Haplodeficiency of the 9p21 tumor suppressor locus causes myeloid disorders driven by the bone marrow microenvironment

The chromosome 9p21 locus comprises several tumor suppressor genes including MTAP, CDKN2A, and CDKN2B, and its homo- or heterozygous deletion is associated with reduced survival in multiple cancer types. We report that mice with germ line monoallelic deletion or induced biallelic deletion of the 9p21-syntenic locus (9p21s) developed a fatal myelodysplastic syndrome/myeloproliferative neoplasm (MDS/MPN)-like disease associated with aberrant trabecular bone formation and/or fibrosis in the bone marrow (BM). Reciprocal BM transfers and conditional targeting of 9p21s suggested that the disease originates in the BM stroma. Single-cell analysis of 9p21s-deficient BM stroma revealed the expansion of chondrocyte and osteogenic precursors, reflected in increased osteogenic differentiation in vitro. It also showed reduced expression of factors maintaining hematopoietic stem/progenitor cells, including Cxcl12. Accordingly, 9p21s-deficient mice showed reduced levels of circulating Cxcl12 and concomitant upregulation of the profibrotic chemokine Cxcl13 and the osteogenesis- and fibrosis-related multifunctional glycoprotein osteopontin/Spp1. Our study highlights the potential of mutations in the BM microenvironment to drive MDS/MPN-like disease.

Subversion of Serotonin Receptor Signaling in Osteoblasts by Kynurenine Drives Acute Myeloid Leukemia

Remodeling of the microenvironment by tumor cells can activate pathways that favor cancer growth. Molecular delineation and targeting of such malignant-cell nonautonomous pathways may help overcome resistance to targeted therapies. Herein we leverage genetic mouse models, patient-derived xenografts, and patient samples to show that acute myeloid leukemia (AML) exploits peripheral serotonin signaling to remodel the endosteal niche to its advantage. AML progression requires the presence of serotonin receptor 1B (HTR1B) in osteoblasts and is driven by AML-secreted kynurenine, which acts as an oncometabolite and HTR1B ligand. AML cells utilize kynurenine to induce a proinflammatory state in osteoblasts that, through the acute-phase protein serum amyloid A (SAA), acts in a positive feedback loop on leukemia cells by increasing expression of IDO1-the rate-limiting enzyme for kynurenine synthesis-thereby enabling AML progression. This leukemia-osteoblast cross-talk, conferred by the kynurenine-HTR1B-SAA-IDO1 axis, could be exploited as a niche-focused therapeutic approach against AML, opening new avenues for cancer treatment.

SIGNIFICANCE

AML remains recalcitrant to treatments due to the emergence of resistant clones. We show a leukemia-cell nonautonomous progression mechanism that involves activation of a kynurenine-HTR1B-SAA-IDO1 axis between AML cells and osteoblasts. Targeting the niche by interrupting this axis can be pharmacologically harnessed to hamper AML progression and overcome therapy resistance. This article is highlighted in the In This Issue feature, p. 873.

Next Generation Bone Marrow Adiposity Researchers: Report From the 1st BMAS Summer School 2021

The first International Summer School on Bone Marrow Adiposity was organized by members of Bone Marrow Adiposity Society and held virtually on September 6-8 2021. The goal of this meeting was to bring together young scientists interested in learning about bone marrow adipose tissue biology and pathology. Fifty-two researchers from different backgrounds and fields, ranging from bone physiopathology to adipose tissue biology and hematology, participated in the summer school. The meeting featured three keynote lectures on the fundamentals of bone marrow adiposity, three scientific workshops on technical considerations in studying bone marrow adiposity, and six motivational and career development lectures, spanning from scientific writing to academic career progression. Moreover, twenty-one participants presented their work in the form of posters. In this report we highlight key moments and lessons learned from the event.

High-resolution 3D imaging uncovers organ-specific vascular control of tissue aging

Blood vessels provide supportive microenvironments for maintaining tissue functions. Age-associated vascular changes and their relation to tissue aging and pathology are poorly understood. Here, we perform 3D imaging of young and aging vascular beds. Multiple organs in mice and humans demonstrate an age-dependent decline in vessel density and pericyte numbers, while highly remodeling tissues such as skin preserve the vasculature. Vascular attrition precedes the appearance of cellular hallmarks of aging such as senescence. Endothelial VEGFR2 loss-of-function mice demonstrate that vascular perturbations are sufficient to stimulate cellular changes coupled with aging. Age-associated tissue-specific molecular changes in the endothelium drive vascular loss and dictate pericyte to fibroblast differentiation. Lineage tracing of perivascular cells with inducible PDGFRβ and NG2 Cre mouse lines demonstrated that increased pericyte to fibroblast differentiation distinguishes injury-induced organ fibrosis and zymosan-induced arthritis. To spur further discoveries, we provide a freely available resource with 3D vascular and tissue maps.

Decreased blood vessel density and endothelial cell subset dynamics during ageing of the endocrine system

Age-associated alterations of the hormone-secreting endocrine system cause organ dysfunction and disease states. However, the cell biology of endocrine tissue ageing remains poorly understood. Here, we perform comparative 3D imaging to understand age-related perturbations of the endothelial cell (EC) compartment in endocrine glands. Datasets of a wide range of markers highlight a decline in capillary and artery numbers, but not of perivascular cells in pancreas, testis and thyroid gland, with age in mice and humans. Further, angiogenesis and β-cell expansion in the pancreas are coupled by a distinct age-dependent subset of ECs. While this EC subpopulation supports pancreatic β cells, it declines during ageing concomitant with increased expression of the gap junction protein Gja1. EC-specific ablation of Gja1 restores β-cell expansion in the aged pancreas. These results provide a proof of concept for understanding age-related vascular changes and imply that therapeutic targeting of blood vessels may restore aged endocrine tissue function. This comprehensive data atlas offers over > 1,000 multicolour volumes for exploration and research in endocrinology, ageing, matrix and vascular biology.

Zoledronic Acid in a Mouse Model of Human Fibrous Dysplasia: Ineffectiveness on Tissue Pathology, Formation of "Giant Osteoclasts" and Pathogenetic Implications

We compared the effects of a nitrogen-containing bisphosphonate (N-BP), zoledronic acid (ZA), and an anti-mouse RANKL antibody (anti-mRANKL Ab) on the bone tissue pathology of a transgenic mouse model of human fibrous dysplasia (FD). For comparison, we also reviewed the histological samples of a child with McCune-Albright syndrome (MAS) treated with Pamidronate for 3 years. EF1α-Gsα^R201C mice with FD-like lesions in the tail vertebrae were treated with either 0.2 mg/kg of ZA at day 0, 7, and 14 or with 300 μg/mouse of anti-mRANKL Ab at day 0 and 21. All mice were monitored by Faxitron and histological analysis was performed at day 42. ZA did not affect the progression of the radiographic phenotype in EF1α-Gsα^R201C mice. FD-like lesions in the ZA group showed the persistence of osteoclasts, easily detectable osteoclast apoptotic activity and numerous "giant osteoclasts". In contrast, in the anti-mRANKL Ab-treated mice, osteoclasts were markedly reduced/absent, the radiographic phenotype reverted and the FD-like lesions were extensively replaced by newly formed bone. Numerous "giant osteoclasts" were also detected in the samples of the child with MAS. This study supports the hypothesis that osteoclasts per se, independently of their resorptive activity, are essential for development and expansion of FD lesions.

Reporting Guidelines, Review of Methodological Standards, and Challenges Toward Harmonization in Bone Marrow Adiposity Research. Report of the Methodologies Working Group of the International Bone Marrow Adiposity Society

The interest in bone marrow adiposity (BMA) has increased over the last decade due to its association with, and potential role, in a range of diseases (osteoporosis, diabetes, anorexia, cancer) as well as treatments (corticosteroid, radiation, chemotherapy, thiazolidinediones). However, to advance the field of BMA research, standardization of methods is desirable to increase comparability of study outcomes and foster collaboration. Therefore, at the 2017 annual BMA meeting, the International Bone Marrow Adiposity Society (BMAS) founded a working group to evaluate methodologies in BMA research. All BMAS members could volunteer to participate. The working group members, who are all active preclinical or clinical BMA researchers, searched the literature for articles investigating BMA and discussed the results during personal and telephone conferences. According to the consensus opinion, both based on the review of the literature and on expert opinion, we describe existing methodologies and discuss the challenges and future directions for (1) histomorphometry of bone marrow adipocytes, (2) ex vivo BMA imaging, (3) in vivo BMA imaging, (4) cell isolation, culture, differentiation and in vitro modulation of primary bone marrow adipocytes and bone marrow stromal cell precursors, (5) lineage tracing and in vivo BMA modulation, and (6) BMA biobanking. We identify as accepted standards in BMA research: manual histomorphometry and osmium tetroxide 3D contrast-enhanced μCT for ex vivo quantification, specific MRI sequences (WFI and H-MRS) for in vivo studies, and RT-qPCR with a minimal four gene panel or lipid-based assays for in vitro quantification of bone marrow adipogenesis. Emerging techniques are described which may soon come to complement or substitute these gold standards. Known confounding factors and minimal reporting standards are presented, and their use is encouraged to facilitate comparison across studies. In conclusion, specific BMA methodologies have been developed. However, important challenges remain. In particular, we advocate for the harmonization of methodologies, the precise reporting of known confounding factors, and the identification of methods to modulate BMA independently from other tissues. Wider use of existing animal models with impaired BMA production (e.g., Pfrt^-/-, Kit^W/W-v) and development of specific BMA deletion models would be highly desirable for this purpose.

RANKL Inhibition in Fibrous Dysplasia of Bone: A Preclinical Study in a Mouse Model of the Human Disease

Fibrous dysplasia of bone/McCune-Albright syndrome (Polyostotic FD/MAS; OMIM#174800) is a crippling skeletal disease caused by gain-of-function mutations of G_s α. Enhanced bone resorption is a recurrent histological feature of FD and a major cause of fragility of affected bones. Previous work suggests that increased bone resorption in FD is driven by RANKL and some studies have shown that the anti-RANKL monoclonal antibody, denosumab, reduces bone turnover and bone pain in FD patients. However, the effect of RANKL inhibition on the histopathology of FD and its impact on the natural history of the disease remain to be assessed. In this study, we treated the EF1α-G_s α^R201C mice, which develop an FD-like phenotype, with an anti-mouse RANKL monoclonal antibody. We found that the treatment induced marked radiographic and microscopic changes at affected skeletal sites in 2-month-old mice. The involved skeletal segments became sclerotic due to the deposition of new, highly mineralized bone within developing FD lesions and showed a higher mechanical resistance compared to affected segments from untreated transgenic mice. Similar changes were also detected in older mice with a full-blown skeletal phenotype. The administration of anti-mouse RANKL antibody arrested the growth of established lesions and, in young mice, prevented the appearance of new ones. However, after drug withdrawal, the newly formed bone was remodelled into FD tissue and the disease progression resumed in young mice. Taken together, our results show that the anti-RANKL antibody significantly affected the bone pathology and natural history of FD in the mouse. Pending further work on the prevention and management of relapse after treatment discontinuation, our preclinical study suggests that RANKL inhibition may be an effective therapeutic option for FD patients. © 2019 American Society for Bone and Mineral Research.

Angiocrine signals regulate quiescence and therapy resistance in bone metastasis

Bone provides supportive microenvironments for hematopoietic stem cells (HSCs) and mesenchymal stem cells (MSCs) and is a frequent site of metastasis. While incidences of bone metastases increase with age, the properties of the bone marrow microenvironment that regulate dormancy and reactivation of disseminated tumor cells (DTCs) remain poorly understood. Here, we elucidate the age-associated changes in the bone secretome that trigger proliferation of HSCs, MSCs, and DTCs in the aging bone marrow microenvironment. Remarkably, a bone-specific mechanism involving expansion of pericytes and induction of quiescence-promoting secretome rendered this proliferative microenvironment resistant to radiation and chemotherapy. This bone-specific expansion of pericytes was triggered by an increase in PDGF signaling via remodeling of specialized type H blood vessels in response to therapy. The decline in bone marrow pericytes upon aging provides an explanation for loss of quiescence and expansion of cancer cells in the aged bone marrow microenvironment. Manipulation of blood flow — specifically, reduced blood flow — inhibited pericyte expansion, regulated endothelial PDGF-B expression, and rendered bone metastatic cancer cells susceptible to radiation and chemotherapy. Thus, our study provides a framework to recognize bone marrow vascular niches in age-associated increases in metastasis and to target angiocrine signals in therapeutic strategies to manage bone metastasis.

Radiation and chemotherapy induce bone-specific expansion of vascular niches, which promotes therapy resistance.

Clinical wear performance of eight experimental dental composites over three years determined by two measuring methods

The effect of matrix selection, filler composition, filler silanization, operator variations, and test site (dental clinic) on the wear rate of eight composites were evaluated. The wear was measured on replicas using both a microscopic and a laser scanning measuring method. The average wear rate on contact-free surfaces was 9.2 +/- 4.2 microm/month with the microscopic measurement and 8.5 +/- 3.7 microm/ month with the laser scanner over the 36-month period. The urethane-based composites performed significantly better than those which were bisGMA-based. Restorations placed at one dental clinic showed significantly lower initial wear. There was also a significant difference between the operators that was most pronounced during the first 6 months. The other variable (filler composition and silane treatment) did not affect the wear rate significantly.

Polymerization shrinkage and elasticity of flowable composites and filled adhesives

OBJECTIVES

The magnitude and kinetics of polymerization shrinkage, together with elastic modulus, may be potential predictors of bond failure of adhesive restorations. This study examined these properties in visible-light-cured resins, in particular new flowable composites and filled adhesives.

METHODS

Polymerization shrinkage values were obtained by digital video imaging before and after light-curing; shrinkage kinetics were obtained by the "deflecting disk" method and the elastic modulus by analysis of the fundamental period of vibration.

RESULTS

Flowable composites generally showed higher shrinkage than traditional non-flowable composites, while more densely filled adhesives presented lower shrinkage than lightly filled or unfilled resins. The elastic moduli of flowable composites were in the low-medium range, whilst the hybrid composites showed the highest values and the microfilled the lowest. More densely filled adhesives were more rigid than lightly filled and unfilled adhesives. The kinetics behavior was material dependent, mainly characterized by the coefficient of near-linear contraction between 10 and 40% of the final shrinkage and the time to reach 75% of the final shrinkage.

SIGNIFICANCE

The higher shrinkage of flowable composites over that of hybrids may indicate a potential for higher interfacial stresses. However, their lower rigidity may be a counteracting factor. The microfilled composite showed low shrinkage and low rigidity, a combination that may prove less damaging to the interface. As the kinetics parameters tended to be material specific, no specific class of materials should be seen as more stress inducing until studies determine the relative importance of each examined parameter. The performance of adhesive resins as stress buffers also remains unpredictable.

A long-term evaluation of composite-bonded natural/resin teeth as replacement of lower incisors with terminal periodontitis

BACKGROUND

In patients with severe peridontitis, lower incisors are prone to terminal breakdown. This study assessed the longevity of composite-bonded resin/natural teeth (reinforced only with a stainless steel mesh) as replacements for periodontally lost lower incisors.

METHODS

Besides the longevity of the restoration, the periodontal condition of the abutment teeth, and the general satisfaction of the patient were evaluated retrospectively via a phone interview, in combination with an analysis of the patient's clinical dental file.

RESULTS

The cumulative proportion of survival rate of these composite restorations was 80% after 5 years of function. No statistically significant difference was found between the survival distribution of one- and two-pontic bridges (P = 0.66). The abutment teeth demonstrated stable probing depths and a negligible loss in attachment (0.1 mm/year). The satisfaction ratings were also favorable.

CONCLUSIONS

The data seem to suggest that composite bonding of 1 or 2 teeth can be considered a semi-permanent rehabilitation for the replacement of 1 or 2 periodontally lost lower incisors.

Monomethacrylate co-monomers for dental resins

Polymerisation shrinkage is widely recognised as a major drawback of resin based dental restoratives. Bis-GMA is often employed as the principal dimethacrylate monomer. Due to its high viscosity, Bis-GMA is normally mixed with large proportions of low viscosity glycol dimethacrylates. The purpose of this study was to determine whether the polymerisation shrinkage of Bis-GMA-based resins would be lower if alternative monomethacrylate co-monomers were used in place of conventional dimethacrylate co-monomers as viscosity modifiers. Conventional resins used were ethyleneglycol dimethacrylate and triethyleneglycol dimethacrylate; the alternative monofunctional co-monomers were tetrahydrofurfuryl methacrylate, hydroxypropyl methacrylate and isobornyl methacrylate. Model resins containing 54% mol/mol of co-monomer in Bis-GMA and 1% w/w of benzoyl peroxide as initiator were heat-cured at 70 degrees C for 8 h. Polymerisation shrinkage, degree of conversion and concentration of remaining methacrylate groups were calculated from density changes obtained gravimetrically. Other properties evaluated were Young's modulus, water uptake and viscosity of the monomer mixtures. The Bis-GMA-based resins exhibited lower shrinkage when mixed using the monomethacrylates rather than with conventional glycol dimethacrylates. Among the alternative co-monomers, tetrahydrofurfuryl methacrylate conferred the best balance of all measured properties.

Long-term strength of aesthetic restoratives

Glass-ionomer cements have established an important role in clinical dentistry since their introduction over 20 years ago. More recently, in an attempt to enhance the strength of the material, resin additions have been made to conventional glass-ionomer cements. This study established the long term flexural strength of two hybrid glass-ionomer cements, by use of a bi-axial flexural strength test (Shell test), and compared the values with those obtained for a light curing composite resin and a conventional glass-ionomer cement. The results demonstrated that those materials with a high resin component relying on polymerization as the main method of setting had a greater initial flexural strength than those with little or no resin addition. Those materials where the glass-ionomer acid-base reaction provided a substantial contribution to the setting reaction showed an increase in strength as they matured, whereas a decline in strength with time was observed for those materials where the resin setting reaction predominated.

THFMA in dental monomer systems

This study investigates the physical properties of a range of dental resins containing up to 30% by weight of tetrahydrofurfuryl methacrylate (THFMA). The principal monomer was 2,2-bis-(4(2-hydroxy-3-methacryloyloxypropoxy)-phenyl)-propane (bis-GMA) or 1,6-bis-(methacryloxy-2-ethoxycarbony lamino)-2,4,4-trimethyl-hexane (UDMA). Heat-cured resins were tested for Young's modulus, flexural strength, refractive index, polymerization shrinkage and degree of conversion. The results indicated that THFMA has negligible effects on the mechanical properties of bis-GMA and UDMA and on the refractive index of UDMA, whilst the other measured properties present a strong relationship with the concentration of the additive. The dental relevance of the results is discussed and it is concluded that there is scope for further research on the use of THFMA as a comonomer in resin-based materials for dental applications.

Novel hydroxyapatite-based dental composites

Newly designed composite resins for dental applications have been studied. The matrix phases were based on 2,2 bis-4(2-hydroxy-3-methacryloyloxypropoxy)phenyl propane and a urethane dimethacrylate. Tetrahydrofurfuryl methacrylate was added as a diluent to both dimethacrylates in a proportion of 30 wt%. Heat-cured composite resins were obtained with filler weight fractions of 60% and 67%. After surface treating hydroxyapatite powder with a silane coupling agent, filler contents of 60%, 67% and 80% were employed. These materials were then evaluated for Young's modulus, flexural strength, diametral tensile strength and Vickers hardness. With the exception of Young's modulus, all mechanical properties of the tested materials were significantly improved when a silanized hydroxyapatite filler had been used.

Novel acrylic resins for dental applications

A heat-cured resin based on a copolymer of bis-phenol-A glycidyl methacrylate (bis-GMA) and tetrahydrofurfuryl methacrylate (THFM) was investigated. Workable pastes were made by adding 90/10 w/w bis-GMA/THFM copolymer powder to a 70/30 w/w monomer of the same composition. The organic filler content was 60-64% w/w. Young's modulus, flexural strength, impact strength, hardness, water absorption and desorption, linear thermal expansion, polymerization shrinkage and glass transition temperature were determined. The materials studied showed high elastic modulus, hardness and glass transition temperature. A relatively low linear thermal expansion was obtained but poor impact strength and low flexural strength, indicating brittleness. Acceptable values were obtained for water absorption.

[Water absorption by composite resins]

A literature review about water absorption in dental composites has led to a number of hypotheses made for the variables affecting the experimental behaviour. It follows a discussion about the possible advantages and disadvantages of the fenomenon.

[Water absorption by denture base resins]

In a review of the international literature about water absorption of denture base resins any effect on the physical properties of these polymers has been considered. The authors discuss the possibilities of controlling the final results on denture base function.

[Proposed use of natural teeth for management of a prosthetic case]

Authors describe the case of a periodontopathic patient having seriously involved lower incisors. They used a splinting system consisting of a lingual metal bar using close healthy teeth as an anchor, and using previously extracted teeth of the patient to get a good aesthetical, psychological and functional result.

[Solubility of luting cements]

An extensive review of the scientific literature for evaluating the current status of luting cements solubility. Both in vitro and in vivo results have been examined and discussed.

[Use of synthetic membranes in periodontal guided tissue regeneration]

Authors evaluated health's possible mechanisms of periodontal lesion and, having they studing most recent literature, they underline large possibilities of using synthetic membranes in order to having guided regeneration of periodontal tissues.

[Validity of motivation in prevention of periodontal disease: knowledge survey of a group of 100 patients]

The Authors examine findings of literature about importance of oral hygiene motivation in order to carry out periodontal disease prevention. Furthermore they present findings of a 100 patients investigation to know how many people understand periodontal disease ethiology and how many know precautionary measures.

[Diagnosis of the active phase of periodontal disease. 2. Non-clinical parameters]

A review of the Literature shows that a lat of (non-clinical) umoral markers have been suggested as indicators of periodontal disease activity. The advantage of simultaneous evaluation of different markers to obtain a profile of local disease activity has been highlighted in this work as an approach that may provide an usefull picture of the local destructive disease.

[The effects of subgingival irrigation with antimicrobial agents on periodontal disease]

This report evaluates the role of local pharmacotherapy by subgingival irrigation to enhance clinical and microbiological periodontal status. This kind of chemical therapy is not a substitute to scaling and root planing, but possibly could increase its beneficial effects.