Study on site-specific expression of bone formation and resorption factors in human dental follicles

We sought to investigate site‐specific expression of bone‐regulatory factors expressed by human dental follicles and to compare the stimulated expression of tumour necrosis factor (ligand) superfamily, member 11/tumour necrosis factor receptor superfamily, member 11b (RANKL/OPG) in human dental follicle cells (HDFCs) from different patients. Analysis of bone‐regulatory markers in follicles from 12 different study participants was performed using RT‐qPCR and immunofluorescence; apical and coronal segments from each dental follicle were processed independently. Four additional dental follicles were used for cell cultures; HDFCs were precultured in osteogenic medium to initiate differentiation and thereafter cultured with 10⁻⁶ M forskolin (FSK) to activate the protein kinase cAMP (PKA/cAMP) signalling pathway and induce RANKL/OPG expression. We demonstrate that RANKL expression is significantly higher in the coronal part of follicles than in the apical part. High levels of collagen type 1 (COL1), alkaline phosphatase (ALP) and Gap‐junction protein, alpha 1, 43 kDa (CX43) were expressed, whereas expression of Sp7 transcription factor (OSX), bone morphogenetic protein 2 (BMP2), colony‐stimulating factor 1 (CSF‐1), chemokine (C‐C motif) ligand 2 (MCP1), and OPG was low in all samples. The immunofluorescence localization of CSF‐1, MCP1, osteocalcin (OCN), RANKL, and BMP2 was not specific for either part of the follicles. In conclusion, a consistently high expression of CX43 suggests that gap‐junction communication in HDFCs is essential for the eruption process. Furthermore, the induced expression of RANKL in HDFCs varies significantly between individuals and may relate to clinical variations in tooth eruption.

Denosumab in patients with aneurysmal bone cysts: A case series with preliminary results

Purpose:

Aneurysmal bone cyst (ABC) is a rare skeletal tumor usually treated with surgery/embolization. We hypothesized that owing to similarities with giant cell tumor of bone (GCTB), denosumab was active also in ABC.

Methods:

In this observational study, a retrospective analysis of ABC patients treated with denosumab was performed. Patients underwent radiologic disease assessment every 3 months. Symptoms and adverse events were noted.

Results:

Nine patients were identified (6 male, 3 female), with a median age of 17 years (range 14–42 years). Primary sites were 6 spine–pelvis, 1 ulna, 1 tibia, and 1 humerus. Patients were followed for a median time of 23 months (range 3–55 months). Patients received a median of 8 denosumab administrations (range 3–61). All symptomatic patients had pain relief and 1 had paresthesia improvement. Signs of denosumab activity were observed after 3 to 6 months of administration: bone formation by computed tomography scan was demonstrated in all patients and magnetic resonance imaging gadolinium contrast media decrease was observed in 7/9 patients. Adverse events were negligible. At last follow-up, all patients were progression-free: 5 still on denosumab treatment, 2 off denosumab were disease-free 11 and 17 months after surgery, and the last 2 patients reported no progression 12 and 24 months after denosumab interruption and no surgery.

Conclusions:

Denosumab has substantial activity in ABCs, with favorable toxicity profile. We strongly support the use of surgery and/or embolization for the treatment of ABC, but denosumab could have a role as a therapeutic option in patients with uncontrollable, locally destructive, or recurrent disease.

Downregulation of RANKL and RANKL/osteoprotegerin ratio in human periodontal ligament cells during their osteogenic differentiation

BACKGROUND AND OBJECTIVE

Human periodontal ligament cells (hPDLCs) are considered the promising seed cells in periodontal tissue engineering. Previous studies have discovered the ability of hPDLCs in alveolar bone formation. It remains unclear, however, how the expression of factors associated with osteoclastogenesis in hPDLCs change during their osteogenic differentiation.

OBJECTIVE

The present study aimed to observe the regulation of receptor activator of nuclear factor-kappa B ligand (RANKL) and osteoprotegerin (OPG) in hPDLCs during their osteogenic differentiation.

MATERIAL AND METHODS

hPDLCs were treated with (M group) or without (C group) the osteogenic induction medium. Alkaline phosphatase activity was displayed with the Gomori calcium phosphate method. Mineralized nodules were detected with von Kossa staining. Expression levels of RANKL and OPG in hPDLCs were analyzed with real-time reverse transcription-polymerase chain reaction and western blot. Tartrate-resistant acid phosphatase (TRAP) staining was used to display the TRAP activity in Raw264.7 cells co-cultured with hPDLCs in the M group and the C group.

RESULTS

We found that alkaline phosphatase staining was shown to be remarkably higher in the M group than that in the C group during the 21 d interval. Mineralized nodules could be seen in the M group but not in the C group. The expression levels of RANKL mRNA significantly decreased in the M group by 1.69-fold (p = 0.096) at day 7, by 2.04-fold (p = 0.000) at day 14 and by 1.84-fold (p = 0.023) at day 21, compared with the corresponding levels of RANKL in the C group. Similarly, the levels of RANKL protein decreased in the M group by 1.82-fold (p = 0.062) at day 7, by 5.64-fold (p = 0.000) at day 14 and by 4.84-fold (p = 0.000) at day 21. The mRNA and protein expression levels of OPG tended to increase in the M group. As a result, the RANKL/OPG mRNA and protein ratios were significantly downregulated by osteogenic induction. In addition, the number of TRAP staining-positive multinuclear cells in the M group was significantly less than in the C group (p = 0.018).

CONCLUSION

hPDLCs may help inhibit the resorption of alveolar bone during their osteogenic differentiation by reducing the RANKL expression and the RANKL/OPG ratio.

Bone status in patients with epilepsy: relationship to markers of bone remodeling

Patients with epilepsy and treated with antiepileptic drugs (AEDs) may develop metabolic bone disease; however, the exact pathogenesis of bone loss with AEDs is still unclear. Included were 75 adults with epilepsy (mean age: 31.90 ± 5.62 years; duration of treatment with AEDs: 10.57 ± 3.55 years) and 40 matched healthy controls. Bone mineral content (BMC) and bone mineral densities (BMD) of the femoral neck and lumbar spine were measured using dual-energy X-ray absorptiometry (DEXA). Blood samples were analyzed for calcium, magnesium, phosphate, alkaline phosphatase (ALP), 25-hydroxy vitamin D (25OHD), soluble receptor activator of nuclear factor-kappa B ligand (sRANKL), osteoprotegerin (OPG), and OPG/RANKL ratio (markers of bone remodeling). Compared to controls, patients had lower BMD, BMC, Z-score, and T-score at the femoral neck and lumbar spine (all p < 0.001). Seventy-two percent and 29.33% of patients had osteoporosis of the lumbar spine and femoral neck. Patients had significantly lower serum calcium, 25(OH)D, and OPG and higher ALP, sRANKL levels, and sRANKL/OPG (all p < 0.001). Fifty-two percent of patients had hypocalcemia, 93% had hypovitaminosis D, 31% had high levels of sRANKL, and 49% had low levels of OPG. No differences were identified between DEXA and laboratory results in relation to the type, dose, or serum levels of AEDs. BMD at the femoral neck and lumbar spine were found to be correlated with the duration of illness (p = 0.043; p = 0.010), duration of treatment with AEDs (p < 0.001; p = 0.012), and serum levels of 25(OH)D (p = 0.042; p = 0.010), sRANKLs (p = 0.005; p = 0.01), and OPG (p = 0.006; p = 0.01). In linear regression analysis and after adjusting for gender, age, weight, duration, and number of AEDs, we observed an association between BMD, 25(OH)D (p = 0.04) and sRANKL (p = 0.03) concentrations. We conclude that AEDs may compromise bone health through disturbance of mineral metabolism and acceleration of bone turnover mechanisms.

Boric acid inhibits alveolar bone loss in rats by affecting RANKL and osteoprotegerin expression

BACKGROUND AND OBJECTIVE

The goal of the present study was to evaluate the effects of systemic boric acid on the levels of expression of RANKL and osteoprotegerin (OPG) and on histopathologic and histometric changes in a rat periodontitis model.

MATERIAL AND METHODS

Twenty-four Wistar rats were divided into three groups of eight animals each: nonligated (NL); ligature only (LO); and ligature plus treatment with boric acid (BA) (3 mg/kg per day for 11 d). A 4/0 silk suture was placed in a subgingival position around the mandibular right first molars; after 11 d the rats were killed, and alveolar bone loss in the first molars was histometrically determined. Periodontal tissues were examined histopathologically to assess the differences among the study groups. RANKL and OPG were detected immunohistochemically.

RESULTS

Alveolar bone loss was significantly higher in the LO group than in the BA and NL groups (p < 0.05). The number of inflammatory infiltrate and osteoclasts in the LO group was significantly higher than that in the NL and BA groups (p < 0.05). The numbers of osteoblasts in LO and BA groups were significantly higher compared with NL group (p < 0.05). There were significantly more RANKL-positive cells in the LO group than in the BA and NL groups (p < 0.05). There was a higher number of OPG-positive cells in the BA group than in the LO and NL groups (p < 0.05).

CONCLUSION

The present study shows that systemic administration of boric acid may reduce alveolar bone loss by affecting the RANKL/OPG balance in periodontal disease in rats.

Association of genetic polymorphisms of RANK, RANKL and OPG with bone mineral density in Chinese peri- and postmenopausal women

OBJECTIVES

To explore the influence of 14 single nucleotide polymorphisms (SNPs) in receptor activator of nuclear factor-kappa B (RANK), RANK ligand (RANKL) and osteoprotegerin (OPG) on bone mineral density (BMD) in a Chinese female population.

DESIGN AND METHODS

A cross-sectional study was conducted in 108 perimenopausal and 127 postmenopausal women aged 43-65 years. All participants underwent lumbar spinal and nondominant femoral BMD evaluation by dual energy X-ray absorptiometry. Fourteen RANK, RANKL and OPG genotypes were determined by chip-based MALDI-TOF mass spectrometry. The differences between the BMDs of the RANK genotypes were analyzed.

RESULTS

Five SNPs (rs6993813, rs4355801, rs1032129 and rs2073618 in OPG and rs3018362 in RANK) were significantly associated with BMD or with BMD adjusted for body weight or years since menopause, mostly at the femoral neck but also partly at the total hip (p<0.05). The risk allele frequencies observed in our sample were different from those found in Europeans but the effects of these risk alleles on BMD values had the same direction in our cohort as in Europeans, except for rs3018362 with G as the risk allele, which was contrary to other studies. None of the SNPs in RANKL were associated with BMD at any anatomical site.

CONCLUSIONS

Our findings suggest that OPG and RANK but not RANKL genetic polymorphisms influence BMD mainly in the femoral neck in peri- and postmenopausal Chinese women. This contributes to the understanding of the role of genetic variation in this pathway in determining bone health.

Low-magnitude high-frequency vibration inhibits RANKL-induced osteoclast differentiation of RAW264.7 cells

Osteoclasts are the key participants in regulation of bone mass. Low-magnitude high-frequency vibration (LMHFV) has been found to be anabolic to bone in vivo. This study aimed to investigate the effect of LMHFV on osteoclast differentiation in vitro. Murine monocyte cell line RAW264.7 cells in the presence of receptor activator of nuclear factor-kappaB ligand (RANKL) were treated with or without LMHFV at 45 Hz (0.3 g) for 15 min day(-1). Tartrate resistant acid phosphatase (TRAP)-positive multinucleated cells (MNCs) and actin ring formation were evaluated. Expression of the osteoclast-specific genes, such as cathepsin K, matrix metallopeptidase-9 (MMP-9) and TRAP, were analyzed using real time-PCR. c-Fos, an osteoclast-specific transcription factor, was determined using Western blot. We found that LMHFV significantly decreased the number of RANKL-induced TRAP-positive MNCs (P<0.01), and inhibited the actin ring formation. The mRNA expression of the cathepsin K, MMP-9 and TRAP were down-regulated by LMHFV intervention (all P<0.001). Furthermore, LMHFV also inhibited the expression of c-Fos protein in the RANKL-treated RAW264.7 cells (P<0.05). Our results suggest that LMHFV can inhibit the RANKL-induced osteoclast differentiation of RAW264.7 cells, which give some new insight into the anabolic effects of LMHFV on bone.