Aseptic-avascular osteonecrosis: local "silent inflammation" in the jawbone and RANTES/CCL5 overexpression

Abstract

Of the definitions listed in the International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10), two disease descriptions can be found together: "idiopathic aseptic bone necrosis" and "avascular bone necrosis." The relevant literature on both the conditions abbreviates both as "aseptic ischemic osteonecrosis in the jawbone" (AIOJ). To shed light on the clinical details of this condition, osteolytic jawbone samples of 24 patients with different systemic immunological diseases were examined using four steps: presurgical dental X-ray, postsurgical histology, polymerase chain reaction DNA analysis (PCR DNA) of bacteria, and RANTES/CCL5 (R/C) expression. These four steps showed that neither X-ray nor histology delivered unambiguous results with respect to inflammatory processes; furthermore, the PCR results did not show evidence of any microbial load within the jaw samples. However, there is a striking, coherent overexpression of chemokine R/C in the AIOJ samples. This study proved the aseptic existence of "silent inflammation" within the jawbone. The ICD-10 (AIOJ) definition, which is hard to interpret, can now be substantiated with clinical evidence, while the cytokine expressions described in this report can explain the systemic immunological effects observed within the group of examined patients.

Keywords: CCL5; ICD-10; PCR; RANTES; aseptic inflammation; jawbone; osteonecrosis; silent inflammation.

Figure 1

(A) Morphology of fatty degenerative osteonecrosis in the jawbone. (B) Red circle indicates FDOJ area. Abbreviation: FDOJ, fatty degenerative osteonecrosis in the jawbone.

Figure 2

Pathohistological structure of typical fatty degenerative osteonecrosis in the jawbone tissue (200 fold).

Figure 3

Paper sticks serving as a pooled sample within a fatty degenerative osteonecrosis in the jawbone lump. Abbreviation: FDOJ, fatty degenerative osteonecrosis in the jawbone.

Figure 4

(A) Measuring the OPG radiodensity of an FDOJ area in the lower jawbone, right-sided region =48/49. (B) Morphology of the extracted FDOJ area, which is compared in size with a ceramic ball mill (Φ=0.6 mm). Abbreviations: ÒPG, orthopantomogram; XrDn, X-ray density; FDOJ, fatty degenerative osteonecrosis in the jawbone.

Figure 5

Histological characteristics of the 24 FDOJ samples, of which only 12% showed “Inflammation-inactive cells.” Abbreviation: FDOJ, fatty degenerative osteonecrosis in the jawbone.

Figure 6

Comparison of RANTES/CCL5 expression in 19 normal jawbone samples (blue column) and 24 FDOJ samples in four groups of ISD patients (red columns). Abbreviations: FDOJ, fatty degenerative osteonecrosis in the jawbone; ISD, immunological systemic disease.

Figure 7

Correlation between radiodensity and RANTES levels in FDOJ. The red lines indicate the mean values of FDOJ collective; the green lines are equivalent to values associated with a normal jawbone. Red dots indicate values out of statistical significant. Abbreviations: XrDn, X-ray density; FDOJ, fatty degenerative osteonecrosis in the jawbone.

Figure 8

Comparison of RANTES/CCL5 expression and OPG X-ray density among the various samples collected between those with FDOJ and the normal results associated with a normal jawbone. Abbreviations: OPG, orthopantomogram; XrDn, X-ray density; FDOJ, fatty degenerative osteonecrosis in the jawbone.