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RANKL and cathepsin K in diffuse sclerosing osteomyelitis of the mandible
M Montonen1, T-F Li, P-L Lukinmaa
1Department of Oral and Maxillofacial Surgery, Helsinki University Central Hospital, Helsinki, Finland. marjut.montonen@kolumbus.fi
Background:
Diffuse sclerosing osteomyelitis (DSO) of the mandible is characterized by mixed bone resorption and formation.
Methods:
Immunohistopathology of DSO in the clinically acute and subacute phases was compared with healthy bone.
Results:
Receptor activator of nuclear factor kappaB ligand (RANKL) was found in DSO lesions. When it was used in vitro to stimulate monocytes, cathepsin K expression was observed in mononuclear prefusion precursors and in multinuclear giant cells. Similarly, exacerbations of DSO were characterized by RANKL and induction of cathepsin K in mononuclear precursor cells, which subsequently seem to differentiate into osteoclasts or foreign body giant cells. The proportion of bone to soft tissue increased with the duration of disease.
Conclusions:
RANKL-driven osteoclastogenesis and acidic cysteine endoproteinase cathepsin K seem to play important roles in DSO as osteoclast-mediated bone resorption may represent the primary disease process later followed by new bone formation.
