Determination of contents of glycosaminoglycans in temporomandibular joint discs in dogs]

Glycosaminoglycans (GAGs) are one of the important components of articular cartilage. The present study had determined the contents of uronic acid, galactomine, glucosamine, and hexosamine of temporomandibular joint discs in 10 dogs by Bitter's carbozole reaction method and derivative spectrophotometry. The data indicated that the contents of these components in different bands of the disc are not significantly different and that the discs of dogs contained averagely 0.6%, 0.987%, 0.4% and 1.4% of uronic acid, galactomine, glucosamine, and hexosamine respectively. The data also suggested that the discs contained keratan sulfate and chondroitin sulfate in some degree. This study is significant for analysing TMJ disc functions and its biomechanical properties in the future.     

The expression of substance P in human temporomandibular joint samples: an immunohistochemical study

The expression of neuropeptide substance P was examined in 18 human temporomandibular joint (TMJ) samples with internal derangement of the TMJ, and in 10 control specimens. The examination was carried out using an immunohistological technique, using paraffin-embedded tissue and specific anti-human substance P polyclonal antibody. We noted five characteristic distribution patterns of substance P expression: at the nerves' fibre bundles in the connective tissues of the anterior and/or posterior attachment; around the blood vessels in the attachments; at the margin of the TMJ disc and synovial membrane layer; on the surface of hypertrophic synovial membranes with inflammation and proliferation; and around the newly formed capillaries in the TMJ discs. In TMJs with internal derangement associated with severe pain, we found distinct substance P expression in most of the specimens. The expression was particularly intense at the margin of the TMJ disc and synovial membrane layer, on the surface of hypertrophic synovial membranes and around the newly formed capillaries in the TMJ discs. The clinical symptoms of internal derangement of the TMJ are thought to be associated with the degree of synovitis. We conclude that the expression of substance P seems to be closely related to histopathological changes of the human TMJ with internal derangement.     

The effect of removal of the disc on the friction in the temporomandibular joint.

PURPOSE: The amount of friction in the temporomandibular joint (TMJ) is dependent on the joint components, including the synovial fluid, disc, and articular surface cartilage. As friction in the TMJ is less than in other (discless) joints, we hypothesized that this is caused by the presence of the disc. MATERIALS AND METHODS: The frictional coefficient of the TMJ was first measured in the intact porcine joint (n = 10). After the disc was removed the measurement of frictional coefficient was conducted again. Furthermore, the subsequent effects of loading duration and the application of hyaluronic acid (HA) were examined. RESULTS: The mean frictional coefficient in the intact joint was 0.0177 (SD 0.0021). After disc resection it became 0.0361 (SD 0.0063). The frictional coefficient increased with the length of the preceding loading duration and exceeded 0.0635 (SD 0.0085) after 30 minutes. Subsequent application of HA resulted in a slight decrease of the frictional coefficient. CONCLUSIONS: The presence of the disc reduces the amount of friction in the TMJ. This reduction is likely due to the role of the disc in reducing the amount of incongruity between the articular surfaces and in increasing synovial fluid lubrication.     

Histopathological study of human TMJ perforated discs with emphasis on synovial membrane response

Fifteen perforated TMJ discs from human cadavers were studied histologically to examine the synovial membranes and to compare the findings with previous experimental results in monkeys. There were four with perforations in the bilaminar zone (these four discs were displaced anteriorly), three in the medial third of the disc, and eight in the lateral third of the disc. Histopathologically, there was an increase in vascularity and strong methyl pyronine-positive cellularity around the margins of the perforations. A young, loose, collagenous tissue lined the lateral margins of the perforated discs. Increased fibrous tissue content of the synovial subintimal territorial matrix and osteochondroid metaplasia were also seen. Severe synovial hyperplasia was visible in all joint recesses, but was greatest within those associated with displaced discs. There was patchy distribution of acidic glycoproteins, especially in the lateral parts of the perforated discs. As in the animal studies, human TMJ disc perforation was associated with a vigorous synovial reaction that was seen to form lateral bridges along the margins.     

Anchored disc phenomenon with a normally positioned disc in the temporomandibular joint: characteristics and behaviour

We aimed to elucidate the pathogenesis and evaluate the therapeutic behaviour of patients with an anchored disc phenomenon but a normally positioned disc of the temporomandibular joint (TMJ). Fourteen patients with internal derangement including closed lock of one TMJ were examined. All had normally positioned discs. Synovial fluid was collected from the TMJ by arthrocentesis. Their symptoms, and the protein concentration in the synovial fluid, were evaluated. Their median duration of illness was 3 months (range 0.5-12), and the median protein concentration was low (343 microg/ml; range 36-791). Arthrocentesis was successful in nine. Arthroscopic findings in the five unsuccessful cases showed severe intra-articular adhesions of the TMJ. The main intra-articular pathological feature was the presence of adhesions, which might be affected by low protein concentrations in the synovial fluid. These findings may provide a new treatment in patients with normally positioned discs, despite the small number studied.     

An interspecies comparison of the temporomandibular joint disc

The temporomandibular joint (TMJ) disc plays a critical role in normal function of the joint, and many disorders of the TMJ are a result of disc dysfunction. Previous quantitative TMJ characterization studies examined either the human or a specific animal model, but no single study has compared different species, in the belief that differences in joint morphology, function, and diet would be reflected in the material properties of the disc. In this study, we examined topographical biochemical (collagen, glycosaminoglycan, and DNA content) and biomechanical (tensile and compressive) properties of the human TMJ disc, and also discs from the cow, goat, pig, and rabbit. Regional and interspecies variations were identified in all parameters measured, and certain disc characteristics were observed across all species, such as a weak intermediate zone under mediolateral tension. While human discs possessed properties distinct from those of the other species, pig discs were most similar to the human, suggesting that the pig may be a suitable animal model for TMJ bioengineering efforts.     

The effect of disc thickness and trauma on disc surface friction in the porcine temporomandibular joint

The pathomechanics of osteoarthritis in the human temporomandibular joint (TMJ) are unknown. Compromised lubrication is a potential factor, but, lubrication within even the normal TMJ is not understood completely. Weeping lubrication is a concept that may be applicable to the TMJ. A characteristic of weeping lubrication is a slow increase in friction during static loading. The rate of increase in friction is related to the rate of lateral movement of synovial fluid away from the loading area. The TMJ disc is expected to be the main source of TMJ lubrication. This study tested two variables, disc thickness and magnitude of trauma to the disc, as factors that can affect the rate of flow of synovial fluid and thus alter lubrication of the disc surfaces. To test these variables, TMJ disc surface friction was measured before and after an impulse load. Before the impulse load, all discs demonstrated a gradual increase in friction during light static loading. The rate of increase in friction was inversely related to the disc thickness (R(2)=0.75). After an impulse load of known magnitude and peak force, disc surface friction was higher. The magnitude of this surface friction was correlated with the magnitude of the impulsive blow (R(2)=0.89) and the area of surface damage (R(2)=0.85). Disc thickness was a significant factor in determining the minimal impulse needed to produce higher surface friction (R(2)=0.99). These results confirm that disc thickness and trauma to the disc affect surface friction in the TMJ, and therefore may be important factors in compromised lubrication and the development of osteoarthritis.     

Histochemistry of the foetal human temporomandibular joint articular disc

The human temporomandibular joint (TMJ) develops from mesenchymal cells that form condensations appearing as condylar and temporal blastema which give rise to the respective anterior and posterior regions of the TMJ articular disc. Previous reports have shown the foetal disc to be avascular, with a high content of organized collagen fibres and a lesser content of elastic fibres. In this study, the articular discs from TMJs of a human foetus at age 22 weeks were evaluated. At this stage of intrauterine (i.u.) development, the disc was found to be a highly cellular, biconcave structure with a dense arrangement of collagen fibres. Cell density was not uniform, with increased density in the intermediate band relative to the anterior and posterior bands. In contrast to earlier reports, capillaries containing red blood cells were observed along the inferior surface of the disc. Immunohistochemical staining for proteoglycans and glycosaminoglycans (GAGS) revealed abundant chondroitin sulphate proteoglycan (CSPG) and hyaluronic acid in the disc while relatively little amounts of dermatan sulphate proteoglycan II (DSPGII) were found. No keratin sulphate proteoglycan (KSPG) was detectable. Foetal human TMJ articular discs at this age were found to have morphology and regional characteristics similar to adult discs.     

山羊颞下颌关节盘细胞透射电镜观察

目的 用透射电镜的方法对两只1月龄健康山羊四只颞下颌关节盘的细胞及胶原结构进行了观察.方法 切取山羊双侧颞下颌关节盘,经组织学处理后行透射电镜观察细胞和胶原超微结构特征.结果 颞下颌关节盘由不均分布的细胞和胶原纤维组成,细胞有成纤维细胞样细胞和软骨细胞样细胞两种,其中成纤维细胞样细胞较软骨细胞样细胞占优势.成纤维细胞样细胞表现有细长的突起,核大,梭形或不规则形,细胞器较少.软骨细胞样细胞胞核呈圆形或椭圆形,周围少有电子透射区,细胞膜不明显,胞突少见.胶原纤维由平行排列的有周期性横纹特征的胶原原纤维组成.结论 颞下颌关节盘细胞有成纤维细胞样和软骨细胞样细胞两种,前者占优势,胶原原纤维表现有周期性横纹特征.这为颞下颌关节盘组织工程研究中细胞来源及表型分析奠定了一定基础.     

Regionally variant collagen alignment correlates with viscoelastic properties of the disc of the human temporomandibular joint

ObjectiveTo determine the regionally variant quality of collagen alignment in human TMJ discs and its statistical correlation with viscoelastic properties.DesignFor quantitative analysis of the quality of collagen alignment, horizontal sections of human TMJ discs with Pricrosirius Red staining were imaged under circularly polarized microscopy. Mean angle and angular deviation of collagen fibers in each region were analyzed using a well-established automated image-processing for angular gradient. Instantaneous and relaxation moduli of each disc region were measured under stress-relaxation test both in tensile and compression. Then Spearman correlation analysis was performed between the angular deviation and the moduli. To understand the effect of glycosaminoglycans on the correlation, TMJ disc samples were treated by chondroitinase ABC (C-ABC).ResultsOur imaging processing analysis showed the region-variant direction of collagen alignment, consistently with previous findings. Interestingly, the quality of collagen alignment, not only the directions, was significantly different in between the regions. The angular deviation of fiber alignment in the anterior and intermediate regions were significantly smaller than the posterior region. Medial and lateral regions showed significantly bigger angular deviation than all the other regions. The regionally variant angular deviation values showed statistically significant correlation with the tensile instantaneous modulus and the relaxation modulus, partially dependent on C-ABC treatment.ConclusionOur findings suggest the region-variant degree of collagen fiber alignment is likely attributed to the heterogeneous viscoelastic properties of TMJ disc that may have significant implications in development of regenerative therapy for TMJ disc.     

Molecular size distribution analysis of human gingival proteoglycans and glycosaminoglycans in specific periodontal diseases

Abstract. In order to determine the molecular-size distribution of gingival proteoglycans (PGs) and glycosaminoglycans (GAGs) both in periodontal health and disease states, gingival tissues were obtained from patients with early onset periodontally (EOP) and adult periodontitis (AP) and also from periodontally healthy subjects. Gel filtration chromatography of gingival PGs revealed different profiles for periodontally diseased and healthy gingiva. Healthy gingiva was mainly composed of high-molecular size proteins and PGs. while diseased gingival tissue presented a decrease in high-molecular size PG forms and a shift towards low-molecular size proteins and PGs. This indicates the degradation of PG macromolecules during periodontal disease activity. Furthermore, this shift towards low-molecular size forms was more intense in EOP patients when compared to AP patients. Gel filtration of gingival GAGs also demonstrated depolymerization of GAGs, with low-molecular size GAGs being more intense in periodontally diseased gingival, while healthy gingival GAGs profile was mainly composed of high-molecular size GAGs. Similar to the profile of gingival PGs. low-molecular size gingival GAGs. were more prominent in gingival tissue from patients with EOP, These findings suggest that both PGs and GAGs. essential components of the extracellular matrix (ECM). are depolmerized during eriodontal disease activity, which is more prominent in EOP, Since the basie feature of periodontal disease is matrix degradation. ECM components, more specifically PGs and GAGs, are likely to provide valuable information for a better understandi ng of periodontal disease activity.     

The distribution of cyclooxygenase-1 in human temporomandibular joint samples: an immunohistochemical study

Cyclooxygenase-1,2 (COX-1,2) or prostaglandin (PG) H synthase, is the first enzyme of the pathway in which arachidonic acid is oxidized to PGs. Thus, we examined the expression of COX-1 in 16 human temporomandibular joint (TMJ) samples with internal derangement and in 10 control specimens by an immunohistological technique using paraffin-embedded tissue and specific antihuman COX-1 polyclonal antibody. There was obvious distinction of COX-1 immunoreactivity between the control specimens and internal derangement cases, at the endothelial cells and fibroblasts, in the region of posterior and/or anterior loose connective tissues and synovial membrane. The findings of the present study suggest that COX-1 might be an important mechanism for maintaining normal homeostasis at the endothelial cells and fibroblasts with internal derangement of TMJ.     

颞下颌关节盘穿孔早期上腔滑液的流体动力学研究

目的 通过建立颞下颌关节流体动力学模型,分析下颌运动中关节盘穿孔区域关节上腔滑液的流动模式和压力分布规律.方法 选择5例单侧颞下颌关节盘穿孔早期患者,利用关节上腔造影与计算机断层扫描相结合的方法获得颞下颌关节在不同下颌骨下降距离时的三维影像学图像,利用Mimics软件及Gambit软件提取患侧关节上腔立体轮廓并进行三维网格划分,应用Fluent软件进行滑液流体动力学分析.利用关节内压测量仪记录开颌运动中滑液压力进行模型验证.结果 颞下颌关节上腔滑液的流体动力学模型结果显示：在开颌运动中右侧关节腔内滑液沿逆时针循环.在闭口和小张口位,关节内力小于阈值,上腔滑液形成规律的循环流动;当下颌骨下降距离到达3 cm以上,上腔滑液压力增至（11.78 ±5.14） mmHg达阈值水平,细小穿孔部位张开形成异常流场和上下腔滑液交通,不利于关节盘的自我修复.结论 颞下颌关节盘穿孔的关节滑液循环仿真模型有助于对颞下颌关节紊乱综合征发病机制的研究,可为指导疾病的诊疗和预防提供依据.     

The expression of transforming growth factor beta (TGF-beta) in the synovial membrane of human temporomandibular joint with internal derangement: a comparison with tenascin expression

We examined the expression of the transforming growth factor beta (TGF-beta) in 28 human temporomandibular joint (TMJ) samples (internal derangement of TMJ and control specimens) by an immunohistological method using paraffin-embedded tissues and a polyclonal antibody specific to human TGF-beta. The resulting reaction of TGF-beta expression divided into three types as follows. The first type, around the fibrocyte and in the lacunae of chondrocytes in the disc. The second type, at the stroma of the mildly hypertrophic synovial membrane and severely hypertrophic synovial membrane. The first type was observed in all the cases including the control cases. The second type showed only in the internal derangement of TMJ, and its expression pattern resembled that of tenascin (TN) within the stroma of hypertrophic synovial membranes. In conclusion, TGF-beta and TN were distributed in the affected synovial membrane of TMJ with internal derangement. These findings suggested that TGF-beta and TN might have a close relationship with synovitis, followed by tissue repair.     

Structure and function of the temporomandibular joint disc: implications for tissue engineering.

The temporomandibular joint (TMJ) disc is a little understood structure that, unfortunately, exhibits a plethora of pathologic disorders. Tissue engineering approaches may be warranted to address TMJ disc pathophysiology, but first a clear understanding of structure-function relationships needs to be developed, especially as they relate to the regenerative potential of the tissue. In this review, we correlate the biochemical content of the TMJ disc to its mechanical behavior and discuss what this correlation infers for tissue engineering studies of the TMJ disc. The disc of the TMJ exhibits a somewhat biconcave shape, being thicker in the anterior and posterior bands and thinner in the intermediate zone. The disc, which is certainly an anisotropic and nonhomogeneous tissue, consists almost entirely of type I collagen with trace amounts of type II and other types. In general, collagen fibers in the intermediate zone appear to run primarily in an anteroposterior direction and in a ringlike fashion around the periphery. Collagen orientation is reflected in higher tensile stiffness and strength in the center anteroposteriorly than mediolaterally and in the anterior and posterior bands than the intermediate zone mediolaterally. Tensile tests have shown the disc is stiffer and stronger in the direction of the collagen fibers. Elastin fibers in general appear along the collagen fibers and most likely function in restoring and retaining disc form after loading. The 2 primary glycosaminoglycans of the disc by far are chondroitin sulfate and dermatan sulfate, although their distribution is not clear. Compression studies are conflicting, but evidence suggests the disc is compressively stiffest in the center. Only a few tissue engineering studies of the TMJ disc have been performed to date. Tissue engineering studies must take advantage of existing information for experimental design and construct validation, and more research is necessary to characterize the disc to create a clearer picture of our goals in tissue engineering the TMJ disc.     

CD44 standard form (CD44H) expression and distribution in dysfunctional human temporomandibular joint discs

The expression pattern of the cell adhesion molecule CD44 standard form (CD44H) in dysfunctional human temporomandibular joint (TMJ) discs was studied immunohistochemically and compared with normal disc pattern in order to evaluate the expression of this adhesion molecule and correlate it to histopathological changes. Immunohistochemistry with anti-CD44H antibodies was performed on paraffin sections of pathological and normal discs. In normal TMJ discs, a moderate immunolabelling with anti-CD44H antibodies was detectable in fibroblastlike cells, in the few fibrochondrocytes and in chondrocytelike cells. In dysfunctional discs, the staining pattern and intensity varied according to the histopathological findings of the specimens. The TMJ discs showing abnormal collagen arrangement or fragmentation of collagen fibres presented overall the same immunolabelling pattern of normal discs. In the discs showing areas of fibrocartilaginous metaplasia, CD44H expression was upregulated in fibrochondrocytes and fibroblastlike cells, especially around the chondroid tissue. Overall, these results suggest that CD44H mediates the binding of some ECM proteins in TMJ disc cells. The up-regulation of CD44H observed in some dysfunctional TMJ discs seems to indicate a prevention of apoptosis in fibroblastlike cells and an important role in phenotypical change of fibrochondrocytes into chondroblastlike cells, enabling the aggregation of chondroid tissue pericellular matrix components.     

Experimental model of temporomandibular joint arthritis: Evaluation of contralateral joint and masticatory muscles

ObjectiveTo investigate morphological and biochemical changes in an experimental model of temporomandibular joint (TMJ) arthritis, as well as examine contralateral joint involvement and morphometric aspects of masticatory muscles in affected animals.DesignForty Wistar rats were allocated into three groups, as follows: a healthy control group (HG); and a group with arthritis induced in the left TMJ (IG); and a contralateral group with noninflamed right TMJ (CG). Arthritis was induced by intra-articular injection of 50 μL of Complete Freund's Adjuvant (CFA). Morphological analysis was performed using histological sections of TMJs stained with hematoxylin-eosin, picrosirius and toluidine blue. In addition, histomorphometric analyses of the articular cartilage, articular disc and masticatory muscles, were performed. Biochemical analysis of TMJ tissues included dosage of sulfated glycosaminoglycans (GAGs), zymography of the Matrix Metalloproteinases (MMPs) 2 and 9 and ELISA for the cytokines IL-6, TNF-α and IL-1β. The data were analyzed by paired and unpaired t-tests, with a p < 0.05.ResultsIG animals presented morphological and biochemical changes in their TMJ, including synovial membrane hyperplasia; chronic inflammatory infiltrate; collagen fiber disorganization in the disc; reduced proteoglycans in the cartilage; greater disc thickness; lower cartilage thickness; lower feed intake; higher activity of MMP-9 and MMP-2, and higher concentration of IL-6, TNF-α, and IL-1β, as compared to HG. CG animals showed posterior disc thickening; reduced proteoglycans in the cartilage; lower collagen fiber organization of the disc; active MMP-9, and higher concentration of IL-6 and TNF-α compared to HG animals. Articular inflammation reduced the area and diameter of fibers of the temporal (right), medial pterygoid (left), and lateral pterygoid (right and left) muscles as compared to HG animals.ConclusionTMJ arthritis reduced the area and diameter of masticatory muscle fibers and caused morphological and molecular changes in the contralateral joint.     

关节盘穿孔对兔颞下颌关节影响的扫描电镜观察

目的研究兔关节盘穿孔后对颞下颌关节（TMJ）髁状突和关节盘表面超微结构的影响。方法12只3～4月龄的新西兰白兔,随机均分为实验组和对照组。以质量分数为50mg/ml的氯胺酮溶液按1ml/kg对实验动物进行肌注麻醉,对照组于无菌条件下先后暴露左右侧关节盘,实验组并以特制的穿刺针于关节盘后外侧部制作直径为2.6mm的穿孔。分别于术后12、24和36周完整取出双侧TMJ,扫描电镜观察关节盘和髁状突的变化。结果扫描电镜下可见关节盘穿孔后关节表面凝胶状物质不完整,关节盘及髁状突表面均出现明显的退行性改变：凝胶样物质掀起、剥脱,胶原纤维疏松、暴露、断裂、排列紊乱。结论关节盘穿孔可以引起TMJ表面退性行改变。     

Analysis of 70Kd heat shock protein expression in patients with internal derangement of the temporomandibular joint

Recent studies have demonstrated that the expression of heat shock protein (HSP) was enhanced under stress in joint diseases, such as rheumatoid arthritis and osteoarthritis. The purpose of this study was to analyze the expression of 70Kd HSP in patients with internal derangement of the temporomandibular joint (TMJ) by immunohistochemical and enzyme-linked immunosorbent assay (ELISA) methods. For immunohistochemistry, 5 extirpated discs and 16 synovial biopsy specimens from patients with TMJ internal derangement and 2 extirpated discs from normal subjects were examined. For ELISA, synovial fluid from 11 patients with TMJ internal derangement and from 6 normal volunteers were investigated. The results showed that the 70Kd HSP staining intensity in chondrocytes around the damaged area of the articular discs from patients with TMJ internal derangement was higher than that in chondrocytes in control specimens. In addition, 70Kd HSP expression in synovial fluid from patients with TMJ internal derangement was slightly higher than that in normal subjects. These findings suggest that elevated 70Kd HSP expression is related to the progression of TMJ internal derangement.     

Osteoarthritis of the temporomandibular joint organ and its relationship to disc displacement

To overcome disagreements with regard to the relationship between disc displacement and osteoarthritis of the temporomandibular joint (TMJ), the evidence for suggested disease mechanisms and clinical course of these disorders is reviewed. The TMJ behaves as a complex organ in which biochemical and biomechanical processes regulate the physiology of cartilage, bone, synovium, ligaments, and synovial fluid. In this concept, TMJ osteoarthritis is an organ failure involving all its structures. The development of as well as recovery from disease appears to be intimately related to exceeding and supporting the adaptive capacity of the tissues that make up the joint organ. Loss of fibrocartilage and inflammation appear to be major pathobiologic processes, while serious doubts exist about the significance of disc position in joint pathology.