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Shah C, Holtfreter B, Hughes FJ, Nibali L. Retrospective exploratory study of smoking status and e-cigarette use with response to non-surgical periodontal therapy. J Periodontol 2023; 94:41-54. [PMID: 35781714 PMCID: PMC10087441 DOI: 10.1002/jper.21-0702] [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] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND To compare periodontal treatment responses in electronic cigarette (e-cigarette) users, non-smokers, former and current smokers. METHODS In this retrospective clinical study, 220 patients with periodontitis were seen for baseline periodontal charting, professional-mechanical-plaque-removal (PMPR) and re-evaluation by postgraduate students. Sixty of these patients were former smokers, twenty were former smokers now using e-cigarettes, twenty current smokers, while all others (n = 120) were non-smokers. Effects of smoking status and treatment duration on clinical outcomes were analyzed by linear models using generalized least squares adjusted for known confounders. The primary outcome was "need for surgery" defined as number of sextants with ≥2 non-adjacent sites of probing depths (PD) ≥5 mm. RESULTS Compared with non-smokers, e-cigarette users had a less favorable treatment response after PMPR. This included statistically significant increased "need for surgery", as well as increased number of sextants with PD ≥5 mm, number of sites with PD >5 mm and mean PD. There were no statistically significant differences between e-cigarette users and current smokers. Former smokers responded statistically significantly better than e-cigarette users for the primary outcome as well as for the number of sextants and sites with PD ≥5 mm and mean PD. CONCLUSIONS Overall, e-cigarette users had a statistically significantly less favorable response to PMPR than non-smokers; their response was not statistically significantly different to those of current smokers. This, however, needs to be validated with further research in prospective clinical and observational studies in different populations.
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Affiliation(s)
- Chandni Shah
- Periodontology UnitCentre for Host Microbiome Interactions, Faculty of DentistryOral & Craniofacial SciencesKing's College LondonLondonUK
| | - Birte Holtfreter
- Department of Restorative DentistryPeriodontologyEndodontologyand Preventive and Pediatric DentistryUniversity Medicine GreifswaldGreifswaldGermany
| | - Francis J. Hughes
- Periodontology UnitCentre for Host Microbiome Interactions, Faculty of DentistryOral & Craniofacial SciencesKing's College LondonLondonUK
| | - Luigi Nibali
- Periodontology UnitCentre for Host Microbiome Interactions, Faculty of DentistryOral & Craniofacial SciencesKing's College LondonLondonUK
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2
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Talakey AA, Hughes FJ, Bernabé E. Can periodontal measures assist in the identification of adults with undiagnosed hyperglycaemia? A systematic review. J Clin Periodontol 2022; 49:302-312. [PMID: 35066921 DOI: 10.1111/jcpe.13596] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 07/28/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/18/2022]
Abstract
AIM The aim of this review was to answer the following question: Can periodontal measures be used to identify dental patients with undiagnosed hyperglycaemia? MATERIALS AND METHODS Systematic searches of electronic databases and the grey literature were carried out to identify studies developing and/or validating prediction models, based on any periodontal measure, to screen adults for undiagnosed hyperglycaemia (pre-diabetes and diabetes). Risk of bias was evaluated using the PRediction mOdel risk-of-Bias ASsessment Tool (PROBAST). RESULTS Ten studies were identified, of which eight were model development studies. The remaining two studies reported the external validation of one existing prediction model. The periodontal prediction model with some evidence of external validation showed moderate diagnostic performance in the development sample but lower performance in the external validation samples. According to PROBAST, all studies had high risk of bias mainly due to methodological limitations in data analysis, but also in the recruitment of participants, choice and measurement of periodontal predictors and diabetes. CONCLUSIONS There is a need for more robust external validation studies of existing prediction models adhering to current recommendations. Dental professionals who see patients at risk of diabetes and routinely collect periodontal measures have an important role to play in their identification and referral.
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Affiliation(s)
- Arwa A Talakey
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK.,Department of Periodontics and Community Dentistry, Faculty of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Francis J Hughes
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Eduardo Bernabé
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
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3
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Garna DF, Hughes FJ, Ghuman MS. Regulation of gingival fibroblast phenotype by periodontal ligament cells in vitro. J Periodontal Res 2022; 57:402-411. [PMID: 35037259 PMCID: PMC9302626 DOI: 10.1111/jre.12971] [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: 12/04/2021] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
Objectives Stem cell transplantation has shown modest effects on periodontal tissue regeneration, and it is still unclear how regenerative effects utilizing this modality are mediated. A greater understanding of the basic interactions between implanted and host cells is needed to improve future strategies. The aims of this study were to investigate the effects of periodontal ligament (PDL) cells on expression of periodontal markers and alkaline phosphatase (ALP) activity of gingival fibroblasts (GF). Materials and Methods Primary human PDL cells were co‐cultured with primary GF cultures either by direct co‐culture with subsequent FACS sorting or indirect co‐culture using transwell cultures and PDL cell conditioned medium. Expression of periodontal markers, asporin, nestin, and periostin, was assessed by qPCR and immunofluorescence staining. Alkaline phosphatase (ALP) expression was assessed by qPCR, histochemical staining, and activity assessed by para‐nitrophenol enzymatic assay. Single cultures of PDL cells and GF were used as controls. The role of Wnt signaling on ALP activity was assessed via Dkk1‐mediated inhibition. Results PDL cells significantly upregulated expression of PDL markers in GF with both direct and indirect co‐culture methods when compared to controls (6.05 vs. 0.73 and 59.48 vs. 17.55 fold change of asporin expression). PDL/GF cell co‐cultures significantly increased ALP activity in GF when compared with single GF cultures. Similar results were obtained when using conditioned medium isolated from PDL cell cultures. Dkk1 caused dose‐dependent reduction in ALP activity of GF cultured in PDL cell conditioned medium. Conclusions PDL cells stimulate expression of periodontal markers and osteogenic capacity of gingival fibroblasts via paracrine signaling which can be partially inhibited with addition of the Wnt antagonist, Dkk1.Further studies are required to identify specific secreted factors responsible for this activity.
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Affiliation(s)
- Devy F Garna
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.,Department of Periodontology, Faculty of Dentistry, Padjadjaran University, Bandung, Indonesia
| | - Francis J Hughes
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Mandeep S Ghuman
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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4
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Hughes FJ. Increasing awareness of drug induced gingival enlargement. BMJ 2021; 373:n1571. [PMID: 34154998 DOI: 10.1136/bmj.n1571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Francis J Hughes
- Faculty of Dental, Oral, and Craniofacial Sciences, King's College London, Guy's Hospital, London, UK
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Lu EMC, Hobbs C, Ghuman M, Hughes FJ. Development of an in vitro model of the dentogingival junction using 3D organotypic constructs. J Periodontal Res 2020; 56:147-153. [PMID: 33010184 DOI: 10.1111/jre.12804] [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: 06/12/2020] [Revised: 08/17/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The overall aim was to propose a plausible model of the dentogingival junction (DGJ) to deepen our understanding of the extrinsic influences responsible for the development of the junctional epithelial phenotype. The specific objective was to test the hypothesis that epithelial migration and proliferation would be inhibited by periodontal ligament (PDL) fibroblasts in an in vitro model of the DGJ consisting of 3D organotypic cultures. BACKGROUND Previously, we showed that 3D organotypic cultures containing human gingival fibroblasts (HGF) supported the development of a multi-layered epithelium, while constructs containing human periodontal ligament fibroblasts (HPDLF) resulted in epithelial atrophy (Lu EMC, Hobbs C, Dyer CJ, Ghuman M, Hughes FJ. J Perio Res., 2020). However, changes in epithelial phenotype have not been studied within an in vitro model of the DGJ. METHODS The in vitro model of the DGJ comprised of a donor HGF construct (H400 epithelium overlying HGF-collagen matrix) supported by a dimensionally larger recipient collagen bed enriched with HPDLF. Samples were harvested, fixed and processed for immunohistochemistry. The changes in epithelial migration and proliferation following contact with HPDLF were assessed by measuring the horizontal extension of the epithelial outgrowth on the recipient collagen matrix. RESULTS Within our in vitro model of the DGJ, epithelial migration and proliferation were inhibited following contact with the recipient HPDLF. By contrast, the control set-up showed a relative increase in epithelial growth, where the epithelium came into contact with the recipient HGF. Overall, there were limited changes in the molecular expression of keratin markers. CONCLUSION This study has proposed a plausible in vitro model of the DGJ to illustrate the role of different fibroblasts in the regulation of dentogingival epithelia. Furthermore, it suggests that the anatomical positional stability of the JE and its apparent resistance to apical migration could be associated with its interaction with the PDL.
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Affiliation(s)
- Emily Ming-Chieh Lu
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, Guy's Hospital, London, UK
| | - Carl Hobbs
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Mandeep Ghuman
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, Guy's Hospital, London, UK
| | - Francis J Hughes
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, Guy's Hospital, London, UK
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Lu EMC, Hobbs C, Dyer C, Ghuman M, Hughes FJ. Differential regulation of epithelial growth by gingival and periodontal fibroblasts in vitro. J Periodontal Res 2020; 55:859-867. [PMID: 32885443 DOI: 10.1111/jre.12778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/19/2020] [Revised: 04/23/2020] [Accepted: 05/13/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the underlying molecular mechanisms by which gingival and periodontal ligament (PDL) fibroblasts regulate epithelial phenotype. BACKGROUND Fibroblast populations regulate the epithelial phenotype through epithelial-mesenchymal interactions (EMI). Previous studies have proposed that maintenance of the junctional epithelium (JE) is dependent on the differential effects from gingival and PDL tissues. However, these cell populations are undefined and the signalling mechanisms which may regulate JE are unknown. METHODS Immunohistochemical analyses were performed on formalin-fixed paraffin-embedded sections of dentogingival tissues to identify phenotypic differences in fibroblast populations. The effect of distinct fibroblasts on epithelial phenotype was studied via 3D organotypic cultures, consisting of an H400 epithelium supported by human gingival fibroblasts (HGF) or human periodontal ligament fibroblasts (HPDLF), embedded in collagen gel. To investigate the involvement of Wnt signalling in EMI, the Wnt antagonist rhDKK1 was added to HGF constructs. The gene expression of Wnt antagonists and agonists was tested via RNA extraction and qPCR. Specific gene silencing using RNA interference was performed on HPDLF/HGF constructs. RESULTS Gingival fibroblasts were characterized by Sca1 expression, and PDL fibroblasts, characterized by Periostin and Asporin expression. Through the construction of 3D organotypic cultures, we showed that HGF supported epithelial multilayering, whilst HPDLF failed to support epithelial cell growth. Furthermore, HGF constructs treated with rhDKK1 resulted in a profound reduction in epithelial thickness. We identified SFRP4 to be highly specifically expressed in HPDLF, at both the mRNA and protein levels. A knockdown of SFRP4 in HPDLF constructs led to an increase in epithelial growth. CONCLUSION The study demonstrates the presence of phenotypically distinct fibroblast populations within dentogingival tissues and that these specific populations have different influences on the epithelium. Our data suggest that a downregulation of Wnt signalling within PDL may be important in maintaining the integrity and anatomical position of the JE.
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Affiliation(s)
- Emily Ming-Chieh Lu
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, Guy's Hospital, London, UK
| | - Carl Hobbs
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, Wolfson Wing, London, UK
| | - Carlene Dyer
- Centre for Craniofacial and Regenerative Biology, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, Guy's Hospital, London, UK
| | - Mandeep Ghuman
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, Guy's Hospital, London, UK
| | - Francis J Hughes
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, Guy's Hospital, London, UK
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Garna D, Kaur M, Hughes FJ, Ghuman M. Comparison of the Expression of Periodontal Markers in Dental and Bone Marrow-derived Mesenchymal Stem Cells. Open Dent J 2020. [DOI: 10.2174/1874210602014010196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background:
Periodontal ligament stem cells are a source of mesenchymal stem cells, but it is unclear whether their phenotype is distinct from mesenchymal stem cells derived from different tissues, such as those derived from bone marrow.
Objective:
To investigate the expression of the putative PDL markers asporin, periostin, nestin and cementum protein 1, by periodontal ligament stem cells both constitutively and during osteogenic differentiation when compared to bone marrow-derived mesenchymal stem cells, and dental pulp stem cells.
Methods:
The primary human periodontal ligament, bone marrow, and dental pulp stem cells, and osteoblasts from different donors were cultured in vitro. The expression of periodontal marker associated genes during osteogenic induction was tested by qRT-PCR and immunofluorescence staining.
Results:
Asporin expression was detected in periodontal ligament stem cells and increased markedly during the time in culture (upregulated x53 fold at 21 days post-induction). During osteogenic differentiation, asporin expression significantly decreased in periodontal ligament cells whereas periostin significantly decreased in dental pulp cells. Periostin expression was absent in osteoblasts, but expression gradually increased in all other cells with time in culture. Nestin expression was mainly seen in the periodontal ligament and dental pulp cells and was largely absent in osteoblasts and bone marrow cells. Cementum protein-1 was most highly expressed in bone marrow cells and osteoblasts following osteogenic induction.
Conclusions:
The results provide further evidence that periodontal ligament-derived and bone marrow derived mesenchymal stem cells are phenotypically distinct. Periodontal markers are also expressed in dental pulp stem cells.
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8
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Zoheir N, Hughes FJ. The Management of Drug-Influenced Gingival Enlargement. Prim Dent J 2020; 8:34-39. [PMID: 32127092 DOI: 10.1308/205016820828463816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
<br/> Drug-influenced gingival enlargement (DIGE) is a reaction to specific medications, namely phenytoin, ciclosporin and calcium channel blockers. DIGE is encountered increasingly in clinical practice due to the widespread use of calcium channel blocker drugs particularly. Approaches to its management are discussed in this review.<br/> Methods: Narrative review of the literature and discussion of clinical implications.<br/> Findings: Management of DIGE involves nonsurgical treatment and may require surgical reduction of the overgrown gingival tissues. Management is complicated by the difficulties in achieving adequate plaque control, given the unfavourable contour of the enlarged gingival tissues, and the high frequency of recurrence of DIGE after surgical management. Replacing the drug involved can be very beneficial in selected cases, but the management of the underlying medical condition limits its application. The decision to replace a drug is not the responsibility of the dental practitioner, but the patient's physician may make it after consultation.<br/> Conclusions: Management of DIGE can be challenging and may require close co-operation between the dental practitioner and a hygienist, a periodontist and the patient's physician. Long term supportive maintenance programmes need to be in place for optimal outcomes.
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9
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Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, Demirel K, de Sanctis M, Ercoli C, Fan J, Geurs NC, Hughes FJ, Jin L, Kantarci A, Lalla E, Madianos PN, Matthews D, McGuire MK, Mills MP, Preshaw PM, Reynolds MA, Sculean A, Susin C, West NX, Yamazaki K. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol 2019; 89 Suppl 1:S237-S248. [PMID: 29926943 DOI: 10.1002/jper.17-0733] [Citation(s) in RCA: 203] [Impact Index Per Article: 40.6] [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: 12/16/2017] [Revised: 02/07/2018] [Accepted: 02/12/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations. METHODS Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants. RESULTS Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues. CONCLUSION An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.
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Affiliation(s)
- Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Jack G Caton
- University of Rochester, Periodontics, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Jasim M Albandar
- Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, PA, USA
| | | | - Philippe Bouchard
- U.F.R. d'Odontologie, Université Paris Diderot, Hôpital Rothschild AP-HP, Paris, France
| | - Pierpaolo Cortellini
- Private practice, Firenze, Italy; European Research Group on Periodontology, Bern, Switzerland
| | - Korkud Demirel
- Department of Periodontology, Istanbul University, Istanbul, Turkey
| | - Massimo de Sanctis
- Department of Periodontology, Università Vita e Salute San Raffaele, Milan, Italy
| | - Carlo Ercoli
- University of Rochester, Prosthodontics & Periodontics, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Jingyuan Fan
- University of Rochester, Periodontics, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Nicolaas C Geurs
- Department of Periodontology, University of Alabama at Birmingham, School of Dentistry, Birmingham, AL, USA
| | | | - Lijian Jin
- Discipline of Periodontology, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China
| | | | - Evanthia Lalla
- Columbia University College of Dental Medicine, Division of Periodontics, New York, NY, USA
| | - Phoebus N Madianos
- Department of Periodontology, School of Dentistry, National and Kapodistrian University of Athens, Greece
| | - Debora Matthews
- Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia
| | | | - Michael P Mills
- Department of Periodontics, University of Texas Health Science Center at San Antonio, TX, USA
| | - Philip M Preshaw
- Centre for Oral Health Research and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Mark A Reynolds
- University of Maryland, School of Dentistry, Department of Advanced Oral Sciences and Therapeutics, Baltimore, MD, USA
| | - Anton Sculean
- Department of Periodontology, University of Bern, Switzerland
| | - Cristiano Susin
- Department of Periodontics, Augusta University Dental College of Georgia, Augusta, GA, USA
| | - Nicola X West
- Restorative Dentistry and Periodontology, School of Oral and Dental Sciences, Bristol Dental School & Hospital, Bristol, UK
| | - Kazuhisa Yamazaki
- Research Unit for Oral-Systemic Connection, Division of Oral Science for Health Promotion, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Kurushima Y, Bowyer R, Ide M, Hughes FJ, Steves CJ. Genetic and environmental contributions to the association between mood disorder and periodontal disease: A cross-sectional study among female twins in the UK. J Clin Periodontol 2019; 46:40-50. [PMID: 30537144 DOI: 10.1111/jcpe.13045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/02/2018] [Revised: 11/02/2018] [Accepted: 12/03/2018] [Indexed: 11/27/2022]
Abstract
AIM This study aimed to investigate the factors associated with periodontal traits considering genetic and environmental background in predominantly older female twins. METHODS This was a cross-sectional study using self-reported questionnaires for periodontal traits in TwinsUK. Age-adjusted and age-stratified multivariate analyses were conducted for all twins. Subsequently, co-twin control analysis within genetically identical twins who were discordant for periodontal traits was performed by controlling for genetic confounders. RESULTS Data of twins aged 20-91 were available in 4,143 individuals for self-reported periodontitis and 4,244 for gum bleeding. Age-adjusted model showed increasing risk in the following: smoking, anxiety/stress and depression for both periodontal traits. Within discordant monozygotic (MZ) twins (514 individuals for periodontitis and 754 for gum bleeding), the association of anxiety/stress remained significant for both periodontitis (OR 1.60, CI: 1.02-2.52) and gum bleeding (OR 1.60, CI: 1.06-2.40). A significant relationship for depression remained for periodontitis (OR 1.68, CI: 1.04-2.70), but it was no longer significant for gum bleeding. Age stratification showed that the association of mood disorders with periodontal traits was generally stronger in older group. CONCLUSIONS Multivariate analysis among discordant MZ female twins found mood disorders were independently associated with periodontal traits, suggesting that genetic/early-life environmental factors may not explain this association.
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Affiliation(s)
- Yuko Kurushima
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
| | - Ruth Bowyer
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
| | - Mark Ide
- Unit of Periodontology, Dental Institute, King's College London, London, UK
| | - Francis J Hughes
- Unit of Periodontology, Dental Institute, King's College London, London, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
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11
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Albandar JM, Susin C, Hughes FJ. Manifestations of systemic diseases and conditions that affect the periodontal attachment apparatus: Case definitions and diagnostic considerations. J Clin Periodontol 2019; 45 Suppl 20:S171-S189. [PMID: 29926486 DOI: 10.1111/jcpe.12947] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [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: 07/22/2016] [Revised: 10/14/2017] [Accepted: 10/21/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This review proposes case definitions and diagnostic considerations of systemic disorders and conditions that affect the periodontal attachment apparatus. IMPORTANCE Periodontal diseases and certain systemic disorders share similar genetic and/or environmental etiological factors, and affected patients may show manifestations of both diseases. Characterizing these diseases and the nature of the association between them could have important diagnostic value and therapeutic implications for patients. FINDINGS Numerous systemic disorders and certain medications can affect the periodontal attachment apparatus and cause loss of periodontal attachment and alveolar bone. Although many of these disorders are rare or uncommon, they often cause significant loss of periodontal tissue by influencing periodontal inflammation or through mechanisms distinct from periodontitis. Most of these disorders are due to innate mechanisms and some are acquired via environmental factors or lifestyle. Several disorders affect periodontal inflammation through alterations in the host immune response to periodontal infection; others cause defects in the gingiva or periodontal connective tissue, instigate metabolic changes in the host that affect various tissues of the periodontal apparatus, or operate by other mechanisms. For some systemic disorders that are more common, their contribution to the loss of periodontal tissue is modest, while for others, contribution is not supported by clear evidence. Few systemic medications are associated with increased loss of periodontal tissue, and these are typically medications used in the treatment of malignancies. CONCLUSIONS This review identifies systemic diseases and conditions that can affect the periodontal attachment apparatus and cause loss of periodontal supporting tissues and, where possible, presents case definitions for these. Many of these diseases are associated with a profound loss of periodontal attachment and alveolar bone, and for some of these disorders the periodontal manifestations may be among the first signs of the disease. These case definitions may be useful in the early diagnosis of these diseases and may contribute to an improvement in the management of periodontal manifestations and improve the quality of life for these patients.
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Affiliation(s)
- Jasim M Albandar
- Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, PA, USA
| | - Cristiano Susin
- Department of Periodontics, Augusta University Dental College of Georgia, Augusta, GA, USA
| | - Francis J Hughes
- Unit of Periodontology, Dental Institute, Kings College London, London, UK
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12
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Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, Demirel K, de Sanctis M, Ercoli C, Fan J, Geurs NC, Hughes FJ, Jin L, Kantarci A, Lalla E, Madianos PN, Matthews D, McGuire MK, Mills MP, Preshaw PM, Reynolds MA, Sculean A, Susin C, West NX, Yamazaki K. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol 2019; 45 Suppl 20:S219-S229. [PMID: 29926500 DOI: 10.1111/jcpe.12951] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [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: 12/16/2017] [Revised: 02/07/2018] [Accepted: 02/12/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations. METHODS Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants. RESULTS Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues. CONCLUSION An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.
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Affiliation(s)
- Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Jack G Caton
- University of Rochester, Periodontics, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Jasim M Albandar
- Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, PA, USA
| | | | - Philippe Bouchard
- U.F.R. d'Odontologie, Université Paris Diderot, Hôpital Rothschild AP-HP, Paris, France
| | - Pierpaolo Cortellini
- Private practice, Firenze, Italy; European Research Group on Periodontology, Bern, Switzerland
| | - Korkud Demirel
- Department of Periodontology, Istanbul University, Istanbul, Turkey
| | - Massimo de Sanctis
- Department of Periodontology, Università Vita e Salute San Raffaele, Milan, Italy
| | - Carlo Ercoli
- University of Rochester, Prosthodontics & Periodontics, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Jingyuan Fan
- University of Rochester, Periodontics, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Nicolaas C Geurs
- Department of Periodontology, University of Alabama at Birmingham, School of Dentistry, Birmingham, AL, USA
| | | | - Lijian Jin
- Discipline of Periodontology, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China
| | | | - Evanthia Lalla
- Columbia University College of Dental Medicine, Division of Periodontics, New York, NY, USA
| | - Phoebus N Madianos
- Department of Periodontology, School of Dentistry, National and Kapodistrian University of Athens, Greece
| | - Debora Matthews
- Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia
| | | | - Michael P Mills
- Department of Periodontics, University of Texas Health Science Center at San Antonio, TX, USA
| | - Philip M Preshaw
- Centre for Oral Health Research and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Mark A Reynolds
- University of Maryland, School of Dentistry, Department of Advanced Oral Sciences and Therapeutics, Baltimore, MD, USA
| | - Anton Sculean
- Department of Periodontology, University of Bern, Switzerland
| | - Cristiano Susin
- Department of Periodontics, Augusta University Dental College of Georgia, Augusta, GA, USA
| | - Nicola X West
- Restorative Dentistry and Periodontology, School of Oral and Dental Sciences, Bristol Dental School & Hospital, Bristol, UK
| | - Kazuhisa Yamazaki
- Research Unit for Oral-Systemic Connection, Division of Oral Science for Health Promotion, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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13
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Abstract
Drug use for both therapeutic and recreational purposes is very widespread in most societies. The range of drugs used, the variations in response to these drugs and other health and behavioral confounders mean that drug use may be an important contributor to individualized periodontal diagnoses. In this narrative review, we review the main reported effects of drugs on the periodontal tissues and periodontal disease processes. Although some of the more common adverse drug reactions on periodontal tissues are well described, in many other cases the evidence for these drug effects is quite limited and based on small case series or isolated reports. Prescription drugs are responsible for a range of effects, including drug-induced gingival overgrowth and increased gingival bleeding, and influence periodontal inflammation and periodontal breakdown. The effects of recreational drugs on the periodontal tissues is less well researched, perhaps for the obvious reason that assembling large cohorts of recreational drug users presents particular challenges. Use of nearly all of these substances is associated with poorer periodontal and dental health, although there is almost certainly a large degree of behavioral confounding in these findings. Overall, further studies of adverse drug reactions on the periodontal tissues are required as this continues to be an important and increasing factor in periodontal health determination.
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Affiliation(s)
| | - P Mark Bartold
- Periodontology, University of Adelaide, Adelaide, SA, Australia
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14
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Gharibi B, Ghuman MS, Cama G, Rawlinson SCF, Grigoriadis AE, Hughes FJ. Site-specific differences in osteoblast phenotype, mechanical loading response and estrogen receptor-related gene expression. Mol Cell Endocrinol 2018; 477:140-147. [PMID: 29928929 DOI: 10.1016/j.mce.2018.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 05/08/2018] [Accepted: 06/16/2018] [Indexed: 12/23/2022]
Abstract
The osteoporosis-resistant nature of skull bones implies inherent differences exist between their cellular responses and those of other osteoporosis-susceptible skeletal sites. Phenotypic differences in calvarial and femoral osteoblastic responses to induction of osteogenesis, mechanical loading, estrogen, growth factor and cytokine stimulation were investigated. Primary rat calvarial and femoral adult male osteoblasts were cultured and osteoblastic mineralisation and maturation determined using Alizarin Red staining and expression of osteogenic marker genes assessed. Expression of known mechanically-responsive genes was compared between sites following loading of scaffold-seeded cells in a bioreactor. Cell proliferation and differentiation following growth factor and estrogen stimulation were also compared. Finally expression of estrogen receptors and associated genes during osteogenic differentiation were investigated. Calvarial osteoblasts exhibited delayed maturation (45d. vs 21d.) and produced less mineralised matrix than femoral osteoblasts when osteogenically induced. PDGF-BB and FGF2 both caused a selective increase in proliferation and decrease in osteoblastic differentiation of femoral osteoblasts. Mechanical stimulation resulted in the induction of the expression of Ccl2 and Anx2a selectively in femoral osteoblasts, but remained unchanged in calvarial cells. Estrogen receptor beta expression was selectively upregulated 2-fold in calvarial osteoblasts. Most interestingly, the estrogen responsive transcriptional repressor RERG was constitutively expressed at 1000-fold greater levels in calvarial compared with femoral osteoblasts. RERG expression in calvarial osteoblasts was down regulated during osteogenic induction whereas upregulation occurred in femoral osteoblasts. Bone cells of the skull are inherently different to those of the femur, and respond differentially to a range of stimuli. These site-specific differences may have important relevance in the development of strategies to tackle metabolic bone disorders.
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Affiliation(s)
- Borzo Gharibi
- Division of Tissue Engineering and Biophotonics, Dental Institute, King's College London, Tower Wing, Guy's Hospital, London, SE1 9RT, UK.
| | - Mandeep S Ghuman
- Division of Tissue Engineering and Biophotonics, Dental Institute, King's College London, Tower Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Giuseppe Cama
- Division of Tissue Engineering and Biophotonics, Dental Institute, King's College London, Tower Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Simon C F Rawlinson
- Centre for Oral Growth and Development, Institute of Dentistry, Queen Mary University of London, New Road, London, E1 2BA, UK
| | - Agamemnon E Grigoriadis
- Centre for Craniofacial and Regenerative Biology, Dental Institute, King's College London, Tower Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Francis J Hughes
- Division of Tissue Engineering and Biophotonics, Dental Institute, King's College London, Tower Wing, Guy's Hospital, London, SE1 9RT, UK.
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15
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Ghuman MS, Al-Masri M, Xavier G, Cobourne MT, McKay IJ, Hughes FJ. Gingival fibroblasts prevent BMP-mediated osteoblastic differentiation. J Periodontal Res 2018; 54:300-309. [PMID: 30511378 PMCID: PMC6492095 DOI: 10.1111/jre.12631] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 01/12/2018] [Revised: 10/04/2018] [Accepted: 11/09/2018] [Indexed: 02/07/2023]
Abstract
Objectives The inhibitory action of the superficial gingival connective tissues may limit the regenerative potential of alveolar bone in periodontal therapy or dental implant applications. The aims of this study were to investigate the hypothesis that gingival fibroblasts (GF) can inhibit bone morphogenetic protein (BMP)‐induced osteoblastic differentiation, to determine their expression of BMP inhibitors, and finally to determine whether reduction of these inhibitors can relieve suppression of osteoblastic differentiation. Methods Gingival fibroblasts were co‐cultured either directly or indirectly with calvarial osteoblasts to assess alkaline phosphatase inhibitory activity, a marker of osteoblastic differentiation. To test total BMP‐inhibitory activity of rat GF, conditioned media (GFCM) were collected from cultures. ROS 17/2.8 osteoblastic cells were stimulated with BMP2, together with GFCM. Inhibitor expression was tested using RT‐qPCR, Western blotting and in situ hybridization. Removal of inhibitors was carried out using immunoprecipitation beads. Results Co‐culture experiments showed GF‐secreted factors that inhibit BMP‐stimulated ALP activity. 10 ng/ml BMP2 increased alkaline phosphatase expression in ROS cells by 41%. GFCM blocked BMP activity which was equivalent to the activity of 100 ng/ml Noggin, a well‐described BMP inhibitor. Cultured gingival fibroblasts constitutively expressed BMP antagonist genes from the same subfamily, Grem1, Grem2 and Nbl1 and the Wnt inhibitor Sfrp1. Gremlin1 (6.7 × reference gene expression) had highest levels of basal expression. ISH analysis showed Gremlin1 expression was restricted to the inner half of the gingival lamina propria and the PDL. Removal of Gremlin1 protein from GFCM eliminated the inhibitory effect of GFCM on ALP activity in ROS cells. Subsequent addition of recombinant Gremlin1 restored the inhibitory activity. Conclusions Factors secreted by gingival fibroblasts inhibit BMP‐induced bone formation and a range of BMP inhibitors are constitutively expressed in gingival connective tissues. These inhibitors, particularly Gremlin1, may limit coronal alveolar bone regenerative potential during oral and periodontal surgery.
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Affiliation(s)
- Mandeep S Ghuman
- Division of Tissue Engineering and Biophotonics, Dental Institute, King's College London, London, UK
| | | | - Guilherme Xavier
- Centre for Craniofacial and Regenerative Biology, Dental Institute, King's College London, Guy's Hospital, London, UK
| | - Martyn T Cobourne
- Centre for Craniofacial and Regenerative Biology, Dental Institute, King's College London, Guy's Hospital, London, UK
| | - Ian J McKay
- Department of Adult Oral Health, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Francis J Hughes
- Division of Tissue Engineering and Biophotonics, Dental Institute, King's College London, London, UK
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16
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Cheng WC, Saleh F, Abuaisha Karim B, Hughes FJ, Taams LS. Comparative analysis of immune cell subsets in peripheral blood from patients with periodontal disease and healthy controls. Clin Exp Immunol 2018; 194:380-390. [PMID: 30120837 DOI: 10.1111/cei.13205] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2018] [Indexed: 12/24/2022] Open
Abstract
Periodontitis is a chronic inflammatory disease caused by the colonization of teeth by the bacterial plaque biofilm and the resultant host immune responses in adjacent periodontal tissues. Disease severity can vary dramatically between patients with periodontitis, with some subjects displaying inflammation without bony destruction (gingivitis), while others experience chronic progressive or rapidly aggressive gingival connective tissue damage and bone loss. To determine whether peripheral immune dysregulation is associated with periodontitis, we performed extensive analysis of immune cell subsets in peripheral blood from patients with chronic or aggressive periodontitis versus periodontally healthy control subjects. Peripheral blood mononuclear cells (PBMC) from patients with chronic periodontitis or aggressive periodontitis and from periodontally healthy controls were analysed by 8-10-colour flow cytometry for the frequencies of various lymphocyte subsets, including interleukin (IL)-17-, interferon (IFN)-γ-, tumour necrosis factor (TNF)-α- and IL-10-producing cells, and the frequencies and phenotype of monocytes. Cytokine levels in serum from the different groups were determined by Luminex assay. We found no significant differences in the frequencies of major immune cell populations [CD4+ T cells, CD8+ T cells, γδ T cells, CD4+ CD45RO+ CD25+ CD127low regulatory T cells (Tregs ), CD19+ B cells, CD14+ monocytes] or of cytokine-producing T cells, or in the phenotype of CD14+ monocytes in peripheral blood from these patient cohorts. Additionally, no significant differences were observed in serum levels of prototypical inflammatory cytokines. These results suggest that the local gingival inflammatory response is not reflected by obvious changes in major blood immune cell subset frequencies.
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Affiliation(s)
- W-C Cheng
- Department of Periodontology, Dental Institute, King's College London, London, UK.,Centre for Inflammation Biology and Cancer Immunology, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, London, UK.,Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - F Saleh
- Department of Periodontology, Dental Institute, King's College London, London, UK
| | - B Abuaisha Karim
- Department of Periodontology, Dental Institute, King's College London, London, UK
| | - F J Hughes
- Department of Periodontology, Dental Institute, King's College London, London, UK
| | - L S Taams
- Centre for Inflammation Biology and Cancer Immunology, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, London, UK
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17
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Albandar JM, Susin C, Hughes FJ. Manifestations of systemic diseases and conditions that affect the periodontal attachment apparatus: Case definitions and diagnostic considerations. J Periodontol 2018; 89 Suppl 1:S183-S203. [DOI: 10.1002/jper.16-0480] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/14/2017] [Accepted: 10/21/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Jasim M. Albandar
- Department of Periodontology and Oral Implantology; Temple University School of Dentistry; Philadelphia PA USA
| | - Cristiano Susin
- Department of Periodontics; Augusta University Dental College of Georgia; Augusta GA USA
| | - Francis J. Hughes
- Unit of Periodontology; Dental Institute; Kings College London; London UK
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18
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Abstract
For decades titanium has been the preferred material for dental implant fabrication, with mechanical and biological performance resulting in high clinical success rates. These have been further enhanced by incremental development of surface modifications aimed at improving speed and degree of osseointegration and resulting in enhanced clinical treatment options and outcomes. However, increasing demand for metal-free dental restorations has also led to the development of ceramic-based dental implants, such as zirconia. In orthopedics, alternative biomaterials, such as polyetheretherketone or silicon nitride, have been used for implant applications. The latter is potentially of particular interest for oral use as it has been shown to have antibacterial properties. In this article we aim to shed light on this particular biomaterial as a future promising candidate for dental implantology applications, addressing basic specifications required for any dental implant material. In view of available preclinical data, silicon nitride seems to have the essential characteristics to be a candidate for dental implants material. This novel ceramic has a surface with potentially antimicrobial properties, and if this is confirmed in future research, it could be of great interest for oral use.
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Affiliation(s)
- Zahi Badran
- Department of Periodontology, Rmes Inserm U1229/UIC11, Faculty of Dental Surgery, Nantes, France
- Department of Oral Implantology, CHU-Faculty of Dental Surgery, Nantes, France
- Unit of Periodontology, Dental Institute, King's College, London, UK
| | - Xavier Struillou
- Department of Periodontology, Rmes Inserm U1229/UIC11, Faculty of Dental Surgery, Nantes, France
- Department of Oral Implantology, CHU-Faculty of Dental Surgery, Nantes, France
| | - Francis J Hughes
- Unit of Periodontology, Dental Institute, King's College, London, UK
| | - Assem Soueidan
- Department of Periodontology, Rmes Inserm U1229/UIC11, Faculty of Dental Surgery, Nantes, France
| | - Alain Hoornaert
- Department of Periodontology, Rmes Inserm U1229/UIC11, Faculty of Dental Surgery, Nantes, France
- Department of Oral Implantology, CHU-Faculty of Dental Surgery, Nantes, France
| | - Mark Ide
- Unit of Periodontology, Dental Institute, King's College, London, UK
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19
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Schneider AK, Cama G, Ghuman M, Hughes FJ, Gharibi B. Sprouty 2
, an Early Response Gene Regulator of FosB
and Mesenchymal Stem Cell Proliferation During Mechanical Loading and Osteogenic Differentiation. J Cell Biochem 2017; 118:2606-2614. [DOI: 10.1002/jcb.26035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 04/05/2017] [Indexed: 01/26/2023]
Affiliation(s)
- A. Kristin Schneider
- Division of Tissue Engineering and Biophotonics; Dental Institute; King's College London, Tower Wing, Guy's Hospital; London SE1 9RT UK
| | - Giuseppe Cama
- Division of Tissue Engineering and Biophotonics; Dental Institute; King's College London, Tower Wing, Guy's Hospital; London SE1 9RT UK
| | - Mandeep Ghuman
- Division of Tissue Engineering and Biophotonics; Dental Institute; King's College London, Tower Wing, Guy's Hospital; London SE1 9RT UK
| | - Francis J. Hughes
- Division of Tissue Engineering and Biophotonics; Dental Institute; King's College London, Tower Wing, Guy's Hospital; London SE1 9RT UK
| | - Borzo Gharibi
- Division of Tissue Engineering and Biophotonics; Dental Institute; King's College London, Tower Wing, Guy's Hospital; London SE1 9RT UK
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20
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Newbould RD, Bishop CA, Janiczek RL, Parkinson C, Hughes FJ. T 2 relaxation mapping MRI of healthy and inflamed gingival tissue. Dentomaxillofac Radiol 2016; 46:20160295. [PMID: 27936919 DOI: 10.1259/dmfr.20160295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To investigate the use and reproducibility of MRI transverse relaxation time (T2) mapping in healthy and inflamed gingivae. METHODS 21 subjects were recruited into 2 groups: those without evidence of gingivitis ("healthy"; n = 11, age 24.0 ± 3.66 years) by visual assessment and those with moderate to severe gingivitis ("gingivitis"; n = 10, age 28.9 ± 6.03 years) exhibited across the second mandibular premolar and first mandibular molar buccal gingivae. Subjects were imaged by MRI twice in a single day. Three T2 weighted turbo spin-echo volumes with 0.25 × 0.25 × 0.8-mm3 resolution were acquired at echo times of 16, 32 and 48 ms for T2 decay fitting. Image analysis was fully blinded; the two imaging sessions were not identifiable as coming from the same subject. Each imaging session had independent regions of interest drawn on the first echo image and applied to the calculated T2 decay maps. RESULTS The coefficient of variation was low and similar in healthy and gingivitis populations: 6.10 and 5.25% populations, respectively, with 5.65% populations across both groups. Bland-Altman analysis revealed no bias (mean -2.93%; 95% confidence intervals -22.20 to 16.34%) between sessions. The intersession agreement was good (r = 0.744, ρ = 0.568, intraclass correlation coefficient = 0.68). T2 mapping did not differentiate healthy from gingivitis groups. The mean T2 value in the healthy group (63.7 ms) was similar to that of the gingivitis group (65.23 ms) (p = 0.30). CONCLUSIONS Mapping of the T2 decay in the gingivae was a repeatable process; however, T2 value alone did not differentiate those with clinical examination-determined gingivitis from those without signs of gingivitis.
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21
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Gharibi B, Ghuman M, Hughes FJ. DDIT4 regulates mesenchymal stem cell fate by mediating between HIF1α and mTOR signalling. Sci Rep 2016; 6:36889. [PMID: 27876894 PMCID: PMC5120275 DOI: 10.1038/srep36889] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 10/24/2016] [Indexed: 12/05/2022] Open
Abstract
Stem cell fate decisions to remain quiescent, self-renew or differentiate are largely governed by the interplay between extracellular signals from the niche and the cell intrinsic signal cascades and transcriptional programs. Here we demonstrate that DNA Damage Inducible Transcript 4 (DDIT4) acts as a link between HIF1α and mTOR signalling and regulation of adult stem cell fate. Global gene expression analysis of mesenchymal stem cells (MSC) derived from single clones and live RNA cell sorting showed a direct correlation between DDIT4 and differentiation potentials of MSC. Loss and gain of function analysis demonstrated that DDIT4 activity is directly linked to regulation of mTOR signalling, expression of pluripotency genes and differentiation. Further we demonstrated that DDIT4 exert these effects down-stream to HIF1α. Our findings provide an insight in regulation of adult stem cells homeostasis by two major pathways with opposing functions to coordinate between states of self-renewal and differentiation.
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Affiliation(s)
- Borzo Gharibi
- Division of Tissue Engineering and Biophotonics, Dental Institute, King's College London, Tower Wing, Guy's Hospital, London, SE1 9RT. UK
| | - Mandeep Ghuman
- Division of Tissue Engineering and Biophotonics, Dental Institute, King's College London, Tower Wing, Guy's Hospital, London, SE1 9RT. UK
| | - Francis J Hughes
- Division of Tissue Engineering and Biophotonics, Dental Institute, King's College London, Tower Wing, Guy's Hospital, London, SE1 9RT. UK
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22
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Abstract
Describes the prevalence of periodontal and other dental disease in an ancient British population from the examination of dried skulls. Estimates that the prevalence of established periodontitis in this population was around 5%, considerably lower than prevalence estimates for modern humans.
Objective The aim of this study was to investigate the prevalence of moderate to severe periodontitis in an ancient British cohort c. 200-400 AD. Design Observational study to assess periodontal and other oral disease parameters. Setting Natural History Museum, London. Subjects and methods 303 skulls from a Romano-British burial site in Poundbury, Dorset were examined for evidence of dental disease. Main outcome measures The primary outcome measure was presence of moderate to severe periodontitis. Secondary outcomes included: amount of horizontal bone loss; prevalence of ante-mortem tooth loss; and presence of other dental pathologies. Results The overall prevalence of moderate to severe periodontitis was just greater than 5%. The prevalence rate remained nearly constant between ages 20 to 60, after which it rose to around 10%. The number of affected teeth increased with age. Horizontal bone loss was generally minor. Caries was seen in around 50% of the cohort, and evidence of pulpal and apical pathology was seen in around 25%. Conclusions The prevalence of moderate to severe periodontitis was markedly decreased when compared to the prevalence in modern populations, underlining the potential importance of risk factors such as smoking and diabetes in determining susceptibility to progressive periodontitis in modern populations.
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Affiliation(s)
- T Raitapuro-Murray
- 1] [2] Barts &The London School of Medicine &Dentistry, Queen Mary University of London
| | | | - F J Hughes
- 1] Barts &The London School of Medicine &Dentistry, Queen Mary University of London [2] Kings College London Dental Institute, Floor 21 Tower Wing, Guys Hospital. London, SE1 9RT
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23
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Cheng WC, van Asten SD, Burns LA, Evans HG, Walter GJ, Hashim A, Hughes FJ, Taams LS. Periodontitis-associated pathogens P. gingivalis and A. actinomycetemcomitans activate human CD14(+) monocytes leading to enhanced Th17/IL-17 responses. Eur J Immunol 2016; 46:2211-21. [PMID: 27334899 PMCID: PMC5031191 DOI: 10.1002/eji.201545871] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [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: 06/19/2015] [Revised: 05/20/2016] [Accepted: 06/17/2016] [Indexed: 12/21/2022]
Abstract
The Th17/IL‐17 pathway is implicated in the pathogenesis of periodontitis (PD), however the mechanisms are not fully understood. We investigated the mechanism by which the periodontal pathogens Porphyromonas gingivalis (Pg) and Aggregatibacter actinomycetemcomitans (Aa) promote a Th17/IL‐17 response in vitro, and studied IL‐17+ CD4+ T‐cell frequencies in gingival tissue and peripheral blood from patients with PD versus periodontally healthy controls. Addition of Pg or Aa to monocyte/CD4+ T‐cell co‐cultures promoted a Th17/IL‐17 response in vitro in a dose‐ and time‐dependent manner. Pg or Aa stimulation of monocytes resulted in increased CD40, CD54 and HLA‐DR expression, and enhanced TNF‐α, IL‐1β, IL‐6 and IL‐23 production. Mechanistically, IL‐17 production in Pg‐stimulated co‐cultures was partially dependent on IL‐1β, IL‐23 and TLR2/TLR4 signalling. Increased frequencies of IL‐17+ cells were observed in gingival tissue from patients with PD compared to healthy subjects. No differences were observed in IL‐17+ CD4+ T‐cell frequencies in peripheral blood. In vitro, Pg induced significantly higher IL‐17 production in anti‐CD3 mAb‐stimulated monocyte/CD4+ T‐cell co‐cultures from patients with PD compared to healthy controls. Our data suggest that periodontal pathogens can activate monocytes, resulting in increased IL‐17 production by human CD4+ T cells, a process that appears enhanced in patients with PD.
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Affiliation(s)
- Wan-Chien Cheng
- Division of Immunology, Infection & Inflammatory Disease, Centre for Molecular and Cellular Biology of Inflammation, King's College London, London, UK.,Department of Periodontology, Dental Institute, King's College London, London, UK.,Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Saskia D van Asten
- Division of Immunology, Infection & Inflammatory Disease, Centre for Molecular and Cellular Biology of Inflammation, King's College London, London, UK
| | - Lachrissa A Burns
- Division of Immunology, Infection & Inflammatory Disease, Centre for Molecular and Cellular Biology of Inflammation, King's College London, London, UK
| | - Hayley G Evans
- Division of Immunology, Infection & Inflammatory Disease, Centre for Molecular and Cellular Biology of Inflammation, King's College London, London, UK
| | - Gina J Walter
- Division of Immunology, Infection & Inflammatory Disease, Centre for Molecular and Cellular Biology of Inflammation, King's College London, London, UK
| | - Ahmed Hashim
- Centre for Immunology and Infectious Disease, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Francis J Hughes
- Department of Periodontology, Dental Institute, King's College London, London, UK
| | - Leonie S Taams
- Division of Immunology, Infection & Inflammatory Disease, Centre for Molecular and Cellular Biology of Inflammation, King's College London, London, UK.
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Gharibi B, Farzadi S, Ghuman M, Hughes FJ. Inhibition of Akt/mTOR attenuates age-related changes in mesenchymal stem cells. Stem Cells 2015; 32:2256-66. [PMID: 24659476 DOI: 10.1002/stem.1709] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [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: 10/30/2013] [Accepted: 02/01/2014] [Indexed: 01/10/2023]
Abstract
The decline in mesenchymal stem cell (MSC) self-renewal and function with aging contributes to diseases associated with impaired osteogenesis. MSC donor age in prolonged culture also limits the therapeutic potential of these cells for tissue engineering and regenerative medicine. Here, we demonstrate an intervention to preserve the immature state MSC and consequently maintain self-renewal and differentiation capacity during in vitro aging. We showed that blocking of phosphatidylinositol 3-kinase/Akt/mammalian target of rapamycin (mTOR) prevents the development of an age-related phenotype and maintains MSC morphology of early passage cells with high clonogenic frequency and enhanced proliferative capacity. MSC cultured in the presence of inhibitors of Akt or mTOR also robustly maintain their osteogenic potential, that is otherwise lost during in vitro aging. We further report that these effects may be mediated by induction of expression of pluripotency genes Nanog and Oct-4 and by the reduction in the production of cytoplasmic reactive oxygen species (ROS). Additionally, loss of Akt/mTOR and ROS was accompanied with lower levels of DNA damage. These results provide an insight into mechanisms involved in MSC aging and suggest possible interventions to maintain quiescence and function of MSC prior to in vivo transplantation or as pharmacological agents in diseases associated with loss of MSC function.
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Affiliation(s)
- Borzo Gharibi
- Department of Periodontology, Dental Institute, King's College London, Tower Wing, Guy's Hospital, London, United Kingdom
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Hashim NT, Linden GJ, Ibrahim ME, Gismalla BG, Lundy FT, Hughes FJ, El Karim IA. Replication of the association of GLT6D1 with aggressive periodontitis in a Sudanese population. J Clin Periodontol 2015; 42:319-24. [DOI: 10.1111/jcpe.12375] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Nada T. Hashim
- Faculty of Dentistry; University of Khartoum; Khartoum Sudan
| | - Gerard J. Linden
- Centre for Public Health; Queen's University of Belfast; Belfast UK
| | | | | | - Fionnuala T. Lundy
- Centre for Infection and Immunity; Queen's University of Belfast; Belfast UK
| | | | - Ikhlas A. El Karim
- Centre for Infection and Immunity; Queen's University of Belfast; Belfast UK
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Cheng WC, Hughes FJ, Taams LS. The presence, function and regulation of IL-17 and Th17 cells in periodontitis. J Clin Periodontol 2014; 41:541-9. [DOI: 10.1111/jcpe.12238] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2014] [Indexed: 01/06/2023]
Affiliation(s)
- Wan-Chien Cheng
- Department of Periodontology; School of Dentistry; King's College London; London UK
- Division of Immunology, Infection & Inflammatory Disease; Centre for Molecular and Cellular Biology of Inflammation; King's College London; London UK
| | - Francis J. Hughes
- Department of Periodontology; School of Dentistry; King's College London; London UK
| | - Leonie S. Taams
- Division of Immunology, Infection & Inflammatory Disease; Centre for Molecular and Cellular Biology of Inflammation; King's College London; London UK
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Gharibi B, Ghuman MS, Hughes FJ. Akt- and Erk-mediated regulation of proliferation and differentiation during PDGFRβ-induced MSC self-renewal. J Cell Mol Med 2014; 16:2789-801. [PMID: 22805337 PMCID: PMC4118247 DOI: 10.1111/j.1582-4934.2012.01602.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Understanding the mechanisms that direct mesenchymal stem cell (MSC) self-renewal fate decisions is a key to most tissue regenerative approaches. The aim of this study here was to investigate the mechanisms of action of platelet-derived growth factor receptor β (PDGFRβ) signalling on MSC proliferation and differentiation. MSC were cultured and stimulated with PDGF-BB together with inhibitors of second messenger pathways. Cell proliferation was assessed using ethynyl-2′-deoxyuridine and phosphorylation status of signalling molecules assessed by Western Blots. To assess differentiation potentials, cells were transferred to adipogenic or osteogenic media, and differentiation assessed by expression of differentiation association genes by qRT-PCR, and by long-term culture assays. Our results showed that distinct pathways with opposing actions were activated by PDGF. PI3K/Akt signalling was the main contributor to MSC proliferation in response to activation of PDGFRβ. We also demonstrate a negative feedback mechanism between PI3K/Akt and PDGFR-β expression. In addition, PI3K/Akt downstream signal cascades, mTOR and its associated proteins p70S6K and 4E-BP1 were involved. These pathways induced the expression of cyclin D1, cyclin D3 and CDK6 to promote cell cycle progression and MSC proliferation. In contrast, activation of Erk by PDGFRβ signalling potently inhibited the adipocytic differentiation of MSCs by blocking PPARγ and CEBPα expression. The data suggest that PDGFRβ-induced Akt and Erk pathways regulate opposing fate decisions of proliferation and differentiation to promote MSC self-renewal. Thus, activation of multiple intracellular cascades is required for successful and sustainable MSC self-renewal strategies.
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Affiliation(s)
- Borzo Gharibi
- Periodontology, Dental Institute, King's College London, London, UK
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Talal A, McKay IJ, Tanner KE, Hughes FJ. Effects of hydroxyapatite and PDGF concentrations on osteoblast growth in a nanohydroxyapatite-polylactic acid composite for guided tissue regeneration. J Mater Sci Mater Med 2013; 24:2211-2221. [PMID: 23832451 DOI: 10.1007/s10856-013-4963-9] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 05/16/2013] [Indexed: 06/02/2023]
Abstract
The technique of guided tissue regeneration (GTR) has evolved over recent years in an attempt to achieve periodontal tissue regeneration by the use of a barrier membrane. However, there are significant limitations in the currently available membranes and overall outcomes may be limited. A degradable composite material was investigated as a potential GTR membrane material. Polylactic acid (PLA) and nanohydroxyapatite (nHA) composite was analysed, its bioactive potential and suitability as a carrier system for growth factors were assessed. The effect of nHA concentrations and the addition of platelet derived growth factor (PDGF) on osteoblast proliferation and differentiation was investigated. The bioactivity was dependent on the nHA concentration in the films, with more apatite deposited on films containing higher nHA content. Osteoblasts proliferated well on samples containing low nHA content and differentiated on films with higher nHA content. The composite films were able to deliver PDGF and cell proliferation increased on samples that were pre-absorbed with the growth factor. nHA-PLA composite films are able to deliver active PDGF. In addition the bioactivity and cell differentiation was higher on films containing more nHA. The use of a nHA-PLA composite material containing a high concentration of nHA may be a useful material for GTR membrane as it will not only act as a barrier, but may also be able to enhance bone regeneration by delivery of biologically active molecules.
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Affiliation(s)
- Ahmed Talal
- College of Dentistry, University of Dammam, Ad Dammām, Saudi Arabia.
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Abstract
UNLABELLED Langerhans cell histiocytosis (LCH) is a rare clonal neoplastic disorder of unknown aetiology which can present with a diverse range of clinical presentations. It encompasses a diverse number of idiopathic conditions which can involve multiple body systems and is characterized by bone marrow-derived Langerhans cell proliferation. The disease can affect multiple body systems and lesions can be solitary or widespread. We present a case of a multifocal eosinophilic granuloma (LCH) in a young adult female with clinical signs and symptoms similar to aggressive periodontitis. CLINICAL RELEVANCE Langerhans cell histiocytosis is a rare disease which can have a similar clinical presentation to aggressive periodontitis.
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Affiliation(s)
- Paul L Ryan
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Turner Street, London, UK
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Gharibi B, Hughes FJ. Effects of medium supplements on proliferation, differentiation potential, and in vitro expansion of mesenchymal stem cells. Stem Cells Transl Med 2012. [PMID: 23197689 DOI: 10.5966/sctm.2010-0031] [Citation(s) in RCA: 211] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mesenchymal stem cells (MSCs) possess great potential for use in regenerative medicine. However, their clinical application may be limited by the ability to expand their cell numbers in vitro while maintaining their differential potentials and stem cell properties. Thus the aim of this study was to test the effect of a range of medium supplements on MSC self-renewal and differentiation potential. Cells were cultured until confluent and subcultured continuously until reaching senescence. Medium supplementation with fibroblast growth factor (FGF)-2, platelet-derived growth factor (PDGF)-BB, ascorbic acid (AA), and epidermal growth factor (EGF) both increased proliferation rate and markedly increased number of cell doublings before reaching senescence, with a greater than 1,000-fold increase in total cell numbers for AA, FGF-2, and PDGF-BB compared with control cultures. Long-term culture was associated with loss of osteogenic/adipocytic differentiation potential, particularly with FGF-2 supplementation but also with AA, EGF, and PDGF-BB. In addition FGF-2 resulted in reduction in expression of CD146 and alkaline phosphatase, but this was partially reversible on removal of the supplement. Cells expressed surface markers including CD146, CD105, CD44, CD90, and CD71 by flow cytometry throughout, and expression of these putative stem cell markers persisted even after loss of differentiation potentials. Overall, medium supplementation with FGF-2, AA, EGF, and PDGF-BB greatly enhanced the total in vitro expansion capacity of MSC cultures, although differentiation potentials were lost prior to reaching senescence. Loss of differentiation potential was not reflected by changes in stem cell surface marker expression.
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Affiliation(s)
- Borzo Gharibi
- Department of Periodontology, King's College London, London, UK
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Bostanci N, Akgül B, Tsakanika V, Allaker RP, Hughes FJ, McKay IJ. Effects of low-dose doxycycline on cytokine secretion in human monocytes stimulated with Aggregatibacter actinomycetemcomitans. Cytokine 2011; 56:656-61. [PMID: 21962932 DOI: 10.1016/j.cyto.2011.08.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 07/22/2011] [Accepted: 08/26/2011] [Indexed: 10/17/2022]
Abstract
Doxycycline is an antibiotic used in the treatment of a variety of inflammatory conditions, including periodontitis. Apart from its antimicrobial properties, this drug also has independent anti-inflammatory effects at sub-antimicrobial doses. The present study aimed to investigate the effects of low-doses of doxycycline (LDD) on cytokine production by human monocytic cells challenged with the periodontal pathogen Aggregatibacter actinomycetemcomitans, for up to 6 h. The simultaneous regulation of 12 cytokines were measured by a Human Cytokine Array Kit. To validate the array findings, selected cytokines were also measured by enzyme-linked immunosorbant assay (ELISA). A. actinomycetemcomitans stimulated the production of tumor necrosis factor (TNF)-α, interleukin (IL)-1α, IL-1β, IL-6 and IL-8 by the cells after 6 h of challenge, and doxycycline significantly inhibited this effect. The kinetics of this regulation demonstrated an early (within 2 h) and significant (P<0.05) inhibition of pro-inflammatory cytokines, with a mild (0.5-fold) up-regulation of the anti-inflammatory cytokine IL-10. The results indicate that LDD acts as an anti-inflammatory agent in human monocytic cells stimulated with A. actinomycetemcomitans. This model provides clear evidence that some of the clinically proven benefits of LDD may be related to its ability to regulate inflammatory mediator release by monocytic cells. This property may contribute to the clinically proven benefits of this antibiotic as an adjunctive treatment for periodontitis.
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Affiliation(s)
- N Bostanci
- Oral Translational Research, Institute of Oral Biology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
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Abstract
Periodontitis affects around 15 per cent of human adult populations. While periodontal treatment aimed at removing the bacterial cause of the disease is generally very successful, the ability predictably to regenerate the damaged tissues remains a major unmet objective for new treatment strategies. Existing treatments include the use of space-maintaining barrier membranes (guided tissue regeneration), use of graft materials, and application of bioactive molecules to induce regeneration, but their overall effects are relatively modest and restricted in application. The periodontal ligament is rich in mesenchymal stem cells, and the understanding of the signalling molecules that may regulate their differentation has increased enormously in recent years. Applying these principles for the development of new tissue engineering strategies for periodontal regeneration will require further work to determine the efficacy of current experimental preclinical treatments, including pharmacological application of growth factors such as bone morphogenetic proteins (BMPs) or Wnts, use of autologous stem cell reimplantation strategies, and development of improved biomaterial scaffolds. This article describes the background to this problem, addresses the current status of periodontal regeneration, including the background biology, and discusses the potential for some of these experimental therapies to achieve the goal of clinically predictable periodontal regeneration.
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Affiliation(s)
- F J Hughes
- Department of Periodontology, Institute of Dentistry, Kings College London, London, UK.
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Hendler A, Mulli TK, Hughes FJ, Perrett D, Bombardieri M, Houri-Haddad Y, Weiss EI, Nissim A. Involvement of autoimmunity in the pathogenesis of aggressive periodontitis. J Dent Res 2010; 89:1389-94. [PMID: 20940360 DOI: 10.1177/0022034510381903] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to investigate the involvement of autoimmune reactions to native and post-translationally modified extracellular matrix components in the pathogenesis of periodontitis. Sera from individuals with aggressive periodontitis (AgP, n = 25), chronic periodontitis (CP, n = 14), and gingivitis (G, n = 18) were tested for the presence of autoantibodies against: (a) native collagen type I (CI) and collagen type III (CIII); (b) CI and CIII post-translationally modified by reactive oxygen species (ROS) of the type present during inflammation; and (c) citrullinated filaggrin-derived peptides (CCP). Autoantibodies to native and ROS-modified CI and CIII as well as autoantibodies to CCP were observed exclusively in patients with AgP and not in those with CP or G. In conclusion, autoimmune reactions to native and post-translationally modified self-antigens may play a role specifically in the pathogenesis of AgP.
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Affiliation(s)
- A Hendler
- Bone and Joint Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
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King GN, King N, Hughes FJ. Effect of two delivery systems for recombinant human bone morphogenetic protein-2 on periodontal regeneration in vivo. J Periodontal Res 2010. [DOI: 10.1111/j.1600-0765.1998.tb02314.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Allaker RP, Waite RD, Hickling J, North M, McNab R, Bosma MP, Hughes FJ. Topographic distribution of bacteria associated with oral malodour on the tongue. Arch Oral Biol 2008; 53 Suppl 1:S8-S12. [PMID: 18460402 DOI: 10.1016/s0003-9969(08)70003-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the topographic distribution of bacterial types and loads associated with mid-morning oral malodour on the tongue surface. DESIGN Fifty subjects with good oral health and at least 20 natural uncrowned teeth were included. Samples were taken with sterile brushes from the dorsal anterior (DA), dorsal middle (DM), dorsal posterior (DP), dorsal posterior to the circumvallate papillae (DPCP), lateral posterior (LP) and ventral posterior (VP) tongue surfaces. Samples were cultured on appropriate media for anaerobic bacteria, aerobic bacteria, Gram-negative anaerobic bacteria, volatile sulphur compound (VSC)-producing bacteria and Streptococcus saliuarius. Malodour was assessed by trained judges on an intensity basis. RESULTS The counts of all bacterial groups were consistently highest at the DPCP surface. Mean VSC-producing bacterial counts (colony forming units/brush x10(5)) were 1.45, 5.67, 32.52, 88.94, 6.46 and 0.33 at DA, DM, DP, DPCP, LP and VP surfaces, respectively. Anaerobic, Gram-negative and VSC counts at DPCP surfaces increased with malodour intensity, whereas aerobic and S. saliuarius counts decreased; however these differences were not statistically significant. CONCLUSION It is concluded that the DPCP area consistently carries the highest load of bacteria capable of contributing to oral malodour. The study demonstrates that tongue surfaces not accessible to routine oral hygiene procedures can significantly contribute to oral malodour.
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Affiliation(s)
- Robert P Allaker
- Institute of Dentistry, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Abstract
OBJECTIVE To evaluate the effect of toothpaste treatments on levels of oral volatile sulphur compounds (VSCs) measured by gas chromatography in two clinical studies. METHODS These were blinded, randomised, controlled, crossover studies with 16 (study A) or 20 (study B) healthy volunteers between the ages of 19-54. Study A: breath samples were collected at baseline, immediately and lhr after brushing. Four dentifrices (Zinc A, Zinc B, commercially available triclosan dentifrice and zinc free control) were evaluated. Study B: breath samples were collected at baseline, immediately, 1, 2, 3 and 7 hours after treatment. Subjects consumed a light breakfast then provided an additional breath sample between baseline assessment and treatment. Two dentifrices (gel-to-foam and a commercially available triclosan dentrifrice) were evaluated. Breath samples were collected in syringes and analysed for VSCs (hydrogen sulphide, methyl mercaptan and Total VSCs) utilising gas chromatography (GC) with flame photometric detection. RESULTS Study A: immediately after treatment, a statistically significant reduction in VSCs from baseline was observed for Zinc A product only. A statistically significant reduction in VSCs from baseline was observed after 1 hour for all products. Both zinc products exhibited a significantly greater reduction from baseline VSCs than Colgate Total and Control at all time points. Study B: a statistically significant reduction in VSCs from baseline was observed at all time points for both products. The gel-to-foam product exhibited significantly greater reduction from baseline Total VSC concentration than Colgate Total at all time points from 1 hour post-treatment. CONCLUSION Control of oral malodour by toothpaste treatment, evaluated as VSC levels using GC, has been demonstrated. Zinc is effective at reducing VSCs and the efficacy of zinc is formulation dependent. A gel-to-foam dentifrice was more effective at reducing VSCs than Colgate Total up to 7 hours.
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Reddi D, Bostanci N, Hashim A, Aduse-Opoku J, Curtis MA, Hughes FJ, Belibasakis GN. Porphyromonas gingivalis regulates the RANKL-OPG system in bone marrow stromal cells. Microbes Infect 2008; 10:1459-68. [PMID: 18789397 DOI: 10.1016/j.micinf.2008.08.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [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] [Received: 06/19/2008] [Revised: 08/07/2008] [Accepted: 08/15/2008] [Indexed: 11/17/2022]
Abstract
Porphyromonas gingivalis is a Gram-negative anaerobe implicated in chronic periodontitis, a bacterial-induced inflammatory condition that causes destruction of the periodontal connective tissues and underlying alveolar bone. The receptor activator of nuclear factor-kappaB ligand (RANKL) is a cytokine that directly stimulates osteoclastogenesis and bone resorption, whereas its decoy receptor osteoprotegerin (OPG) blocks this action. This study aimed to investigate the effects of P. gingivalis culture supernatants on RANKL and OPG expression in W20-17 bone marrow stromal cells, and evaluate the involvement of its virulence factors, particularly gingipains and lipopolysaccharide. P. gingivalis up-regulated RANKL and down-regulated OPG mRNA expression and protein production. These effects were blocked by indomethacin, suggesting mediation by prostaglandins. Furthermore, P gingivalis induced the production of prostaglandin E(2). Heat-inactivation, or chemical inhibition of P. gingivalis gingipains did not affect RANKL and OPG regulation. However, lipopolysaccharide depletion by polymyxin B abolished RANKL induction, and partly rescued the suppression of OPG. In conclusion, P. gingivalis regulates the RANKL-OPG system via prostaglandin E(2) in bone marrow stromal cells, in a manner that favours osteoclastogenesis. A non-proteolytic and non-proteinaceous P. gingivalis component is involved in these events, most probably its lipopolysaccharide. This activity may contribute to the bone loss characteristic of periodontitis.
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Affiliation(s)
- Durga Reddi
- Institute of Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AD, UK
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Bostanci N, Allaker RP, Belibasakis GN, Rangarajan M, Curtis MA, Hughes FJ, McKay IJ. Porphyromonas gingivalis antagonises Campylobacter rectus induced cytokine production by human monocytes. Cytokine 2007; 39:147-56. [PMID: 17709256 DOI: 10.1016/j.cyto.2007.07.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [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] [Received: 04/05/2007] [Revised: 05/29/2007] [Accepted: 07/05/2007] [Indexed: 11/26/2022]
Abstract
Porphyromonas gingivalis and Campylobacter rectus are two major bacterial species implicated in the pathogenesis of periodontitis. P. gingivalis can antagonise the inflammatory response to other periodontal pathogens, a property commonly attributed to its lipopolysaccharide (LPS). The aim of this study was to investigate the capacity of P. gingivalis to antagonise C. rectus induced cytokine stimulation from human monocytes, and to investigate the involvement of its LPS. Primary human monocytes and Monomac-6 cells were challenged with culture supernatants from P. gingivalis and C. rectus, and levels of IL-1beta, IL-6 and IL-8 produced were measured by ELISA after 6h incubation. Purified P. gingivalis LPS was also added alone or in combination with C. rectus culture supernatant. Both species significantly stimulated the production of all three cytokines from the two cell lines, but P. gingivalis was considerably weaker inducer. Co-stimulation of the cells with P. gingivalis and C. rectus suppressed the cytokine-stimulatory capacity of the latter. P. gingivalis LPS alone was sufficient to antagonise IL-6 and IL-8, but not IL-1beta stimulation by C. rectus. In conclusion, mixed infections may impair host immune responses by reducing pro-inflammatory cytokine levels, which may be of relevance to the pathogenesis of periodontitis.
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Affiliation(s)
- N Bostanci
- Centre for Adult Oral Health, Bart's and The London School of Medicine and Dentistry, Queen Mary's University of London, 4 Newark Street (Blizard Building), London E1 2AT, UK.
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Bostanci N, Ilgenli T, Emingil G, Afacan B, Han B, Töz H, Berdeli A, Atilla G, McKay IJ, Hughes FJ, Belibasakis GN. Differential expression of receptor activator of nuclear factor-?B ligand and osteoprotegerin mRNA in periodontal diseases. J Periodontal Res 2007; 42:287-93. [PMID: 17559623 DOI: 10.1111/j.1600-0765.2006.00946.x] [Citation(s) in RCA: 69] [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: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Receptor activator of nuclear factor-kappaB ligand (RANKL) is responsible for the induction of osteoclastogenesis and bone resorption, whereas its decoy receptor, osteoprotegerin, can directly block this action. Because this dyad of cytokines is crucial for regulating the bone remodelling process, imbalances in their expression may cause a switch from the physiological state to enhanced bone resorption or formation. This study investigated the mRNA expression of RANKL and osteoprotegerin, as well as their relative ratio, in the gingival tissues of patients with various forms of periodontal diseases. MATERIAL AND METHODS Gingival tissue was obtained from nine healthy subjects and 41 patients, who had gingivitis, chronic periodontitis, generalized aggressive periodontitis, and chronic periodontitis and were receiving immunosuppressant therapy. Quantitative real-time polymerase chain reaction was employed to evaluate the mRNA expression of RANKL and osteoprotegerin in these tissues. RESULTS Compared with healthy individuals, patients in all periodontitis groups, but not those with gingivitis, exhibited stronger RANKL expression and a higher relative RANKL/osteoprotegerin ratio. In addition, osteoprotegerin expression was weaker in patients with chronic periodontitis. When patients with generalized aggressive periodontitis and chronic periodontitis were compared, the former exhibited stronger RANKL expression, whereas the latter exhibited weaker osteoprotegerin expression, and there was no difference in their relative ratio. When chronic periodontitis patients were compared with chronic periodontitis patients receiving immunosuppressant therapy, osteoprotegerin, but not RANKL, expression was stronger in the latter. CONCLUSION This study demonstrates that RANKL and osteoprotegerin expression are differentially regulated in various forms of periodontitis, and the relative RANKL/osteoprotegerin ratio appears to be indicative of disease occurrence. This information may confer diagnostic and therapeutic value in periodontitis.
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Affiliation(s)
- N Bostanci
- Department of Periodontology, School of Dentistry, Ege University, Izmir, Turkey.
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Belibasakis GN, Bostanci N, Hashim A, Johansson A, Aduse-Opoku J, Curtis MA, Hughes FJ. Regulation of RANKL and OPG gene expression in human gingival fibroblasts and periodontal ligament cells by Porphyromonas gingivalis: a putative role of the Arg-gingipains. Microb Pathog 2007; 43:46-53. [PMID: 17448630 DOI: 10.1016/j.micpath.2007.03.001] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [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] [Received: 11/20/2006] [Revised: 02/26/2007] [Accepted: 03/06/2007] [Indexed: 11/24/2022]
Abstract
Porphyromonas gingivalis is highly implicated in the pathogenesis of periodontitis, which is characterized by the destruction of periodontal connective tissues and the supporting alveolar bone. Receptor Activator of NF-kappaB Ligand (RANKL) stimulates bone resorption, whereas osteoprotegerin (OPG) blocks its action, and this bi-molecular system is implicated in periodontitis. The aim of this work was (a) to investigate the regulation of RANKL and OPG gene expression in human periodontal ligament (PDL) cells and gingival fibroblasts (GF), in response to P. gingivalis culture supernatants, by quantitative real-time PCR and (b) to attempt to identify putative virulence factors involved in this process. The results indicated that P. gingivalis induced RANKL and reduced OPG mRNA expression by the studied cells, resulting in an increased RANKL/OPG expression ratio. Heat-inactivation of P. gingivalis resulted in significant reduction of RANKL mRNA expression. A Lys-gingipain mutant strain did not affect, whereas an Arg-gingipain mutant strain further enhanced RANKL mRNA expression, compared to their parental wild-type strain. In conclusion, P. gingivalis up-regulates the RANKL/OPG expression ratio in GF and PDL cells, denoting an enhanced osteoclastogenic potential by the cells. The component mainly responsible for RANKL induction appears to be proteinaceous, and it may be regulated by the Arg-gingipains.
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Affiliation(s)
- Georgios N Belibasakis
- Centre for Adult Oral Health, Bart's and the London School of Medicine and Dentistry, Queen Mary's University of London, London E1 2AT, UK.
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Bostanci N, Ilgenli T, Emingil G, Afacan B, Han B, Töz H, Atilla G, Hughes FJ, Belibasakis GN. Gingival crevicular fluid levels of RANKL and OPG in periodontal diseases: implications of their relative ratio. J Clin Periodontol 2007; 34:370-6. [PMID: 17355365 DOI: 10.1111/j.1600-051x.2007.01061.x] [Citation(s) in RCA: 171] [Impact Index Per Article: 10.1] [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: 01/11/2023]
Abstract
AIM Receptor activator of NF-kappaB ligand (RANKL) and osteoprotegerin (OPG) are a system of molecules that regulate bone resorption. This study aims to compare the levels of RANKL, OPG and their relative ratio in gingival crevicular fluid (GCF) of healthy and periodontal disease subjects. MATERIAL AND METHODS GCF was obtained from healthy (n=21), gingivitis (n=22), chronic periodontitis (n=28), generalized aggressive periodontitis (n=25) and chronic periodontitis subjects under immunosuppressant therapy (n=11). RANKL and OPG concentrations in GCF were measured by enzyme-linked immunosorbent assays. RESULTS RANKL levels were low in health and gingivitis groups, but increased in all three forms of periodontitis. OPG levels were higher in health than all three periodontitis, or gingivitis groups. There were no differences in RANKL and OPG levels between chronic and generalized aggressive periodontitis groups, whereas these were lower in the immunosuppressed chronic periodontitis group. The RANKL/OPG ratio was significantly elevated in all three periodontitis forms, compared with health or gingivitis, and positively correlated to probing pocket depth and clinical attachment level. CONCLUSION GCF RANKL and OPG levels were oppositely regulated in periodontitis, but not gingivitis, resulting in an enhanced RANKL/OPG ratio. This ratio was similar in all three periodontitis groups and may therefore predict disease occurrence.
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Affiliation(s)
- Nagihan Bostanci
- Adult Oral Health, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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James JA, Poulton KV, Haworth SE, Payne D, McKay IJ, Clarke FM, Hughes FJ, Linden GJ. Polymorphisms of TLR4 but not CD14 are associated with a decreased risk of aggressive periodontitis. J Clin Periodontol 2007; 34:111-7. [PMID: 17309585 DOI: 10.1111/j.1600-051x.2006.01030.x] [Citation(s) in RCA: 42] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study whether there is an association between the frequency of functional polymorphisms in the toll-like receptor 4 (TLR4) and cluster differentiation 14 (CD14) genes and periodontitis. METHODOLOGY Genotyping for the TLR4 single-nucleotide polymorphisms (SNPs) Asp299Gly, Thr399Ile and the CD14 SNPs -159 and -1359 was completed for subjects with periodontal disease compared with control subjects. Two disease populations were investigated: 73 subjects with aggressive periodontitis (AgP; 28 males, 45 females) and 95 males with chronic periodontitis (CP). The TLR4 and CD14 polymorphisms were determined using SNaPshot primer extension with capillary electrophoresis. Comparison of allele and genotype frequencies for each polymorphism was by Fisher's exact test or chi2 analysis. RESULTS The TLR4 Asp299Gly genotype was present in a significantly (p=0.026) lower proportion of AgP subjects (5.5%) compared with control subjects (16.3%). The unadjusted odds ratio for the Asp299Gly genotype to be associated with AgP was 0.30, 95% confidence interval 0.10-0.91. No differences were found in the prevalence of the TLR4 Asp299Gly genotype in men with CP (18.9%) compared with an age-matched control group with no evidence of periodontitis (17%). In addition, there was no difference in the distribution of the CD14 polymorphisms in either the AgP or CP populations studied compared with controls. CONCLUSION It is concluded that in West European Caucasians, the Asp299Gly TLR4 gene polymorphism is associated with a decreased risk of AgP but not CP. Promoter polymorphisms of the CD14 gene, however, did not influence susceptibility to inflammatory periodontitis in the population cohorts studied.
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Affiliation(s)
- Jacqueline A James
- Centre for Cancer Research and Cell Biology, Queens University, Belfast, UK.
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Bostanci N, Allaker R, Johansson U, Rangarajan M, Curtis MA, Hughes FJ, McKay IJ. Interleukin-1? stimulation in monocytes by periodontal bacteria: antagonistic effects of Porphyromonas gingivalis. ACTA ACUST UNITED AC 2007; 22:52-60. [PMID: 17241171 DOI: 10.1111/j.1399-302x.2007.00322.x] [Citation(s) in RCA: 35] [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: 11/29/2022]
Abstract
Periodontal pathogenic bacteria are associated with elevated levels of interleukin-1alpha (IL-1alpha) but it is unclear if all species can induce cytokine production equally. Porphyromonas gingivalis may be able antagonize IL-1alpha induced by other species through the activity of its proteases or lipopolysaccharide (LPS). Monomac-6 cells and primary human monocytes were treated with culture supernatants from Porphyromonas gingivalis, Fusobacterium nucleatum, Campylobacter rectus, Actinobacillus actinomycetemcomitans, Prevotella intermedius, Veillonella atypical and Prevotella nigrescens. IL-1alpha protein levels were measured after 6 h of incubation. In addition, monocytes were co-stimulated with supernatants from P. gingivalis and other bacteria. The role of P. gingivalis proteases was tested using Arg-X and Lys-X mutant strains. The role of LPS was investigated using purified P. gingivalis LPS and polymixin depletion. All species tested induced significant IL-1alpha production, but P. gingivalis was the weakest. Co-stimulation of monocytes with P. gingivalis antagonized the ability of other bacterial species to induce IL-1alpha production. This effect was at its greatest with C. rectus (resulting in a 70% reduction). Gingipain mutant strains and chemical inhibition of protease activity did not reduce antagonistic activity. However, 100 ng/ml of P. gingivalis LPS can reproduce the antagonistic activity of P. gingivalis culture supernatants. Periodontitis-associated bacterial species stimulate IL-1alpha production by monocytes. P. gingivalis can antagonize this effect, and its LPS appears to be the crucial component. This study highlights the importance of mixed infections in the pathogenesis of periodontal disease because reduction of pro-inflammatory cytokine levels may impair the ability of the host to tackle infection.
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Affiliation(s)
- N Bostanci
- Centre for Adult Oral Health, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, London, UK
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Bostanci N, Ilgenli T, Pirhan DC, Clarke FM, Marcenes W, Atilla G, Hughes FJ, McKay IJ. Relationship between IL-1A polymorphisms and gingival overgrowth in renal transplant recipients receiving Cyclosporin A. J Clin Periodontol 2006; 33:771-8. [PMID: 16965524 DOI: 10.1111/j.1600-051x.2006.00990.x] [Citation(s) in RCA: 16] [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] [Indexed: 11/28/2022]
Abstract
AIM Levels of interleukin-1alpha (IL-1alpha) are elevated in periodontal inflammation. IL-1A gene polymorphisms are associated with inflammatory diseases. This study aimed to investigate IL-1A gene polymorphism in Cyclosporin A (CsA)-treated renal transplant patients and investigate the association between this polymorphism and gingival crevicular fluid (GCF) levels of several cytokines. MATERIALS AND METHODS Fifty-one renal transplant patients on CsA treatment (25 with and 26 without gingival overgrowth) and 29 healthy controls were recruited for the study. Demographic, pharmacological and periodontal parameters were recorded and gingival overgrowth was assessed. RESULTS Multiple regression analysis showed that genotype was significantly associated with gingival overgrowth (p=0.02). Carriage of the IL-1A (-889) T allele was strongly protective [95% confidence interval (CI): 0.046-0.77], although not significantly associated with IL-1alpha protein levels in GCF. IL-1alpha, IL-1beta and IL-8, but not IL-6, were detected in GCF of CsA-treated patients, but none of them was significantly associated with gingival overgrowth. CONCLUSIONS This study is the first to associate a gene polymorphism as a risk factor for CsA-induced gingival overgrowth in renal transplant patients, demonstrating that IL-1A polymorphism might alter individual susceptibility to CsA. However, there was no association between GCF cytokine levels and the presence of gingival overgrowth or patient IL-1A genotype.
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Affiliation(s)
- Nagihan Bostanci
- Department of Periodontology, School of Dentistry, Ege University, Izmir, Turkey.
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Hughes FJ, Syed M, Koshy B, Bostanci N, McKay IJ, Curtis MA, Marcenes W, Croucher RE. Prognostic factors in the treatment of generalized aggressive periodontitis: II. Effects of smoking on initial outcome. J Clin Periodontol 2006; 33:671-6. [PMID: 16856898 DOI: 10.1111/j.1600-051x.2006.00965.x] [Citation(s) in RCA: 32] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study was to investigate the effects of smoking on the response to non-surgical treatment for aggressive periodontitis. METHODS Seventy-nine patients with generalized aggressive periodontitis were included in the study; 20 were smokers. All patients received a course of non-surgical periodontal therapy and outcomes assessed 10 weeks post-operatively. Non-responding patients were designated if they had 30% or more non-responding deep sites. RESULTS At baseline, bleeding scores were lower in smokers. There was no difference in baseline plaque, pocket depth (PD), recession or clinical attachment levels (CALs); when sites were selected by equal levels of CAL, increased recession was seen in smokers. Outcomes were poorer in smokers (mean PD change 1.75+/-0.56 versus 2.23+/-0.87 mm). The odds ratio for 30% of sites not responding in smokers was 2.9; for 40% non-responding it was 5.9. Smoking altered the distribution of site-specific responses to increase specifically the number of non-responding sites. There was no significant difference in responses between ex-smokers and never-smokers. CONCLUSIONS The results demonstrate that smoking is a major risk factor for poor response to initial treatment and emphasize the importance of smoking cessation in periodontal therapy.
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Affiliation(s)
- Francis J Hughes
- Collaborative Group in Risk Factors for Periodontal Disease, Centre for Adult Oral Health, Institute of Dentistry, London, UK.
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Hughes FJ, Syed M, Koshy B, Marinho V, Bostanci N, McKay IJ, Curtis MA, Croucher RE, Marcenes W. Prognostic factors in the treatment of generalized aggressive periodontitis: I. Clinical features and initial outcome. J Clin Periodontol 2006; 33:663-70. [PMID: 16856897 DOI: 10.1111/j.1600-051x.2006.00966.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [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: 11/28/2022]
Abstract
AIMS The aims of this study were to investigate prognostic factors for initial response to non-surgical periodontal treatment for generalized aggressive periodontitis. METHODS Seventy-nine patients with generalized aggressive periodontitis were included in this prospective follow-up intervention study. Patients' clinical and demographic parameters were collected at baseline and 10 weeks following a standard course of treatment (four visits of non-surgical root surface debridement together with OHI as required). The relationship between clinical variables and treatment outcome were analysed at site-specific level by chi(2) analysis and for patient-specific variables by logistic regression. RESULTS In general, there was a good response to the treatment provided. In deep sites the mean pocket depth reduction was 2.11+/-2.01 mm. Site-specific analysis showed that the presence of plaque had a small but significant predictive effect on outcome (odds ratio 1.4). Sites on teeth with grade II/III mobility showed a significantly reduced response to treatment. Twenty-five patients were classified as "non-responders". Current smoking was strongly associated with non-responding patients (odds ratio 3.8) in a logistic regression model; plaque, baseline bleeding and initial pocket depth were not significantly associated with treatment outcomes. CONCLUSIONS Overall, the results emphasize the importance of smoking as a negative prognostic factor, and suggest that treatment outcomes may be determined by a wide range of different determinants requiring further study.
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Affiliation(s)
- Francis J Hughes
- Collaborative Group in Risk Factors for Periodontal Disease, Institute of Dentistry, Queen Mary's School of Medicine, London, UK.
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Affiliation(s)
- Francis J Hughes
- Centre for Adult Oral Health, Barts and The London, Queen Mary's School of Medicine and Dentistry, London, UK
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Gamboa ABO, Hughes FJ, Marcenes W. The relationship between emotional intelligence and initial response to a standardized periodontal treatment. A pilot study. J Clin Periodontol 2005; 32:702-7. [PMID: 15966874 DOI: 10.1111/j.1600-051x.2005.00771.x] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Emotional intelligence (EI) is a psychological construct, which has been proposed as a measure of coping mechanisms. The aim of this pilot study was to investigate the relationship between different domains of EI, and initial response to a simplified non-surgical treatment protocol in 29 patients with chronic periodontitis. METHODS Assessment of patients included socio-demographic and behavioural variables and assessment of EI. Clinical assessment included measurement of plaque and gingival bleeding. Patients received oral hygiene instruction (OHI) and supra-gingival scaling and polishing over two visits, and re-assessed after 3 weeks. RESULTS There was a significant overall reduction in plaque and bleeding. Plaque reduction was positively associated with the EI construct of intentionality, resilience, constructive discontent and personal power (Spearman's rank test). Reduction in bleeding was positively correlated with resilience, constructive discontent and intuition. CONCLUSIONS This pilot study demonstrated an association between EI domains and short-term changes in plaque and bleeding, and suggest that initial responses to standardized periodontal treatment may be partly related to EI.
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Affiliation(s)
- Ana Beatriz O Gamboa
- Centre for Adult Oral Health, Barts & The London, Queen Mary's School of Medicine & Dentistry, London E12 2AD, UK
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