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Choi Y, Ji JM, Kim CH, Sung KP. Surgical management of severe cherubism persisting into early adulthood: a case report and literature review. Arch Craniofac Surg 2024; 25:38-43. [PMID: 38461827 PMCID: PMC10924791 DOI: 10.7181/acfs.2023.00577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/07/2023] [Accepted: 12/20/2023] [Indexed: 03/12/2024] Open
Abstract
Cherubism is a rare fibro-osseous condition characterized by bilateral expansion of the mandible and maxilla. Due to its rarity, treatment guidelines for cherubism have not been clearly established. Observation without surgical intervention is typically recommended, as cherubism often regresses spontaneously after puberty. However, a surgical intervention may be necessary if aggressive lesions lead to severe complications. In this report, we present a case involving surgical management of cherubism that did not spontaneously regress until early adulthood. An 18-year-old man was diagnosed with cherubism, presenting characteristic upward-looking eyes and a swollen face. He strongly desired surgical management. Gross contouring of the mandible was performed using an osteotome. Subsequently, delicate contouring was performed by bone burring and curettage. The remaining multiple locular bony defects were filled with demineralized bone matrix. No major complications, including infection and hematoma, occurred during the 8-month follow-up period. The facial contour remained stable without the aggravation of cherubism. The patient was satisfied with the cosmetic results. Considering that cherubism is a rare disease globally, with few reported cases in Korea, and that treatment guidelines are not clearly established, we anticipate that the results of this case will contribute to the development of future protocols for treating cherubism.
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Affiliation(s)
- Youngwoong Choi
- Department of Plastic and Reconstructive Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jeong Min Ji
- Department of Plastic and Reconstructive Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Choong Hyeon Kim
- Department of Plastic and Reconstructive Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Ki Pyo Sung
- Department of Plastic and Reconstructive Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea
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2
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Wang Y, Ren J, Hou G, Ge X. NFATC1 and NFATC2 expression patterns in human osteochondromas. Heliyon 2023; 9:e13018. [PMID: 36747924 PMCID: PMC9898645 DOI: 10.1016/j.heliyon.2023.e13018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/05/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Background Our previous study in genetic mouse models found that NFATc1 and NFATc2 suppress osteochondroma formation from entheseal progenitors. However, it remains unclear whether NFAT signaling is also involved in human osteochondromagenesis. As the first step in addressing this question, the current study aimed to determine the expression patterns of NFATC1 and NFATC2 in human osteochondroma samples. Methods Immunohistochemistry (IHC) was used to examine and analyze NFATC1 and NFATC2 expression in human osteochondroma samples. The human periosteum was used to map the expression of NFATC1 under physiological conditions by IHC. Furthermore, human periosteal progenitors were isolated and identified from the periosteal tissues of bone fracture healing patients. The expression of NFATC1 in human periosteal progenitors was characterized by Western blotting compared to human bone marrow stromal cells (BMSC). Results The IHC results showed that the expression of NFATC1 was undetectable in most human osteochondromas cells, and only a small proportion of osteochondroma cells, especially clonally grown chondrocytes, showed positive staining of NFATC1. NFATC2 expression was also undetectable in most chondrocytes in human osteochondromas. The mouse and human periosteum showed a comparable ratio of NFATC1 positive cells (9.56 ± 0.80% vs 11.04 ± 2.05%, P = 0.3101). Furthermore, Western blotting analysis revealed that NFATC1 expression was highly enriched in human periosteal progenitors compared to BMSC. Conclusions NFATC1 and NFATC2 are undetectable in most human osteochondroma chondrocytes. The expression pattern of NFATC1 in human osteochondromas and the normal periosteum suggests that NFAT signaling could be suppressed during human osteochondromagenesis.
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Affiliation(s)
- Yuanyuan Wang
- Department of Stomatology, Xuanwu Hospital Capital Medical University, Beijing, China,National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Jiangdong Ren
- Department of Joint Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopaedics of Guangdong Province), Guangzhou, Guangdong, China
| | - Guojin Hou
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Xianpeng Ge
- Department of Stomatology, Xuanwu Hospital Capital Medical University, Beijing, China,National Clinical Research Center for Geriatric Diseases, Beijing, China,Corresponding author. Department of Stomatology, Xuanwu Hospital Capital Medical University, Beijing, China.
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3
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Cailleaux PE, Porporatti AL, Cohen-Solal M, Kadlub N, Coudert AE. Pharmacological management of cherubism: A systematic review. Front Endocrinol (Lausanne) 2023; 14:1104025. [PMID: 36998472 PMCID: PMC10044089 DOI: 10.3389/fendo.2023.1104025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/20/2023] [Indexed: 03/15/2023] Open
Abstract
OBJECTIVE The aim of this systematic review was to determine if there exists an efficacious drug treatment for cherubism, based on published studies. METHODS This systematic review included observational case studies reporting pharmacological management of cherubism. We developed specific search strategies for PubMed (including Medline), ScienceDirect, Web of Science. We evaluated the methodological quality of the included studies using criteria from the Joanna Briggs Institute's critical appraisal tools. RESULTS Among the 621 studies initially identified by our search script, 14 were selected for inclusion, of which five were classified as having a low risk of bias, four as having an unclear risk, and five a high risk. Overall, 18 cherubism patients were treated. The sample size in each case study ranged from one to three subjects. This review identified three types of drugs used for cherubism management: calcitonin, immunomodulators and anti-resorptive agents. However, the high heterogeneity in case reports and the lack of standardized outcomes precluded a definitive conclusion regarding the efficacy of any treatment for cherubism. CONCLUSIONS The present systematic review could not identify an effective treatment for cherubism due to the heterogeneity and limitations of the included studies. However, in response to these shortcomings, we devised a checklist of items that we recommend authors consider in order to standardize the reporting of cherubism cases and specifically when a treatment is given toward identification of an efficacious cherubism therapy. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022351044, identifier CRD42022351044.
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Affiliation(s)
- Pierre-Emmanuel Cailleaux
- Université Paris Cité, Institut National de la Santé et de la recherche médicale (Inserm) U1132 Biologie de l'os et du cartilage (BIOSCAR), Paris, France
- *Correspondence: Pierre-Emmanuel Cailleaux, ; Amélie E. Coudert,
| | - André Luís Porporatti
- Faculté or Unité de formation et de recherche (UFR) d’Odontologie, Laboratoire de Neurobiologie Oro-Faciale (EA 7543), Université Paris Cité, Paris, France
| | - Martine Cohen-Solal
- Faculté or Unité de formation et de recherche (UFR) de Médecine, Université Paris Cité, Institut National de la Santé et de la recherche médicale (Inserm) U1132 Biologie de l'os et du cartilage (BIOSCAR), Hôpital Lariboisière, Paris, France
| | - Natacha Kadlub
- Faculté or Unité de formation et de recherche (UFR) de Médecine, Université Paris Cité, Inserm 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Amélie E. Coudert
- Faculté or Unité de formation et de recherche (UFR) d’Odontologie, Université Paris Cité, Institut National de la Santé et de la recherche médicale (Inserm) U1132 Biologie de l'os et du cartilage (BIOSCAR), Paris, France
- *Correspondence: Pierre-Emmanuel Cailleaux, ; Amélie E. Coudert,
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Fujii Y, Monteiro N, Sah SK, Javaheri H, Ueki Y, Fan Z, Reichenberger EJ, Chen I. Tlr2/4
‐Mediated Hyperinflammation Promotes Cherubism‐Like Jawbone Expansion in
Sh3bp2
(
P416R
) Knockin Mice. JBMR Plus 2021; 6:e10562. [PMID: 35079675 PMCID: PMC8771001 DOI: 10.1002/jbm4.10562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 11/20/2022] Open
Abstract
Cherubism (CBM), characterized by expansile jawbones with multilocular fibrocystic lesions, is caused by gain‐of‐function mutations in SH3 domain‐binding protein 2 (SH3BP2; mouse orthologue Sh3bp2). Loss of jawbone and dental integrity significantly decrease the quality of life for affected children. Treatment for CBM is limited to multiple surgeries to correct facial deformities. Despite significant advances made with CBM knockin (KI) mouse models (Sh3bp2KI/KI), the activation mechanisms of CBM lesions remain unknown because mutant mice do not spontaneously develop expansile jawbones. We hypothesize that bony inflammation of an unknown cause triggers jawbone expansion in CBM. To introduce jawbone inflammation in a spatiotemporally controlled manner, we exposed pulp of the first right mandibular molar of 6‐week‐old Sh3bp2+/+, Sh3bp2KI/+, and Sh3bp2KI/KI mice. Bacterial invasion from the exposed pulp into root canals led to apical periodontitis in wild‐type and mutant mice. The pathogen‐associated molecular patterns (PAMPs)‐induced inflammation of alveolar bone resulted in jawbone expansion in Sh3bp2KI/+ and Sh3bp2KI/KI mice. CBM‐like lesions developed exacerbated inflammation with increased neutrophil, macrophage, and osteoclast numbers. These lesions displayed excessive neutrophil extracellular traps (NETs) compared to Sh3bp2+/+ mice. Expression levels of IL‐1β, IL‐6, and TNF‐α were increased in periapical lesions of Sh3bp2+/+, Sh3bp2KI/+, and Sh3bp2KI/KI mice and also in plasma and the left untreated mandibles (with no pulp exposure) of Sh3bp2KI/KI mice, suggesting a systemic upregulation. Ablation of Tlr2/4 signaling or depletion of neutrophils by Ly6G antibodies ameliorated jawbone expansion induced by PAMPs in Sh3bp2KI/KI mice. In summary, successful induction of CBM‐like lesions in jaws of CBM mice is important for studying initiating mechanisms of CBM and for testing potential therapies. Our findings further emphasize a critical role of host immunity in the development of apical periodontitis and the importance of maintaining oral health in CBM patients. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Yasuyuki Fujii
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine University of Connecticut Health Farmington CT USA
| | - Nelson Monteiro
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine University of Connecticut Health Farmington CT USA
| | - Shyam Kishor Sah
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine University of Connecticut Health Farmington CT USA
| | - Homan Javaheri
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine University of Connecticut Health Farmington CT USA
| | - Yasuyoshi Ueki
- Department of Biomedical Sciences and Comprehensive Care Indiana University School of Dentistry Indianapolis IN USA
- Indiana Center for Musculoskeletal Health Indiana University, School of Medicine Indianapolis IN USA
| | - Zhichao Fan
- Department of Immunology, School of Medicine University of Connecticut Health Farmington CT USA
| | - Ernst J Reichenberger
- Center for Regenerative Medicine and Skeletal Development, Department of Reconstructive Sciences University of Connecticut Health Farmington CT USA
| | - I‐Ping Chen
- Department of Oral Health and Diagnostic Sciences, School of Dental Medicine University of Connecticut Health Farmington CT USA
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Zoe N, Antigoni S, Christodoulos L, Albaghal Y, Zervides C, Ilana K. Cherubism treated with intranasal calcitonin: A case report and literature review. Oral and Maxillofacial Surgery Cases 2021. [DOI: 10.1016/j.omsc.2021.100225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bradley D, Patel V, Honeyman C, McGurk M. Adjuvant Alendronic Acid in the Management of Severe Cherubism: A Case Report and Literature Review. J Oral Maxillofac Surg 2020; 79:598-607. [PMID: 33159843 DOI: 10.1016/j.joms.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 11/26/2022]
Abstract
Cherubism is a rare disease of the jaws characterized by bilateral symmetrical painless expansion of the mandible and maxilla. In extreme cases, larger lesions can become exophytic and have profound functional and esthetic implications. Several pharmacologic agents have been trialed in the treatment of cherubism with variable success reported. Bisphosphonates have not been significantly studied in this setting. We present a case where oral alendronic acid was used as an adjuvant treatment after surgical debulking of the maxilla in a 13-year-old boy with a severe case of cherubism.
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Affiliation(s)
- Daniel Bradley
- Locum Resident, Oral and Maxillofacial Surgery Department, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Vinod Patel
- Consultant Oral Surgeon, Oral Surgery Department, Guys Dental Institute, Guys & St Thomas NHS Foundation Trust, London, United Kingdom
| | - Calum Honeyman
- Resident, Plastic Surgery, Canniesburn Plastic Surgery and Burns Unit, Scotland, United Kingdom
| | - Mark McGurk
- Professor of Oral and Maxillofacial Surgery, Department of Head and Neck Surgery, University College London Hospital, London, United Kingdom.
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7
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Morice A, Joly A, Ricquebourg M, Maruani G, Durand E, Galmiche L, Amiel J, Vial Y, Cavé H, Belhous K, Piketty M, Cohen-Solal M, Berdal A, Collet C, Picard A, Coudert AE, Kadlub N. Cherubism as a systemic skeletal disease: evidence from an aggressive case. BMC Musculoskelet Disord 2020; 21:564. [PMID: 32825821 PMCID: PMC7441549 DOI: 10.1186/s12891-020-03580-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/10/2020] [Indexed: 11/24/2022] Open
Abstract
Background Cherubism is a rare autosomal dominant genetic condition caused by mutations in the SH3BP2 gene. This disease is characterized by osteolysis of the jaws, with the bone replaced by soft tissue rich in fibroblasts and multinuclear giant cells. SH3BP2 is a ubiquitous adaptor protein yet the consequences of SH3BP2 mutation have so far been described as impacting only face. Cherubism mouse models have been generated and unlike human patients, the knock-in mice exhibit systemic bone loss together with a systemic inflammation. Case presentation In light of these observations, we decided to search for a systemic cherubism phenotype in a 6-year-old girl with an aggressive cherubism. We report here the first case of cherubism with systemic manifestations. Bone densitometry showed low overall bone density (total body Z-score = − 4.6 SD). Several markers of bone remodelling (CTx, BALP, P1NP) as well as inflammation (TNFα and IL-1) were elevated. A causative second-site mutation in other genes known to influence bone density was ruled out by sequencing a panel of such genes. Conclusions If this systemic skeletal cherubism phenotype should be confirmed, it would simplify the treatment of severe cherubism patients and allay reservations about applying a systemic treatment such as those recently published (tacrolimus or imatinib) to a disease heretofore believed to be localised to the jaws.
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Affiliation(s)
- Anne Morice
- Laboratoire de Physiopathologie Orale Moléculaire, INSERM UMRS 1138, Equipe 5, Centre de Recherche de Cordeliers, 75006, Paris, France. .,Université Paris Descartes, 75006, Paris, France. .,APHP, Necker Enfants Malades, Service de Chirurgie Maxillo-faciale et Plastique, 75015, Paris, France. .,APHP, CRMR des Malformations Rares de la Face et de la Cavité Buccale, 75015, Paris, France.
| | - Aline Joly
- APHP, Necker Enfants Malades, Service de Chirurgie Maxillo-faciale et Plastique, 75015, Paris, France.,APHP, CRMR des Malformations Rares de la Face et de la Cavité Buccale, 75015, Paris, France
| | - Manon Ricquebourg
- BIOSCAR, INSERM U1132, Université de Paris, Hôpital Lariboisière, 75010, Paris, France.,Service de Biochimie et Biologie Moléculaire, CHU-Paris-GH Saint Louis Lariboisière Widal, Paris, France
| | - Gérard Maruani
- Université Paris Descartes, 75006, Paris, France.,Institut Necker Enfants-Malades, INSERM U1151 - CNRS UMR 8253, Université Paris Descartes-Sorbonne Paris Cité, 75014, Paris, France.,Service de Physiologie, Hôpital Necker - Enfants Malades and Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015, Paris, France
| | - Emmanuel Durand
- IR4M - Université Paris-Sud, CNRS, Université Paris-Saclay, F91401, Orsay, France
| | - Louise Galmiche
- Université Paris Descartes, 75006, Paris, France.,APHP, Necker Enfants Malades, Service d'Anatomopathologie et cytologie, 75015, Paris, France
| | - Jeanne Amiel
- Université Paris Descartes, 75006, Paris, France.,APHP, Necker Enfants Malades, Département de Génétique Médicale, 75015, Paris, France
| | - Yoann Vial
- APHP, Hôpital Robert Debré, Département de Génétique, 75019, Paris, France.,INSERM UMR 1131, Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - Hélène Cavé
- APHP, Hôpital Robert Debré, Département de Génétique, 75019, Paris, France.,INSERM UMR 1131, Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - Kahina Belhous
- APHP, Necker Enfants Malades, Service d'imagerie médicale pédiatrique, 75015, Paris, France
| | - Marie Piketty
- APHP, Necker Enfants Malades, Service des Explorations Fonctionnelles, 75015, Paris, France
| | - Martine Cohen-Solal
- Service de Biochimie et Biologie Moléculaire, CHU-Paris-GH Saint Louis Lariboisière Widal, Paris, France
| | - Ariane Berdal
- Laboratoire de Physiopathologie Orale Moléculaire, INSERM UMRS 1138, Equipe 5, Centre de Recherche de Cordeliers, 75006, Paris, France.,UFR Odontologie, Garancière, Université Paris Diderot, 75006, Paris, France
| | - Corinne Collet
- BIOSCAR, INSERM U1132, Université de Paris, Hôpital Lariboisière, 75010, Paris, France.,Service de Biochimie et Biologie Moléculaire, CHU-Paris-GH Saint Louis Lariboisière Widal, Paris, France
| | - Arnaud Picard
- Laboratoire de Physiopathologie Orale Moléculaire, INSERM UMRS 1138, Equipe 5, Centre de Recherche de Cordeliers, 75006, Paris, France.,Université Paris Descartes, 75006, Paris, France.,APHP, Necker Enfants Malades, Service de Chirurgie Maxillo-faciale et Plastique, 75015, Paris, France.,APHP, CRMR des Malformations Rares de la Face et de la Cavité Buccale, 75015, Paris, France
| | - Amelie E Coudert
- Laboratoire de Physiopathologie Orale Moléculaire, INSERM UMRS 1138, Equipe 5, Centre de Recherche de Cordeliers, 75006, Paris, France.,Service de Biochimie et Biologie Moléculaire, CHU-Paris-GH Saint Louis Lariboisière Widal, Paris, France.,UFR Odontologie, Garancière, Université Paris Diderot, 75006, Paris, France
| | - Natacha Kadlub
- Laboratoire de Physiopathologie Orale Moléculaire, INSERM UMRS 1138, Equipe 5, Centre de Recherche de Cordeliers, 75006, Paris, France.,Université Paris Descartes, 75006, Paris, France.,APHP, Necker Enfants Malades, Service de Chirurgie Maxillo-faciale et Plastique, 75015, Paris, France.,APHP, CRMR des Malformations Rares de la Face et de la Cavité Buccale, 75015, Paris, France
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Abstract
The jawbone is a unique structure as it serves multiple functions in mastication. Given the fact that the jawbone is remodeled faster than other skeletal bones, bone cells in the jawbone may respond differently to local and systemic cues to regulate bone remodeling and adaptation. Osteoclasts are bone cells responsible for removing old bone, playing an essential role in bone remodeling. Although bone resorption by osteoclasts is required for dental tissue development, homeostasis and repair, excessive osteoclast activity is associated with oral skeletal diseases such as periodontitis. In addition, antiresorptive medications used to prevent bone homeostasis of tumors can cause osteonecrosis of the jaws that is a major concern to the dentist. Therefore, understanding of the role of osteoclasts in oral homeostasis under physiological and pathological conditions leads to better targeted therapeutic options for skeletal diseases to maintain patients' oral health. Here, we highlight the unique features of the jawbone compared to the long bone and the involvement of osteoclasts in the jawbone-specific diseases.
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Affiliation(s)
- Maiko Omi
- Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Yuji Mishina
- Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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9
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Kadlub N, Sessiecq Q, Mandavit M, L'Hermine AC, Badoual C, Galmiche L, Berdal A, Descroix V, Picard A, Coudert AE. Molecular and cellular characterizations of human cherubism: disease aggressiveness depends on osteoclast differentiation. Orphanet J Rare Dis 2018; 13:166. [PMID: 30236129 PMCID: PMC6148781 DOI: 10.1186/s13023-018-0907-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 09/12/2018] [Indexed: 11/29/2022] Open
Abstract
Background Cherubism is a rare autosomal dominant disorder of the jaws caused by mutation of the SH3BP2 gene. The bone is replaced by a fibrous granuloma containing multinucleated giant cells. Cells of the cherubism granuloma have never been systematically analyzed. Hence, the aim of this study was to characterize the cells in human cherubism granulomas, to determine the osteoclastic characteristics of the multinucleated giant cells and to investigate the potential role of TNF-α in human cherubism. Results Seven granulomas were analyzed in pathology, molecular biology and immunohistochemistry. Granulomas were composed mainly of macrophages or osteoclasts within a fibroblastic tissue, with few lymphoid cells. Myeloid differentiation and nuclear NFATc1 localization were both associated with disease aggressiveness. OPG and RANKL immunohistochemical expression was unexpected in our specimens. Five granuloma cells were cultured in standard and osteoclastogenic media. In culture, cherubism cells were able to differentiate into active osteoclasts, in both osteoclastogenic and standard media. IL-6 was the major cytokine present in the culture supernatants. Conclusion Multinucleated giant cells from cherubism granulomas are CD68 positive cells, which differentiate into macrophages in non-aggressive cherubism and into osteoclasts in aggressive cherubism, stimulated by the NFATc1 pathway. This latter differentiation appears to involve a disturbed RANK-L/RANK/OPG pathway and be less TNF-α dependent than the cherubism mouse model. Electronic supplementary material The online version of this article (10.1186/s13023-018-0907-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Natacha Kadlub
- INSERM, UMRS 1138 Equipe 5, Laboratoire de Physiopathologie Orale Moléculaire, Centre de Recherche de Cordeliers, 75006, Paris, France. .,Université Paris Descartes, 75006, Paris, France. .,APHP, Necker Enfants Malades, service de Chirurgie Maxillo-faciale et Plastique, , Hôpital Necker Enfants Malades, 146 rue de Sèvres, 75015, Paris, France. .,APHP, CRMR des Malformations Rares de la Face et de la Cavité Buccale, 75015, Paris, France.
| | - Quentin Sessiecq
- CHU de Bordeaux, Service de Chirurgie Maxillofaciale, 33000, Bordeaux, France
| | - Marion Mandavit
- INSERM U 970, Equipe 10, PARCC, faculté Paris Descartes, 75015, Paris, France
| | - Aurore Coulomb L'Hermine
- APHP, Hôpital Armand Trousseau, Service d'Anatomopathologie et cytologie, 75012, Paris, France.,Université Pierre et Marie Curie, 75005, Paris, France
| | - Cecile Badoual
- Université Paris Descartes, 75006, Paris, France.,INSERM U 970, Equipe 10, PARCC, faculté Paris Descartes, 75015, Paris, France.,APHP, Hôpital Européen Georges Pompidou, Service d'Anatomopathologie et cytologie, 75015, Paris, France
| | - Louise Galmiche
- Université Paris Descartes, 75006, Paris, France.,APHP, Necker Enfants Malades, Service d'Anatomopathologie et cytologie, 75015, Paris, France
| | - Ariane Berdal
- INSERM, UMRS 1138 Equipe 5, Laboratoire de Physiopathologie Orale Moléculaire, Centre de Recherche de Cordeliers, 75006, Paris, France.,UFR Odontologie, Garancière, Université Paris Diderot, 75006, Paris, France
| | - Vianney Descroix
- INSERM, UMRS 1138 Equipe 5, Laboratoire de Physiopathologie Orale Moléculaire, Centre de Recherche de Cordeliers, 75006, Paris, France.,UFR Odontologie, Garancière, Université Paris Diderot, 75006, Paris, France.,APHP, Hôpital Pitié Salpétrière, Service d'Odontologie, 75013, Paris, France
| | - Arnaud Picard
- INSERM, UMRS 1138 Equipe 5, Laboratoire de Physiopathologie Orale Moléculaire, Centre de Recherche de Cordeliers, 75006, Paris, France.,Université Paris Descartes, 75006, Paris, France.,APHP, Necker Enfants Malades, service de Chirurgie Maxillo-faciale et Plastique, , Hôpital Necker Enfants Malades, 146 rue de Sèvres, 75015, Paris, France.,APHP, CRMR des Malformations Rares de la Face et de la Cavité Buccale, 75015, Paris, France
| | - Amélie E Coudert
- INSERM, UMRS 1138 Equipe 5, Laboratoire de Physiopathologie Orale Moléculaire, Centre de Recherche de Cordeliers, 75006, Paris, France.,UFR Odontologie, Garancière, Université Paris Diderot, 75006, Paris, France
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11
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Lenouvel D, Chapireau D, Bentley R. Late Reactivation of Cherubism in a Patient With New-Onset Polycystic Ovary Syndrome. J Oral Maxillofac Surg 2015; 73:1957-61. [DOI: 10.1016/j.joms.2015.03.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/27/2015] [Accepted: 03/28/2015] [Indexed: 01/24/2023]
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Mukai T, Gallant R, Ishida S, Kittaka M, Yoshitaka T, Fox DA, Morita Y, Nishida K, Rottapel R, Ueki Y. Loss of SH3 domain-binding protein 2 function suppresses bone destruction in tumor necrosis factor-driven and collagen-induced arthritis in mice. Arthritis Rheumatol 2015; 67:656-67. [PMID: 25470448 DOI: 10.1002/art.38975] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 11/25/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE SH3 domain-binding protein 2 (SH3BP2) is a signaling adapter protein that regulates the immune and skeletal systems. The present study was undertaken to investigate the role of SH3BP2 in arthritis using 2 experimental mouse models, i.e., human tumor necrosis factor α-transgenic (hTNF-Tg) mice and mice with collagen-induced arthritis (CIA). METHODS First, Sh3bp2(-/-) and wild-type (Sh3bp2(+/+) ) mice were crossed with hTNF-Tg mice. Inflammation and bone loss were examined by clinical inspection and histologic and micro-computed tomography analysis, and osteoclastogenesis was evaluated using primary bone marrow-derived macrophage colony-stimulating factor-dependent macrophages (BMMs). Second, CIA was induced in Sh3bp2(-/-) and Sh3bp2(+/+) mice, and the incidence and severity of arthritis were evaluated. Anti-mouse type II collagen (CII) antibody levels were measured by enzyme-linked immunosorbent assay, and lymph node cell responses to CII were determined. RESULTS SH3BP2 deficiency did not alter the severity of joint swelling but did suppress bone erosion in the hTNF-Tg mouse model. Bone loss at the talus and tibia was prevented in Sh3bp2(-/-) /hTNF-Tg mice compared to Sh3bp2(+/+) /hTNF-Tg mice. RANKL- and TNFα-induced osteoclastogenesis was suppressed in Sh3bp2(-/-) mouse BMM cultures. NF-ATc1 nuclear localization in response to TNFα was decreased in Sh3bp2(-/-) mouse BMMs compared to Sh3bp2(+/+) mouse BMMs. In the CIA model, SH3BP2 deficiency suppressed the incidence of arthritis and this was associated with decreased anti-CII antibody production, while antigen-specific T cell responses in lymph nodes were not significantly different between Sh3bp2(+/+) and Sh3bp2(-/-) mice. CONCLUSION SH3BP2 deficiency prevents loss of bone via impaired osteoclastogenesis in the hTNF-Tg mouse model and suppresses the induction of arthritis via decreased autoantibody production in the CIA model. Therefore, SH3BP2 could potentially be a therapeutic target in rheumatoid arthritis.
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Abstract
Cherubism is a benign, self-limiting fibro-osseous lesion characterized by bilateral symmetric painless expansion of jaw which is more prominent in mandible than in maxilla. Males are commonly affected (2:1) and with greater severity. It becomes noticeable in early childhood and gradually regresses after puberty. Although cherubism is considered as a familial/inherited disease but many sporadic cases have been reported in literature with no familial history. Osteoblastic and osteoclastic remodeling replaces normal bone by excessive amount of fibrovascular tissue containing multinucleated giant cells. Here, we present a case report of cherubism in a 10 year old boy describing the clinical, histological, biochemical and radiographic features.
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Affiliation(s)
- Saikrishna Degala
- Department of OMFS, JSS Dental College and Hospital, JSS University, Mysore, Karnataka India
| | - K P Mahesh
- Oral Medicine & Radiology, JSS University, Mysore, Karnataka India
| | - Monalisha
- Department of OMFS, JSS Dental College and Hospital, JSS University, Mysore, Karnataka India
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Mukai T, Ishida S, Ishikawa R, Yoshitaka T, Kittaka M, Gallant R, Lin YL, Rottapel R, Brotto M, Reichenberger EJ, Ueki Y. SH3BP2 cherubism mutation potentiates TNF-α-induced osteoclastogenesis via NFATc1 and TNF-α-mediated inflammatory bone loss. J Bone Miner Res 2014; 29:2618-35. [PMID: 24916406 PMCID: PMC4262741 DOI: 10.1002/jbmr.2295] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 05/19/2014] [Accepted: 06/02/2014] [Indexed: 01/03/2023]
Abstract
Cherubism (OMIM# 118400) is a genetic disorder with excessive jawbone resorption caused by mutations in SH3 domain binding protein 2 (SH3BP2), a signaling adaptor protein. Studies on the mouse model for cherubism carrying a P416R knock-in (KI) mutation have revealed that mutant SH3BP2 enhances tumor necrosis factor (TNF)-α production and receptor activator of nuclear factor-κB ligand (RANKL)-induced osteoclast differentiation in myeloid cells. TNF-α is expressed in human cherubism lesions, which contain a large number of tartrate-resistant acid phosphatase (TRAP)-positive multinucleated cells, and TNF-α plays a critical role in inflammatory bone destruction in homozygous cherubism mice (Sh3bp2(KI/KI) ). The data suggest a pathophysiological relationship between mutant SH3BP2 and TNF-α-mediated bone loss by osteoclasts. Therefore, we investigated whether P416R mutant SH3BP2 is involved in TNF-α-mediated osteoclast formation and bone loss. Here, we show that bone marrow-derived M-CSF-dependent macrophages (BMMs) from the heterozygous cherubism mutant (Sh3bp2(KI/+) ) mice are highly responsive to TNF-α and can differentiate into osteoclasts independently of RANKL in vitro by a mechanism that involves spleen tyrosine kinase (SYK) and phospholipase Cγ2 (PLCγ2) phosphorylation, leading to increased nuclear translocation of NFATc1. The heterozygous cherubism mutation exacerbates bone loss with increased osteoclast formation in a mouse calvarial TNF-α injection model as well as in a human TNF-α transgenic mouse model (hTNFtg). SH3BP2 knockdown in RAW264.7 cells results in decreased TRAP-positive multinucleated cell formation. These findings suggest that the SH3BP2 cherubism mutation can cause jawbone destruction by promoting osteoclast formation in response to TNF-α expressed in cherubism lesions and that SH3BP2 is a key regulator for TNF-α-induced osteoclastogenesis. Inhibition of SH3BP2 expression in osteoclast progenitors could be a potential strategy for the treatment of bone loss in cherubism as well as in other inflammatory bone disorders.
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Affiliation(s)
- Tomoyuki Mukai
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
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Mukai T, Gallant R, Ishida S, Yoshitaka T, Kittaka M, Nishida K, Fox DA, Morita Y, Ueki Y. SH3BP2 gain-of-function mutation exacerbates inflammation and bone loss in a murine collagen-induced arthritis model. PLoS One 2014; 9:e105518. [PMID: 25144740 PMCID: PMC4140794 DOI: 10.1371/journal.pone.0105518] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/21/2014] [Indexed: 12/13/2022] Open
Abstract
Objective SH3BP2 is a signaling adapter protein which regulates immune and skeletal systems. Gain-of-function mutations in SH3BP2 cause cherubism, characterized by jawbone destruction. This study was aimed to examine the role of SH3BP2 in inflammatory bone loss using a collagen-induced arthritis (CIA) model. Methods CIA was induced in wild-type (Sh3bp2+/+) and heterozygous P416R SH3BP2 cherubism mutant knock-in (Sh3bp2KI/+) mice, an SH3BP2 gain-of-function model. Severity of the arthritis was determined by assessing the paw swelling and histological analyses of the joints. Micro-CT analysis was used to determine the levels of bone loss. Inflammation and osteoclastogenesis in the joints were evaluated by quantitating the gene expression of inflammatory cytokines and osteoclast markers. Furthermore, involvement of the T- and B-cell responses was determined by draining lymph node cell culture and measurement of the serum anti-mouse type II collagen antibody levels, respectively. Finally, roles of the SH3BP2 mutation in macrophage activation and osteoclastogenesis were determined by evaluating the TNF-α production levels and osteoclast formation in bone marrow-derived M-CSF-dependent macrophage (BMM) cultures. Results Sh3bp2KI/+ mice exhibited more severe inflammation and bone loss, accompanying an increased number of osteoclasts. The mRNA levels for TNF-α and osteoclast marker genes were higher in the joints of Sh3bp2KI/+ mice. Lymph node cell culture showed that lymphocyte proliferation and IFN-γ and IL-17 production were comparable between Sh3bp2+/+ and Sh3bp2KI/+ cells. Serum anti-type II collagen antibody levels were comparable between Sh3bp2+/+ and Sh3bp2KI/+ mice. In vitro experiments showed that TNF-α production in Sh3bp2KI/+ BMMs is elevated compared with Sh3bp2+/+ BMMs and that RANKL-induced osteoclastogenesis is enhanced in Sh3bp2KI/+ BMMs associated with increased NFATc1 nuclear localization. Conclusion Gain-of-function of SH3BP2 augments inflammation and bone loss in the CIA model through increased macrophage activation and osteoclast formation. Therefore, modulation of the SH3BP2 expression may have therapeutic potential for the treatment of rheumatoid arthritis.
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Affiliation(s)
- Tomoyuki Mukai
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Richard Gallant
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Shu Ishida
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
- Department of Periodontal Medicine, Applied life Sciences, Institute of Biomedical and Health Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Teruhito Yoshitaka
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Mizuho Kittaka
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Keiichiro Nishida
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Human Morphology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - David A. Fox
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Yoshitaka Morita
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Japan
| | - Yasuyoshi Ueki
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
- * E-mail:
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Tsodoulos S, Ilia A, Antoniades K, Angelopoulos C. Cherubism: a case report of a three-generation inheritance and literature review. J Oral Maxillofac Surg 2013; 72:405.e1-9. [PMID: 24280174 DOI: 10.1016/j.joms.2013.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 10/02/2013] [Accepted: 10/04/2013] [Indexed: 11/15/2022]
Abstract
Cherubism is a rare, non-neoplastic pathologic entity first described by Jones in 1933. It affects mostly younger individuals and is usually inherited. Cherubism presents as a painless jaw enlargement that affects both the maxilla and the mandible and is characterized by replacement of the osseous tissue by fibrous connective tissue. Radiologically, the lesions appear as multiple, multilocular radiolucent spaces with distinct borders divided by bony septations, which often dramatically alter the shape and size of the jaw structures. These often result in marked facial abnormalities. Cervical lymphadenopathy is not uncommon in those affected. The disease is self-limited and can reverse itself with time. Approximately 250 cases have been reported in published studies, mostly affecting males. The purpose of our report was to present a case of cherubism diagnosed in a young girl and the long-term (3 generations) follow-up evaluation of her mother and grandmother, both of whom had been diagnosed with the same pathologic entity.
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Affiliation(s)
- Spyridon Tsodoulos
- Associate Professor, Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Ilia
- Dentist, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Konstantinos Antoniades
- Professor, Department of Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Angelopoulos
- Consultant, Department of Maxillofacial Radiology, Bronx Veterans Affairs Hospital, Bronx, NY
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Hero M, Suomalainen A, Hagström J, Stoor P, Kontio R, Alapulli H, Arte S, Toiviainen-Salo S, Lahdenne P, Mäkitie O. Anti-tumor necrosis factor treatment in cherubism--clinical, radiological and histological findings in two children. Bone 2013; 52:347-53. [PMID: 23069372 DOI: 10.1016/j.bone.2012.10.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 10/03/2012] [Accepted: 10/04/2012] [Indexed: 11/27/2022]
Abstract
Cherubism is a rare and disfiguring genetic disorder with excessive bone resorption and multilocular lesions in the mandible and/or maxilla. The disease-causing gain-of-function mutations in the SH3-binding protein 2 (SH3BP2) gene result in increased myeloid cell responses to macrophage colony stimulating factor and RANK ligand, formation of hyperactive osteoclasts (giant cells), and hyper-reactive macrophages that produce excessive amounts of the inflammatory cytokine tumor necrosis factor α (TNF-α). Recent findings in the cherubism mouse model suggest that TNF-α plays a major role in disease pathogenesis and that removal of TNF-α prevents development of the bone phenotype. We treated two children with cherubism with the TNF-α antagonist adalimumab for approximately 2.5 years and collected extensive clinical, radiological and histological follow-up data during the treatment. Histologically the treatment resulted in a significant reduction in the number of multinucleated giant cells and TNF-α staining positivity in both patients. As evaluated by computed tomography and magnetic resonance imaging, the lesions in Patient 1 showed either moderate enlargement (mandibular symphysis) or remained stable (mandibular rami and body, the maxilla). In Patient 2, the lesions in mandibular symphysis showed enlargement during the first 8 months of treatment, and thereafter the lesions remained unchanged. Bone formation and resorption markers remained unaffected. The treatment was well tolerated. Based on our findings, TNF-α antagonist may decrease the formation of pathogenic giant cells, but does not result in lesion regression or prevent lesion expansion in active cherubism. TNF-α modulator treatment thus does not appear to provide sufficient amelioration for patients suffering from cherubism.
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Affiliation(s)
- M Hero
- Childrens' Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
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Abstract
Cherubism is a skeletal dysplasia characterized by bilateral and symmetric fibro-osseous lesions limited to the mandible and maxilla. In most patients, cherubism is due to dominant mutations in the SH3BP2 gene on chromosome 4p16.3. Affected children appear normal at birth. Swelling of the jaws usually appears between 2 and 7 years of age, after which, lesions proliferate and increase in size until puberty. The lesions subsequently begin to regress, fill with bone and remodel until age 30, when they are frequently not detectable. Fibro-osseous lesions, including those in cherubism have been classified as quiescent, non-aggressive and aggressive on the basis of clinical behavior and radiographic findings. Quiescent cherubic lesions are usually seen in older patients and do not demonstrate progressive growth. Non-aggressive lesions are most frequently present in teenagers. Lesions in the aggressive form of cherubism occur in young children and are large, rapidly growing and may cause tooth displacement, root resorption, thinning and perforation of cortical bone. Because cherubism is usually self-limiting, operative treatment may not be necessary. Longitudinal observation and follow-up is the initial management in most cases. Surgical intervention with curettage, contouring or resection may be indicated for functional or aesthetic reasons. Surgical procedures are usually performed when the disease becomes quiescent. Aggressive lesions that cause severe functional problems such as airway obstruction justify early surgical intervention.
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Affiliation(s)
- Maria E Papadaki
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA
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Fernandes Gomes M, Ferraz de Brito Penna Forte L, Hiraoka CM, Augusto Claro F, Costa Armond M. Clinical and surgical management of an aggressive cherubism treated with autogenous bone graft and calcitonin. ISRN Dent 2011; 2011:340960. [PMID: 21991467 PMCID: PMC3169853 DOI: 10.5402/2011/340960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 10/10/2010] [Indexed: 11/23/2022]
Abstract
Cherubism is a rare autosomal-dominant inherited syndrome and is usually self-limiting; it starts in early childhood and involutes by puberty. It is a benign fibroosseous disease, characterized by excessive bone degradation of the upper and lower jaws followed by development of fibrous tissue masses. The purpose of this clinical report is to describe a rare and aggressive form of cherubism on an adult female patient that has been treated in our Bioscience Center for Special Health Care Needs-CEBAPE. The patient was firstly submitted to the surgical procedure with partial curettage of the lesion, and the cavity was filled with autogenous cancellous bone and bone marrow grafts. Furthermore, the support treatment used was the administration of salmon calcitonin by nasal spray during the first year after the preconized procedure. At 4-year followup, we confirmed the stomatognathic system improvement and esthetic rehabilitation, which led to a significant increase in the patient's quality of life.
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Affiliation(s)
- Mônica Fernandes Gomes
- Bioscience Center for Special Health Care Needs (Centro de Biociências Aplicado a Pacientes com Necessidades Especiais/CEBAPE-UNESP), São José dos Campos Dental School of the São Paulo State University (UNESP), São José dos Campos, São Paulo, Brazil
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Etoz OA, Dolanmaz D, Gunhan O. Treatment of cherubism with salmon calcitonin: a case report. Eur J Dent 2011; 5:486-91. [PMID: 21912506 PMCID: PMC3170034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cherubism is a familial disease of the jaws which is inherited via autosomal dominant manner. Typical features of cherubism include a painless bilateral, symmetrical enlargement of the jaws, misalignment of teeth, and intra-osseous central giant cell granuloma-like lesions, which are usually evident in early childhood. Treatment of cherubism consists of local curettage of the lesions, jaw contouring, intralesional steroid injections, and systemic calcitonin administration as well. Calcitonin therapy for central giant cell granuloma of the jaws is well documented, and favorable results have been achieved. However, fewer reports have been presented in regard to calcitonin administration for cherubism. In the present report, a 14-year-old boy with cherubism who had intra-osseous cherubic lesions in his mandible was treated with an administration of 200 IU systemic calcitonin every other day via his nasal passage for duration of more than two years. After 30 months of calcitonin therapy, the lesions in the mandible were significantly regressed, and calcitonin application was ceased. Despite some drawbacks, such as unpredictable efficient absorption and patient tolerability, nasal administration is the easiest way to use calcitonin therapy on children. In this report, every-other-day applications of calcitonin increased patient tolerability and might be considered as an effective treatment for mild cherubic lesions.
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Affiliation(s)
- Osman A. Etoz
- Assistant Professor, Erciyes University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Kayseri, Turkey,Corresponding author: Dr. Osman Etoz, Erciyes Universitesi, Dis Hekimligi Fakultesi, Cerrahi Bolumu, 38039 Melikgazi, Kayseri, Turkey, Phone: +90 352 437 49 37, Fax: +90 352 438 06 57, E-mail:
| | - Dogan Dolanmaz
- Associate Professor, Selcuk University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Konya, Turkey
| | - Omer Gunhan
- Professor, Gülhane Military Medical Academy and Medical Faculty, Department of Pathology, Ankara, Turkey
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Mukherjee PM, Wang CJ, Chen IP, Jafarov T, Olsen BR, Ueki Y, Reichenberger EJ. Cherubism gene Sh3bp2 is important for optimal bone formation, osteoblast differentiation, and function. Am J Orthod Dentofacial Orthop 2010; 138:140.e1-140.e11; discussion 140-1. [PMID: 20691350 DOI: 10.1016/j.ajodo.2009.05.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Revised: 05/01/2009] [Accepted: 05/01/2009] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Cherubism is a human genetic disorder that causes bilateral symmetrical enlargement of the maxilla and the mandible in children. It is caused by mutations in SH3BP2. The exact pathogenesis of the disorder is an area of active research. Sh3bp2 knock-in mice were developed by introducing a Pro416Arg mutation (Pro418Arg in humans) in the mouse genome. The osteoclast phenotype of this mouse model was recently described. METHODS We examined the bone phenotype of the cherubism mouse model, the role of Sh3bp2 during bone formation, osteoblast differentiation, and osteoblast function. RESULTS We observed delays in early postnatal development of homozygous Sh3bp2(KI/KI) mice, which exhibited increased growth plate thickness and significantly decreased trabecular bone thickness and bone mineral density. Histomorphometric and microcomputed tomography analyses showed bone loss in the cranial and appendicular skeletons. Sh3bp2(KI/KI) mice also exhibited a significant decrease in osteoid formation that indicated a defect in osteoblast function. Calvarial osteoblast cell cultures had decreased alkaline phosphatase expression and mineralization, suggesting reduced differentiation potential. Gene expression of osteoblast differentiation markers such as collagen type I, alkaline phosphatase, and osteocalcin were decreased in osteoblast cultures from Sh3bp2(KI/KI) mice. CONCLUSIONS These data suggest that Sh3bp2 regulates bone homeostasis through not only osteoclast-specific effects, but also through effects on osteoblast differentiation and function.
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GuezGuez A, Prod'homme V, Mouska X, Baudot A, Blin-Wakkach C, Rottapel R, Deckert M. 3BP2 adapter protein is required for receptor activator of NFκB ligand (RANKL)-induced osteoclast differentiation of RAW264.7 cells. J Biol Chem 2010; 285:20952-63. [PMID: 20439986 DOI: 10.1074/jbc.m109.091124] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The adapter protein 3BP2 (also known as SH3BP2 and Abl SH3-binding protein 2) has been involved in leukocyte signaling and activation downstream immunoreceptors. Genetic studies have further associated 3BP2 mutations to the human disease cherubism and to inflammation and bone dysfunction in mouse. However, how wild type 3BP2 functions in macrophage differentiation remains poorly understood. In this study, using small interfering RNA-mediated silencing of 3BP2 in the RAW264.7 monocytic cell line, we show that 3BP2 was required for receptor activator of NFkappaB ligand (RANKL)-induced differentiation of RAW264.7 cells into multinucleated mature osteoclasts but not for granulocyte macrophage-colony stimulating factor/interleukin-4-induced differentiation into dendritic cells. 3BP2 silencing was associated with impaired activation of multiple signaling events downstream of RANK, including actin reorganization; Src, ERK, and JNK phosphorylation; and up-regulation of osteoclastogenic factors. In addition, 3BP2 knockdown cells induced to osteoclast by RANKL displayed a reduced increase of Src and nuclear factor of activated T cells (NFATc1) mRNA and protein expression. Importantly, 3BP2 interacted with Src, Syk, Vav, and Cbl in monocytic cells, and the introduction of constitutively active mutants of Src and NFATc1 in 3BP2-deficient cells restored osteoclast differentiation. Finally, the expression of a 3BP2 cherubism mutant was found to promote increased Src activity and NFAT-dependent osteoclast formation. Together, this study demonstrates that wild type 3BP2 is a key regulator of RANK-mediated macrophage differentiation into osteoclast through Src and NFATc1 activation.
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Affiliation(s)
- Amel GuezGuez
- INSERM, UMR576, Hôpital de l'Archet, Nice F-06202, France
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Flanagan AM, Delaney D, O'Donnell P. Benefits of molecular pathology in the diagnosis of musculoskeletal disease : Part II of a two-part review: bone tumors and metabolic disorders. Skeletal Radiol 2010; 39:213-24. [PMID: 19669759 DOI: 10.1007/s00256-009-0758-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 07/08/2009] [Indexed: 02/02/2023]
Abstract
The second part of this review, on the benefits of molecular pathology in the diagnosis disease, focuses on the genetics of bone tumors and metabolic disease. Unlike soft tissue tumors, the number of currently exploitable molecular abnormalities for diagnosing bone neoplasms is small, although the same gene rearrangements are found in primitive neuroectodermal tumor/Ewing sarcoma in both skeletal and extraskeletal sites. Compared with soft tissue tumors, genetic abnormalities, which are valuable to diagnosticians in skeletal disease, are often germline and post-zygotic aberrations rather than somatic translocations. In addition, the review highlights the range of disease entities classified as "osteoclast-rich lesions," some of which harbor germline mutations. It also addresses the importance of phosphate metabolism in skeletal disorders including phosphaturic mesenchymal tumor, vitamin D-resistant rickets, and tumoral calcinosis.
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Affiliation(s)
- Adrienne M Flanagan
- Department of Histopathology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, UK.
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Abstract
Objectives Cherubism is a congenital childhood disease of autosomal dominant
inheritance. This disease is characterized by painless bilateral
enlargement of the jaws, in which bone is replaced with fibrous tissue.
The condition has sui generis clinical, radiographic and
histological features, of which the clinician should be aware for a
better differential diagnosis in the presence of a fibro-osseous lesion
affecting the bones of the maxillomandibular complex. The purpose of
present paper was to review the literature and to report the most
important aspects of cherubism in order to facilitate the study of this
disease Material and Methods Literature was reviewed about cherubism, emphasizing the relevant
clinicoradiographic features and treatment. Literature was selected
through a search of PubMed and Scielo electronic databases. The keywords
used for search were adolescent, cherubism, cherubism/physiopathology,
cherubism/treatment, cherubism/radiography. A manual search of the
reference lists of the identified articles and the authors' article
files and recent reviews was conducted to identify additional
publications. Those studies that described new features about cherubism
were included in this review. Results In total 44 literature sources were obtained and reviewed. Studies that
described new features about cherubism physiopathology, diagnostics and
treatment were reviewed. Conclusions Despite the exceptions, cherubism is a clinically well-characterized
disease. In cases of a suspicion of cherubism, radiographic examination
is essential since the clinical presentation, the location and
distribution of the lesions may define the diagnosis. Histopathological
examination is complementary. Nowadays, genetic tests should be used for
final diagnosis of cherubism.
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Affiliation(s)
- Gabriela de Morais Gouvêa Lima
- Postgraduation Program in Oral Biopathology, São José dos Campos Dental School, São Paulo State University - UNESP, São José dos Campos, São Paulo Brazil
| | - Janete Dias Almeida
- Postgraduation Program in Oral Biopathology, São José dos Campos Dental School, São Paulo State University - UNESP, São José dos Campos, São Paulo Brazil
| | - Luiz Antonio Guimarães Cabral
- Department of Biosciences and Oral Diagnosis, São José dos Campos Dental School, São Paulo State University - UNESP, São José dos Campos, São Paulo Brazil
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Mortellaro C, Bello L, Lucchina AG, Pucci A. Diagnosis and Treatment of Familial Cherubism Characterized by Early Onset and Rapid Development. J Craniofac Surg 2009; 20:116-20. [DOI: 10.1097/scs.0b013e318190e23c] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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van Capelle CI, Hogeman PHG, van der Sijs-Bos CJM, Heggelman BGF, Idowu B, Slootweg PJ, Wittkampf ARM, Flanagan AM. Neurofibromatosis presenting with a cherubism phenotype. Eur J Pediatr 2007; 166:905-9. [PMID: 17120035 DOI: 10.1007/s00431-006-0334-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Accepted: 10/05/2006] [Indexed: 11/28/2022]
Abstract
We report on a child who presented clinical manifestations of both neurofibromatosis type 1 (NF1) and cherubism. With genetic testing, we found a mutation in the NF-1 gene, confirming the neurocutaneous disorder. Histology when correlated with radiological evaluation of a mandibular biopsy was consistent with cherubism. This is the first report in the literature of a child with proven neurofibromatosis type 1 and cherubism without extragnathic lesions. This emphasises that cherubism is a clinical phenotype that can be associated with a number of germline mutations involving SH3BP2, PTPN11 and NF1.
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Affiliation(s)
- C I van Capelle
- Department of Pediatrics, Meander Medisch Centrum, Amersfoort, The Netherlands
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28
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Abstract
PURPOSE OF REVIEW This review provides an update on clinical, genetic, and immunologic aspects of the autoinflammatory bone disorders. RECENT FINDINGS Chronic noninfectious inflammation of the bone is a clinical feature of both chronic recurrent multifocal osteomyelitis and (to a lesser degree) cherubism. The genes responsible for Majeed syndrome (LPIN2), murine chronic multifocal osteomyelitis (pstpip2), and cherubism (SH3BP2 and possibly PTPN11) have been identified. Murine models of both chronic recurrent multifocal osteomyelitis and cherubism have demonstrated that the bone inflammation is mediated by hematopoietically derived cells and can occur in the absence of a functioning adaptive immune system. As the immunologic defects become better defined, the cells of the myeloid lineage are emerging as the primary players. SUMMARY Chronic multifocal osteomyelitis and cherubism are hereditary chronic inflammatory disorders in which bone is the primary inflammatory target. Recent genetic and immunologic discoveries demonstrate involvement of the innate immune system, which places these entities in the category of autoinflammatory disorders.
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Affiliation(s)
- Polly J Ferguson
- Department of Pediatrics, University of Iowa, Iowa City, Iowa 52242, USA.
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de Lange J, van den Akker HP, Scholtemeijer M. Cherubism Treated With Calcitonin: Report of a Case. J Oral Maxillofac Surg 2007; 65:1665-7. [PMID: 17656300 DOI: 10.1016/j.joms.2006.06.266] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2005] [Revised: 03/01/2006] [Accepted: 06/12/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Jan de Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Center/Academic Center for Dentistry (ACTA), University of Amsterdam, Amsterdam, The Netherlands.
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30
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Abstract
Adaptor proteins that do not contain intrinsic enzymatic activity play a critical role in cell biology by regulating the assembly of large multimolecular signaling complexes involved in extracellular signal transduction. The increasing number of diseases associated with aberrant function or expression of adaptor proteins further illustrate their key role in cellular regulation. The adaptor 3BP2 (or SH3BP2) was originally identified more than 10 years ago as an c-Abl binding protein, and next as a partner of Syk family kinases in 1998. 3BP2 displays the typical modular organization of an adapter protein with an amino-terminal PH domain, a central proline rich region and a carboxyl-terminal SH2 domain. Although its physiological function remains unknown, studies have implicated a role for 3BP2 in immunoreceptor signaling through its interaction with a number of signaling molecules including Src and Syk families of protein tyrosine kinases, the membrane adaptor LAT, Vav exchange factors, PLC-gamma, and 14-3-3 proteins. Recently, the 3bp2/sh3bp2 locus was shown to be mutated in a rare human disease involved in cranial-facial development called cherubism, suggesting a role for 3BP2 in regulating osteoclast and hematopoietic cell function.
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Affiliation(s)
- Marcel Deckert
- Inserm U576, Régulation des réponses immune et inflammatoire, Hôpital de l'Archet, Route Saint-Antoine de Ginestière, 06202 Nice, France.
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Carvalho Silva E, Carvalho Silva GC, Vieira TC. Cherubism: Clinicoradiographic Features, Treatment, and Long-Term Follow-Up of 8 Cases. J Oral Maxillofac Surg 2007; 65:517-22. [PMID: 17307601 DOI: 10.1016/j.joms.2006.05.061] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Revised: 02/14/2006] [Accepted: 05/31/2006] [Indexed: 11/17/2022]
Affiliation(s)
- Edgard Carvalho Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
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32
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Chen G, Dimitriou ID, La Rose J, Ilangumaran S, Yeh WC, Doody G, Turner M, Gommerman J, Rottapel R. The 3BP2 adapter protein is required for optimal B-cell activation and thymus-independent type 2 humoral response. Mol Cell Biol 2007; 27:3109-22. [PMID: 17283041 PMCID: PMC1899947 DOI: 10.1128/mcb.01014-06] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
3BP2 is a pleckstrin homology domain- and Src homology 2 (SH2) domain-containing adapter protein that is mutated in the rare human bone disorder cherubism and which has also been implicated in immunoreceptor signaling. However, a function for this protein has yet to be established. Here we show that mice lacking 3BP2 exhibited a perturbation in the peritoneal B1 and splenic marginal-zone B-cell compartments and diminished thymus-independent type 2 antigen response. 3BP2(-/-) B cells demonstrated a proliferation defect in response to antigen receptor cross-linking and a heightened sensitivity to B-cell receptor-induced death via a caspase-3-dependent apoptotic pathway. We show that 3BP2 binds via its SH2 domain to the CD19 signaling complex and is required for optimum Syk phosphorylation and calcium flux.
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Affiliation(s)
- Grace Chen
- Princess Margaret Hospital/Ontario Cancer Institute, Room 10-105, University Ave., Toronto, ON, Canada
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33
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34
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Abstract
Background Cherubism is a rare hereditary multi-cystic disease of the jaws, characterized by its typical appearance in early childhood, and stabilization and remission after puberty. It is genetically transmitted in an autosomal dominant fashion and the gene coding for SH3-binding protein 2 (SH3BP2) may be involved. Case presentation We investigated a family consisting of 21 members with 3 female affected individuals with cherubism from Northern China. Of these 21 family members, 17 were recruited for the genetic analysis. We conducted the direct sequence analysis of the SH3BP2 gene among these 17 family members. A disease-causing mutation was identified in exon 9 of the gene. It was an A1517G base change, which leads to a D419G amino acid substitution. Conclusion To our knowledge, the A1517G mutation has not been reported previously in cherubism. This finding is novel.
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Affiliation(s)
- Cui-Ying Li
- Department of Oral Pathology, School of Stomatology, Peking University, Beijing, China
| | - Shi-Feng Yu
- Department of Oral Pathology, School of Stomatology, Peking University, Beijing, China
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35
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Silva GCC, Gomez RS, Vieira TC, Silva EC. Cherubism: long-term follow-up of 2 patients in whom it regressed without treatment. Br J Oral Maxillofac Surg 2006; 45:567-70. [PMID: 17030358 DOI: 10.1016/j.bjoms.2006.08.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2006] [Indexed: 11/19/2022]
Abstract
Cherubism is a rare hereditary, self-limiting fibrous dysplasia characterised by painless enlargement of the jaws in childhood. Although, it is accepted that the lesions of cherubism are eventually replaced by bone, there have been few long-term follow-up reports with clinicoradiographic documentation of spontaneous remission of the disease, without treatment. We report two cases of cherubic boys who were followed for 17 and 19 years. Clinicoradiographic examination during this period showed regression of the disease without surgical correction.
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Affiliation(s)
- Guilherme Costa Carvalho Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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36
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Wolvius EB, de Lange J, Smeets EEJ, van der Wal KGH, van den Akker HP. Noonan-Like/Multiple Giant Cell Lesion Syndrome: Report of a Case and Review of the Literature. J Oral Maxillofac Surg 2006; 64:1289-92. [PMID: 16860226 DOI: 10.1016/j.joms.2006.04.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2004] [Indexed: 11/21/2022]
Affiliation(s)
- Eppo B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus MC Rotterdam, Rotterdam, The Netherlands.
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37
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Wang CN, Song YL, Peng B, Lu DH, Fan MW, Li J, Ye XQ, Fan HL, Bian Z. The aggressive form of cherubism: report of two cases in unrelated families. Br J Oral Maxillofac Surg 2005; 44:322-4. [PMID: 16310907 DOI: 10.1016/j.bjoms.2005.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Accepted: 10/13/2005] [Indexed: 11/21/2022]
Abstract
Cherubism is a benign lesion that causes painless symmetrical enlargement of the jaws, usually with a familial tendency. We describe in two Chinese families two cases of the aggressive form of cherubism with extensive swelling on both sides of the mandible, typical microscopic findings, and apparent familial history.
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Affiliation(s)
- C N Wang
- Key Lab. for Oral Biomedical Engineering of Ministry of Education, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan 430079, PR China
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38
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39
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Gomes MF, de Souza Setúbal Destro MF, de Freitas Banzi EC, dos Santos SH, Claro FA, de Oliveira Nogueira T. Aggressive behaviour of cherubism in a teenager: 4-years of clinical follow-up associated with radiographic and histological features. Dentomaxillofac Radiol 2005; 34:313-8. [PMID: 16120883 DOI: 10.1259/dmfr/32866350] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cherubism is a rare hereditary fibro-osseous childhood disease characterized by bone degradation and fibrous tissue replacement at the angles of the mandible and at the tuberosity areas of the maxilla that leads to prominence of the lower face and an appearance reminiscent of the cherub's portrayal in Renaissance art. This disease has an autosomal dominant hereditary characteristic. The purpose of this report is to analyse laboratory tests, clinicopathological and radiographic features of cherubism and its intraoral manifestations in a patient during 4-years of follow-up, correlating the features observed in this case with those of the literature. Also discussed is the atypical and aggressive behaviour of this case during puberty.
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Affiliation(s)
- M F Gomes
- Faculdade de Odontologia de São José dos Campos, UNESP, Departamento de Biociências e Diagnóstico Oral, São Paulo, Brasil.
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40
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Abstract
The authors reviewed 24 cases of familial or nonfamilial cherubism. The age at onset was between 6 and 10 years. It was characterized by bilateral painless swelling of jaws and eyes-to-heaven appearance was visible when the maxillae were affected as well. Radiographs showed well-defined multilocular radiolucencies and with age, thick sclerotic borders were visible. A malocclusive and abnormal dentition, worse in the mandible can be seen. Histopathologically, numerous randomly distributed multinucleated giant cells and vascular spaces within a fibrous connective tissue stroma with or without eosinophilic collagen perivascular cuffing were apparent. Multinucleated giant cells were positive for osteoclastic specific markers, tartrate-resistant acid phosphatase and human alphaV beta3 integrin, 23C6. Results after follow-up were available for 14 cases. Of these, no treatment was carried out in five cases, cherubism resolved (three cases) or grew slowly (two cases); curettage or surgical contouring was performed in seven cases, during the rapid growth of the lesions. This not only gave good immediate results, but also arrested active growth of remnant cherubic lesions and even stimulated bone regeneration. Segmental mandibulectomy followed by reconstruction was performed in two cases with extensive lesion and the risk of pathologic fracture of the mandible, and excellent results were obtained.
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Affiliation(s)
- X-M Meng
- Department of Oral Pathology, Peking University School of Stomatology, Haidian District, Beijing 100081, PR China.
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41
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Delozier JB, Egger ME, Bottomy MB. Infantile fibrous dysplasia of the mandible. J Craniofac Surg 2004; 15:1039-43. [PMID: 15547401 DOI: 10.1097/00001665-200411000-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Fibrous dysplasia of the craniofacial skeleton is an uncommon benign neoplasm. Its appearance in infancy (<1 year) is extremely rare. The authors report a case of mandibular fibrous dysplasia presenting in a patient 12 weeks of age as a painless, primarily left-sided, enlarging neoplasm of bone. Surgical contouring was successfully performed when the patient was 9 months of age. The authors anticipate recurrence, but at 6 months of follow-up no new growth has been observed.
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42
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Ozkan Y, Varol A, Turker N, Aksakalli N, Basa S. Clinical and radiological evaluation of cherubism: a sporadic case report and review of the literature. Int J Pediatr Otorhinolaryngol 2003; 67:1005-12. [PMID: 12907058 DOI: 10.1016/s0165-5876(03)00179-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Many cases have been published on cherubism since Jones described it first time in three children of the same family [Am. J. Cancer 17 (1933) 946]. Cherubism is an autosomal-dominant disorder in which the normal bone is replaced by cellular fibrous tissue and immature bone. Extracranial skeletal involvement is rarely seen in hereditary and non-hereditary forms of the disorder. The mandible is the most severely affected craniofacial component, in which uncontrolled growth of the malady deteriorates the aesthetic balance of the face. Bilateral swelling of the cheeks, mandibular enlargement and maxillary spongious hypertrophy cause orbital manifestations and tendency of eyes looking up to the sky. Thus, the pathognomic clinical feature resembles the appearance of "raised to heaven" Renaissance cherubs. The sporadic case concerns a child affected by cherubism. Radiographic and clinical data of the patient are presented and brief review of the literature is included.
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Affiliation(s)
- Yasar Ozkan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Marmara University, Buyukciftlik Sok. No. 6, 80200 Nisantasi, Istanbul, Turkey.
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43
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Lo B, Faiyaz-Ul-Haque M, Kennedy S, Aviv R, Tsui LC, Teebi AS. Novel mutation in the gene encoding c-Abl-binding protein SH3BP2 causes cherubism. Am J Med Genet A 2003; 121A:37-40. [PMID: 12900899 DOI: 10.1002/ajmg.a.20226] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cherubism is a rare autosomal dominant inherited condition caused by mutations in the c-Abl-binding protein SH3BP2. It is characterized by multiple cystic giant cell lesions of the jaw appearing in early childhood with stabilization and remission after puberty. In the present study, we used direct sequence analysis of the SH3BP2 gene of several individuals from a family with cherubism to search for additional SH3BP2 mutations resulting in cherubism. In affected relatives, we found a previously unreported G to A transition in exon 9 leading to a Gly to Arg substitution at amino acid position 420. G420R has been reported previously with a G to C transversion. To date there have been no disease causing mutations outside exon 9. Therefore, the amino acid sequence from positions 415 to 420 may represent a specific protein domain which, when disrupted, leads to the cherubism phenotype.
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Affiliation(s)
- Bryan Lo
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
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44
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Abstract
Cherubism is a hereditary childhood disease of autosomal dominant inheritance that is more common in the male sex. Some cases have also revealed a mutation of the gene FGF-RIII (fibroblast growth factor receptor III). The clinical picture of cherubism is characterized by painless symmetrical swelling of the mandible and polycystic destruction of the mandibular bone structure. Complications include delayed dentition, dental root resorption, malalignment of teeth, and impacted teeth. The disease progression comes to a halt of its own accord at the end of puberty. Spontaneous recoveries have been observed. Histologically, multinuclear giant cells with osteoclastic activity, which correspond to a giant cell granuloma, are found in fibrous stroma. It is generally agreed that decisions about surgical intervention should be considered carefully. A case report describes the course of the disease and therapy of a female patient with a periorbital manifestation of cherubism. The latero-orbital enlargement of the intraorbital and latero-orbital region of the zygomatic bone resulted in displacement of the orbital contents with a motility disorder of the eyes. The motility disorder was eliminated by reduction of the diseased hard tissue as well as by carrying out a modeling orbitotomy and by reconstructing an anatomically correct localized and irregular bilateral osseous structure of the zygomatic bone in the intraorbital and latero-orbital region.
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Affiliation(s)
- Stefan Schultze-Mosgau
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Germany.
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45
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Abstract
Cherubism is a rare hereditary condition characterised by progressive cystic proliferation of the mandible and maxilla in childhood, followed by post-pubertal involution of the process and jaw remodelling in adulthood. Its name is derived from the cherubic appearance that results from the jaw hypertrophy. Here, we present the case of a young boy with cherubism, in the context of his pedigree, to illustrate the clinical characteristics and their variable expression. We also seek to distinguish cherubism from central giant cell granuloma and giant cell tumour of the jaws, with which it holds a false synonymity.
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Affiliation(s)
- D A Lannon
- The Craniofacial and Plastic Surgery Department, Temple Street Children's Hospital, Dublin, Ireland
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46
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Abstract
PURPOSE To demonstrate the clinical, radiologic, and histopathologic features of a patient with orbital involvement in cherubism that prompted surgical treatment. DESIGN Single interventional case report. INTERVENTION Findings of the ophthalmic evaluation, computed tomography (CT) scans, intraoperative examination, and light microscopy of the specimens were analyzed. MAIN OUTCOME MEASURES Globe displacement, orbital bony lesions detected on CT scans, histopathology, and postoperative results were assessed. RESULTS A 27-year-old female was seen with a slowly progressive superonasal globe displacement and a temporal orbital mass bilaterally of 6 years' duration. She had a history of cherubism, but her cheeks and jaws had a normal appearance instead of the bilateral fullness of the lower half of the face typical of the disease. CT scans demonstrated multicystic bony lesions arising from the orbital floors bilaterally. The masses were excised using an anterior transcutaneous transseptal orbitotomy. Histopathology demonstrated numerous giant cells in a fibrovascular stroma, confirming the clinical diagnosis of cherubism. Postoperative recovery was complete. CONCLUSIONS Orbital involvement in cherubism may develop beyond puberty, after stabilization or regression of the lesions in the jaws. Patients with cherubism should be routinely evaluated by an ophthalmologist.
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Affiliation(s)
- F Colombo
- Department of Ophthalmology and Eye Hospital, University of Erlangen-Nürnberg, Erlangen, Germany
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47
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Abstract
Cherubism is a rare, inherited condition characterized by fibro-osseous lesions of the maxilla and mandible. It has recently been localized to chromosome 4p16.3. The fullness of the lower half of the face and retraction of the lower lids gives the characteristic 'eyes raised to heaven' cherubic appearance. A case report of a 7-year-old girl with extensive orbital involvement of cherubism is presented. The patient underwent multidisciplinary surgery for the bony lesions, which extended from the maxillary antrum into adjacent structures, including extensive extraperiosteal orbital involvement. Cherubism may have orbital manifestations including lower lid retraction, proptosis, diplopia, globe displacement and visual loss due to optic atrophy. Ophthalmologists should be aware of the syndrome, its ophthalmic features and overall management.
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Affiliation(s)
- A L Carroll
- Department of Ophthalmology, Royal Brisbane Hospital, Queensland, Australia
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48
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Von Wowern N. Cherubism: a 36-year long-term follow-up of 2 generations in different families and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90:765-72. [PMID: 11113824 DOI: 10.1067/moe.2000.108438] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To clarify the relationships between the varying clinical or radiographic features of cherubism. STUDY DESIGN Nonparametric statistics were used in a long-term follow-up of 18 patients through 2 generations from 6 Danish families. RESULTS The radiographic grade of cherubism was significantly related to sex, maximal buccal bone expansion, course of cherubism, and number of aplasia or ectopic impacted teeth, but it was not related to families. Normal dentition in nonaffected regions was present or was obtained in 14 of 14 patients (age, >14 years). Surgical treatment did not provoke growth of lesional tissue in 22 of 22 cases. Radiographically, the bone structure in the lesional areas was related to age in all grades of cherubism: new bone formation in radiolucent areas (age, >20 years), normal bone structure with multilocular sketches (age, 32 to 39 years), and completely normal bone structure (age, >41 years), also found in 7 of 7 carriers of cherubism (age, >32 years). CONCLUSIONS This group analysis verifies the knowledge of cherubism previously based on cumulative reviews of findings in single-family and case reports.
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Affiliation(s)
- N Von Wowern
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Copenhagen, Denmark
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49
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Mangion J, Rahman N, Edkins S, Barfoot R, Nguyen T, Sigurdsson A, Townend JV, Fitzpatrick DR, Flanagan AM, Stratton MR. The gene for cherubism maps to chromosome 4p16.3. Am J Hum Genet 1999; 65:151-7. [PMID: 10364527 PMCID: PMC1378085 DOI: 10.1086/302454] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cherubism is a rare familial disease of childhood characterized by proliferative lesions within the mandible and maxilla that lead to prominence of the lower face and an appearance reminiscent of the cherubs portrayed in Renaissance art. Resolution of these bony abnormalities is often observed after puberty. Many cases are inherited in an autosomal dominant fashion, although several cases without a family history have been reported. Using two families with clinically, radiologically, and/or histologically proved cherubism, we have performed a genomewide linkage search and have localized the gene to chromosome 4p16.3, with a maximum multipoint LOD score of 5. 64. Both families showed evidence of linkage to this locus. Critical meiotic recombinants place the gene in a 3-cM interval between D4S127 and 4p-telomere. Within this region a strong candidate is the gene for fibroblast growth factor receptor 3 (FGFR3); mutations in this gene have been implicated in a diverse set of disorders of bone development.
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Affiliation(s)
- J Mangion
- Section of Cancer Genetics, Institute of Cancer Research, Sutton, Surrey, United Kingdom
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