अमूर्त

Nutrient-enriched microenvironments: An immunometabolic approach to the management of MRONJ -A case series.

Mark Tuffley*

Objective: To test the clinical effectiveness of adjunctive nutrient augmentation of medicationrelated osteonecrosis of the jaw (MRONJ).

Background: MRONJ represents disordered bone and soft tissue physiology with impaired osseoimmune competence. It often has unacceptable rates of healing particularly in the subgroup of patients suffering osseous malignancies; attempted healing takes place in the context of harsh micro-environmental factors such as hypoxia and nutrient depletions and at times, immune modulating chemotherapy. Immune cell's metabolism is tightly linked to nutrient availability which acts as cues shaping immunological signaling. The resultant immunomodulation is central to adaptive and innate immunity and has profound implications for the healing responses being mediated by myeloid and lymphoid derived cells. We therefore proposed a clinical trial in which we targeted various nutritional sensing pathways via the topical augmentation of MRONJ's nutritional milieu.

Results: 15 consecutive patients were managed over a 7 year period utilizing a comprehensive, nutrient containing hydrogel [CNM] as a wound dressing; this approach was integrated into the overall AAOMS protocol for the management of MRONJ. All patients achieved resolution; the areas of healing remained asymptomatic with intact mucosal coverage for a minimum follow up of 27 months. (Patient 1 in the series improved with a better quality of life before succumbing to her metastatic disease)

Conclusion: The predictable and stable healing responses points to beneficial immuno-modulation of MRONJ's wounds utilising nutritional augmented therapy.