Efeito de diferentes gomas de mascar sobre o pH salivar de crianças

Objective: To evaluate the effect of different chewing gum brands on the salivary pH of children with primary dentition. Method: Forty children were selected and assigned to four groups: control (no chewing gum); sugarless chewing gum; chewing gum with casein phosphopeptide-amorphous calcium phosphate; and chewing gum with xylitol. The first saliva collection was made after supervised tooth brushing for stabilization of the oral pH. Next, all children were instructed to drink slowly 100 mL of a cola-based soft drink (Coca-Cola®) and a new saliva collection was made 10 min later. Then, each group chewed on the chewing gum for 5 min and discarded it after this time. Saliva was collected again at 5, 10 and 15 min intervals after start using the chewing gum. Measurement of salivary pH was made with colorimetric test papers and a digital pH-meter. Data were analyzed statistically by analysis of variance and Tukey’s test at a 5% significance level. Results: The use of chewing gums accelerated the increase of salivary pH to considerably alkaline levels after consumption of an acidic beverage, especially within the first minutes. The highest levels were obtained in the groups of children that used chewing gums containing xylitol and casein phosphopeptide-amorphous calcium phosphate. Conclusion: Children that used the chewing gums after ingestion of an acidic soft drink presented an increase in salivary pH, with the best results in the groups that used chewing gums containing casein phosphopeptide-amorphous calcium phosphate and xylitol.

Different protocols to produce artificial dentine carious lesions in vitro and in situ: hardness and mineral content correlation

This study compared dentine demineralization induced by in vitro and in situ models, and correlated dentine surface hardness (SH), cross-sectional hardness (CSH) and mineral content by transverse microradiography (TMR). Bovine dentine specimens (n = 15/group) were demineralized in vitro with the following: MC gel (6% carboxymethylcellulose gel and 0.1 m lactic acid, pH 5.0, 14 days); buffer I (0.05 m acetic acid solution with calcium, phosphate and fluoride, pH 4.5, 7 days); buffer II (0.05 m acetic acid solution with calcium and phosphate, pH 5.0, 7 days), and TEMDP (0.05 m lactic acid with calcium, phosphate and tetraethyl methyl diphosphonate, pH 5.0, 7 days). In an in situ study, 11 volunteers wore palatal appliances containing 2 bovine dentine specimens, protected with a plastic mesh to allow biofilm development. The volunteers dripped a 20% sucrose solution on each specimen 4 times a day for 14 days. In vitro and in situ lesions were analyzed using TMR and statistically compared by ANOVA. TMR and CSH/SH were submitted to regression and correlation analysis (p < 0.05). The in situ model produced a deep lesion with a high R value, but with a thin surface layer. Regarding the in vitro models, MC gel produced only a shallow lesion, while buffers I and II as well as TEMDP induced a pronounced subsurface lesion with deep demineralization. The relationship between CSH and TMR was weak and not linear. The artificial dentine carious lesions induced by the different models differed significantly, which in turn might influence further de- and remineralization processes. Hardness analysis should not be interpreted with respect to dentine mineral loss

In situ effect of chewing gum containing CPP–ACP on the mineral precipitation of eroded bovine enamel

Objectives: Stimulation of salivary flow is considered a preventive strategy for dental erosion. Alternatively, products containing calcium phosphate, such as a complex of casein phosphopeptide–amorphous calcium phosphate (CPP–ACP), have also been tested against dental erosion. Therefore, this in situ study analyzed the effect of chewing gum containing CPP–ACP on the mineral precipitation of initial bovine enamel erosion lesions. Methods: Twelve healthy adult subjects wore palatal appliances with two eroded bovine enamel samples. The erosion lesions were produced by immersion in 0.1% citric acid (pH 2.5) for 7 min. During three experimental crossover in situ phases (1 day each), the subjects chewed a type of gum, 3 times for 30 min, in each phase: with CPP–ACP (trident total), without CPP–ACP (trident), and no chewing gum (control). The Knoop surface microhardness was measured at baseline, after erosion in vitro and the mineral precipitation in situ. The differences in the degree of mineral precipitation were analyzed using repeated measures (RM-) ANOVA and post hoc Tukey’s test ( p < 0.05). Results: Significant differences were found among the remineralizing treatments ( p < 0.0001). Chewing gum (19% of microhardness recovery) improved the mineral precipitation compared to control (10%) and the addition of CPP–ACP into the gum promoted the best mineral precipitation effect (30%). Conclusions: Under this protocol, CPP–ACP chewing gum improved the mineral precipitation of eroded enamel. Clinical significance: Since the prevalence of dental erosion is steadily increasing, CPP–ACP chewing gum might be an important strategy to reduce th eprogression of initial erosion lesions.

Saliva and dental erosion

Dental erosion is a multifactorial condition. The consideration of chemical, biological and behavioral factors is fundamental for its prevention and therapy. Among the biological factors, saliva is one of the most important parameters in the protection against erosive wear. Objective: This review discusses the role of salivary factors on the development of dental erosion. Material and Methods: A search was undertaken on MeDLINe website for papers from 1969 to 2010. The keywords used in the research were "saliva", "acquired pellicle", "salivary flow", "salivary buffering capacity" and "dental erosion". Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were solved by discussion and consensus or by a third party. Results: Several characteristics and properties of saliva play an important role in dental erosion. Salivary clearance gradually eliminates the acids through swallowing and saliva presents buffering capacity causing neutralization and buffering of dietary acids. Salivary flow allows dilution of the acids. In addition, saliva is supersaturated with respect to tooth mineral, providing calcium, phosphate and fluoride necessary for remineralization after an erosive challenge. Furthermore, many proteins present in saliva and acquired pellicle play an important role in dental erosion. Conclusions: Saliva is the most important biological factor affecting the progression of dental erosion. Knowledge of its components and properties involved in this protective role can drive the development of preventive measures targeting to enhance its known beneficial effects.

Ektopische Expression schwer exprimierbarer nikotinischer Acetylcholinrezeptoren in Zellinien

Deutsch:In dieser Arbeit wurden Versuche zur funktionellen Expression von schwer ektopisch exprimierbaren nAChR in HEK-293/a1-Zellen durchgeführt: a7 nAChR und a6-enthaltenden nAChR. Die Probleme lagen dabei nicht auf dem Niveau der Transfektion, Transkription, Translation oder der Assemblierung, sondern beim Transport der Rezeptoren zur Zellmembran.Die Expression von a7 nAChR in der Plasmamembran von HEK-293/a1-Zellen konnte durch verbesserte Expressionsbedingungen (Koexpression des Faltungshelfers Calnexin oder weiterer nAChR-Untereinheiten, Erniedrigung der Expressionstemperatur, Expression in Gegenwart nikotinischer Antagonisten) nicht erreicht werden. Auch in anderen Zellinien mit neuronalem oder nicht-neuronalem Ursprung (QT6, GH4C1, S2 und PCC7-Mz1) war die EGFP-gekoppelte a7 nAChR-Untereinheit nur im Zellinneren lokalisiert.Eine intrazelluläre Lokalisation verhinderte auch eine funktionelle Expression homomerer a6 sowie heteromerer a6b2 und a6b3 nAChR in HEK-293/a1-Zellen. Im Gegensatz dazu führte eine Expression von stabil mit den nAChR-Untereinheiten a6 und b4 transfizierten HEK-293/a1-Zellen in Gegenwart von Calciumphosphat-Transfektionslösung und anschließend bei 30°C zu einem verbesserten Transport der Rezeptoren zur Zellmembran und damit zum erfolgreichen Expression funktioneller a6b4 nAChR. Die Wirkung der Transfektionslösung kann durch die erhöhte Calciumkonzentration erklärt werden, da in Ganzzellableitungen eine potenzierende Wirkung von Calciumionen auf den a6b4 nAChR bewiesen wurde. Somit konnte erstmalig der humane a6b4 nAChR in einer Säugerzellinie stabil und funktionell exprimiert werden.

Spectroscopic study of Bioceramics for Endodontic and Orthopaedics

This thesis was aimed at investigating the physical-chemical properties and the behaviour in physiological environment of two classes of bioceramics: calcium silicate-based dental cements and alumina-based femoral heads for hip joint prostheses. The material characterization was performed using spectroscopic techniques such as that allow to obtain information on the molecular structure of the species and phases present in the analyzed samples. Raman, infrared and fluorescence spectroscopy was principally used. Calcium silicate cements, such as MTA (Mineral Trioxide Aggregate), are hydraulic materials that can set in presence of water: this characteristic makes them suitable for oral surgery and in particular as root-end filling materials. With the aim to improve the properties of commercial MTA cements, several MTA-based experimental formulations have been tested with regard to bioactivity (i.e. apatite forming ability) upon ageing in simulated body fluids. The formation of a bone-like apatite layer may support the integration in bone tissue and represents an essential requirement for osteoconduction and osteoinduction. The spectroscopic studies demonstrated that the experimental materials under study had a good bioactivity and were able to remineralize demineralized dentin. . Bioceramics thanks to their excellent mechanical properties and chemical resistance, are widely used as alternative to polymer (UHMWPE) and metal alloys (Cr-Co) for hip-joint prostesis. In order to investigate the in vivo wear mechanisms of three different generations of commercial bioceramics femoral heads (Biolox®, Biolox® forte, and Biolox® delta), fluorescence and Raman spectroscopy were used to investigate the surface properties and residual stresses of retrieved implants. Spectroscopic results suggested different wear mechanisms in the three sets of retrievals. Since Biolox® delta is a relatively recent material, the Raman results on its retrievals has been reported for the first time allowing to validate the in vitro ageing protocols proposed in the literature to simulate the effects of the in vivo wear.

Biodegradable systems for the development of functional materials

This PhD work was aimed to design, develop, and characterize gelatin-based scaffolds, for the repair of defects in the muscle-skeletal system. Gelatin is a biopolymer widely used for pharmaceutical and medical applications, thanks to its biodegradability and biocompatibility. It is obtained from collagen via thermal denaturation or chemical-physical degradation. Despite its high potential as biomaterial, gelatin exhibits poor mechanical properties and a low resistance in aqueous environment. Crosslinking treatment and enrichment with reinforcement materials are thus required for biomedical applications. In this work, gelatin based scaffolds were prepared following three different strategies: films were prepared through the solvent casting method, electrospinning technique was applied for the preparation of porous mats, and 3D porous scaffolds were prepared through freeze-drying. The results obtained on films put into evidence the influence of pH, crosslinking and reinforcement with montmorillonite (MMT), on the structure, stability and mechanical properties of gelatin and MMT/gelatin composites. The information acquired on the effect of crosslinking in different conditions was utilized to optimize the preparation procedure of electrospun and freeze-dried scaffolds. A successful method was developed to prepare gelatin nanofibrous scaffolds electrospun from acetic acid/water solution and stabilized with a non-toxic crosslinking agent, genipin, able to preserve their original morphology after exposure to water. Moreover, the co-electrospinning technique was used to prepare nanofibrous scaffolds at variable content of gelatin and polylactic acid. Preliminary in vitro tests indicated that the scaffolds are suitable for cartilage tissue engineering, and that their potential applications can be extended to cartilage-bone interface tissue engineering. Finally, 3D porous gelatin scaffolds, enriched with calcium phosphate, were prepared with the freeze-drying method. The results indicated that the crystallinity of the inorganic phase influences porosity, interconnectivity and mechanical properties. Preliminary in vitro tests show good osteoblast response in terms of proliferation and adhesion on all the scaffolds.

Fiber-reinforced ceramics for thermostructural applications, produced by polymer impregnation pyrolysis

Several CFCC (Continuous Fiber Composite Ceramics) production processes were tested, concluding that PIP (Polymer Impregnation, or Infiltration, Pyrolysis) and CBC (Chemically Bonded Ceramics) based procedures have interesting potential applications in the construction and transportation fields, thanks to low costs to get potentially useful thermomechanical performances. Among the different processes considered during the Doctorate (from the synthesis of new preceramic polymers, to the PIP production of SiC / SiC composites) the more promising results came from the PIP process with poly-siloxanes on basalt fabrics preforms. Low processing time and costs, together with fairly good thermomechanical properties were demonstrated, even after only one or two PIP steps in nitrogen flow. In alternative, pyrolysis in vacuum was also tested, a procedure still not discussed in literature, but which could originate an interesting reduction of production costs, with only a moderate detrimental effect on the mechanical properties. The resulting CFCC is a basalt / SiCO composite that can be applied for continuous operation up to 600°C, also in oxidant environment, as TG and XRD demonstrated. The failure upon loading is generally pseudo-plastic, being interlaminar delamination the most probable rupture mechanism. . The strength depends on several different factors (microstructure, polymer curing and subsequent ceramic phase evolution, fiber pull-out, fiber strength, fiber percentage) and can only be optimized empirically. In order to be open minded in selecting the best technology, also CBC (Chemically Bonded Ceramics) matrixes were considered during this Doctorate, making some preliminary investigations on fire-resistant phosphate cements. Our results on a commercial product evidenced some interesting thermomechanical capabilities, even after thermal treatments. However the experiments showed also phase change and possible cracking and deformations even on slow drying (at 130°C) and easy rehydration upon exposure to environmental humidity.

Miniemulsionen als räumliche Begrenzungen : Synthese von Polymer-Hydroxylapatit-Nanopartikeln, bio-inspirierten Nanokapseln und Polymer-Einzelkettenpartikeln

In der vorliegenden Arbeit wurden Miniemulsionen als räumliche Begrenzungen für die Synthese von unterschiedlichen funktionellen Materialien mit neuartigen Eigenschaften verwendet. Das erste Themengebiet umfasst die Herstellung von Polymer/Calciumphosphat-Hybridpartikeln und –Hybridkapseln über die templatgesteuerte Mineralisation von Calciumphosphat. Die funktionalisierte Oberfläche von Polymernanopartikeln, welche über die Miniemulsionspolymerisation hergestellt wurden, diente als Templat für die Kristallisation von Calciumphosphat auf den Partikeln. Der Einfluss der funktionellen Carboxylat- und Phosphonat-Oberflächengruppen auf die Komplexierung von Calcium-Ionen sowie die Mineralisation von Calciumphosphat auf der Oberfläche der Nanopartikel wurde mit mehreren Methoden (ionenselektive Elektroden, REM, TEM und XRD) detailliert analysiert. Es wurde herausgefunden, dass die Mineralisation bei verschiedenen pH-Werten zu vollkommen unterschiedlichen Kristallmorphologien (nadel- und plättchenförmige Kristalle) auf der Oberfläche der Partikel führt. Untersuchungen der Mineralisationskinetik zeigten, dass die Morphologie der Hydroxylapatit-Kristalle auf der Partikeloberfläche mit der Änderung der Kristallisationsgeschwindigkeit durch eine sorgfältige Wahl des pH-Wertes gezielt kontrolliert werden kann. Sowohl die Eigenschaften der als Templat verwendeten Polymernanopartikel (z. B. Größe, Form und Funktionalisierung), als auch die Oberflächentopografie der entstandenen Polymer/Calciumphosphat-Hybridpartikel wurden gezielt verändert, um die Eigenschaften der erhaltenen Kompositmaterialien zu steuern. rnEine ähnliche bio-inspirierte Methode wurde zur in situ-Herstellung von organisch/anorganischen Nanokapseln entwickelt. Hierbei wurde die flexible Grenzfläche von flüssigen Miniemulsionströpfchen zur Mineralisation von Calciumphosphat an der Grenzfläche eingesetzt, um Gelatine/Calciumphosphat-Hybridkapseln mit flüssigem Kern herzustellen. Der flüssige Kern der Nanokapseln ermöglicht dabei die Verkapselung unterschiedlicher hydrophiler Substanzen, was in dieser Arbeit durch die erfolgreiche Verkapselung sehr kleiner Hydroxylapatit-Kristalle sowie eines Fluoreszenzfarbstoffes (Rhodamin 6G) demonstriert wurde. Aufgrund der intrinsischen Eigenschaften der Gelatine/Calciumphosphat-Kapseln konnten abhängig vom pH-Wert der Umgebung unterschiedliche Mengen des verkapselten Fluoreszenzfarbstoffes aus den Kapseln freigesetzt werden. Eine mögliche Anwendung der Polymer/Calciumphosphat-Partikel und –Kapseln ist die Implantatbeschichtung, wobei diese als Bindeglied zwischen künstlichem Implantat und natürlichem Knochengewebe dienen. rnIm zweiten Themengebiet dieser Arbeit wurde die Grenzfläche von Nanometer-großen Miniemulsionströpfchen eingesetzt, um einzelne in der dispersen Phase gelöste Polymerketten zu separieren. Nach der Verdampfung des in den Tröpfchen vorhandenen Lösungsmittels wurden stabile Dispersionen sehr kleiner Polymer-Nanopartikel (<10 nm Durchmesser) erhalten, die aus nur wenigen oder einer einzigen Polymerkette bestehen. Die kolloidale Stabilität der Partikel nach der Synthese, gewährleistet durch die Anwesenheit von SDS in der wässrigen Phase der Dispersionen, ist vorteilhaft für die anschließende Charakterisierung der Polymer-Nanopartikel. Die Partikelgröße der Nanopartikel wurde mittels DLS und TEM bestimmt und mit Hilfe der Dichte und des Molekulargewichts der verwendeten Polymere die Anzahl an Polymerketten pro Partikel bestimmt. Wie es für Partikel, die aus nur einer Polymerkette bestehen, erwartet wird, stieg die mittels DLS bestimmte Partikelgröße mit steigendem Molekulargewicht des in der Synthese der Partikel eingesetzten Polymers deutlich an. Die Quantifizierung der Kettenzahl pro Partikel mit Hilfe von Fluoreszenzanisotropie-Messungen ergab, dass Polymer-Einzelkettenpartikel hoher Einheitlichkeit hergestellt wurden. Durch die Verwendung eines Hochdruckhomogenisators zur Herstellung der Einzelkettendispersionen war es möglich, größere Mengen der Einzelkettenpartikel herzustellen, deren Materialeigenschaften zurzeit näher untersucht werden.rn

The effect of a slow mode of BMP-2 delivery on the inflammatory response provoked by bone-defect-filling polymeric scaffolds

We investigated the inflammatory response to, and the osteoinductive efficacies of, four polymers (collagen, Ethisorb, PLGA and Polyactive) that bore either an adsorbed (fast-release kinetics) or a calcium-phosphate-coating-incorporated (slow-release kinetics) depot of BMP-2. Titanium-plate-supported discs of each polymer (n = 6 per group) were implanted at an ectopic (subcutaneous) ossification site in rats (n = 48). Five weeks later, they were retrieved for a histomorphometric analysis of the volumes of ectopic bone and foreign-body giant cells (a gauge of inflammatory reactivity), and the degree of polymer degradation. For each polymer, the osteoinductive efficacy of BMP-2 was higher when it was incorporated into a coating than when it was directly adsorbed onto the material. This mode of BMP-2 carriage was consistently associated with an attenuation of the inflammatory response. For coated materials, the volume density of foreign-body giant cells was inversely correlated with the volume density of bone (r(2) = 0.96), and the volume density of bone was directly proportional to the surface-area density of the polymer (r(2) = 0.97). Following coating degradation, other competitive factors, such as the biocompatibility and the biodegradability of the polymer itself, came into play.

Functionalization of deproteinized bovine bone with a coating-incorporated depot of BMP-2 renders the material efficiently osteoinductive and suppresses foreign-body reactivity

The repair of critical-sized bony defects remains a challenge in the fields of implantology, maxillofacial surgery and orthopaedics. As an alternative bone-defect filler to autologous bone grafts, deproteinized bovine bone (DBB) is highly osteoconductive and clinically now widely used. However, this product suffers from the disadvantage of not being intrinsically osteoinductive. In the present study, this property was conferred by coating DBB with a layer of calcium phosphate into which bone morphogenetic protein 2 (BMP-2) was incorporated. Granules of DBB bearing a coating-incorporated depot of BMP-2--together with the appropriate controls (DBB bearing a coating but no BMP-2; uncoated DBB bearing adsorbed BMP-2; uncoated DBB bearing no BMP-2)--were implanted subcutaneously in rats. Five weeks later, the implants were withdrawn for a histomorphometric analysis of the volume densities of (i) bone, (ii) bone marrow, (iii) foreign-body giant cells and (iv) fibrous capsular tissue. Parameters (i) and (ii) were highest, whilst parameters (iii) and (iv) were lowest in association with DBB bearing a coating-incorporated depot of BMP-2. Hence, this mode of functionalization not only confers DBB with the property of osteoinductivity but also improves its biocompatibility--thus dually enhancing its clinical potential in the repair of bony defects.

Osseointegration: the slow delivery of BMP-2 enhances osteoinductivity

Although the placement of dental and orthopedic implants is now generally a safe, reliable and successful undertaking, the functional outcome is less assured in patients whose bone-healing capacity is compromised. To enhance peri-implant osteogenesis in these individuals, BMP-2 could be locally administered. However, neither a free suspension nor an implant-adsorbed depot of the agent is capable of triggering sustained bone formation. We hypothesize that this end could be achieved by incorporating BMP-2 into the three-dimensional crystalline latticework of a bone-mineral like, calcium-phosphate implant coating, where from it would be liberated gradually - as the inorganic layer undergoes osteoclast-mediated degradation - not rapidly, as from an implant-adsorbed (two-dimensional) depot. To test this postulate, we compared the osteoinductive efficacies of implant coatings bearing either an incorporated, an adorbed, or an incorporated and an adsorbed depot of BMP-2 at a maxillary site in miniature pigs. The implants were retrieved 1, 2 and 3 weeks after surgery for the histomorphometric analysis of bone formation within a defined 'osteoinductive' space. At each juncture, the volume of newly-formed bone within the osteoinductive space was greatest around implants that bore a coating-incorporated depot of BMP-2, peak osteogenic activity being attained during the first week and sustained thereafter. In the other groups, the temporal course of bone formation was variable, and the peak levels were not sustained. The findings of this study confirm our hypothesis: they demonstrate that we now have at our disposal a means of efficaciously augmenting and expediting peri-implant bone formation. Clinically, this possibility would render the process of implant placement a safer and a more reliable undertaking in patients whose bone-healing capacity is compromised, and would also permit a curtailment of the postoperative recovery period by a forestallment of the mechanical-loading phase.

Glucocorticosteroid-induced spinal osteoporosis: scientific update on pathophysiology and treatment

Glucocorticosteroid-induced spinal osteoporosis (GIOP) is the most frequent of all secondary types of osteoporosis. The understanding of the pathophysiology of glucocorticoid (GC) induced bone loss is of crucial importance for appropriate treatment and prevention of debilitating fractures that occur predominantly in the spine. GIOP results from depressed bone formation due to lower activity and higher death rate of osteoblasts on the one hand, and from increase bone resorption due to prolonged lifespan of osteoclasts on the other. In addition, calcium/phosphate metabolism may be disturbed through GC effects on gut, kidney, parathyroid glands and gonads. Therefore, therapeutic agents aim at restoring balanced bone cell activity by directly decreasing apoptosis rate of osteoblasts (e.g., cyclical parathyroid hormone) or by increasing apoptosis rate of osteoclasts (e.g., bisphosphonates). Other therapeutical efforts aim at maintaining/restoring calcium/phosphate homeostasis: improving intestinal calcium absorption (using calcium supplementation, vitamin D and derivates) and avoiding increased urinary calcium loss (using thiazides) prevent or counteract a secondary hyperparthyroidism. Bisphosphonates, particularly the aminobisphosphonates risedronate and alendronate, have been shown to protect patients on GCs from (further) bone loss to reduce vertebral fracture risk. Calcitonin may be of interest in situation where bisphosphonates are contraindicated or not applicable and in cases where acute pain due to vertebral fracture has to be manage. The intermittent administration of 1-34-parathormone may be an appealing treatment alternative, based on its documented anabolic effects on bone resulting from the reduction of osteoblastic apoptosis. Calcium and vitamin D should be a systematic adjunctive measure to any drug treatment for GIOP. Based on currently available evidence, fluoride, androgens, estrogens (opposed or unopposed) cannot be recommended for the prevention and treatment of GIOP. However, substitution of gonadal hormones may be indicated if GC-induced hypogonadism is present and leads to clinical symptoms. Data using the SERM raloxifene to treat or prevent GIOP are lacking, as are data using the promising bone anabolic agent strontium ranelate. Kyphoplasty performed in appropriately selected osteoporotic patients with painful vertebral fractures is a promising addition to current medical treatment.

Effect of cinacalcet cessation in renal transplant recipients with persistent hyperparathyroidism

BACKGROUND: Persistent hyperparathyroidism after renal transplantation affects bone and allografts. Cinacalcet, a calcimimetic, reduces serum calcium and PTH in renal transplant recipients with persistent hyperparathyroidism. Here, we address the question whether this effect of cinacalcet persists after withdrawal. METHODS: Therefore, cinacalcet was stopped after 12 months treatment in 10 stable renal transplant patients. Serum calcium, phosphate, PTH, creatinine and cystatin C were monitored for 3 months. RESULTS: Serum calcium, normalized in nine patients before cessation of cinacalcet (2.32 +/- 0.05mmol/l, mean +/- SEM), increased after 3 months of discontinuation by 0.17 +/- 0.04mmol/l, P < 0.05, but remained within the normal range in eight patients. Compared with the time point of cessation, PTH remained unchanged or decreased further after 3 months without therapy in six patients. Measurements of cystatin C suggested an improvement of the glomerular filtration rate after cessation in 9 out of 10 patients (1.55 +/- 0.09 vs 1.33 +/- 0.12 mg/l, P < 0.01). CONCLUSION: First, a beneficial effect of cinacalcet beyond the duration of a 12-month therapy appears to be present in some patients and second, the previously suspected influence of cinacalcet therapy on renal function is reversible. Thus, it is reasonable to consider a trial of cinacalcet cessation to identify these patients. The optimal time point for such a discontinuation is unknown. The present observations are preliminary. They clearly require a prospective randomized trial for definitive confirmation.

Pathophysiology and diagnosis of nephrocalcinosis

Nephrocalcinosis is the result of a myriad of hereditary or acquired diseases in the calcium, phosphate or oxalate metabolism that lead to deposition of calcium containing precipitates within the kidney. Nephrocalcinosis and nephrolithiasis are pathophysiologically tightly related and often co-exist. In the case of recurrent nephrolithiasis, nephrocalcinosis has to be excluded. Stone analysis can yield important clues to the underlying disease process. The best way to diagnose nephrocalcinosis and an accompanying nephrolithiasis is by native computer tomography scans. Untreated, nephrocalcinosis will lead to a progressive decline in renal function and eventually to end stage renal disease. Thus, for each case, the underlying disease process has to be determined and a causative therapy initiated.