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Familial hypophosphatemic rickets: study about salivary peptides and dental mineral structure / Raquitismo hipofosfatÃmico familiar: estudo sobre peptÃdeos salivares e estrutura mineral dentÃriaThyciana Rodrigues Ribeiro 31 May 2013 (has links)
FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / X-linked hypophosphatemic rickets (XLHR) is the most common cause of heritable rickets, with an incidence of 1:20,000 live births, representing more than 80% of familial hypophosphatemic rickets. Saliva is the most easily available and accessible body fluid, which makes it one of the most sought after tools in diagnostic pathology. In this context, this thesis, constituted by 4 articles aimed to: (1) describe the main systemic manifestations, oral findings and dental management in 3 generations of an affected family; (2) analyze the mineralization pattern of enamel and dentin in patients affected by XLHR using micro-CT, and to associate enamel and dentin mineralization in primary and permanent teeth with tooth position, gender and presence/absence of this disease; (3) evaluate the peptide profile in the saliva of patients with X-linked hypophosphatemic rickets using high performance liquid chromatography; and (4) characterize salivary proteins in this condition using unidimensional electrophoresis. On study 1, oral exams, laboratorial and histologic evaluations, cone-beam computed tomographies, panoramic and periapical radiographs were performed to properly institute the most adequate treatment strategy. On study 2, teeth were collected from 5 individuals from the same family. Gender, age, tooth position (anterior/posterior) and tooth type (deciduous/permanent) were recorded for each patient. Following collection, teeth were placed in 0.1% thymol solution until Micro-CT scan. Projection images were reconstructed and analyzed. On study 3, unstimulated whole and stimulated parotid saliva were obtained from 8 individuals with (AFF) and 8 healthy individuals, both genders, without (CON) x-linked hypophosphatemic rickets aged from 8 to 66 years. Supernatants were analyzed by high performance liquid chromatography, and the salivary flow rate (ml/min) was calculated. Each major peak in the HPLC chromatogram of each sample was characterized. On study 4, unstimulated whole and stimulated parotid saliva were also obtained, being total protein concentration determined by the Bicinchoninic Acid Protein (BCA) method. Proteins were characterized according to their molecular weights within the unidimensional electrophoresis. The study 1 showed the importance of the knowledge of clinical signs and symptoms of XLHR for the correct diagnosis of this disease, and for the establishment of preventive and comprehensive dental care. On article 2, teeth of all affected patients presented dentin with a different mineralization pattern compared to the teeth of the healthy individual with dentin defects observed next to the pulp chambers. On the third article, whole and parotid salivary flows were significantly different (p = 0.001), being flow of whole saliva higher (0.518  0.282 mL/min) than parotid saliva (0.124  0.086 mL/min). Whole salivary flow rate was higher in the AFF group (0.698  0.229) than in the CON group (0.339  0.210 mL/min) (p = 0.006). Twenty-eight peaks were found in whole and 21 peaks in parotid saliva. Whole saliva of the CON group presented lower number of peaks than AFF group. In parotid saliva, peaks 17 and 28 (retention times: 24 and 39 min) were found exclusively in the AFF group, and peak 13 (retention time: 19 min) exclusively in the CON. Article 4 showed difference concerning to total protein concentration between whole and parotid saliva (p < 0.001), being higher concentration found in whole saliva (102.603  42.336 Âg/mL) than in parotid saliva (0.699  0.438 Âg/mL). Bands with 102 kDa, 48 kDa and 24 kDa presented higher intensity in whole saliva of CON group (p = 0.015, p = 0.043 and p = 0.022). In conclusion, XLHR patients presented specific characteristics in dentin mineralization and salivary proteins and peptides, which can lead to differentiate these patients from healthy individuals, improving the diagnostic field. / Raquitismo hipofosfatÃmico ligado ao cromossomo X (XLHR) à a maior causa de raquitismo hereditÃrio, com uma incidÃncia de 1:20.000 nascidos vivos, representando mais de 80% das formas de raquitismo hipofosfatÃmico familiar. A saliva à o fluido humano mais disponÃvel e de fÃcil acesso, o que faz dela uma das ferramentas mais pesquisadas no diagnÃstico de patologias. Nesse contexto, essa tese, constituÃda de 4 artigos objetivou: (1) descrever as principais manifestaÃÃes sistÃmicas, achados orais e tratamentos dentÃrios em 3 geraÃÃes de uma famÃlia afetada; (2) analisar o padrÃo de mineralizaÃÃo do esmalte e da dentina nos pacientes afetados por XLHR, utilizando microtomografia computadorizada (Micro CT), e associar a mineralizaÃÃo do esmalte e da dentina em dentes decÃduos e permanentes, segundo gÃnero e presenÃa/ausÃncia da doenÃa; (3) avaliar o perfil de peptÃdeos na saliva de pacientes com XLHR, utilizando cromatografia lÃquida de alta performance (HPLC); e (4) caracterizar proteÃnas salivares nessa condiÃÃo, utilizando eletroforese unidimensional. No estudo 1, exames orais, laboratoriais e avaliaÃÃes histolÃgicas, tomografias computadorizadas cone-beam e radiografias periapicais foram realizadas para a apropriada instituiÃÃo da estratÃgia de tratamento mais adequada. No estudo 2, dentes foram coletados de 5 indivÃduos de uma mesma famÃlia. GÃnero, idade, posiÃÃo dentÃria (anterior/posterior) e tipo dentÃrio (decÃduo/permanente) foram registrados para cada paciente. ApÃs a coleta, os dentes foram colocados em soluÃÃo de timol a 0,1% atà a anÃlise atravÃs do Micro CT. As imagens projetadas foram reconstruÃdas e analisadas. No estudo 3, saliva total nÃo estimulada e saliva de parÃtida estimulada foram obtidas de 8 indivÃduos afetados com (AFF) e 8 indivÃduos sem (CON) XLHR, de ambos os gÃneros e idades entre 8 e 66 anos. Sobrenadantes foram analisados por meio de HPLC e o fluxo salivar (mL/min) foi calculado. Os picos que se apresentaram maiores nos cromatogramas do HPLC foram caracterizados. No estudo 4, saliva total nÃo estimulada e saliva de parÃtida estimulada tambÃm foram obtidas, sendo a concentraÃÃo de proteÃnas totais determinada pelo MÃtodo do Ãcido BicinconÃnico (BCA). ProteÃnas foram caracterizadas de acordo com o peso molecular atravÃs de eletroforese unidimensional. O estudo 1 mostrou a importÃncia do conhecimento dos sinais e sintomas clÃnicos do XLHR para o correto diagnÃstico dessa doenÃa, e para o estabelecimento de atendimento odontolÃgico preventivo e abrangente. No artigo 2, os dentes de todos os pacientes afetados apresentaram dentina com padrÃo de mineralizaÃÃo diferente comparado aos dentes de indivÃduos saudÃveis, sendo os defeitos na dentina observados prÃximo Ãs cÃmaras pulpares. No artigo 3, os fluxos salivares da saliva total e de parÃtida foram significativamente diferentes (p=0,001), sendo o fluxo de saliva total maior (0,518  0,282 mL/min) do que o de saliva de parÃtida (0,124  0,086 mL/min). O fluxo salivar da saliva total foi maior no grupo AFF (0,698  0,229) que no grupo CON (0,339  0,210 mL/min) (p = 0,006). Vinte e oito picos foram encontrados em saliva total e 21 em saliva de parÃtida. A saliva total do grupo CON apresentou menor nÃmero de picos que a do grupo AFF. Na saliva de parÃtida, os picos 17 e 28 (tempos de retenÃÃo: 24 e 39 min) foram encontrados exclusivamente no grupo AFF e o pico 13 (tempo de retenÃÃo: 19 min) no CON. Artigo 4 demonstrou diferenÃa relacionada à concentraÃÃo de proteÃnas totais entre saliva total e de parÃtida (p < 0,001), sendo a maior concentraÃÃo encontrada na saliva total (102,603  42,336 Âg/mL) que na saliva de parÃtida (0,699  0,438 Âg/mL). Bandas com 102 kDa, 48 kDa e 24 kDa apresentaram maior intensidade na saliva total do grupo CON (p = 0,015, p = 0,043 e p = 0,022). Em conclusÃo, pacientes com XLHR apresentaram caracterÃsticas especÃficas relacionadas à mineralizaÃÃo dentinÃria e proteÃnas e peptÃdeos salivares que podem levar à diferenciaÃÃo desses pacientes de indivÃduos saudÃveis, avanÃando no campo diagnÃstico.
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The Role of Fibroblast Growth Factor 23 in Phosphate HomeostasisLarsson, Tobias Erik Martin January 2004 (has links)
<p>The regulation of serum phosphate (Pi) concentrations is a complex process and our current models are far from complete. Due to major advancements in biotechnology and the development of more powerful research tools, recent advances in the field of genetics has led to the identification of several candidates for the long sought-after phosphatonin(s), or Pi regulating hormones. One of these candidates is fibroblast growth factor 23 (FGF-23) and this thesis is based upon studies of the role of FGF-23 in Pi homeostasis. We demonstrate that FGF-23 is a secreted protein which is highly expressed in tumors giving rise to oncogenic hypophosphatemic osteomalacia (OOM). Furthermore, we have developed a two-site enzyme-linked immunosorbent assay for the detection of circulating FGF-23 and established that FGF-23 is present in the circulation of healthy individuals. Also, FGF-23 serum levels are elevated in patients with disturbances in Pi homeostasis such as OOM, X-linked hypophosphatemic rickets (XLH) and chronic kidney disease and are likely to play an important role in the pathogenesis of these disorders. A transgenic mouse model that express human FGF-23 under the control of the α1(I) collagen promoter exhibit similar clinical and biochemical characteristics as do patients with OOM, XLH and autosomal dominant hypophosphatemic rickets indicating that FGF-23 is an important determinant of Pi homeostasis, vitamin D metabolism and bone mineralization.</p>
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The Role of Fibroblast Growth Factor 23 in Phosphate HomeostasisLarsson, Tobias Erik Martin January 2004 (has links)
The regulation of serum phosphate (Pi) concentrations is a complex process and our current models are far from complete. Due to major advancements in biotechnology and the development of more powerful research tools, recent advances in the field of genetics has led to the identification of several candidates for the long sought-after phosphatonin(s), or Pi regulating hormones. One of these candidates is fibroblast growth factor 23 (FGF-23) and this thesis is based upon studies of the role of FGF-23 in Pi homeostasis. We demonstrate that FGF-23 is a secreted protein which is highly expressed in tumors giving rise to oncogenic hypophosphatemic osteomalacia (OOM). Furthermore, we have developed a two-site enzyme-linked immunosorbent assay for the detection of circulating FGF-23 and established that FGF-23 is present in the circulation of healthy individuals. Also, FGF-23 serum levels are elevated in patients with disturbances in Pi homeostasis such as OOM, X-linked hypophosphatemic rickets (XLH) and chronic kidney disease and are likely to play an important role in the pathogenesis of these disorders. A transgenic mouse model that express human FGF-23 under the control of the α1(I) collagen promoter exhibit similar clinical and biochemical characteristics as do patients with OOM, XLH and autosomal dominant hypophosphatemic rickets indicating that FGF-23 is an important determinant of Pi homeostasis, vitamin D metabolism and bone mineralization.
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