Kövér Zsanett, Bán Ágnes, Gajdács Márió, Polgár Beáta, Urbán Edit
1Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, Tüzér u. 1., 7623 Pécs, Hungary.
2Department of Oral Biology and Experimental Dental Research, Faculty of Dentistry, University of Szeged, Tisza Lajos krt. 64-66., 6725, Szeged, Hungary.
Eur J Microbiol Immunol (Bp). 2023 Dec 1;13(4):125-134. doi: 10.1556/1886.2023.00041. Print 2023 Dec 21.
Medication-related osteonecrosis of the jaw (MRONJ) is an increasingly common consequence of antiresorptive treatment, which often leads to the development of necrotic exposed bone surfaces with inflammatory processes affecting the jawbone. Although the development of MRONJ is often associated with the inflammatory response or infections caused by the colonizing members of the oral microbiota, the exact pathogenesis of MRONJ is still not fully understood. In the present paper, we aimed to provide additional, microbiological culture-supported evidence, supporting the "infection hypothesis" that Actinomyces spp. and related organisms may play an important pathogenic role in the development of MRONJ and the resulting bone necrosis. In our case series, all patients presented with similar underlying conditions and anamnestic data, and have received antiresorptive medications (bisphosphonates or a RANK ligand (RANKL) inhibitor) to prevent the occurrence or progression of bone metastases, secondary to prostate cancer. Nevertheless, a few years into antiresorptive drug therapy, varying stages of MRONJ was identified in the mentioned patients. In all three cases, quantitative microbiological culture of the necrotic bone samples yielded a complex microbiota, dominated by Actinomyces and Schaalia spp. with high colony counts. Additionally, our followed-up case series document the treatment of these patients with a combination of surgical intervention and long-term antibiotic therapy, where favourable clinical responses were seen is all cases. If the "infection hypothesis" is valid, it may have significant consequences in the preventative and therapeutic strategies associated with this disease.
药物相关性颌骨坏死（MRONJ）是抗吸收治疗越来越常见的后果，常导致坏死暴露骨面的形成，并伴有影响颌骨的炎症过程。尽管MRONJ的发生通常与口腔微生物群定殖成员引起的炎症反应或感染有关，但其确切发病机制仍未完全明确。在本文中，我们旨在提供更多微生物培养支持的证据，以支持“感染假说”，即放线菌属及相关微生物可能在MRONJ的发生及由此导致的骨坏死中起重要致病作用。在我们的病例系列中，所有患者均有相似的基础疾病和既往史，且均接受了抗吸收药物（双膦酸盐或核因子κB受体活化因子配体（RANKL）抑制剂）以预防继发于前列腺癌的骨转移的发生或进展。然而，在抗吸收药物治疗数年后，上述患者中发现了不同阶段的MRONJ。在所有3例病例中，坏死骨样本的定量微生物培养均显示出以放线菌属和沙雷菌属为主、菌落计数高的复杂微生物群。此外，我们的随访病例系列记录了这些患者采用手术干预和长期抗生素治疗相结合的治疗方法，所有病例均观察到了良好的临床反应。如果“感染假说”成立，可能会对与该疾病相关的预防和治疗策略产生重大影响。
