sham group ($P\le 0.05$ to $P\le 0.001$). It also significantly reduced IL-1β, TNF-α, and IL-6 levels in the cortex, hippocampus, and liver ($P\le 0.05$ to $P\le 0.0001$) and increased CAT and SOD while decreasing MDA levels ($P\le 0.05$ to $P\le 0.001$) compared to control and sham groups. Conclusion. Long-term administration of silymarin extract can improve learning and memory, reverse cognitive impairment caused by ovariectomy, and reduce oxidative stress and inflammatory factors induced by ovariectomy in the liver and brain of Wistar rats. This is due to the reduction in MDA levels and an increase in CAT activity, although silymarin has some effect on SOD at high doses.

Recent progress in bone-repair strategies in diabetic conditions

Bone regeneration following trauma, tumor resection, infection, or congenital disease is challenging. Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia. It can result in complications affecting multiple systems including the musculoskeletal system. The increased number of diabetes-related fractures poses a great challenge to clinical specialties, particularly orthopedics and dentistry. Various pathological factors underlying DM may directly impair the process of bone regeneration, leading to delayed or even non-union of fractures. This review summarizes the mechanisms by which DM hampers bone regeneration, including immune abnormalities, inflammation, reactive oxygen species (ROS) accumulation, vascular system damage, insulin/insulin-like growth factor (IGF) deficiency, hyperglycemia, and the production of advanced glycation end products (AGEs). Based on published data, it also summarizes bone repair strategies in diabetic conditions, which include immune regulation, inhibition of inflammation, reduction of oxidative stress, promotion of angiogenesis, restoration of stem cell mobilization, and promotion of osteogenic differentiation, in addition to the challenges and future prospects of such approaches.

Challenges to Improve Bone Healing Under Diabetic Conditions

Diabetes mellitus (DM) can affect bone metabolism and the bone microenvironment, resulting in impaired bone healing. The mechanisms include oxidative stress, inflammation, the production of advanced glycation end products (AGEs), etc. Improving bone healing in diabetic patients has important clinical significance in promoting fracture healing and improving bone integration. In this paper, we reviewed the methods of improving bone healing under diabetic conditions, including drug therapy, biochemical cues, hyperbaric oxygen, ultrasound, laser and pulsed electromagnetic fields, although most studies are in preclinical stages. Meanwhile, we also pointed out some shortcomings and challenges, hoping to provide a potential therapeutic strategy for accelerating bone healing in patients with diabetes.

Stereological and gene expression examinations on the combined effects of photobiomodulation and curcumin on wound healing in type one diabetic rats

We examined the effects of photobiomodulation (PBM) independently and combined with curcumin on stereological parameters and basic fibroblast growth factor (bFGF), hypoxia-inducible factor-1α (HIF-1α), and stromal cell-derived factor-1α (SDF-1α) gene expressions in an excisional wound model of rats with type one diabetes mellitus (T1DM). T1DM was induced by an injection of streptozotocin (STZ) in each of the 90 male Wistar rats. One round excision was generated in the skin on the back of each of the 108 rats. The rats were divided into six groups (n = 18 per group): control (diabetic), untreated group; vehicle (diabetic) group, which received sesame oil; PBM (diabetic) group; curcumin (diabetic) group; PBM + curcumin (diabetic) group; and a healthy control group. On days 4, 7, and 15, we conducted both stereological and quantitative real-time PCR (qRT-PCR) analyses. The PBM and PBM + curcumin groups had significantly better inflammatory response modulation in terms of macrophages (P < .01), neutrophils (P < .001), and increased fibroblast values compared with the other groups at day 4 (P < .001), day 7 (P < .01), and day 15 (P < .001). PBM treatment resulted in increased bFGF gene expression on days 4 (P < .001) and 7 (P < .001), and SDF-1α gene expression on day 4 (P < .001). The curcumin group had increased bFGF (P < .001) expression on day 4. Both the PBM and PBM + curcumin groups significantly increased wound healing by modulation of the inflammatory response, and increased fibroblast values and angiogenesis. The PBM group increased bFGF and SDF-1α according to stereological and gene expression analyses compared with the other groups. The PBM and PBM + curcumin groups significantly increased the skin injury repair process to more rapidly reach the proliferation phase of the wound healing in T1DM rats.

Molecular impacts of photobiomodulation on bone regeneration: A systematic review

Photobiomodulation (PBM) encompasses a light application aimed to increase healing process, tissue regeneration, and reducing inflammation and pain. PBM is specifically aimed to modify the expression of cellular molecules; however, PBM impacts on cellular and molecular pathways especially in bone regenerative medicine have been investigated in scattered different studies. The purpose of the current study is to systematically review evidence on molecular impact of PBM on bone regeneration. A comprehensive electronic search in Medline, Scopus, EMBASE, EBSCO, Cochrane library, web of science, and google scholar was conducted from January 1975 to October 2018 limited to English language publications on administrations of photobiomodulation for bone regeneration which evaluated biological factors. In addition, hand search of selected journals was done to retrieve all articles. This systematic review was performed based on PRISMA guideline. Among these studies, five articles reported in vitro results, twelve articles were in vivo, and three of them were clinical trials. The data tabulated according to the type of markers (osteogenic markers, angiogenic markers, growth factors, and inflammation mediators). PBM's effects depend on many parameters which energy density is more important than the others. PBM can significantly enhance expression of osteocalcin, collagen, RUNX-2, vascular endothelial growth factor, bone morphogenic proteins, and COX-2. Although since the heterogeneity of the studies and their limitations, an evidence-based decision for definite therapeutic application of PBM is still unattainable, the findings of our review can help other researchers to ameliorate their study design and elect more efficient approach for their investigation.

Effect of low‐level laser therapy and oxytocin on osteoporotic bone marrow‐derived mesenchymal stem cells

Postmenopausal osteoporosis (OP) is a major concern for public health. Low‐level laser therapy (LLLT) has a positive effect on the health of bone marrow mesenchymal stem cells (BMMSCs). The purpose of this study is to evaluate the influence of LLLT and oxytocin (OT) incubation—individually and in combination—on osteoporotic BMMSCs in ovariectomized rats. Twelve female rats were randomized into two groups to undergo either a sham surgery (sham group) or ovariectomy‐induced osteoporosis (OVX group). MSCs harvested from the BM of healthy and OVX rats underwent culture expansion. There were five groups. In Groups one (sham‐BMMSC) and two (OVX‐BMMSC) the cells were held in osteogenic condition medium without any intervention. In the group three (OT), OT incubation with optimum dose was performed for 48 h (two times, 10−12 molar). In Group four, laser‐treated‐OVX‐BMMSCs were treated with optimum protocol of LLLT (one time, 1.2 J/cm2). In Group five (laser + OT group), the OT incubation plus the laser irradiation was performed. The biostimulatory effect of LLLT is demonstrated by a significant increase in the viability of OVX‐BMMSCs, cell cycle, and extracellular levels of Transforming growth factor beta (TGF‐β), insulin‐like growth factor‐I (IGF‐I), and Alkaline phosphatase (ALP) compared to control OVX‐BMMSCs and/or the sham group. OT incubation and laser + OT incubation have a positive effect on OVX‐BMMSCs. However, LLLT is more effective statistically. We conclude that LLLT significantly improved cell viability, enhanced the osteogenic potential of the OVX‐BMMSCs, and increased the extracellular levels of the TGF‐β, IGF‐I, and ALP.

The effects of pentoxifylline adminstration on fracture healing in a postmenopausal osteoporotic rat model

Previous studies report positive effects of pentoxifylline (PTX) alone or in combination with other drugs on some pathologic bone diseases as well as an ability to accelerate osteogensis and fracture healing in both animal models and human patients. The aim of this present study was to evaluate the effects of PTX administration on Hounsfield unit and bone strength at catabolic response (bone resorbing) of a fracture in an experimental rat model of ovariectomy induced osteoporosis (OVX-D). Thirty adult female rats were divided into groups as follows: 1 (OVX, control, no treatment); 2 (OVX, sham: daily distilled water); 3 (OVX, daily alendronate: 3 mg/kg); 4 (OVX, twice daily 100 mg/kg PTX) and 5 (OVX, PTX+alenderonate). OVX was induced by bilateral ovariectomy in all rats. A complete standardized osteotomy of the right femur was made after 3.5 months. PTX and alendronate treatments were performed for eight weeks. Then, rats were euthanized and had its right femur subjected to computerized tomography scanning for measuring Hounsfield unit; eventually, the samples were sent for a three point bending test for evaluation of the bone strength. Administration of PTX with 200 mg/kg and alendronate alone and in combination showed no significant alteration in Hounsfield unit and biomechanical properties of repairing callus of the complete osteotomy compared with the control group. Results showed increased bending stiffness and stress high load mean values of repairing complete osteotomy in PTX-treated rats compared to the control OVX-D.