ASSESSMENT OF LEUKOCYTES FUNCTION IN PERIPHERAL BLOOD IN PATIENTS WITH MEDICINAL JAWS OSTEONEKROSIS.

The aim of the study was to assess the functional activity of peripheral blood phagocytes in patients with drug-induced osteonecrosis of the jaws to develop a new approach to treatment. A total of 35 people were examined, including: 10 healthy individuals, 8 with purulent-inflammatory diseases of the maxillofacial region (GVZ ChLO), 17 patients with medical osteonecrosis of the jaws (MRONJ). Among patients with MRONJ, there were 10 men and 7 women, aged from 54 to 73 years, with a mean age of 62 years. She had a history of cancer (prostate cancer, breast cancer). In connection with the presence of metastases, the patients took bisphosphonates - the drug Zometa (zoledronic acid) in injections of 4 mg intravenously 1 time per month. Phagocytic activity of peripheral blood leukocytes was determined by flow cytometry. The examination of the patients was carried out before and on the 14th day after the surgical treatment, osteonecrectomy. In patients with MRONJ and HVD, the phagocytic activity of leukocytes was reduced by 30-40% compared with healthy individuals (p<0.05). Low phagocytic activity was confirmed by the indicators of stimulation of E. coli leukocytes and the stimulation index (oxidative burst). On the 14th day after surgical treatment in patients with BRONJ, the leukocyte phagocytosis indices did not normalize. The dysfunction of macrophage cells is more pronounced in cancer patients treated with bisphosphonates than in patients with HVD ChLH. A low level of indices of innate immunity factors contributes to the recurrence of osteonecrosis.

[ALGORITHM FOR TREATMENT PATIENTS WITH MEDICAL OSTEONEKROSIS OF JAWS BY CORRECTING ORAL MICROBIOTAL DISORDERS].

The aim of the study was to develop a new approach to the treatment of patients with drug-induced osteonecrosis of the jaws based on the correction of disorders of the oral microbiota. We examined 22 patients with MRONJ and 10 healthy individuals aged 55 to 76 years. All patients underwent surgical treatment for cancer, in connection with tumor metastasis, they took bisphosphonates - the drug Zometa (zoledronic acid) in injections of 4 mg intravenously 1 time per month. To assess the microbiota of the oral cavity, we used the method of chromatography-mass spectrometry (CMS) of microbial markers before and after osteonecrectomy. Patients with MRONJ in the oral cavity showed high rates of aerobic-anaerobic associations, actinobacteria, Candida fungi and viruses, the number of which was 2-80 times higher than in healthy individuals. After surgical treatment, the indices returned to normal only in mild MRONJ patients. The level of normal flora in the oral microbiota in patients with MRONJ was characterized by low levels of Bifidobacterium spp. After 6 months. after surgical treatment, relapses occur in 25% of patients with mild course and in 71% of patients with severe course of MRONJ. The new algorithm of complex treatment consists in carrying out drug treatment in the postoperative period, including long-term use of local antiseptics with a pronounced complex antibacterial, antifungal and antiviral effect, and probiotics containing bifidobacteria.

THE CONTENT OF NK CELLS AND THEIR SUBTYPES IN THE CASE OF DRUG-INDUCED JAW OSTEONECROSIS.

The goal of the study is assessing the population structure of lymphocytes and the subpopulation composition of NK cells in the peripheral blood of humans in the case of drug-induced osteonecrosis of the jaw for improving the quality of diagnosis, treatment, and prevention of osteonecrosis of the jaw. Thirty patients were examined, including 15 patients with drug-induced osteonecrosis of the jaw (ONJ), 10 healthy individuals, and five patients with pyoinflammatory diseases of the maxillofacial region, aged 49 to 77. Every four weeks, the patients had been receiving 4 mg intravenous injections of bisphosphonates (the Zometa preparation (zoledronic acid)) for 1.5 - 3 years. The study was performed on a FACS Canto II flow cytometer manufactured by Becton Dickinson (BD), USA. In the patients with ONJ, an imbalance of the NK cell subtypes was observed. As to the common NK cells, the level of subtypes of cytolytic NK cells (CD3-CD16+(or hight)56dim) was elevated, and the level of cytokine-producing cells (СD3-CD16-(or low) 56bright) was reduced, compared to the healthy individuals (p<0.05). In the patients with ONJ, after the surgical treatment, the relative and absolute levels of lymphocytes and the total level of NK cells (CD3-CD16+/56+) normalized on the seventh day. The level of NK cells subtypes did not change after the treatment. This pathology is characterized by a low level of innate protection factors, as evidenced by the reduction of the total population of NK cells, and the imbalance of NK cells subtypes. The imbalance of NK cells (the natural killer cells) was an indicator of unfavorable prognosis for osteonecrosis treatment.

[Diagnostic value of chromato-mass-spectrometry in patients with drug-induced jaws osteonecrosis]. / Kliniko-diagnosticheskoe znachenie khromato-mass-spektrometrii pri medikamentoznom osteonekroze cheliustei.

In patients with drag-induced jaw osteonecrosis which developed in cancer patients due to administration of bisphosphonates for metastases, the microflora of the oral cavity was examined by chromatography-mass spectrometry (HMS). The method of HMS can be used as an additional method of diagnostics in complex clinical cases with ineffective treatment.

[The expression of TLR4 and HBD3 in epithelial cells of oral mucosa by surgical treatment of periodontitis]. / Ekspressiya genov TLR4 i HBD-3 v epitelial'nykh kletkakh slizistoi obolochki pri khirurgicheskom lechenii parodontita.

The expression of TLR4 and HBD3 in epithelial cells of the oral cavity was studied using polymerase chain reaction in real-time in patients with inflammatory and destructive periodontal lesions before and after surgery using osteoplastic material. Analysis of TLR4 and HBD3 expression in epithelial cells demonstrates the key role of the innate immune factors in the pathogenesis of inflammatory and destructive periodontal lesions. TLR4 gene expression was increased 1.5-7.0 times and HBD3 1.5-5.0 times compared to healthy individuals. Surgical treatment resulted in an effective rehabilitation and normalization of innate immunity.