<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article  PUBLIC "-//NLM//DTD Journal Publishing DTD v3.0 20080202//EN" "http://dtd.nlm.nih.gov/publishing/3.0/journalpublishing3.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="3.0" xml:lang="en" article-type="research article"><front><journal-meta><journal-id journal-id-type="publisher-id">OJST</journal-id><journal-title-group><journal-title>Open Journal of Stomatology</journal-title></journal-title-group><issn pub-type="epub">2160-8709</issn><publisher><publisher-name>Scientific Research Publishing</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.4236/ojst.2020.103004</article-id><article-id pub-id-type="publisher-id">OJST-98905</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine&amp;Healthcare</subject></subj-group></article-categories><title-group><article-title>
 
 
  LRP&lt;sub&gt;5&lt;/sub&gt; Affects Homeostasis of the Periodontal Complex
 
</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Joo-Hyung</surname><given-names>Kim</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Ye-Hyun</surname><given-names>Kim</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Won</surname><given-names>Hee Lim</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib></contrib-group><aff id="aff1"><addr-line>Department of Orthodontics, School of Dentistry &amp;amp; Dental Research Institute, Seoul National University, Seoul, Korea</addr-line></aff><pub-date pub-type="epub"><day>16</day><month>03</month><year>2020</year></pub-date><volume>10</volume><issue>03</issue><fpage>29</fpage><lpage>37</lpage><history><date date-type="received"><day>12,</day>	<month>February</month>	<year>2020</year></date><date date-type="rev-recd"><day>14,</day>	<month>March</month>	<year>2020</year>	</date><date date-type="accepted"><day>17,</day>	<month>March</month>	<year>2020</year></date></history><permissions><copyright-statement>&#169; Copyright  2014 by authors and Scientific Research Publishing Inc. </copyright-statement><copyright-year>2014</copyright-year><license><license-p>This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/</license-p></license></permissions><abstract><p>
 
 
  Purpose: The signals responsible for homeostasis in the periodontal complex are unclear. The purpose of this study was to evaluate the role of Low-density lipoprotein receptor-related protein 5(LRP
  <sub>5</sub>) in this process by removing LRP
  <sub>5</sub>, and observing the effects of LRP
  <sub>5</sub> depletion on cells of the periodontal structures. 
  Material and Methods: The function of this LRP
  <sub>5</sub> was evaluated by conditional elimination of the LRP
  <sub>5</sub> gene using an Osteocalcin Cre driver. The 
  <em>OCN-Cre</em>; 
  <inline-formula><inline-graphic xlink:href="dit_ea3fd2a8-4e52-4060-8d7a-4f00cfd45ac3.png" xlink:type="simple"/></inline-formula> mice were examined using micro-CT and histology, immunohistochemistry to evaluate the periodontal complex. 
  Results: Elimination of LRP
  <sub>5</sub> in the periodontal complex of 
  <em>OCN-Cre</em>; 
  <inline-formula><inline-graphic xlink:href="dit_467f5470-a481-40c0-a71e-4861ecc5f9a1.png" xlink:type="simple"/></inline-formula> mice results in a different expression of Fibromodulin in the periodontal ligament space. A decrease in osteoclastic activity was found in the periodontal ligament.
   Conclusion: Osteoclastic activities are decreased and expression of fibromodulin is decreased, which implies the involvement of LRP
  <sub>5 </sub>in homeostasis of the periodontal ligament.
 
</p></abstract><kwd-group><kwd>LRP&lt;sub&gt;5&lt;/sub&gt;</kwd><kwd> Periodontal Ligament</kwd><kwd> Homeostasis</kwd></kwd-group></article-meta></front><body><sec id="s1"><title>1. Introduction</title><p>Low-density lipoprotein receptor-related protein 5 (LRP<sub>5</sub>) is known to be a key component in Wnt signaling pathway. Mutations in LRP<sub>5</sub> cause alteration in bone mass. During bone development, a deletion of LRP<sub>5</sub> leads to a decrease in bone mass [<xref ref-type="bibr" rid="scirp.98905-ref1">1</xref>]. On the other hand, a gain in LRP<sub>5</sub> causes an increase in bone mass [<xref ref-type="bibr" rid="scirp.98905-ref2">2</xref>] [<xref ref-type="bibr" rid="scirp.98905-ref3">3</xref>]. Thus, LRP<sub>5</sub> is involved in disease related to bone. It has been known that homeostasis of bone mass is controlled by LRP<sub>5</sub> through osteocytes [<xref ref-type="bibr" rid="scirp.98905-ref4">4</xref>] [<xref ref-type="bibr" rid="scirp.98905-ref5">5</xref>]. However, a controlling process of bone mass by LRP<sub>5</sub> is not well established. It is believed that high bone mass mutation occurs in either limb or osteoblast [<xref ref-type="bibr" rid="scirp.98905-ref6">6</xref>]. For treatment of osteoporosis, an osteocyte-specific protein binding to LRP<sub>5</sub> has been used to block Wnt signaling pathway [<xref ref-type="bibr" rid="scirp.98905-ref7">7</xref>].</p><p>Mice that carry the same G171V substitution (e.g., Lrp5G171V mice) show an increase in bone mass and bone density [<xref ref-type="bibr" rid="scirp.98905-ref8">8</xref>]. In addition, Lrp5G171V mice exhibited a decrease in the width of periodontal ligament, which is concomitant with an increase in alveolar bone mass [<xref ref-type="bibr" rid="scirp.98905-ref9">9</xref>]. To create a loss of LRP<sub>5</sub> function phenotype, we used OCN-Cre; LRP 5 f l / f l mice [<xref ref-type="bibr" rid="scirp.98905-ref10">10</xref>]. Analyses of the loss of LRP<sub>5</sub> function animal models provided new information regarding homeostasis of periodontal complex.</p></sec><sec id="s2"><title>2. Material and Methods</title><sec id="s2_1"><title>2.1. Generation of Mouse Strains</title><p>The generation of OCN-Cre; LRP 5 f l / f l mice has been previously described. Ten 3 month-old mice were analyzed; 5 were OCN-Cre; LRP 5 f l / f l mice and 5 were wild-type littermates.</p></sec><sec id="s2_2"><title>2.2. Micro-CT Analysis</title><p>Micro-CT was taken using MicroXCT-200 (SkyScan, Belgium) at 60 kV and 7.98 Watt and a resolution of 2 microns. CT slices were reconstructed using MicroXCT7.0 reconstruction software (SkyScan, Belgium). Inveon Research Workplace (IRW) (Erlangen, Germany) was used for analysis.</p></sec><sec id="s2_3"><title>2.3. Sample Preparation, Processing and Histology</title><p>Harvested maxillae from the wild type and OCN-Cre; LRP 5 f l / f l mice were fixed in 4% paraformaldehyde for one night at 4˚C and then decalcified in a heat-controlled microwave in 19% EDTA for 14 days. After this process, specimens were dehydrated using ethanol series and then embedded with paraffin. Eight-micron-thick sections were cut and collected for analyses.</p></sec><sec id="s2_4"><title>2.4. Histology</title><p>Pentachrome staining was performed [<xref ref-type="bibr" rid="scirp.98905-ref11">11</xref>].</p></sec><sec id="s2_5"><title>2.5. Cellular Assays and Immunohistochemistry</title><p>Alkaline phosphatase staining was performed to investigate osteogenic factors. For immunostaining analyses, tissue sections were deparaffinized and endogenous peroxidase activity was smothered using 3% hydrogen peroxide then washed with PBS. Slides were blocked out using 5% goat serum (Vector S-1000) for 1 hour. The relevant primary antibody was attached and cultured for one night at 4˚C, then washed with PBS. Samples were cultured using relevant biotinylated secondary antibodies (Vector BA-x) for half an hour, and washed in PBS. An advidin/biotinylated enzyme complex (Kit ABC Peroxidase Standard Vectastain PK-4000) was attached and cultured for 30 minutes and a DAB substrate kit (Kit Vector Peroxidase subtrate DAB SK-4100) was utilized to detect the color reaction. Used antibodies include osteocalcin (Origene, dilution 1:100), Osterix (NIH LF 175, dilution 1:4000), Fibromodulin (Santa Cruz Biotech, dilution 1:1000), dentin sialoprotein (DSP, Millipore, dilution 1:2000), CD 68 (Thermo Fisher Scineticif, dilution 1:100) and Receptor activator of nuclear factor kappa-Β ligand (RANKL, (Lab Vision, dilution 1:100)).</p></sec></sec><sec id="s3"><title>3. Results</title><sec id="s3_1"><title>3.1. Bone Volume Is Maintained in OCN-Cre; LRP<sub>5</sub><sup>fl</sup><sup>/fl</sup> Mice</title><p>Micro-CT examination of the craniofacial skeleton of OCN-Cre; LRP 5 f l / f l mice revealed that similar bone volume of skeletal elements (<xref ref-type="fig" rid="fig1">Figure 1</xref>). Deletion of LRP<sub>5</sub> did not affect the size of the skeletal elements (<xref ref-type="fig" rid="fig1">Figure 1</xref>). The dentition of OCN-Cre; LRP 5 f l / f l mice was similar compared to wild-type mice. The overall size, shape, and position of the teeth were the same between wild-type and OCN-Cre; LRP 5 f l / f l mice (<xref ref-type="fig" rid="fig1">Figure 1</xref>). The gross morphology of the molars and incisors was similar in wild-type and mutant mice.</p></sec><sec id="s3_2"><title>3.2. Fibromodulin Expression Is Altered in OCN-Cre; LRP<sub>5</sub><sup>fl</sup><sup>/fl</sup> Mice</title><p>Histologic examination of the maxillary periodontal complex confirmed the finding in micro-CT examination (<xref ref-type="fig" rid="fig2">Figure 2</xref>(A) and <xref ref-type="fig" rid="fig2">Figure 2</xref>(B)). In wild-type mice (<xref ref-type="fig" rid="fig2">Figure 2</xref>(C)), the periodontal ligament consisted of numerous cells and</p><p>collagen fiber bundles. Histological examination of the periodontal complex demonstrated that, compared to wild-type mice, there was no alteration in the fibrillar structure of the PDL in OCN-Cre; LRP 5 f l / f l mice (<xref ref-type="fig" rid="fig2">Figure 2</xref>(D)). In addition, the width of periodontal ligament showed no difference between wild-type and OCN-Cre; LRP 5 f l / f l mice. Higher magnification revealed that there was no difference in the alveolar bone and root surfaces in OCN-Cre; LRP 5 f l / f l mice compared to wild-type mice.</p><p>Using Fibromodulin immunostaining [<xref ref-type="bibr" rid="scirp.98905-ref12">12</xref>], we found variations in expression. In wild-type mice, Fibromodulin was uniformly dispensed in the PDL space (<xref ref-type="fig" rid="fig2">Figure 2</xref>(E)). In OCN-Cre; LRP 5 f l / f l mice, however, Fibromodulin expression was very low in the PDL space (<xref ref-type="fig" rid="fig2">Figure 2</xref>(F)).</p><p>There was no difference in expression of DSP between wild-type and mutant mice (<xref ref-type="fig" rid="fig2">Figure 2</xref>(G) and <xref ref-type="fig" rid="fig2">Figure 2</xref>(H)).</p></sec><sec id="s3_3"><title>3.3. Alteration of Osteogenic Markers in Periodontal Ligament Space of OCN-Cre; LRP<sub>5</sub><sup>fl/fl</sup> Mice</title><p>In wild-type mice, osteocalcin was expressed throughout the PDL space (<xref ref-type="fig" rid="fig3">Figure 3</xref>(A)). In OCN-Cre; LRP 5 f l / f l mice, osteocalcin was minimally expressed in the periodontal ligament (<xref ref-type="fig" rid="fig3">Figure 3</xref>(B)). We also found that Osterix was strongly expressed in the wild-type and mutant periodontal ligament (<xref ref-type="fig" rid="fig3">Figure 3</xref>(C) and <xref ref-type="fig" rid="fig3">Figure 3</xref>(D)).</p></sec><sec id="s3_4"><title>3.4. Alteration of Osteoclastic Activity in OCN-Cre; LRP<sub>5</sub><sup>fl/fl</sup> Mice</title><p>In wild-type mice, CD 68 was expressed throughout the PDL space (<xref ref-type="fig" rid="fig4">Figure 4</xref>(A)), while expression of CD 68 was altered in the periodontal ligament of OCN-Cre; LRP 5 f l / f l mice (<xref ref-type="fig" rid="fig4">Figure 4</xref>(B)). RANKL expression in wild-type mice found throughout the PDL space (<xref ref-type="fig" rid="fig4">Figure 4</xref>(C)) while expression of RANKL was reduced in the periodontal ligament of OCN-Cre; LRP 5 f l / f l mice (<xref ref-type="fig" rid="fig4">Figure 4</xref>(D)). No difference in ALP activity was found between the wild-type and OCN-Cre; LRP 5 f l / f l mice periodontal ligament (<xref ref-type="fig" rid="fig4">Figure 4</xref>(C) and <xref ref-type="fig" rid="fig4">Figure 4</xref>(D)).</p></sec></sec><sec id="s4"><title>4. Discussion</title><p>Wnt signaling pathway is involved in homeostasis of periodontal complex [<xref ref-type="bibr" rid="scirp.98905-ref9">9</xref>] [<xref ref-type="bibr" rid="scirp.98905-ref13">13</xref>] [<xref ref-type="bibr" rid="scirp.98905-ref14">14</xref>] [<xref ref-type="bibr" rid="scirp.98905-ref15">15</xref>]. Using gain- and loss-of-Wnt function animal models, reduced Wnt</p><p>signaling exhibits an increase in the width of the PDL while elevated Wnt signaling reduces the width of the PDL. Elevated Wnt signaling by mutations in the Wnt co-receptor Lrp5 caused an increased osteogenic gene expression and decreased bone resorption, which leaded to alveolar bone accumulation. On the other hand, our CT data and histology showed that OCN-Cre; LRP 5 f l / f l mice exhibited insignificant changes in alveolar bone mass. One possible explanation for this comes from the fact that a reduction in bone mass occurs when LRP<sub>5</sub> is removed only in osteocytes [<xref ref-type="bibr" rid="scirp.98905-ref16">16</xref>].</p><p>Periodontal cells are reported to be Wnt responsive [<xref ref-type="bibr" rid="scirp.98905-ref17">17</xref>], so PDL cells are affected by Wnt signaling. Expression of fibromodulin in Lrp5<sup>ACT</sup> mice is strong in a previous study [<xref ref-type="bibr" rid="scirp.98905-ref9">9</xref>], while expression of fibromodulin in OCN-Cre; LRP 5 f l / f l mice was dramatically reduced. The reason for this is not known. However, it may implicate that a reduction of fibromodulin leads to a disorganized periodontal collagen and missing its typical extracellular matrix [<xref ref-type="bibr" rid="scirp.98905-ref18">18</xref>].</p><p>Bone formation is known to be influenced by LRP<sub>5</sub>. However, it is not clear that bone resorption depends on LRP<sub>5</sub>. Osteoclast activity is known to be influenced by the coupled action of the Osteoprotegerin and RANKL. Osteoclast activity indicated by TRAP staining was significantly decreased in Lrp5<sup>ACT</sup> mice, while RANKL expression in Lrp5<sup>ACT</sup> mice was not altered compared to the wild-type mice [<xref ref-type="bibr" rid="scirp.98905-ref9">9</xref>]. In this study, osteoclast activity indicated by CD 68 expression, and RANKL expression were decreased in OCN-Cre; LRP 5 f l / f l mice. Here, bone resorption was influenced by LRP<sub>5</sub>, although the mechanism appears elusive. On the other hand, Ad-Dkk1 treated mice showed a significant increase in both TRAP activity and expression of RANKL [<xref ref-type="bibr" rid="scirp.98905-ref9">9</xref>]. In the case where Wnt signaling is particularly lower, both TRAP and RANKL activity are influenced. Ongoing work is in progress to explain the mechanism related to the role of LRP<sub>5</sub> during bone resorption.</p></sec><sec id="s5"><title>5. Conclusion</title><p>Using loss-of-LRP<sub>5</sub> function animal model, we show that reduced LRP<sub>5</sub> is involved in altered collagen structure in the periodontal ligament and bone resorption.</p></sec><sec id="s6"><title>Acknowledgements</title><p>This work was supported by a Gran No. 05-2014-0011 from the Seoul National University Dental Hospital Research Fund.</p></sec><sec id="s7"><title>Conflicts of Interest</title><p>The authors declare no conflicts of interest regarding the publication of this paper.</p></sec><sec id="s8"><title>Cite this paper</title><p>Kim, J.-H., Kim, Y.-H. and Lim, W.H. (2020) LRP<sub>5</sub> Affects Homeostasis of the Periodontal Complex. 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