Effect of therapeutic ultrasound on human periodontal ligament cells for dental and periodontal tissue engineering

Latest progress in low-intensity pulsed ultrasound for studying exosomes derived from stem/progenitor cells

Stem cells have self-renewal, replication, and multidirectional differentiation potential, while progenitor cells are undifferentiated, pluripotent or specialized stem cells. Stem/progenitor cells secrete various factors, such as cytokines, exosomes, non-coding RNAs, and proteins, and have a wide range of applications in regenerative medicine. However, therapies based on stem cells and their secreted exosomes present limitations, such as insufficient source materials, mature differentiation, and low transplantation success rates, and methods addressing these problems are urgently required. Ultrasound is gaining increasing attention as an emerging technology. Low-intensity pulsed ultrasound (LIPUS) has mechanical, thermal, and cavitation effects and produces vibrational stimuli that can lead to a series of biochemical changes in organs, tissues, and cells, such as the release of extracellular bodies, cytokines, and other signals. These changes can alter the cellular microenvironment and affect biological behaviors, such as cell differentiation and proliferation. Here, we discuss the effects of LIPUS on the biological functions of stem/progenitor cells, exosomes, and non-coding RNAs, alterations involved in related pathways, various emerging applications, and future perspectives. We review the roles and mechanisms of LIPUS in stem/progenitor cells and exosomes with the aim of providing a deeper understanding of LIPUS and promoting research and development in this field.

Application of low-intensity pulsed ultrasound on tissue resident stem cells: Potential for ophthalmic diseases

INTRODUCTION

Tissue-resident stem cells (TRSCs) have the ability to self-renew and differentiate throughout an individual's lifespan, and they utilize both mechanisms to maintain homeostasis and regenerate damaged tissues. Several studies suggest that these stem cells can serve as a potential source for cell-replacement-based therapy by promoting differentiation or expansion. In recent years, low-intensity pulsed ultrasound (LIPUS) has been demonstrated to effectively stimulate stem cell proliferation and differentiation, promote tissue regeneration, and inhibit inflammatory responses.

AIMS

To present a comprehensive overview of current application and mechanism of LIPUS on tissue resident stem cells.

METHODS

We searched PubMed, Web of Science for articles on the effects of LIPUS on tissue resident stem cells and its application.

RESULTS

The LIPUS could modulate cellular activities such as cell viability, proliferation and differentiation of tissue resident stem cells and related cells through various cellular signaling pathways. Currently, LIPUS, as the main therapeutic ultrasound, is being widely used in the treatment of preclinical and clinical diseases.

CONCLUSION

The stem cell research is the hot topic in the biological science, while in recent years, increasing evidence has shown that TRSCs are good targets for LIPUS-regulated regenerative medicine. LIPUS may be a novel and valuable therapeutic approach for the treatment of ophthalmic diseases. How to further improve its efficiency and accuracy, as well as the biological mechanism therein, will be the focus of future research.

LIPUS as a potential strategy for periodontitis treatment: A review of the mechanisms

Periodontitis is a chronic inflammatory condition triggered by oral bacteria. A sustained inflammatory state in periodontitis could eventually destroy the alveolar bone. The key objective of periodontal therapy is to terminate the inflammatory process and reconstruct the periodontal tissues. The traditional Guided tissue regeneration (GTR) procedure has unstable results due to multiple factors such as the inflammatory environment, the immune response caused by the implant, and the operator's technique. Low-intensity pulsed ultrasound (LIPUS), as acoustic energy, transmits the mechanical signals to the target tissue to provide non-invasive physical stimulation. LIPUS has positive effects in promoting bone regeneration, soft-tissue regeneration, inflammation inhibition, and neuromodulation. LIPUS can maintain and regenerate alveolar bone during an inflammatory state by suppressing the expression of inflammatory factors. LIPUS also affects the cellular behavior of periodontal ligament cells (PDLCs), thereby protecting the regenerative potential of bone tissue in an inflammatory state. However, the underlying mechanisms of the LIPUS therapy are still yet to be summarized. The goal of this review is to outline the potential cellular and molecular mechanisms of periodontitis-related LIPUS therapy, as well as to explain how LIPUS manages to transmit mechanical stimulation into the signaling pathway to achieve inflammatory control and periodontal bone regeneration.

Advances in the application of low-intensity pulsed ultrasound to mesenchymal stem cells

Mesenchymal stem cells (MSCs) are stem cells that exhibit self-renewal capacity and multi-directional differentiation potential. They can be extracted from the bone marrow and umbilical cord, as well as adipose, amnion, and other tissues. They are widely used in tissue engineering and are currently considered an important source of cells in the field of regenerative medicine. Since certain limitations, such as an insufficient cell source, mature differentiation, and low transplantation efficiency, are still associated with MSCs, researchers have currently focused on improving the efficacy of MSCs. Low-intensity pulsed ultrasound (LIPUS) has mechanical, cavitation, and thermal effects that can produce different biological effects on organs, tissues, and cells. It can be used for fracture treatment, cartilage repair, and stem cell applications. An in-depth study of the role and mechanism of action of LIPUS in MSC treatment would promote our understanding of LIPUS and promote research in this field. In this article, we have reviewed the progress in research on the use of LIPUS with various MSCs and comprehensively discussed the progress in the use of LIPUS for promoting the proliferation, differentiation, and migration of MSCs, as well as its future prospects.

The effect of low intensity pulsed ultrasound on dentoalveolar structures during orthodontic force application in diabetic ex-vivo model

OBJECTIVE

This study aimed to investigate the effect of the low intensity pulsed ultrasound (LIPUS) on the dentoalveolar structures during orthodontic force application in ex-vivo model using mandible slice organ culture (MSOC) of diabetic rats.

DESIGN

18 male Wistar rats with a mean weight (275 g) were randomly divided into three main groups: 1) normal rats, 2) Insulin treated diabetic rats, and 3) diabetic rats. Diabetes mellitus (DM) was induced by streptozotocin. Four weeks later, rats were euthanized, mandibles were dissected, divided into 1.5-mm slices creating mandible slice organ cultures (MSOCs). MSOCs were cultured at 37 °C in air with 5 % CO₂. The following day, orthodontic spring delivering a 50-g of force was applied to each slice. In each group, rats were randomly assigned to 2 subgroups; one received 10 min of LIPUS daily and the other was the control. Culture continued for 7 days, and then the sections were prepared for histological and histomorphometric analysis.

RESULTS

For all study groups (Normal, Insulin Treated Diabetic and Diabetic), LIPUS treatment significantly increased the thickness of predentin, cementum, and improved bone remodeling on the tension side and increased odontoblast, sub-odontoblast, and periodontal ligaments cell counts and bone resorption lacunae number on the compression side.

CONCLUSIONS

Application of LIPUS treatment for 10 min daily for a week enhanced bone remodeling and repair of cementum and dentin in normal as well as diabetic MSOCs.

Periodontal tissue regeneration after low-intensity pulsed ultrasound stimulation with or without intra-marrow perforation in two-wall intra-bony defects-A pilot study in dogs

AIM

To evaluate the effects of low-intensity pulsed ultrasound (LIPUS) with/without intra-marrow perforation (IMP) on periodontal healing in two-wall intra-bony defects in dogs.

MATERIALS AND METHODS

Two-wall intra-bony defects (5 mm wide, 5 mm deep) were created at the distal and mesial aspects of mandibular premolars in four beagle dogs (four defects per dog). The 16 defects were divided into four treatment groups: IMP, LIPUS, IMP + LIPUS (IMP/LIPUS) and control (open flap debridement). The LIPUS and IMP/LIPUS sites received daily LIPUS exposure for 3 weeks starting 1 week after surgery. The animals were euthanized 4 weeks after surgery for histologic evaluation.

RESULTS

There was significantly greater new bone formation at LIPUS (2.93 ± 0.74 mm) and IMP/LIPUS (3.18 ± 0.52 mm) sites than at control sites (1.65 ± 0.46 mm). New bone area at LIPUS (6.36 ± 2.28 mm² ) and IMP/LIPUS (6.13 ± 1.25 mm² ) sites was significantly greater than that at control sites (2.15 ± 1.75 mm² ). New cementum length at LIPUS sites (4.09 ± 0.75 mm) was significantly greater than that at control (2.29 ± 1.02 mm) and IMP (2.41 ± 0.41 mm) sites. No significant difference was observed between LIPUS and IMP/LIPUS sites in any histomorphometric parameter.

CONCLUSIONS

These findings suggest that LIPUS effectively promotes periodontal regeneration in two-wall intra-bony defects in dogs.

A preliminary study of effects of low-intensity pulsed ultrasound (LIPUS) irradiation on dentoalveolar ankylosis

The purpose of this experiment was to investigate whether low-intensity pulsed ultrasound (LIPUS) irradiation can inhibit dentoalveolar ankylosis in transplanted rat teeth. LIPUS irradiation (the pulsed ultrasound signal had a frequency of 3.0 MHz, a spatial average intensity of 30 mW/cm², and a pulse ratio of 1:4) was performed on the face over the re-planted teeth of rats for 4 weeks. After the rats were euthanized, we measured mobility (Periotest value [PTV]) of the transplanted and control teeth using a Periotest. Finally, we performed histological evaluation to detect ankylosis. PTVs tended to be significantly lower for re-planted teeth than for control teeth. Histological evaluation revealed that the roots of all re-planted teeth were coalescent with alveolar bone. Furthermore, no ankylosis was observed in three-fifths of the re-planted teeth following LIPUS irradiation. These results indicate the potential efficacy of LIPUS to inhibit dentoalveolar ankylosis.

Low‑intensity pulsed ultrasound promotes periodontal ligament stem cell migration through TWIST1‑mediated SDF‑1 expression

Low‑intensity pulsed ultrasound (LIPUS) is a non‑invasive therapeutic treatment for accelerating fracture healing. A previous study from our group demonstrated that LIPUS has the potential to promote periodontal tissue regeneration. However, the underlying molecular mechanism by which LIPUS promotes periodontal tissue regeneration remains unknown. In the present study, periodontal ligament stem cells (PDLSCs) were isolated from premolars. Flow cytometry and differentiation assays were used to characterize the isolated PDLSCs. LIPUS treatment was administered to PDLSCs, and stromal cell‑derived factor‑1 (SDF‑1) expression levels were examined by reverse transcription‑quantitative polymerase chain reaction with or without blocking the SDF‑1/C‑X‑C motif chemokine receptor 4 (CXCR4) pathway with AMD3100. ELISA was used to evaluate SDF‑1 secretion in PDLSCs. Wound healing and transwell assays were conducted to assess the migration‑promoting effect of LIPUS. A potential upstream gene of SDF‑1, twist family bHLH transcription factor 1 (TWIST1), was silenced by small interfering (si) RNA transfection. The results demonstrated that LIPUS treatment promoted the expression of TWIST1 and SDF‑1 at both the mRNA and protein levels. In addition, LIPUS treatment enhanced the cell migration of PDLSCs. Knockdown of TWIST1 impaired the expression of SDF‑1 and the cell migration ability of PDLSCs. TWIST1 may be an upstream regulator of SDF‑1 in PDLSCs. Taken together, these findings indicate that the SDF1/CXCR4 signaling pathway is involved in LIPUS‑promoted PDLSC migration, which might be one of the mechanisms for LIPUS‑mediated periodontal regeneration. TWIST1 might be a mechanical stress sensor during mechanotransduction.

Role of Piezo Channels in Ultrasound-stimulated Dental Stem Cells

INTRODUCTION

Piezo1 and Piezo2 are mechanosensitive membrane ion channels. We hypothesized that Piezo proteins may play a role in transducing ultrasound-associated mechanical signals and activate downstream mitogen-activated protein kinase (MAPK) signaling processes in dental cells. In this study, the expression and role of Piezo channels were investigated in dental pulp stem cells (DPSCs) and periodontal ligament stem cells (PDLSCs) after treatment with low-intensity pulsed ultrasound (LIPUS).

METHODS

Cell proliferation was evaluated by bromodeoxyuridine incorporation. Western blots were used to analyze the proliferating cell nuclear antigen as well as the transcription factors c-fos and c-jun. Enzyme-linked immunosorbent assay and Western blotting were used to determine the activation of MAPK after LIPUS treatment. Ruthenium red (RR), a Piezo ion channel blocker, was applied to determine the functional role of Piezo proteins in LIPUS-stimulated cell proliferation and MAPK signaling.

RESULTS

Western blotting showed the presence of Piezo1 and Piezo2 in both dental cell types. LIPUS treatment significantly increased the level of the Piezo proteins in DPSCs after 24 hours; however, no significant effects were observed in PDLSCs. Treatment with RR significantly inhibited LIPUS-stimulated DPSC proliferation but not PDLSC proliferation. Extracellular signal-related kinase (ERK) 1/2 MAPK was consistently activated in DPSCs over a 24-hour time period after LIPUS exposure, whereas phosphorylated c-Jun N-terminal kinase and p38 mitogen-activated protein kinase MAPK were mainly increased in PDLSCs. RR affected MAPK signaling in both dental cell types with its most prominent effects on ERK1/2/MAPK phosphorylation levels; the significant inhibition of LIPUS-induced stimulation of ERK1/2 activation in DPSCs by RR suggests that stimulation of DPSC proliferation by LIPUS involves Piezo-mediated regulation of ERK1/2 MAPK signaling.

CONCLUSIONS

This study for the first time supports the role of Piezo ion channels in transducing the LIPUS response in dental stem cells.