Diagnosis, classification and treatment of gestational trophoblastic neoplasia / Diagnóstico, classificação e tratamento da neoplasia trofoblástica gestacional

Gestational trophoblastic neoplasia (GTN) is the term to describe a set of malignant placental diseases, including invasive mole, choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor. Both invasive mole and choriocarcinoma respond well to chemotherapy, and cure rates are greater than 90%. Since the advent of chemotherapy, low-risk GTN has been treated with a single agent, usually methotrexate or actinomycin D. Cases of high-risk GTN, however, should be treated with multiagent chemotherapy, and the regimen usually selected is EMA-CO, which combines etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine. This study reviews the literature about GTN to discuss current knowledge about its diagnosis and treatment.

Neoplasia trofoblástica gestacional (NTG) é o termo que descreve o conjunto de anomalias malignas da placenta, incluindo a mola invasora, coriocarcinoma, tumor trofoblástico do sítio placentário e tumor trofoblástico epitelióide. Ambos a mola invasora e o coriocarcinoma respondem bem à quimioterapia, com taxas de cura superiores a 90%. Desde o advento da quimioterapia, NTG de baixo risco tem sido tratada com monoquimioterapia, pelo geral methotrexate ou actinomicina-D. Casos de NTG de alto risco, contudo, devem ser tratados com poliquimioterapia, e o regime usualmente escolhido é o EMA-CO que combina etoposide, methotrexate, actinomicina-D, ciclofosfamida e vincristina. Esse estudo revê a literatura sobre NTG a fim de discutir os conhecimentos atuais sobre seu diagnóstico e tratamento.

Participación de MT1-MMP en la remodelación del ligamento periodontal durante la movilización dentaria / Role of MT1-MMP in the remodeling of the periodontal ligament during tooth movement

La movilización dentaria involucra una serie de cambios en los tejidos de soporte caracterizados por la activa remodelación de estos. La MT1-MMP o MMP-14 es una potente enzima proteolítica capaz de degradar colágeno tipo I, la principal molécula estructural del ligamento periodontal. La migración dentaria requiere de la degradación controlada del colágeno constituyente del ligamento periodontal. Sin embargo, no existen evidencias de la participación de MT1-MMP en la remodelación del tejido periodontal durante este proceso. En el presente estudio hemos analizado la expresión de MT1 -MMP y del marcador de actividad osteoclástica Fosfatasa Acida Tartrato Resistente (TRAP) en un modelo de migración dentaria en ratas. La migración dentaria fue activada mediante la inserción de una banda separadora entre los incisivos superiores. La expresión y distribución de TRAP y MT1-MMP fue evaluada a través de citoquímica e inmunohistoquímica a los días 1, 3, 5 y 7. La producción de TRAP fue identificada principalmente en osteoclastos ubicados en la zona de compresión del ligamento periodontal. La producción de MT1-MMP fue observada en fibroblastos de la zona de compresión del ligamento periodontal y osteoclastos ubicados en esta misma región. Nuestros resultados permiten proponer que tanto MT1 -MMP como TRAP participan en la remodelación de los tejidos de soporte periodontal durante la migración dentaria.

Tooth movement involves a series of changes of the supporting periodontal tissues characterized by the active connective tissue remodeling. MT1-MMP or MMP-14 belongs to the family of matrix metalloproteinases that are able to degrade type I collagen, the main molecule involved in periodontal attachment. Tooth migration requires the controlled degradation of periodontal ligament collagen fibers. However, evidences linking MT1 -MMP expression with periodontal tissue remodeling are lacking. In the present study, we have evaluated the expression of MT1-MMPand of the osteoclast marker Tartrate Resistant Acid Phosphatase (TRAP) in a model of tooth migration in rats. Tooth migration was induced after the insertion of a rubber band between the upper incisors. The distribution of TRAP and MT1 -MMP was evaluated by means of cytochemistry and immunohistochemistry respectively at days 1, 3, 5 and 7. TRAP production was identified in osteoclasts at the area of compression of the periodontal ligament. MT1-MMP distribution was observed in fibroblastsatthe compressed area of the periodontal ligament and also in osteoclasts of the same region. Our findings allow us to propose that MT1-MMP and TRAP take part of the tissue remodeling events observed during tooth movement.