AIM To assess serum levels of RANK-ligand(RANKL) and osteoprotegerin(OPG) as biomarkers for periprosthetic joint infection(PJI) and compare their accuracy with standard tests.METHODS One hundred and twenty patients pr...AIM To assess serum levels of RANK-ligand(RANKL) and osteoprotegerin(OPG) as biomarkers for periprosthetic joint infection(PJI) and compare their accuracy with standard tests.METHODS One hundred and twenty patients presenting with a painful total knee or hip arthroplasty with indication for surgical revision were included in this prospective clinical trial. Based on standard diagnostics(joint aspirate, microbiological, and histological samples) and Musculoskeletal Infection Society consensus classification,patients were categorized into PJI, aseptic loosening,and control groups. Implant loosening was assessed radiographically and intraoperatively. Preoperative serum samples were collected and analyzed for RANKL, OPG, calcium, phosphate, alkaline phosphatase(AP), and the bone-specific subform of AP(b AP). Statistical analysis was carried out, testing for significant differences between the three groups and between stable and loose implants. RESULTS All three groups were identical in regards to age, gender, and joint distribution. No statistically significant differences in the serum concentration of RANKL(P = 0.16) and OPG(P = 0.45) were found between aseptic loosening and PJI, with a trend towards lower RANKL concentrations and higher OPG concentrations in the PJI group. The RANKL/OPG ratio was significant for the comparison between PJI and non-PJI(P = 0.005). A ratio > 60 ruled out PJI in all cases(specificity: 100%, 95%CI: 89, 11% to 100.0%) but only 30% of non-PJI patients crossed this threshold. The positive predictive value remained poor at any cut-off. In the differentiation between stable and loose implants, none of the parameters measured(calcium, phosphate, AP, and b AP) showed a significant difference, and only AP and b AP measurements showed a tendency towards higher values in the loosened group(with P = 0.09 for AP and P = 0.19 for b AP). CONCLUSION Lower RANKL and higher OPG concentrations could be detected in PJI, without statistical significance.展开更多
核因子-κB受体活化因子配体(receptor activator of Nuclear factor-kappa B Ligand,RANKL)、核因子-κB受体活化因子(receptor activator of nuclear factor-kappa B,RANK)、骨保护素(osteoprotegerin,OPG)作为肿瘤坏死因子家族的成员...核因子-κB受体活化因子配体(receptor activator of Nuclear factor-kappa B Ligand,RANKL)、核因子-κB受体活化因子(receptor activator of nuclear factor-kappa B,RANK)、骨保护素(osteoprotegerin,OPG)作为肿瘤坏死因子家族的成员,通过RANKL/RANK/OPG信号通路调节破骨细胞发生及成熟,调控骨代谢,其表达水平直接影响骨质代谢与重塑,现被广泛研究。RANKL/RANK/OPG通路在口腔颌面部形成及改建过程中发挥了关键作用,直接或间接反映出口腔骨破坏类疾病的发生与发展状态。该通路的失衡往往伴随RANKL的增加和(或)OPG的减少,RANKL/OPG的比值影响破骨细胞的成熟及功能,但部分疾病中相关因子的表达水平存在争议,且尚无能应用于临床疾病诊疗的阈值。本文就RANKL/RANK/OPG信号通路调节机制及其在牙周炎、种植、牙齿发育、正畸、颌面部骨缺损修复与再生等口腔相关领域的研究现状进行综述,以进一步探讨口腔中骨代谢及骨破坏类疾病的调节机制,并评价相关因子作为生物标志物的诊断和预后潜力,以期指导临床诊疗及探寻可能的免疫调节靶点。展开更多
Vascular calcifications are commonly observed in patients with chronic kidney disease （CKD） and contri-bute to the excessive cardiovascular morbidity and mortality rates observed in these patients populations. Altho...Vascular calcifications are commonly observed in patients with chronic kidney disease （CKD） and contri-bute to the excessive cardiovascular morbidity and mortality rates observed in these patients populations. Although the pathogenetic mechanisms are not yet fully elucidated, recent evidence suggests a link between bone metabolism and the development and progression of vascular calcifications. Moreover, accumulating data indicate that receptor activator of nuclear factor κB ligand/osteoprotegerin axis which plays essential roles in the regulation of bone metabolism is also involved in extra-osseous bone formation. Further studies are required to establish the prognostic significance of the above biomarkers as predictors of the presence and severity of vascular calcifications in CKD patients and of cardiovascular morbidity and mortality. Moreover, randomized clinical trials are needed to clarify whether inhibition of osteoclast activity will protect from vascular calcifcations.展开更多
骨骼从生理学上讲是在成骨细胞所介导的骨形成和破骨细胞介导的骨吸收之间达到动态平衡的一个状态。以上两个过程均受到细胞因子和生长因子的精确调控。近年来,由骨保护素(osteoprotegerin,OPG)、核因子-κB受体活化因子配体(receptor a...骨骼从生理学上讲是在成骨细胞所介导的骨形成和破骨细胞介导的骨吸收之间达到动态平衡的一个状态。以上两个过程均受到细胞因子和生长因子的精确调控。近年来,由骨保护素(osteoprotegerin,OPG)、核因子-κB受体活化因子配体(receptor activator of NF-κB ligand,RANKL)、核因子-κB受体活化因子(receptor activator of NF-κB,RANK)3个隶属于肿瘤坏死因子家族的细胞因子组成OPG/RANKL/RANK系统的发现,使得在骨骼生理研究领域取得了重大突破。随着对OPG/RANKL/RANK系统研究的不断深入,发现该系统可为口腔医学领域中的多个学科提供有益的思路。本文就OPG/RANKL/RANK系统及其在口腔颌面组织中表达的相关研究进展作一综述。展开更多
基金Supported by The"Deutsche Arthrose-Hilfe e.V.",No.P192-A362-2009-12
文摘AIM To assess serum levels of RANK-ligand(RANKL) and osteoprotegerin(OPG) as biomarkers for periprosthetic joint infection(PJI) and compare their accuracy with standard tests.METHODS One hundred and twenty patients presenting with a painful total knee or hip arthroplasty with indication for surgical revision were included in this prospective clinical trial. Based on standard diagnostics(joint aspirate, microbiological, and histological samples) and Musculoskeletal Infection Society consensus classification,patients were categorized into PJI, aseptic loosening,and control groups. Implant loosening was assessed radiographically and intraoperatively. Preoperative serum samples were collected and analyzed for RANKL, OPG, calcium, phosphate, alkaline phosphatase(AP), and the bone-specific subform of AP(b AP). Statistical analysis was carried out, testing for significant differences between the three groups and between stable and loose implants. RESULTS All three groups were identical in regards to age, gender, and joint distribution. No statistically significant differences in the serum concentration of RANKL(P = 0.16) and OPG(P = 0.45) were found between aseptic loosening and PJI, with a trend towards lower RANKL concentrations and higher OPG concentrations in the PJI group. The RANKL/OPG ratio was significant for the comparison between PJI and non-PJI(P = 0.005). A ratio > 60 ruled out PJI in all cases(specificity: 100%, 95%CI: 89, 11% to 100.0%) but only 30% of non-PJI patients crossed this threshold. The positive predictive value remained poor at any cut-off. In the differentiation between stable and loose implants, none of the parameters measured(calcium, phosphate, AP, and b AP) showed a significant difference, and only AP and b AP measurements showed a tendency towards higher values in the loosened group(with P = 0.09 for AP and P = 0.19 for b AP). CONCLUSION Lower RANKL and higher OPG concentrations could be detected in PJI, without statistical significance.
文摘核因子-κB受体活化因子配体(receptor activator of Nuclear factor-kappa B Ligand,RANKL)、核因子-κB受体活化因子(receptor activator of nuclear factor-kappa B,RANK)、骨保护素(osteoprotegerin,OPG)作为肿瘤坏死因子家族的成员,通过RANKL/RANK/OPG信号通路调节破骨细胞发生及成熟,调控骨代谢,其表达水平直接影响骨质代谢与重塑,现被广泛研究。RANKL/RANK/OPG通路在口腔颌面部形成及改建过程中发挥了关键作用,直接或间接反映出口腔骨破坏类疾病的发生与发展状态。该通路的失衡往往伴随RANKL的增加和(或)OPG的减少,RANKL/OPG的比值影响破骨细胞的成熟及功能,但部分疾病中相关因子的表达水平存在争议,且尚无能应用于临床疾病诊疗的阈值。本文就RANKL/RANK/OPG信号通路调节机制及其在牙周炎、种植、牙齿发育、正畸、颌面部骨缺损修复与再生等口腔相关领域的研究现状进行综述,以进一步探讨口腔中骨代谢及骨破坏类疾病的调节机制,并评价相关因子作为生物标志物的诊断和预后潜力,以期指导临床诊疗及探寻可能的免疫调节靶点。
文摘Vascular calcifications are commonly observed in patients with chronic kidney disease （CKD） and contri-bute to the excessive cardiovascular morbidity and mortality rates observed in these patients populations. Although the pathogenetic mechanisms are not yet fully elucidated, recent evidence suggests a link between bone metabolism and the development and progression of vascular calcifications. Moreover, accumulating data indicate that receptor activator of nuclear factor κB ligand/osteoprotegerin axis which plays essential roles in the regulation of bone metabolism is also involved in extra-osseous bone formation. Further studies are required to establish the prognostic significance of the above biomarkers as predictors of the presence and severity of vascular calcifications in CKD patients and of cardiovascular morbidity and mortality. Moreover, randomized clinical trials are needed to clarify whether inhibition of osteoclast activity will protect from vascular calcifcations.
文摘骨骼从生理学上讲是在成骨细胞所介导的骨形成和破骨细胞介导的骨吸收之间达到动态平衡的一个状态。以上两个过程均受到细胞因子和生长因子的精确调控。近年来,由骨保护素(osteoprotegerin,OPG)、核因子-κB受体活化因子配体(receptor activator of NF-κB ligand,RANKL)、核因子-κB受体活化因子(receptor activator of NF-κB,RANK)3个隶属于肿瘤坏死因子家族的细胞因子组成OPG/RANKL/RANK系统的发现,使得在骨骼生理研究领域取得了重大突破。随着对OPG/RANKL/RANK系统研究的不断深入,发现该系统可为口腔医学领域中的多个学科提供有益的思路。本文就OPG/RANKL/RANK系统及其在口腔颌面组织中表达的相关研究进展作一综述。
