Journal
JOURNAL OF ORAL PATHOLOGY & MEDICINE
Volume 35, Issue 10, Pages 620-625Publisher
BLACKWELL PUBLISHING
DOI: 10.1111/j.1600-0714.2006.00454.x
Keywords
cathepsin K; mandible; osteomyelitis; RANKL; sclerosing
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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 kappa B 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.
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