上海交通大学学报(医学版) ›› 2024, Vol. 44 ›› Issue (6): 663-675.doi: 10.3969/j.issn.1674-8115.2024.06.001
• 牙颌面畸形专题 • 下一篇
收稿日期:
2024-02-29
接受日期:
2024-04-01
出版日期:
2024-06-28
发布日期:
2024-06-28
通讯作者:
江凌勇
E-mail:jianglingyong@sjtu.edu.cn
作者简介:
江凌勇(1978—),男,主任医师,博士;电子信箱:jianglingyong@sjtu.edu.cn。
基金资助:
Received:
2024-02-29
Accepted:
2024-04-01
Online:
2024-06-28
Published:
2024-06-28
Contact:
JIANG Lingyong
E-mail:jianglingyong@sjtu.edu.cn
Supported by:
摘要:
牙颌面骨畸形发病率高、病因复杂、症状严重、诊疗困难,缺乏早期干预策略,其主要原因在于相关机制研究较少、不够深入。这类疾病主要表现为骨性畸形、牙列不齐等骨与牙的形态结构、位置关系及口颌功能异常,其中颌面骨与牙-牙周复合体是两大核心结构,分别决定了颜面美观与咬合功能。颌面骨畸形精准防治需从病因角度研究发育与致病机制,而牙列不齐等牙-牙周复合体畸形矫治则需从临床正畸应力角度研究稳态与应激改建机制,两方面机制研究均可为牙颌面骨畸形防治策略发展提供重要理论基础。既往相关研究常以突变基因与差异因子表达谱的描述为主。近年来,Cre-LoxP等条件性基因编辑技术的发展,使研究者得以在体内直观地评价单一细胞谱系中致病基因的功能,助力牙颌面骨畸形研究从表型层面向分子机制层面推进。该文梳理了国内外学者近年的研究以及笔者所在课题组的研究成果,提出牙颌面骨畸形机制研究“一体两翼”模式,即牙颌面骨畸形为“一体”,颌面骨发育与畸形致病机制为“一翼”,牙-牙周复合体稳态与应激改建机制为“另一翼”;该模式的提出旨在系统性研究疾病的发生发展,探索临床干预新思路。近年的相关研究运用前沿技术从“两翼”出发探究“一体”的机制:一方面,牙颌面骨的胚胎发育来源复杂,组成型条件性模式动物成为研究关键细胞中关键因子功能的重要新策略;另一方面,牙-牙周复合体的成体改建最为频繁,诱导型条件性模式动物为模型时程精准控制提供了技术支持。随着单细胞测序与谱系示踪技术的开发,组织特异性干细胞因其原位、特化的特征渐受青睐,越来越多的研究者开始关注其特征功能,这一发展趋势十分契合“一体两翼”的研究模式,有望加快牙颌面骨畸形的理论基础建设与应用转化。该文就牙颌面骨畸形机制“一体两翼”的研究模式进行述评。
中图分类号:
江凌勇. 牙颌面骨畸形机制研究的现状与发展[J]. 上海交通大学学报(医学版), 2024, 44(6): 663-675.
JIANG Lingyong. Status and advances in the mechanism research on dento-maxillofacial skeletal abnormalities[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(6): 663-675.
图2 LacZ 工具鼠实验提示WNT信号、SHH信号、RA信号、BMP信号、Notch信号参与牙颌面组织发育形成的示意图
Fig 2 Schematic diagram of the roles of WNT signaling, SHH signaling, RA signaling, BMP signaling, and Notch signaling during dento-maxillofacial development using LacZ tool mice
Key cell lineage (marker-Cre) | Gene | Pathway | Characteristic of abnormalities | Related phenotype, syndrome or disease | Reference |
---|---|---|---|---|---|
NCC (Wnt1-Cre) | Med23 | WNT signaling | ③④ | Pierre Robin syndrome, micrognathia, cleft palate | [ |
NCC (Wnt1-Cre) | Fgf18 | WNT signaling | ①③④ | Micrognathia, cleft palate, hypoplastic craniofacial bones | [ |
NCC (Wnt1-Cre) | Six1 | WNT signaling, BMP signaling | ③④ | Branchio-oto-renal syndrome, micrognathia, cleft palate with ankyloglossia | [ |
NCC (Wnt1-Cre) | Bmp2 | BMP signaling | ③④ | Pierre Robin syndrome | [ |
NCC (Wnt1-Cre) | Bmp4 | BMP signaling | ②③④ | Severe deformation of molar buds, palate, and maxilla-mandibular bony structures; defected Meckel's cartilage | [ |
NCC (Wnt1-Cre) | Foxf2 | SHH signaling | ④ | Cleft palate | [ |
NCC (Wnt1-Cre) | Setdb1 | BMP signaling, WNT signaling | ④ | Cleft palate | [ |
NCC (Wnt1-Cre) | Ift20 | WNT signaling | ①③④ | Death shortly after birth due to difficulties in feeding and breathing, severe craniofacial malformation, loss of craniofacial bones, frontonasal dysplasia, micrognathia, cleft palate | [ |
NCC (Wnt1-Cre, Sox9-Cre) | G9a | SHH signaling | Wnt1: ①③; Sox9: ①② | Wnt1: death shortly after birth, shortened maxilla, restricted airway, frontonasal dysplasia Sox9: death shortly after birth, cranial skeletal dysplasia, smaller tooth germ, impaired tooth inner enamel epithelium | [ |
NCC (Wnt1-Cre) | Tak1 | FGF signaling | ③④ | Pierre Robin syndrome, micrognathia, abnormal tongue, cleft palate | [ |
NCC (Wnt1-Cre) | Tgfbr2 | FGF signaling | ‒ | Abnormal tongue | [ |
NCC (Wnt1-Cre) | Nell1 | WNT signaling | ① | Craniosynostosis | [ |
NCC (Wnt1-Cre) | Dlx3 | WNT signaling | ①③ | Tricho-dento-osseous syndrome, defected frontal bone and mandible | [ |
NCC (Wnt1-Cre) | Yap/Taz | WNT signaling | ①③ | Neural tube malformation, craniofacial vascular malformation, mandibular abnormalities | [ |
NCC (Wnt1-Cre) | Tfap2 | WNT signaling, RA signaling | ①③④ | Branchio-oto-renal syndrome, midface cleft, defected craniofacial bone | [ |
NCC (Wnt1-Cre) | Twist1 | FGF signaling | ① | Defected craniofacial bone | [ |
NCC (Wnt1-Cre) | Brca1/2 | P53 signaling | ①④ | Craniostenosis, cleft palate, defected craniofacial bone | [ |
NCC (Wnt1-Cre) | Smo | SHH signaling | ① | Defected craniofacial bone | [ |
NCC (Wnt1-Cre) | Ldb1 | WNT signaling | ④ | Cleft palate | [ |
NCC (Wnt1-Cre) | Osx | FGF signaling | ①③ | Micrognathia, defected craniofacial bone | [ |
First branchial arch mesenchymal cell (Pax2-Cre) | Bmp4 | BMP signaling | ‒ | Bilateral hyperplastic tissues | [ |
First branchial arch mesenchymal cell (Hand2-Cre) | Twist1 | FGF signaling | ③④ | Micrognathia, cleft palate | [ |
Mesenchymal cell (Twist2-Cre) | Fgf18 | WNT signaling | ①③ | Micrognathia, defected craniofacial bone | [ |
Mesenchymal cell (Twist1-Cre) | Twist1 | FGF signaling | ② | Defected dentin and enamel, tooth abnormalities | [ |
Osteoblast (Prx1-Cre) | Ift20 | WNT signaling | ① | Craniostenosis | [ |
Osteoblast (Osx-Cre, Col1-Cre) | Fgfr3 | WNT signaling | ① | Osx: CATSHL syndrome, frontonasal dysplasia Col1: CATSHL syndrome | [ |
Osteoblast (Osx-Cre) | Rar | RA signaling | ①③ | Vitamin A deficiency, micrognathia, frontonasal dysplasia | [ |
Osteoblast (Prx1-Cre, Osx-Cre) | Ror2 | BMP signaling, STAT signaling | ①②③ | Robinow syndrome, brachyrhinia | [ |
Osteoblast (Prx1-Cre, Osx-Cre) | Stat3 | STAT signaling | ①③ | AD-HIES syndrome, defected craniofacial bone | [ |
Osteoblast/chondroblast (Dermo1-Cre, Col2a1-Cre, Prx1-Cre, Osx-Cre) | Cbfb | WNT signaling | ①②③ | Dermo1 & Col2a1: Cleidocranial dysostosis, hypomineralized craniofacial bones, clavicle dysplasia Prx1: Cleidocranial dysostosis, hypomineralized parietal bones, clavicle missing Osx: Cleidocranial dysostosis, hypomineralized parietal bones, tooth deformities | [ |
Osteoblast/chondroblast (Prx1-Cre, Col2-Cre) | Recql4 | P53 signaling | ①② | Rothmund-Thomson syndrome, Baller-Gerold syndrome | [ |
Chondroblast (Col2-Cre) | Yap/Taz | WNT signaling | ①④ | Defected craniofacial bone, cleft palate | [ |
Osteoblast (Ocn-Cre) | Wls | WNT signaling | ①③ | Defected craniofacial bone, molar deformity | [ |
Osteoblast (Ocn-Cre) | Ift20 | WNT signaling | ① | Osteopenia-like phenotypes in skulls | [ |
Osteoblast (Osx-Cre) | Notch2 | Notch signaling | ①②③ | Hajdu-Cheney syndrome | [ |
Osteoblast (Osx-Cre) | Fgfr2 | FGF signaling | ①②③ | Crouzon syndrome | [ |
Osteoblast (Prrx1-Cre) | Gα | RANKL signaling | ① | Fibrous dysplasia | [ |
Osteoblast (Osx-Cre) | Efnb1 | Unclear | ①③ | Larger cranial height, larger interorbital and nasal widths, smaller maxillary width | [ |
Osteoblast (Osx-Cre) | Atg5 | MMP signaling | ① | Defected craniofacial bone | [ |
Osteoblast (Osx-Cre) | Fip200 | MMP signaling | ① | Defected craniofacial bone | [ |
Epithelial cell (Krt14-Cre、Eiia-Cre) | Wnt10a | WNT signaling | ② | Taurodontism | [ |
Epithelial cell (Krt14-Cre) | Tgfbr2 | WNT signaling | ④ | Soft palate cleft | [ |
Epithelial cell (Krt14-Cre) | Dlx3 | WNT signaling | ② | Hypomineralized enamel | [ |
Epithelial cell (Krt14-Cre) | Fgfr2 | FGF signaling | ② | Retarded tooth formation, cleft palate | [ |
Epithelial cell (Shh-Cre) | Wls | WNT signaling | ② | Defective ameloblast and odontoblast differentiation | [ |
CNC-derived cell subset in the developing palatal mesenchyme (Osr2-Cre) | β-catenin | WNT signaling | ④ | Cleft palate | [ |
CNC-derived cell subset in the developing palatal mesenchyme (Osr2-Cre) | Runx2 | RA signaling | ④ | Cleft palate | [ |
Pharyngeal endoderm cell (Foxg1-Cre) | Tbx1 | Unclear | ①③ | Velo-cardio-facial syndrome | [ |
表1 条件性基因编辑小鼠鉴定得到的牙颌面关键细胞谱系及其相关畸形致病基因
Tab 1 Key cell lineages and related genes responsible for dento-maxillofacial abnormalities through conditional gene-edited mice
Key cell lineage (marker-Cre) | Gene | Pathway | Characteristic of abnormalities | Related phenotype, syndrome or disease | Reference |
---|---|---|---|---|---|
NCC (Wnt1-Cre) | Med23 | WNT signaling | ③④ | Pierre Robin syndrome, micrognathia, cleft palate | [ |
NCC (Wnt1-Cre) | Fgf18 | WNT signaling | ①③④ | Micrognathia, cleft palate, hypoplastic craniofacial bones | [ |
NCC (Wnt1-Cre) | Six1 | WNT signaling, BMP signaling | ③④ | Branchio-oto-renal syndrome, micrognathia, cleft palate with ankyloglossia | [ |
NCC (Wnt1-Cre) | Bmp2 | BMP signaling | ③④ | Pierre Robin syndrome | [ |
NCC (Wnt1-Cre) | Bmp4 | BMP signaling | ②③④ | Severe deformation of molar buds, palate, and maxilla-mandibular bony structures; defected Meckel's cartilage | [ |
NCC (Wnt1-Cre) | Foxf2 | SHH signaling | ④ | Cleft palate | [ |
NCC (Wnt1-Cre) | Setdb1 | BMP signaling, WNT signaling | ④ | Cleft palate | [ |
NCC (Wnt1-Cre) | Ift20 | WNT signaling | ①③④ | Death shortly after birth due to difficulties in feeding and breathing, severe craniofacial malformation, loss of craniofacial bones, frontonasal dysplasia, micrognathia, cleft palate | [ |
NCC (Wnt1-Cre, Sox9-Cre) | G9a | SHH signaling | Wnt1: ①③; Sox9: ①② | Wnt1: death shortly after birth, shortened maxilla, restricted airway, frontonasal dysplasia Sox9: death shortly after birth, cranial skeletal dysplasia, smaller tooth germ, impaired tooth inner enamel epithelium | [ |
NCC (Wnt1-Cre) | Tak1 | FGF signaling | ③④ | Pierre Robin syndrome, micrognathia, abnormal tongue, cleft palate | [ |
NCC (Wnt1-Cre) | Tgfbr2 | FGF signaling | ‒ | Abnormal tongue | [ |
NCC (Wnt1-Cre) | Nell1 | WNT signaling | ① | Craniosynostosis | [ |
NCC (Wnt1-Cre) | Dlx3 | WNT signaling | ①③ | Tricho-dento-osseous syndrome, defected frontal bone and mandible | [ |
NCC (Wnt1-Cre) | Yap/Taz | WNT signaling | ①③ | Neural tube malformation, craniofacial vascular malformation, mandibular abnormalities | [ |
NCC (Wnt1-Cre) | Tfap2 | WNT signaling, RA signaling | ①③④ | Branchio-oto-renal syndrome, midface cleft, defected craniofacial bone | [ |
NCC (Wnt1-Cre) | Twist1 | FGF signaling | ① | Defected craniofacial bone | [ |
NCC (Wnt1-Cre) | Brca1/2 | P53 signaling | ①④ | Craniostenosis, cleft palate, defected craniofacial bone | [ |
NCC (Wnt1-Cre) | Smo | SHH signaling | ① | Defected craniofacial bone | [ |
NCC (Wnt1-Cre) | Ldb1 | WNT signaling | ④ | Cleft palate | [ |
NCC (Wnt1-Cre) | Osx | FGF signaling | ①③ | Micrognathia, defected craniofacial bone | [ |
First branchial arch mesenchymal cell (Pax2-Cre) | Bmp4 | BMP signaling | ‒ | Bilateral hyperplastic tissues | [ |
First branchial arch mesenchymal cell (Hand2-Cre) | Twist1 | FGF signaling | ③④ | Micrognathia, cleft palate | [ |
Mesenchymal cell (Twist2-Cre) | Fgf18 | WNT signaling | ①③ | Micrognathia, defected craniofacial bone | [ |
Mesenchymal cell (Twist1-Cre) | Twist1 | FGF signaling | ② | Defected dentin and enamel, tooth abnormalities | [ |
Osteoblast (Prx1-Cre) | Ift20 | WNT signaling | ① | Craniostenosis | [ |
Osteoblast (Osx-Cre, Col1-Cre) | Fgfr3 | WNT signaling | ① | Osx: CATSHL syndrome, frontonasal dysplasia Col1: CATSHL syndrome | [ |
Osteoblast (Osx-Cre) | Rar | RA signaling | ①③ | Vitamin A deficiency, micrognathia, frontonasal dysplasia | [ |
Osteoblast (Prx1-Cre, Osx-Cre) | Ror2 | BMP signaling, STAT signaling | ①②③ | Robinow syndrome, brachyrhinia | [ |
Osteoblast (Prx1-Cre, Osx-Cre) | Stat3 | STAT signaling | ①③ | AD-HIES syndrome, defected craniofacial bone | [ |
Osteoblast/chondroblast (Dermo1-Cre, Col2a1-Cre, Prx1-Cre, Osx-Cre) | Cbfb | WNT signaling | ①②③ | Dermo1 & Col2a1: Cleidocranial dysostosis, hypomineralized craniofacial bones, clavicle dysplasia Prx1: Cleidocranial dysostosis, hypomineralized parietal bones, clavicle missing Osx: Cleidocranial dysostosis, hypomineralized parietal bones, tooth deformities | [ |
Osteoblast/chondroblast (Prx1-Cre, Col2-Cre) | Recql4 | P53 signaling | ①② | Rothmund-Thomson syndrome, Baller-Gerold syndrome | [ |
Chondroblast (Col2-Cre) | Yap/Taz | WNT signaling | ①④ | Defected craniofacial bone, cleft palate | [ |
Osteoblast (Ocn-Cre) | Wls | WNT signaling | ①③ | Defected craniofacial bone, molar deformity | [ |
Osteoblast (Ocn-Cre) | Ift20 | WNT signaling | ① | Osteopenia-like phenotypes in skulls | [ |
Osteoblast (Osx-Cre) | Notch2 | Notch signaling | ①②③ | Hajdu-Cheney syndrome | [ |
Osteoblast (Osx-Cre) | Fgfr2 | FGF signaling | ①②③ | Crouzon syndrome | [ |
Osteoblast (Prrx1-Cre) | Gα | RANKL signaling | ① | Fibrous dysplasia | [ |
Osteoblast (Osx-Cre) | Efnb1 | Unclear | ①③ | Larger cranial height, larger interorbital and nasal widths, smaller maxillary width | [ |
Osteoblast (Osx-Cre) | Atg5 | MMP signaling | ① | Defected craniofacial bone | [ |
Osteoblast (Osx-Cre) | Fip200 | MMP signaling | ① | Defected craniofacial bone | [ |
Epithelial cell (Krt14-Cre、Eiia-Cre) | Wnt10a | WNT signaling | ② | Taurodontism | [ |
Epithelial cell (Krt14-Cre) | Tgfbr2 | WNT signaling | ④ | Soft palate cleft | [ |
Epithelial cell (Krt14-Cre) | Dlx3 | WNT signaling | ② | Hypomineralized enamel | [ |
Epithelial cell (Krt14-Cre) | Fgfr2 | FGF signaling | ② | Retarded tooth formation, cleft palate | [ |
Epithelial cell (Shh-Cre) | Wls | WNT signaling | ② | Defective ameloblast and odontoblast differentiation | [ |
CNC-derived cell subset in the developing palatal mesenchyme (Osr2-Cre) | β-catenin | WNT signaling | ④ | Cleft palate | [ |
CNC-derived cell subset in the developing palatal mesenchyme (Osr2-Cre) | Runx2 | RA signaling | ④ | Cleft palate | [ |
Pharyngeal endoderm cell (Foxg1-Cre) | Tbx1 | Unclear | ①③ | Velo-cardio-facial syndrome | [ |
图3 应力下牙-牙周复合体整体代谢水平评价模式的转变Note: OPG—osteoprotegerin; M1/M2/M3—molar 1/2/3; ROI—region of interest.
Fig 3 Transform of evaluation of the general metabolic level of tooth-periodontal complex under stress
图5 牙颌面骨畸形“一体两翼”研究模式的现状、发展与展望Note:qPCR—quantitative polymerase chain reaction; WB—Western blotting; IF—immunofluorescence; IHC—immunohistochemistry; KO—knockout; cKO—conditional knockout; ScRNA-seq—single cell RNA sequencing.
Fig 5 Current status and future of the "One Centre, Two Motives" research mode for dento-maxillofacial skeletal abnormalities
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