Worldental Daily, Wednesday, 29 August 2012

Opinion Wednesday, 29 August 2012 I n September 2011, a UN High- level Meeting on Noncommuni- cable Diseases (NCDs) was held in New York City. This was a water- shed moment in the global fight against NCDs with the adoption of the Political Declaration on NCDs byUNmemberstates,meaningthat all nations must take action against this global epidemic. The four prin- cipal NCDs, cardiovascular disease, cancer, diabetes and respiratory diseases, accounted for 60 % of all deaths globally and 80% of deaths in low- and middle-income coun- tries in 2005.TheWHO projects that deaths attributed to NCDs will rise globally by 17% by 2015. There are four primary risk fac- tors that fuel the rising incidence of NCDs: tobacco use, alcohol abuse, poor nutrition and physical inactiv- ity. Disease prevention and control focused on minimising public expo- sure to such risk is vital to revers- ing the rising tide of NCDs. If this is not done, NCDs will continue to be a major obstacle to socio-economic development and a barrier to the achievement of the Millennium De- velopment Goals and the Post-2015 UN development agenda. Oral disease, the most common NCD and one of the most expensive totreat,isaglobalpublichealthcon- cern. The political declaration notes that oral diseases “share common risk factors and can benefit from common responses”. Therefore, in- terventions and strategies to im- prove nutrition should haveapositiveimpacton all NCDs, including the prevention and control of oral disease. The UN knows how to deal with NCDs; it is a matter of taking action by opera- tionalisingexistingplans such as the WHO Global Strategy on Diet, Physi- cal Activity and Health, and utilising processes and structures such as the WHO Innovative Care for Chronic Conditions Framework. The WHO will be the lead agency implement- ing prevention and con- trol measures for NCDs; however, progress will require a multifaceted approach from multiple sectors. In terms of nu- trition, concerted action with other UN agencies and subsidiaries such as the Food and Agriculture Organization of the United Nations and the Codex Ali- mentariusCommission,andpartner- ships with external agencies, includ- ing global NGOs such as the FDI World Dental Federation and the International Diabetes Federation (IDF), is needed. Diets comprised of processed foods with high fat, salt, and sugar content are common lifestyle choices in today’s society. Improving nutrition will require gov- ernments to mandate legislation and regulation reflective of health in all policies; a philosophical shift in the agrifood industry to provide af- fordable, healthy food; health-care providers to educate and facilitate behaviour change in the public they serve; and all of society to engage in healthy lifestyle practices. Partnerships are crucial to the successoffutureendeavoursagainst NCDs. Many NGOs and civil society organisations have already come together under the NCD Alliance and the World Health Professions Alliance to share expertise and co- ordinate efforts to facilitate change. The FDI and IDF recognise the impor- tance of partnership as witnessed by the release of “A call to action for integrated case management of thediabeticpatient”duringthe2007 Annual World Dental Congress in Dubai. This led IDF to create oral health resources for diabetes care providers and raised awareness about the importance of oral health in diabetes management. Today we have the task of imple- mentingthePoliticalDeclara- tion on NCDs by addressing complex issues such as poor nutrition. Mitigating this risk factor will help with the pre- vention and control of oral disease and type 2 diabetes. Now is the time for both fed- erations to renew efforts for collaborative action on this global concern. Dr Martin Gillis is an assis- tant professor at the Dal- housie University’s Faculty of Dentistry in Halifax, Canada, and a member of IDF’s Con- sultative Section on Diabetes Education. He also serves as the oral health representa- tive for IDF. Today, he will be presenting a paper entitled “Poor nutrition: A risk factor driving the NCD epidemic” as part of the scientific pro- gramme at this year’s con- gress in room S221 of the HKCEC. NCDs—Amajorobstacletosocio-economicdevelopment ByDrMartinGillis,Canada IDrMartinGillis “Oral disease, the most common NCD and one of the most expensive to treat, is a global public health concern.” M esenchymalstemcells(MSCs) are a population of hierar- chical postnatal stem cells with the potential to differentiate in- tomesodermallineage-derivedcells, includingosteoblasts,chondrocytes, adipocytes, cardiomyocytes, myo- blasts and non-mesodermal lineage- derived cells, such as neural cells. They are a promising source for regenerative medicine in terms of formingmineralisedtissuetoreplace damagedanddiseasedtissue. The orofacial region contains mul- tiplelineage,includingbonemarrow- derived MSCs (BMMSCs), dental-pulp stem cells, periodontal ligament stem cells (PDLSCs), stem cells from human exfoliated deciduous teeth, stem cells from root apical papilla, and gingival stem/progenitor cells. Our team of researchers at the Uni- versity of Southern California has identified that PDLSCs can be used successfully to treat periodontitis with regeneration of cementum and Sharpey’s fibres in swine and hu- mans. More interestingly, we used oro- facial MSCs to regenerate root/peri- odontal complexes that are capable of supporting artificial porcelain crowns, resulting in restoration of normal tooth function in swine. We were also able to generate jaw os- teonecrosis in mice and employed BMMSC implantation to treat the necrosis, suggesting a novel thera- peutic approach to treating jaw ne- crosis using new BMMSC-generated bone and bone marrow. Although stem cell-based regen- erative medicine is a promising ap- proach for functional tissue recon- struction,theroleofimmuneresponse in cell-based tissue regeneration re- mainsunclear.Wedemonstratedthat pro-inflammatory T cells in the reci- pients inhibited BMMSC-mediated bone formation via T helper 1 cyto- kine interferon (IFN)-γ-induced down- regulation of runt-related transcrip- tion factor 2 pathway and tumour necrosis factor (TNF)-α-regulated BMMSC apoptosis. We found that TNF-αconvertedIFN-γ-activatednon- apoptotic Fas to a caspase 3/8-asso- ciated apoptotic signalling in BMM- SCs through inhibition of nuclear factor kappa B, resulting in BMMSC apoptosis. Conversely, reduction of IFN-γ and TNF-α levels at the implantation sites by systemic infusion of Foxp3+ regulatory T cells markedly improved BMMSC-based bone regeneration and calvarial defect repair in C57BL6 mice. For potential pharmacological intervention, we demonstrated that local administration of aspirin re- duced levels of IFN-γ and TNF-α at the implantation site and significant- ly improved BMMSC-based calvarial defect repair. These results collectively uncover a previously unrecognised role of re- cipientTcellsinBMMSC-basedtissue engineering and suggest a practical approachtoenhancingboneregener- ation by pharmacological control of local cytokines. MSC-based immunotherapy has demonstratedsuccessfuloutcomesin several human diseases and preclini- cal disease models, including acute graft-versus-host disease, systemic lupus erythematosus and SS, etc. The promising results of such therapeutic effects have led to exploration of the underlying mechanisms. It has been shown that MSCs, including orofacial tissue-derived MSCs, target lympho- cytes through several soluble factors, such as nitric oxide, indoleamine 2,3- dioxygenase, and the Fas/FasL path- way. The immunomodulatory proper- ties of MSCs also play an important role in treating immune-related oral diseases, such as bisphosphonate- related osteonecrosis of the jaw char- acterisedbysuppressionofregulatory TcellsandactivationofThelper17cells. Our and others’ studies indicate the great potential for using MSCs to treat a variety of disorders and to regenerate functional mineralised tissue. DrSongtaoShiisanassociatepro- fessor at the University of Southern California’s Center for Craniofacial Molecular Biology in Los Angeles in the US.This afternoon, he will be pre- senting a paper on MSCs as part of thescientificprogrammeatthisyear’s congress in Hall F of the HKCEC. Mesenchymalstemcells:Fromclinicstobenchtopandback ByDrSongtaoShi,USA IDrSongtaoShi “...the role of immune response in cell-based tissue regeneration remains unclear.” 04 www.fdiworldental.org