Immunoprecipitation high performance liquid chromatographic analysis of healing process in chronic suppurative osteomyelitis of the jaw.

PURPOSE: Chronic suppurative osteomyelitis (CSO) of the jaw is one of the most difficult infectious diseases to manage, because it causes progressive bony destruction and is associated with bacterial inhabitation of the sequestra. A combination of antibiotic therapy and surgical debridement is often used to treat CSO. Nevertheless, various systemic conditions can lead to life-threatening complications.

METHODS: The present study aimed to explore the wound healing progress in 16 cases of CSO through protein expression analysis of postoperative exudates (POE) that were collected 6 h, 1 day, and 2 days after saucerization and/or decortication. A bony lesion was removed during surgery and then examined pathologically, and the CSO POE was examined by immunoprecipitation thus high performance chromatography (IP-HPLC). The POE at 6 h was used as a comparative control.

RESULTS: Histologically the CSO lesion showed a necrotic granulomatous lesion heavily infiltrated with polymorphonuclear leukocytes, macrophages, and plasma cells, admixed with multiple sequestra inhabited by bacterial colonies. The IP-HPLC analysis displayed a slight increase in innate immunity-related proteins, i.e., NFkB, TNFα, IL-1, IL-6, IL-28, and LL-37, but a gradual decrease of bacteria-related inflammatory proteins, i.e., IL-8, IL-12, CD31, CD68, and lysozyme. The angiogenesis-related proteins, i.e., VEGF-A and VEGF-C, were slightly decreased but TGF-β1 and bFGF were markedly increased on day 2. The osteogenesis-related proteins, i.e., OPG and ALP, were slightly increased, while the osteoclastogenesis-related protein, RANKL was slightly decreased compared to the control.

CONCLUSION: These findings indicate that the infected CSO undergoes a rapid wound healing process with active osteogenesis and a gradual decrease in bacteria-related inflammation, predicting a favorable prognosis after surgery. Moreover, IP-HPLC can be useful in monitoring the POE and wound healing processes during the postoperative period.