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Periosteal microcirculatory reactions in a zoledronate-induced osteonecrosis model of the jaw in rats

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Abstract

Objectives

Nitrogen-containing bisphosphonates induce osteonecrosis mostly in the jaw and less frequently in other bones. Because of the crucial role of periosteal perfusion in bone repair, we investigated zoledronate-induced microcirculatory reactions in the mandibular periosteum in comparison with those in the tibia in a clinically relevant model of bisphosphonate-induced medication-related osteonecrosis of the jaw (MRONJ).

Materials and methods

Sprague–Dawley rats were treated with zoledronate (ZOL; 80 i.v. μg/kg/week over 8 weeks) or saline vehicle. The first two right mandibular molar teeth were extracted after 3 weeks. Various systemic and local (periosteal) microcirculatory inflammatory parameters were examined by intravital videomicroscopy after 9 weeks.

Results

Gingival healing disorders (∼100 %) and MRONJ developed in 70 % of ZOL-treated cases but not after saline (shown by micro-CT). ZOL induced significantly higher degrees of periosteal leukocyte rolling and adhesion in the mandibular postcapillary venules (at both extraction and intact sites) than at the tibia. Leukocyte NADPH-oxidase activity was reduced; leukocyte CD11b and plasma TNF-alpha levels were unchanged.

Conclusion

Chronic ZOL treatment causes a distinct microcirculatory inflammatory reaction in the mandibular periosteum but not in the tibia. The local reaction in the absence of augmented systemic leukocyte inflammatory activity suggests that topically different, endothelium-specific changes may play a critical role in the pathogenesis of MRONJ.

Clinical relevance

This model permits for the first time to explore the microvascular processes in the mandibular periosteum after chronic ZOL treatment. This approach may contribute to a better understanding of the pathomechanism and the development of strategies to counteract bisphosphonate-induced side effects.

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Acknowledgments

This publication is supported by the European Union and co-funded by the European Social Fund. Research grants: TÁMOP 4.2.4. A/2-11-1-2012-0001 “National Excellence Program—Elaborating and operating an inland student and researcher personal support system convergence program;” TÁMOP 4.2.1/B-09/1/KONV-2010-0005; TÁMOP 4.2.2A-11/1/KONV-2012-0035; TÁMOP 4.2.2A-11/1/KONV-2012-0073 “Telemedicine-focused research activities on the field of Mathematics, Informatics and Medical sciences,” and OTKA 109388.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, University of Szeged, Szeged, Hungary

    Ágnes Janovszky, Renáta Varga & József Piffkó

  2. Institute of Surgical Research, University of Szeged, Szőkefalvi-Nagy Béla 6, Szeged, H-6720, Hungary

    Andrea Szabó, Dénes Garab, Mihály Boros, Csilla Mester & Nikolett Beretka

  3. Department of Pathology, University of Szeged, Szeged, Hungary

    Tamás Zombori

  4. Institute of Materials Science, Max Bergmann Center of Biomaterials, TU Dresden, Dresden, Germany

    Hans-Peter Wiesmann & Ricardo Bernhardt

  5. Department of Biochemistry, University of Szeged, Szeged, Hungary

    Imre Ocsovszki

  6. Department of Image Processing and Computer Graphics, University of Szeged, Szeged, Hungary

    Péter Balázs

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  1. Ágnes Janovszky
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  2. Andrea Szabó
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Correspondence to Andrea Szabó.

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Ágnes Janovszky and Andrea Szabó contributed equally to this work.

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Janovszky, Á., Szabó, A., Varga, R. et al. Periosteal microcirculatory reactions in a zoledronate-induced osteonecrosis model of the jaw in rats. Clin Oral Invest 19, 1279–1288 (2015). https://doi.org/10.1007/s00784-014-1347-6

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