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Periodontics--tissue engineering and the future.

Periodontics has a long history of utilizing advances in science to expand and improve periodontal therapies. Recently the American Academy of Periodontology published the findings of the Contemporary Science Workshop, which conducted state-of-the-art evidence-based reviews of current and emerging areas in periodontics. The findings of this workshop provide the basis for an evidence-based approach to periodontal therapy. While the workshop evaluated all areas of periodontics, it is in the area of tissue engineering that the most exciting advances are becoming a reality.

Becaplermin↗

Tissue engineering for periodontal regeneration.

As a result of periodontal regeneration research, a series of clinical techniques have emerged that permit tissue engineering to be performed for more efficient regeneration and repair of periodontal defects and improved implant site development. Historically, periodontal regeneration research has focused on a quest for "magic filler" material. This search has led to the development of techniques utilizing autologous bone and bone marrow, allografts, xenografts, and various man-made bone substitutes. Though these techniques have had limited success, the desire for a more effective regenerative approach has resulted in the development of tissue engineering techniques. Tissue engineering is a relatively new field of reconstructive biology which utilizes mechanical, cellular, or biologic mediators to facilitate reconstruction/regeneration of a particular tissue. In periodontology, the concept of tissue engineering had its beginnings with guided tissue regeneration, a mechanical approach utilizing nonresorbable membranes to obtain regeneration in defects. In dental implantology, guided bone regeneration membranes +/- mechanical support are used for bone augmentation of proposed implant placement sites. With the availability of partially purified protein mixture from developing teeth and growth factors from recombinant technology, a new era of tissue engineering whereby biologic mediators can be used for periodontal regeneration. The advantage of recombinant growth factors is this tissue engineering device is consistent in its regenerative capacity, and variations in regenerative response are due to individual healing response and/or poor surgical techniques. In this article, the authors review how tissue engineering has advanced and discuss its impact on the clinical management of both periodontal and osseous defects in preparation for implant placement. An understanding of these new tissue engineering techniques is essential for comprehending today's ever-expanding oral plastic surgery procedures.

Algorithms↗

[Effect of qingfei oral liquid on protein expression of transforming growth factor-beta1 and platelet derived growth factor-BB of adenovirus type 3I, 7b induced human embryonic lung fibroblast cells].

OBJECTIVE: To explore the effect of qingfei oral liquid (QOL) contained serum on protein expression of transforming growth factor-beta1 (TGF-beta1) and platelet derived growth factor-BB (PDGF-BB) of adenovirus type 3I, 7b induced human embryonic lung fibroblast cells. METHODS: The cells were divided into 5 groups, the normal cells group (NCG), the virus control group (VCG), the blank serum group (BSG), the ribavirin group (RVG) and the QOL contained serum group (QSG). All the cells except those in the NCG were challenged by adenovirus type 3I, 7b and treated with correspondent medicine. The contents of TGF-beta1 and PDGF-BB in the supernatant of cell culture were monitored by ELISA and compared among groups. RESULTS: Contents of TGF-beta1 and PDGF-BB in VCG were significantly higher, while those in QSG were significantly lower than those in VCG (P < 0.01). CONCLUSION: Adenovirus infection can increase the protein expression of TGF-beta1 and PDGF-BB of human embryonic lung fibroblast cells. QOL can decrease the protein expression of these cytokines, which maybe one of the mechanisms of its antiviral effect.

Adenoviruses, Human↗

[Preventive effect of multi-glycoside of tripterygium Wilfordii Hook. f. on proteinuria and mesangial injury in experimental mesangial proliferative glomerulonephritis].

OBJECTIVE: To observe the preventive effect of multi-glycoside of Tripterygium Wilfordii Hook. f. (GYW) on proteinuria and mesentery injury in experimental mesangial proliferative glomerulonephritis in vivo. METHODS: The reversible anti-Thyl.1 antibody glomerulo nephritis model of rats was established with monoclonal antibody 1-22-3 and intervened with GTW, and a control group was set up in the same time. Changes of 24h urinary protein excretion, serum creatinine (Scr), blood urea nitrogen (BUN), total plasma protein (TP) and glomerular morphology were observed, and the level of mRNA expression of proliferative factors, including platelet-derived growth factor-BB (PDGF-BB) and transforming growth factor-beta (TGF-beta), in renal tissue was determined. RESULTS: GTW could inhibit proteinuria and mesangial injury in anti-Thyl. 1 antibody nephritis model. The PDGF-BB and TGF-beta mRNA expression in the anti-Thy1.1 antibody nephritis model rats were increased for 2.84 and 1.64 times respectively to those in the normal control group. GTW could down-regulate the over-expression of PDGF-BB mRNA by 33.1%, it was significantly different to that in the control group (P < 0.05). CONCLUSION: GTW could reduce the proteinuria and inhibit mesangial cells proliferation and extracellular matrix deposition, these effects maybe related to the down-regulating of PDGF-BB mRNA expression.

Animals↗

[Effects of aldose reductase transfection on the proliferation of rat mesangial cells in vitro].

OBJECTIVE: To study the effects of aldose reductase (AR) on the proliferation of rat mesangial cells (MsC) in vitro and to investigate its mechanism. METHODS: Cell proliferation was assessed by MTT colorimetric assay. Cell cycle and apoptosis were analyzed by flow cytometry. The growth of normal MsC and AR transfected MsC was compared. The proliferation of PDGF-BB and cellular growth stimulation by 10% NBS were investigated using AR inhibitors (ARI) Sorbinil and Zopolrestat. The effects of PDGF-BB on the expression of AR, p65 and c-Jun were assessed by Western blot. Activation of AP-1 was measured by EMSA. RESULTS: AR expression of transfected MsC was distinctly higher than that of the control. Transfected MsC grew quicker than normal cells. ARI partially inhibited the proliferation of transfected MsC under the stimulation of PDGF-BB and 10% NBS, whereas 10% NBS had no effect on normal MsC. PDGF-BB upregulated the expression of AR and c-Jun, but had no effect on p65. The upregulation of c-Jun and the activation of AP-1 could be attenuated by ARI. CONCLUSION: AR may participate in the pathological proliferation of MsC through the pathway related to the activation of AP-1.

Aldehyde Reductase↗

c-MYC deregulation is involved in melphalan resistance of multiple myeloma: role of PDGF-BB.

Oncogenes are important regulators of cancer growth and progression and their action may be modulated by proteins of the growth factor family, such as angiogenic cytokines, known to be strongly involved in neoplastic evolution. Reciprocal interactions between oncogenes and angiogenic modulators may represent, in haematological neoplasms, including multiple myeloma (MM), a possible mechanism of drug resistance. The aim of this work is to investigate in vitro and in vivo whether or not c-myc deregulation is involved in the melphalan resistance elicited by myeloma patients and consequently to clarify the role of the angiogenic factor PDGF-BB in modulating c-myc protein expression. Fifty-one MM patients on chemotherapy with melphalan were analyzed for structural alterations of the c-myc gene, c-Myc protein expression, as well as for serum PDGF-BB release. For the in vitro study, two M14-derived established cell clones, differing for the c-Myc protein expression (c-Myc low -expressing or constitutively expressing clones) were used. Our results show that PDGF-BB is able to up-regulate Myc expression and reduce melphalan sensitivity of tumor cell clones, constitutively expressing c-myc gene product. In addition, down-regulation of c-Myc protein induces the expression of PDGF-beta receptor molecules and reduces PDGF-BB release. In agreement with these results, in vivo data show that melphalan-resistant MM patients present overexpressed c-Myc protein and higher serum PDGF-BB receptor levels compared to minor responding patients.

Adult↗

Comparison of recombinant human platelet-derived growth factor-BB plus beta tricalcium phosphate and a collagen membrane to subepithelial connective tissue grafting for the treatment of recession defects: a case series.

When mixed with an osteoconductive scaffold, recombinant human platelet-derived growth factor (rhPDGF-BB), a potent wound-healing protein, has been shown to promote clinical attachment gain, radiographic bone fill, and regeneration of the periodontium. This human case series evaluated the clinical outcome of rhPDGF with beta tricalcium phosphate (3-TCP) and a collagen membrane in the treatment of recession-type defects. The control was the clinical gold standard for root coverage: the subepithelial connective tissue graft (CTG). Seven patients with recession defects > or = 3 mm in contralateral quadrants of the maxilla, excluding molars, were treated in this series. Patients were followed postoperatively, and healing was evaluated at 8, 16, and 24 weeks, with recession depth as the primary outcome measure. This case series revealed a favorable tissue response to rhPDGF-BB + beta-TCP and a collagen membrane and comparable clinical outcomes to CTG, warranting a controlled clinical trial of greater magnitude.

Adult↗

During muscle ageing the activation of the mitogenic signalling is not sufficient to guarantee cellular duplication.

Satellite cells are quiescent cells that can be induced to proliferate by a variety of stimuli such as injury and exercise, providing in this way a source of new myoblasts that repopulate the damaged muscle. It is well known that, as senescence progresses, the muscle regenerative potential progressively diminishes, but the molecular mechanisms underlying this process are not yet completely defined. Many growth factors, including Platelet Derived Growth Factor (PDGF-BB)*, have been associated to satellite cells activation, acting as potent mitogenic agents for these cells. The aim of this study is to explore if the diminished response of senescent myoblasts to growth stimuli could be due to the inability to receive and transduce hormonal signals. Herein, we demonstrate that that although PDGF-r expression is down-regulated during senescence, the receptor is fully able to be phosphorylated and to transmit the signal. Although senescent myoblasts display increased level of phosphotyrosine phosphatases (PTPs), neither the PDGF receptor (PDGF-r) phosphorylation level nor the citosolic signal transduction machinery is affected. Indeed, we demonstrated that senescent human myoblasts are able to initiate a proper mitogenic signalling cascade, since the activation of mitogen-activated protein kinases (MAPK) and phosphatydil inositole 3 kinase (PI-3K) pathways is similar in young and senescent cells. Our data underline that, despite a conserved capability to activate PDGF-r after agonist stimulation and a functional signal transduction machinery, the mitogenic signal initiated by growth factors in senescent cells does not lead to cell division, being unable to overcome the cell cycle block, likely caused by the accumulation of the inhibitor p21WAF1.

Becaplermin↗

[Molecular cloning and expression of human PDGF-B chain peptide gene and its effect on cat corneal endothelial cell proliferation in vitro].

OBJECTIVE: To construct pET-PDGF-B plasmid with over expression of PDGF and investigate its effects on cat corneal endothelial cells proliferation in vitro. METHODS: Gene rearrangement technique was used to construct the prokaryotic vector with insertion of pET-PDGF-B. The recombinant PDGF-B was obtained from E. coli BL21 (DE3). The effects of recombinant PDGF-B on proliferation and morphologic changes of cultured cat corneal endothelial cells were assayed by modified tertrozalium salt (MTT), inverted phase contrast microscope and transmission electron microscope. RESULTS: PDGF-B peptide gene was inserted into prokaryotic expression vector pET-28a (+), which was confirmed by sequence analysis; a 27,000 protein band was demonstrated as pET-PDGF-B from extraction of E. coli BL21 (DE3) using western blot; MTT assay showed PDGF-BB promoted the proliferation of cat corneal endothelial cells. CONCLUSIONS: A constructed pET-PDGF-B plasmid vector over expression of PDGF is produced. Recombinant PDGF-BB promotes cultured cat corneal endothelial cells proliferation.

Animals↗

[Effect of platelet derived growth factor BB on healing of medial collateral ligament in rats].

OBJECTIVE: To examine an effect of the locally-used platelet derived growth factor-BB (PDGF-BB) on the healing of the medial collateral ligament (MCL) in the knee joints of rats. METHODS: Forty-eight rats were equally randomly divided into 2 groups: the experimental group (group A) and the control group (group B). MCL of all the rats were ruptured to establish the wound models. In group A, 5 microg of PDGF-BB was locally injected in the wound of each rat and then the wound was sutured; but in group B, the wound was only sutured. After 2 weeks, histological evaluations were performed to determine whether PDGF-BB could promote the healing of MCL. RESULTS: There were significantly more fibroblasts formed during the ligament healing process in group A than in group B (213.44 +/- 15.32 vs. 180.42 +/- 12.78, P < 0.01). The fibroblasts were more mature and more regularly-arranged in group A than in group B. The type, content, and crosslink of the collagen were improved to a greater extent in group A than in group B (P < 0.01). CONCLUSION: PDGF can promote the healing of the injured ligament.

Animals↗

rhPDGF-BB promotes healing of periodontal defects: 24-month clinical and radiographic observations.

A new therapeutic system using purified recombinant human platelet-derived growth factor-BB (rhPDGF-BB) in combination with a biocompatible, osteoconductive, synthetic scaffold beta-tricalcium phosphate (beta-TCP) has recently been shown in a large-scale, prospective, blinded, randomized clinical trial to safely and effectively treat advanced periodontal osseous defects. A significant gain in clinical attachment level was observed 3 months postsurgery for sites treated with 0.3 mg/mL rhPDGF-BB + beta-TCP versus beta-TCP + buffer (active control), with this trend continuing at 6 months postsurgery. Additionally, sites treated with 0.3 mg/mL rhPDGF-BB + beta-TCP also had significantly greater radiographic linear bone gain and percent defect fill at 6 months postsurgery than sites that received bone substitute with buffer. Representative cases from the clinical trial were followed to assess their ability to maintain the initial effect of treatment observed at 6 months. At 18 or 24 months postsurgery, with the same clinical and radiographic measurement techniques used as were performed at the 6-month time point for the clinical trial, these cases demonstrated maintenance of the clinical attachment level for all but one case, with all cases demonstrating substantial increases in linear bone gain and percent bone fill versus measurements obtained at 6 months postsurgery. Substantial radiographic changes in the appearance of the defect fill were observed for both rhPDGF-BB treatment groups, consisting of increased radiopacity and bone trabeculation, indicative of increased mineralization and maturation of the bone observed 6 months postsurgery.

Adult↗

[Effects of salvianolic acid B on signal transduction induced by transforming growth factor-beta1 and platelet-derived growth factor- BB in hepatic stellate cells of rats].

OBJECTIVE: To explore the anti-hepatic fibrosis mechanisms of salvianolic acid B (SA-B). METHODS: Hepatic stellate cells (HSCs) isolated from rats were primarily cultured in uncoated plastic culture dish for 7 days, then were incubated with 10(-6) mmol/L SA-B and stimulated with 10 ng/ml transforming growth factor-beta1 (TGF-beta1) or platelet-derived growth factor-BB (PDGF-BB). Expressions of extracellular-regulated kinase (ERK) and its phosphorylation in HSC, and expressions of TGF beta1, receptor I (TbetaR I) and II (TbetaR II) and PDGF receptor beta (PDGFR-beta) on the surface of HSC induced by TGF-beta1 or PDGF-BB were detected with Western blot assay. RESULTS: SA-B inhibited the phosphorylation of ERK1/2 in HSC primary normally cultivated for 9 days stimulated or un-stimulated by TGF-beta1, but could not affect the expressions of TbetaR I and TbetaR II on the HSC surface; it down-regulated the expression of PDGFR-beta, but had no obvious effect on the phosphorylation of ERK1/2 in those HSC stimulated or un-stimulated by PDGF-BB. CONCLUSION: SA-B inhibits the ERK signal transduction induced by TGF-beta1 in HSC, which is independent of the expressions of TbetaR on HSC surface and also free from the ERK signal transduction stimulated by PDGF-BB. And its inhibition on PDGF-BB signal transduction in HSC is by way of restraining the expression of PDGFR in HSC.

Animals↗

TGFbeta induces transdifferentiation of iBREC to alphaSMA-expressing cells.

Transforming growth factor beta (TGFbeta) both inhibits proliferation of macrovascular endothelial cells and promotes their transdifferentiation to alpha-smooth-muscle-actin (alphaSMA)-expressing mesenchymal cells in vitro. Recently, we have confirmed that proliferation of immortalized bovine retinal microvascular endothelial cells (iBREC) is strongly inhibited by TGFbeta2. We now demonstrate a complete transition of both parental iBREC and single cell-derived subclones from cobblestone morphology to a ragged appearance as a consequence of incubation for a few days with 10 ng/ml TGFbeta1 or TGFbeta2. Depending on the type of culture medium, 5-40% of these cells strongly expressed alphaSMA after approximately 6 days whereas expression of the endothelial cell-specific marker proteins von Willebrand factor and VE Cadherin (CD144) declined. Expression of alphaSMA, associated with formation of stress fibers, was first detected in single cells and then spread to adjacent cells, and declined slowly after prolonged cultivation in medium without TGFbeta2. However, re-constitution of vWF expression was not observed. TGFbeta2-induced phenotypic alterations were specific, as they were not caused by treatment of iBREC with VEGF, IGF-1 or bFGF. Induction of alphaSMA expression but not effects on morphology was strongly inhibited by bFGF, whereas IGF-1 enhanced TGFbeta2-induced alphaSMA expression. These findings may have an important impact on the understanding of development of microvascular complications of diabetes such as diabetic retinopathy.

Actins↗

Using recombinant platelet-derived growth factor to facilitate wound healing.

Recombinant human platelet-derived growth factor (rhPDGF-BB) is a bioactive protein that has been combined with bone graft materials in an effort to regenerate the periodontium to its prediseased state more predictably. The combination of a biocompatible scaffold with this highly purified, recombinant human growth factor capitalizes on PDGF's stimulatory effects on cellular migration and proliferation, with subsequent matrix formation, to drive the healing process toward regeneration. When using a growth factor such as rhPDGF-BB with broad wound healing activity, an added clinical benefit is the more rapid soft tissue wound healing pattern observed at the surgical site. This also may be seen as a patient-centered benefit because it allows dentists to provide for a patient's prosthetic care on a timely basis, leading to a faster return to normal function. Also, the patient may resume plaque control efforts earlier, which further facilitates the wound-healing process. The purpose of these 2 case reports is to document the use of rhPDGF-BB as a wound-healing agent in 2 clinical situations and to provide a rationale for its use in this capacity.

Aged↗

Vertical ridge augmentation by means of deproteinized bovine bone block and recombinant human platelet-derived growth factor-BB: a histologic study in a dog model.

The primary objective of this proof-of-principle study was to evaluate the outcome of vertical ridge augmentation in a standardized dog model by combining purified recombinant platelet-derived growth factor (rhPDGF-BB) and a block of deproteinized cancellous bovine bone. The secondary objective was to determine the value of a resorbable barrier membrane to improve the efficacy of the procedure. Six adult foxhounds were committed to bilateral surgical extraction of all four mandibular premolars. A vertical alveolar ridge defect was created at the time of the extractions. Three months later, the artificially created defects were grafted: Group A used a deproteinized bovine bone block in combination with a collagen barrier membrane, group B used a deproteinized bovine bone block infused with rhPDGF-BB only, and group C included a deproteinized bovine bone block infused with rhPDGF-BB, plus a collagen resorbable barrier membrane. After 4 months, the animals were sacrificed. Histologic examination of group B revealed a large amount of newly formed bone, and a large amount of bone-to-implant contact was visible in the areas of bone regeneration extending over the top of the implant cover screw. The results of this preclinical canine study provide proof-of-principle that rhPDGF-BB, used in combination with a deproteinized bovine block without placement of a barrier membrane, has the potential to regenerate significant amounts of new bone in severe mandibular ridge defects. In addition, the results seem to point to the importance of the periosteum as a source of osteoprogenitor cells in growth factor-mediated regenerative procedures.

Absorbable Implants↗

A new era in periodontal and periimplant regeneration: use of growth-factor enhanced matrices incorporating rhPDGF.

A new, powerful off-the-shelf wound healing and bone regeneration technology termed growth-factor enhanced matrix (GEM) has recently become available for clinical use. This graft material consists of a concentrated solution of pure recombinant human platelet-derived growth factor (rhPDGF-BB), the synthetic form of the body's key natural wound healing stimulator PDGF-BB, and an osteoconductive (bone scaffold) matrix. This is the first available purified, recombinant (synthetic) growth factor product and is the result of over a decade of extensive research. Clinical and animal study results with this graft material demonstrate that it is capable of simultaneously promoting wound healing, regeneration of bone, and acceleration of gingival attach-plent gain in challenging periodontal and periimplant defects.

Alveolar Bone Loss↗

Growth factors in porcine full and partial thickness burn repair. Differing targets and effects of keratinocyte growth factor, platelet-derived growth factor-BB, epidermal growth factor, and neu differentiation factor.

The topical application of recombinant growth factors such as epidermal growth factor, platelet-derived growth factor-BB homodimer (rPDGF-BB), keratinocyte growth factor (rKGF), and neu differentiation factor has resulted in significant acceleration of healing in several animal models of wound repair. In this study, we established highly reproducible and quantifiable full and deep partial thickness porcine burn models in which burns were escharectomized 4 or 5 days postburn and covered with an occlusive dressing to replicate the standard treatment in human burn patients. We then applied these growth factors to assess their efficacy on several parameters of wound repair: extracellular matrix and granulation tissue production, percent reepithelialization, and new epithelial area. In full thickness burns, only rPDGF-BB and the combination of rPDGF-BB and rKGF induced significant changes in burn repair. rPDGF-BB induced marked extracellular matrix and granulation tissue production (P = 0.013) such that the burn defect was filled within several days of escharectomy, but had no effect on new epithelial area or reepithelialization. The combination of rPDGF-BB and rKGF in full thickness burns resulted in a highly significant increase in extracellular matrix and granulation tissue area (P = 0.0009) and a significant increase in new epithelial area (P = 0.007), but had no effect on reepithelialization. In deep partial thickness burns, rKGF induced the most consistent changes. Daily application of rKGF induced a highly significant increase in new epithelial area (P < 0.0001) but induced only a modest increase in reepithelialization (83.7% rKGF-treated versus 70.2% control; P = 0.016) 12 days postburn. rKGF also doubled the number of fully reepithelialized burns (P = 0.02) at 13 days postburn, at least partially because of marked stimulation of both epidermal and follicular proliferation as assessed by proliferating cell nuclear antigen expression. In situ hybridization for KGFR in porcine burns revealed strong expression of KGFR on hair follicles and basal epidermis, confirming direct rKGF action on follicular as well as epidermal keratinocytes. Although the epithelial proliferation induced by rKGF resulted in marked neoepidermal psoriasiform hyperplasia with exaggerated rete ridges and neoepidermal and follicular maturation as assessed by expression of cytokeratin 10, a marker of keratinocyte terminal differentiation was not delayed and appeared to be accelerated in some rKGF-treated burns. Recombinant epidermal growth factor induced a trend toward increased new epithelial area in deep partial thickness burns, but had no effect on reepithelialization. The recombinant neu differentiation factor-alpha 2 isoform had no significant biological effects in either full or deep partial thickness burns.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗