Wnt/ß-catenin Signaling Controls Maxillofacial Hyperostosis.

The roles of Wnt/ß-catenin signaling in regulating the morphology and microstructure of craniomaxillofacial (CMF) bones was explored using mice carrying a constitutively active form of ß-catenin in activating Dmp1-expressing cells (e.g., daßcatOt mice). By postnatal day 24, daßcatOt mice exhibited midfacial truncations coupled with maxillary and mandibular hyperostosis that progressively worsened with age. Mechanistic insights into the basis for the hyperostotic facial phenotype were gained through molecular and cellular analyses, which revealed that constitutively activated ß-catenin in Dmp1-expressing cells resulted in an increase in osteoblast number and an increased rate of mineral apposition. An increase in osteoblasts was accompanied by an increase in osteocytes, but they failed to mature. The resulting CMF bone matrix also had an abundance of osteoid, and in locations where compact lamellar bone typically forms, it was replaced by porous, woven bone. The hyperostotic facial phenotype was progressive. These findings identify for the first time a ligand-independent positive feedback loop whereby unrestrained Wnt/ß-catenin signaling results in a CMF phenotype of progressive hyperostosis combined with architecturally abnormal, poorly mineralized matrix that is reminiscent of craniotubular disorders in humans.

Molecular Basis for Craniofacial Phenotypes Caused by Sclerostin Deletion.

Some genetic disorders are associated with distinctive facial features, which can aid in diagnosis. While considerable advances have been made in identifying causal genes, relatively little progress has been made toward understanding how a particular genotype results in a characteristic craniofacial phenotype. An example is sclerosteosis/van Buchem disease, which is caused by mutations in the Wnt inhibitor sclerostin (SOST). Affected patients have a high bone mass coupled with a distinctive appearance where the mandible is enlarged and the maxilla is foreshortened. Here, mice carrying a null mutation in Sost were analyzed using quantitative micro-computed tomographic (µCT) imaging and histomorphometric analyses to determine the extent to which the size and shape of craniofacial skeleton were altered. Sost-/- mice exhibited a significant increase in appositional bone growth, which increased the height and width of the mandible and reduced the diameters of foramina. In vivo fluorochrome labeling, histology, and immunohistochemical analyses indicated that excessive bone deposition in the premaxillary suture mesenchyme curtailed overall growth, leading to midfacial hypoplasia. The amount of bone extracellular matrix produced by Sost-/- cells was significantly increased; as a consequence, osteoid seams were evident throughout the facial skeleton. Collectively, these analyses revealed a remarkable fidelity between human characteristics of sclerosteosis/van Buchem disease and the Sost-/- phenotype and provide clues into the conserved role for sclerostin signaling in modulating craniofacial morphology.

Genetic deletion of Sost or pharmacological inhibition of sclerostin prevent multiple myeloma-induced bone disease without affecting tumor growth.

Multiple myeloma (MM) causes lytic bone lesions due to increased bone resorption and concomitant marked suppression of bone formation. Sclerostin (Scl), an osteocyte-derived inhibitor of Wnt/ß-catenin signaling, is elevated in MM patient sera and increased in osteocytes in MM-bearing mice. We show here that genetic deletion of Sost, the gene encoding Scl, prevented MM-induced bone disease in an immune-deficient mouse model of early MM, and that administration of anti-Scl antibody (Scl-Ab) increased bone mass and decreases osteolysis in immune-competent mice with established MM. Sost/Scl inhibition increased osteoblast numbers, stimulated new bone formation and decreased osteoclast number in MM-colonized bone. Further, Sost/Scl inhibition did not affect tumor growth in vivo or anti-myeloma drug efficacy in vitro. These results identify the osteocyte as a major contributor to the deleterious effects of MM in bone and osteocyte-derived Scl as a promising target for the treatment of established MM-induced bone disease. Further, Scl did not interfere with efficacy of chemotherapy for MM, suggesting that combined treatment with anti-myeloma drugs and Scl-Ab should effectively control MM growth and bone disease, providing new avenues to effectively control MM and bone disease in patients with active MM.

Estudio funcional de los polimorfismos del promotor del gen de la esclerostina / Functional study of promoter gene polymorphisms of sclerostin

La esclerostina, codificada por el gen SOST, es un inhibidor de la vía Wnt, y por ello tiene una influencia negativa sobre la masa ósea. Algunos polimorfismos del promotor de SOST se han asociado a diferencias en la densidad mineral ósea (DMO) en varios estudios, pero se desconocen cuáles son los mecanismos moleculares implicados. El objetivo de este estudio fue comprobar las consecuencias funcionales de uno de esos polimorfismos in vitro . Para ello se clonó la región promotora proximal del gen SOST, con diferentes alelos del polimorfismo rs851054, y se transfectaron en células HEK-293T, SAOS-2 y HOSTE85. En ningún caso se observaron diferencias significativas en la actividad transcripcional entre los vectores con el alelo A y los vectores con el alelo G. La co-transfección de vectores de expresión de los factores de transcripción RUNX2 y OSX estimuló claramente la actividad transcripcional (2,5±0,9 veces sobre el valor basal para el alelo A y 1,9±0,8 veces para el alelo G; en ambos casos, p<0,05), sin que hubiera, sin embargo, diferencias entre los alelos. Tampoco se hallaron diferencias en la fijación a proteínas nucleares analizadas en experimentos de retardo de la movilidad electroforética. En conclusión, la región situada antes del inicio de la traducción del gen SOST tiene una potente actividad promotora, que es aumentada por los factores RUNX2 y OSX. Las variantes frecuentes de esta región se han asociado con la DMO, pero los mecanismos implicados son aún desconocidos, puesto que los alelos analizados no muestran diferencias en la actividad transcripcional in vitro (AU)

Sclerostin, encoded by the SOST gene, inhibits the Wnt pathway and, consequently, tends to decrease bone mass. Some polymorphisms of the SOST promoter have been associated with bone mineral density (BMD), but the molecular mechanisms involved are unknown. The aim of this study was to study the functional role of one polymorphism in vitro. We cloned the proximal promoter region of SOST gene, containing different alleles at the rs851054 SNP, in luciferase reporter vectors and transfected them into the cell lines HEK-293T, SAOS-2 and HOS-TE85. We did not find significant differences in the transcriptional activity of vectors with either the A or the G allele of the SNP. The co-transfection of vectors expressing RUNX2 and OSX markedly increased the transcriptional activity of the SOST promoter constructs (A allele, 2.5±0.9 fold, p<0.05; G allele, 1.9±0.8 fold, p<0.05), without significant differences between the rs851054 alleles. Moreover, no allele differences were detected in EMSAs. In conclusion, the DNA region upstream of the TSS of the SOST gene has a strong promoter activity that is enhanced by RUNX2 and OSX. Frequent allelic variants in this region have been associated with BMD, but the mechanisms involved remain to be elucidated because no functional differences between alleles were detected in vitro (AU)

[Disruption of anterointernal weight bearing: sequelae of surgical treatment of hallux valgus]. / Alteración del apoyo anterointerno como secuela del tratamiento quirúrgico del hallux valgus.

Sequelae of forefoot surgery range between 30 and 40%; the most frequent ones are transfer metatarsalgia and deformity relapse. Forefoot surgery complications disrupt biomechanics. Anterointernal weight bearing alteration is most frequent, due to involvement of the metatarsal, the phalanx or both. Metatarsophalangeal arthrodesis normalizes the length of the first ray and pressure transmission. The use of this technique has made it possible to confirm pain relief, as well as improved function and a better cosmetic result, which allows the patient to wear ormal footwear.