• Journal of the korean academy of Pediatric Dentistry
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• v.30 no.3
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• pp.391-405
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• 2003

Craniosynostosis, known as a premature fusion of cranial sutures, is a developmental disorder characterized by precocious differentiation and mineralization of osteoblasts in the calvarial sutures. Recent genetic studies have demonstrated that mutation in the homeobox gene Msx2 causes Boston-type human craniosynostosis. Additionally, the phenotype of Dlx5 homozygote mutant mouse presents craniofacial abnormalities including a delayed ossification of calvarial bone. Furthermore transcription of osteocalcin, a mature osteoblast marker, is reciprocally regulated by the homeodomain proteins Msx2 and Dlx5. These facts suggest important roles of osteocalcin, Msx2 and Dlx5 genes in the calvarial bone growth and suture morphogenesis. To elucidate the function of these molecules in the early morphogenesis of mouse cranial sutures, we have first analyzed by in situ hybridization the expression of osteocalcin, Msx2 and Dlx5 genes in the developing parietal bone and sagittal suture of mouse calvaria during the embryonic (E15-E18) stage. Osteocalcin mRNA was found in the periosteum of parietal bones from E15, and gradually more highly expressed with aging. Msx2 mRNA was intensely expressed in the sutural mesenchyme, osteogenic fronts and mildly expressed in the dura mater during the embryonic stage. Dlx5 mRNA was intensely expressed osteogenic fronts and the periostem of parietal bones. To further examine the upstream signaling molecules of transcription factor Msx2 and Dlx5, we have done in vitro experiments in E15.5 mouse calvarial explants. Interestingly, implantation of BMP2-, BMP4-soaked beads onto the osteogenic fronts after 48 hours organ culture induced etopic expressions of Msx2 and Dlx5 genes. On the other hand, overexpression of $TGF{\beta}1$, GDF-6, -7, FGF-2, -4 and Shh did not induce the expression of Msx2 and Dlx5. Taken together. these data indicate that transcription factor Msx2 and Dlx5 play critical roles in the calvarial bone and suture development, and that BMP siganling is involved in the osteogenesis of calvarial bones and the maintenance of cranial sutures through regulating these two transcriotpn factors. Furthermore, different expression patterns between Msx2 and Dlx5 suggest their specific functions in the osteoblast differentiation.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1982.05a
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• pp.16.2-16
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• 1982

The palatine tonsils which are located in entrance of digestive and upper respiratory tracts are the most important organ in anatomical and functional structures of the pharyngeal lymphatic tissues. As for function of the tonsil, there have been many suspected theories that were included hematopoietic, hormonal, digestive function and production of vitamin, entry of bacteria with other antigenous materials and defence mechanism of which has taken charge by Virchow in 1860 in past. But among these theories, in recently, defence mechanism of the tonsil was strongly accepted immunologically. For the purpose of elucidating immune response of the tonsil, the author observed serum immunoglobulin levels, peripheral total lymphocyte counts and populations of T, B and Null lymphocytes before and after tonsillectomy in 30 cases of patients with chronic tonsillitis and 29 cases of healthy controls. The results obtained were as follows; 1) Serum Ig M level was significantly higher in patient group than in control group but was not significantly different preoperative from postoperative patient group. 2) Population of T-lymphocyte more significantly decreased in patient group than in control group but it was not significantly different preoperative from postoperative patient group. 3) Population of B-lymphocyte more significiantly increased in patient group than in control group but it was not significantly different preoperative from postoperative patient group. On the basis of these results, it may be suggested that tonsil play partially a role in the immune response of human.

• Journal of the korean academy of Pediatric Dentistry
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• v.30 no.2
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• pp.308-319
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• 2003

Mechanical forces are known to have an effect on bone formation, maintenance and remodeling, and there is evidence that the development of the mandibular condyle in the rat or mouse is influenced by altered functional force. However, studies are lacking in molecular-biologic mechanism such as the identification of differentiation factor induced from functional force. Here a mouse model was used to investigate the functional stress-responsive gene or factors which is related to the altered force by comparing the expression genes of functional state and hypo-functional state of the mouse mandible. ICR mice were provisioned with either a soft, mushy diet (soft-diet group) or hard rat pellets (hard-diet group) beginning at weaning for the alteration of functional force and subsequently sacrificed at 89 days of age. Incisor of mice in group 1 were trimmed twice a week to reduce occlusal forces. After killing the animals, mandibular bone including condyle were collected for RNA extraction, subtractive hybridization, northern blot analysis and mRNA in-situ hybridization. The results as follows; 1. A total of 39 clones were sequenced, and 11 individual sequence types were subsequently identified by subtractive hybridization, as 28 clones were represented twice in the analyzed sets. 2. Consequently four candidate clones, FS-s (functional stress-specific)2, -5, -18, and -22 were identified and characterized by homolgy search and northern analysis. Four of these clones, FS-s2, -5, -18, and -22, were shown to be expressed differentially in the hard-diet group. 3. Histologic sections showed that osteoblastic activity along the bone trabeculae and active bone remodeling were significantly lower in soft than in hard diet animals. A soft diet seems to enable a longer period of endochondral ossification in the mandibular condyle. 4. Although the mRNAs of FS-s2, -5, -18, and -22 were expressed rarely by cells of the soft-diet group, highest expression was detected in the cells of the hard-diet group. Together with the above results, it is suggested that FS-s2, -5, -18, and -22 could act as an important factors controlling the tissue changes in response to functional stress. The exact functional significance of these findings remains to be established.

• Journal of the korean academy of Pediatric Dentistry
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• v.30 no.2
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• pp.217-228
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• 2003

Co-ordinate growth of the brain and skull is achieved through a series of tissue interactions between the developing brain, the growing bones of the skull and the sutures that unite the bones. Craniosynostosis, the premature fusion of cranial sutures, presumably involves disturbance of these interactions. Bmp2, one of bone morphogenetic proteins (Bmps), is involved in the regulation of the shapes of individual bones and the relative proportions of the skeleton. Mutations in the homeobox gene Msx2, known as a downstream gene of Bmp, cause Boston-type human craniosynostosis. The phenotype of Dlx5 homozygote mutant mouse presents craniofacial abnormalities including a delayed ossification of calvarial bone. These facts suggest important roles of Bmp2, Msx2 and Dlx5 genes in the cranial bone growth and suture morphogenesis. To elucidate the function of these molecules in the early morphogenesis of mouse cranial sutures, we first analyzed by in situ hybridization the expression of Bmp2(E15-18), Msx2 and Dlx5 genes in the developing sagittal suture of calvaria during the embryonic stage. Bmp2 mRNA was intensely expressed in the osteogenic fronts and also at the low level in the periosteum of parietal bones during embryonic stage, Msx2 mRNA was intensely expressed in the sutural mesenchyme and mildly expressed in the dura mater during the embryonic stage. Dlx5 mRNA was intensely expressed osteogenic fronts and parietal bones. To further examine the role of Bmp signaling in cranial suture, we did in vitro experiments in E15.5 mouse calvarial explants. Interestingly, implantation of Bmp2-soaked beads onto the osteogenic fronts after 48 hours organ culture resulted in the increase of the tissue thickness and cell number around Bmp2 beads, compared to BSA control beads. In addition Bmp2 induced etopic expressions of Msx2 and Dlx5 genes. On the other hand, overexpression of FGF2 did not induce the expression of Msx2 and Dlx5. Taken together, these data indicate that Bmp2 signaling molecule has a important role in regulating the cranial bone growth and early morphogenesis of cranial suture. We also suggest that Bmp signaling is involved in all the stages of osteogenesis of cranial bones and the maintenance of cranial suture by regulating Msx2 and Dlx5 genes, and that Msx2 and Dlx5 genes are specific transcription factors of Bmp signaling pathway.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.5
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• pp.385-396
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• 2001

The purpose of this experiment was to examine the histological changes and the pattern of expression of proliferating cell nuclear antigen(PCNA) and type I collagen in the elongated bone affected by osteodistraction of the mandibular body in an adult canine model. Seven adult male mongrel dogs weighing over 20kg were used for this experiment. The author excluded 3 animals because they died before the planned time of sacrifice. The custom-made linear extraoral device and 4 bicortical fixation screws 2.3mm in diameter, 50mm in total length, 15mm in screw length were used in each animal. The distal part of the distractor produced a 0.75mm gap between proximal and distal bony segments every $360^{\circ}$ turn of the rotation rod of the device. The mandibular body of the right side from each animal was experimental side and the left side was left intact and served as control. At the experimental side, the mandibular body was osteotomized. After 5-day latency period, the segments were distracted with a rate of 1.1mm/day and a rhythm of two/day for ensuing 7 days. The animals were sacrificed at the 4th. 17th, and 32th day after the end of the distraction. The bony specimens were decalcified, embedded in paraffin, sectioned $5{\mu}m$ thick and stained with Masson trichrome and examined under the light microscope. The immunohistochemical examinations using anti-PCNA antibody and anti-type-I collagen antibody were performed to examine the pattern of the expression of PCNA and type I collagen, respectively. Results : 1. The mean increment of the distance between the proximal and distal screw-holding parts of the distractor was 6.8mm. The average elongation of the mandible in the experimental side was 5.3mm. The loss of elongation was 1.5mm in average. 2. New bone was already observed at the 4th. day after the end of distraction. But, bony union was not completed in the distraction gap at the 32th. day after the end of distraction by radiographic and microscopic examinations. 3. The expression rate of PCNA positive cells in the distraction gap had a tendency of decrease from 35.1-68.8% initially, to 49.1%, and finally to 17.6-27.2%. But at the final period, the tissue of the elongated gap still had the ability of cell proliferation. On the other hand, the expression of PCNA positive cells in the control side were negligible through the experimental period. 4. PCNA positive cells were observed primarily both at the central fibrous zone and at the region of just adjacent to CFZ which initiated new bone formation. 5. The expression pattern of the type I collagen was not zone-specific. They were observed diffusely throughout the elongation gap. 6. The predominant mechanism of new bone formation in the distraction gap was intramembranous. But, some of the regenerated bone was formed by endochondral ossification.

• Journal of the korean academy of Pediatric Dentistry
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• v.31 no.4
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• pp.651-658
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• 2004

Runx2 is a transcription factor in homologous with Drosophila runt gene and it is essential for bone formation during embryogenesis and a critical gene for osteoblast differentiation and osteoblast function. Runx2-haploinsufficency causes cleidocranial dysplasia (CCD). CCD is an autosomal-dominant inherited disorder characterized by hypoplastic clevicle and delayed ossification in fontanelles and wormian bones. Dental defects are possibly shown to CCD patients : multiple supernumerary teeth, irregular and compressed permanent tooth crowns, hypoplastic and hypomineralized defects in enamel and dentin, an excess of epithelial root remnants, the absence of cellular cementum, and abnormally shaped roots. In addition, delayed eruption of the secondary dentition is a constant finding. The aim of this study is to evaluate the role of Runx2 in the tooth development and eruption through analyzing the expression pattern of Runx2 by in situ hybridization during crown (late bell stage) and root formation of tooth, using postnatal day 1, 4, 7, 14 and 21 mice mandibular molar teeth. mRNA of Runx2-full length is expressed in dental follicle and surrounding tissue at postnatal day1 and 4. At postnatal day 7, it is expressed in ameloblasts of occlusal surface of enamel and bone area surrounding the tooth. In comparison with previous stage, at postnatal day 14, it is expressed in ameloblasts of proximal surface of enamel. At postnatal day 21 it's expression is observed only in bone area. mRNA of Runx2-typeII is not expressed. At postnatal day 1 and 7. At postnatal day 14 and 21, it's expression is observed in the bone area. In this study, we suggest that Runx2 have a relation of ameloblasts differentiation and an important role to tooth eruption made by dental follicle during intraosseous eruption stage. Also we can confirm that Runx2 has a role to bone formation.

• Journal of the Korean Orthopaedic Association
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• v.55 no.6
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• pp.520-526
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• 2020

Purpose: The need for revision fusion surgery after spinal fusion has increased. A revision rod that connects to the previous rod was newly developed for revision surgery. The purpose of this study was to analyze the clinical and radiological results after spinal fusion revision surgery using revision rods. Materials and Methods: Twenty-one patients who underwent revision fusion surgery after spinal fusion in two university hospitals with minimum 1 year follow-up were reviewed. This study assessed 16 cases of adjacent-segment disease, four cases of thoracolumbar fracture, and one case of ossification of ligament flavum. The Oswestry Disability Index (ODI) and numerical rating scale (NRS) were evaluated as clinical outcomes, and the union rate, lordosis or kyphosis of the revision level, lumbar lordosis, T5-12 kyphosis, and proximal junctional kyphosis angle were evaluated as the radiological outcomes. Results: The average ODI was 54.6±12.5 before surgery and improved to 29.8±16.5 at the final follow-up. The NRS for back pain and leg pain was 5.0±1.7 and 6.4±2.0 before surgery, which changed to 2.9±1.6 and 2.9±2.2 at the final follow-up. Lumbar lordosis was 18.1°±11.9° before surgery and 21.1°±10.3° at the final follow-up. Proximal junctional kyphosis was 10.8°±10.1° before surgery, and 9.2°±10.5° at the final follow-up. These angles were not changed significantly after surgery. Bony union was successful in all cases except for one case who underwent posterolateral fusion. Conclusion: Revision surgery using a newly developed revision rod on the thoracolumbar spine achieved good clinical outcomes with successful bony union. No problems with the newly developed revision rod were encountered.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.21 no.1
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• pp.7-14
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• 2021

Purpose: Pseudohypoparathyroidism (PHP) is caused by genetic and epigenetic alteration in the GNAS locus, and characterized by the resistance to multiple hormones and the Albright's hereditary osteodystrophy (AHO) phenotype. This study investigated the phenotypic characteristics and molecular features of PHP. Methods: Eight patients who diagnosed as PHP were enrolled at Pusan National University Children's hospital and clinical features, biochemical and genetic findings were retrospectively reviewed. Results: Of a total of 8 patients, 5 were diagnosed with PHP1a, and 3 were diagnosed with PHP1b. Patients with PHP1a had three different mutations in the GNAS gene, and patients with PHPIb had imprinting defect in differentially methylated regions (DMRs) of the GNAS locus. Two novel GNAS variants were identified in patients with PHP1a, including c.313-2A>T and c.1094G>A. All patients with PHP1a displayed AHO features; short stature (80%), brachydactyly (80%), a round face (80%), obesity (40%), heterotopic ossification (60%), and intellectual disability (60%), whereas only one patient (33.3%) with PHP1b showed AHO feature such as a round face. When phenotypic features between PHP1a and PHP1b patients were compared, patients with PHP1b showed a tendency of higher current height standard deviation scores (SDS) compared to patients with PHP1a, (-3.2±2.1 vs.-1.1±0.8; P=0.06) Conclusions: This study summarizes the phenotypic and genetic features of the PHP patients. Although we found considerable clinical overlap between PHP1a and PHP1b, further long-term follow-up is needed to evaluate the growth and development of children with PHP, as well as the effects of end-organ resistances to endocrine hormones.