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Resorption

Resorption is the process by which living tissues or structures are broken down and absorbed into the circulatory system through biochemical activity, often mediated by specialized cells that dissolve and remove components such as minerals or organic matrix.^[1] This phenomenon is essential for physiological maintenance, repair, and adaptation in various biological contexts, including skeletal and dental systems, where it facilitates the release of essential ions like calcium and phosphorus into the bloodstream.^[2] In bone biology, resorption is a critical phase of bone remodeling, where multinucleated osteoclasts adhere to bone surfaces, secrete acids and proteolytic enzymes to degrade the mineralized matrix, and create resorption pits known as Howship's lacunae.^[3] This process is tightly coupled with bone formation by osteoblasts, ensuring skeletal integrity, repair of microdamage, and calcium homeostasis; imbalances can lead to conditions like osteoporosis when resorption exceeds formation.^[4] Osteoclasts, derived from hematopoietic precursors, are activated by signaling pathways involving RANKL and regulated by hormones such as parathyroid hormone.^[3] Beyond bone, resorption manifests prominently in dental tissues, where it involves the progressive loss of tooth structure—enamel, dentin, or cementum—due to clastic cell activity, often triggered by trauma, inflammation, or orthodontic forces.^[5] Tooth resorption is classified into internal (originating from the pulp) and external (from the periodontal ligament) types, with subtypes including inflammatory, replacement, and surface resorption; early detection via radiographic imaging is vital, as advanced cases may necessitate root canal therapy or extraction to prevent complications like tooth mobility or ankylosis.^[5] In reproductive biology, resorption can also refer to the disintegration and maternal reabsorption of embryos or fetuses, typically in early gestation stages due to developmental anomalies or environmental factors.^[6]

Overview

Definition

Resorption refers to the physiological or pathological process involving the breakdown and subsequent absorption of cells, tissues, or structures—particularly hard tissues such as bone, dentin, and cementum—into the circulatory system or surrounding environment, resulting in the loss of substance through degradation by specialized cells.^[7] This catabolic activity is essential for maintaining tissue homeostasis and is primarily mediated by multinucleated cells like osteoclasts in bone and odontoclasts in dental tissues.^[8] Unlike absorption, which denotes the general uptake of nutrients, fluids, or solutes into cells or the bloodstream without degradation, or reabsorption, the selective reclamation of filtered substances (such as water and ions) from the renal filtrate back into the blood in the kidneys, resorption entails the active dissolution of pre-existing structural components.^[9]^[7] In biological contexts, resorption predominantly occurs in the skeletal and dental systems, where it facilitates bone remodeling and tooth root maintenance, but it also plays roles in developmental processes, such as the resorption of larval tails during amphibian metamorphosis, and in pathological conditions like osteoporosis or inflammatory resorption.^[2]^[10] From an evolutionary standpoint, resorption represents an adaptive mechanism in vertebrates, enabling dynamic tissue remodeling for growth, mechanical adaptation to environmental stresses, repair of microdamage, and regulation of mineral homeostasis in the skeleton.^[11] This process underscores the balance between tissue degradation and formation that has been conserved across vertebrate lineages to support skeletal integrity and physiological flexibility.^[12]

Etymology and Historical Development

The term "resorption" originates from the Latin words re- (meaning "back" or "again") and sorbere (meaning "to suck in" or "absorb"), literally connoting the act of sucking back or reabsorbing material.^[13] In English, it first appeared in the early 18th century in general scientific contexts, but entered medical usage around 1810–1820 to describe the biochemical dissolution or disappearance of tissues, such as the loss of bone or other structures.^[14] This etymological root reflects the process's conceptual basis in absorption and reversal, distinguishing it from mere degradation. Early 19th-century medical literature marked the term's initial application in pathology, with references to tissue dissolution appearing in texts around the 1830s; for instance, internal dental resorption was first documented by Thomas Bell in 1830 as a form of hard tissue loss.^[15] Prior to this, anatomists like John Hunter (1728–1793) laid foundational observations on bone dynamics in the late 18th century, noting through experiments on fracture healing and growth that bone undergoes continuous remodeling, involving both formation and breakdown—a concept that implicitly involved resorptive elements without using the specific term.^[16] By the mid-19th century, the term had broadened to include general medical phenomena, such as the absorption of pus or exudates in inflammatory conditions, as described in surgical and pathological works of the era.^[17] A key milestone came in 1873 when Rudolf Albert von Kölliker identified and named osteoclasts as the multinucleated cells responsible for bone breakdown, providing a cellular basis for understanding resorption as an active process rather than passive dissolution.^[18] The 20th century saw a refinement and specialization of "resorption" from a broad descriptor of tissue loss to a precise biological mechanism, particularly in endocrinology following the isolation of parathyroid hormone (PTH) in 1925 by James Collip and colleagues.^[19] Early PTH studies in the late 1920s demonstrated its role in stimulating bone resorption to maintain calcium homeostasis, standardizing the term within endocrine physiology and linking it to hormonal regulation.^[20] Post-1950s advancements in electron microscopy further transformed its usage; transmission electron micrographs from 1961 onward revealed ultrastructural details of osteoclast activity during bone resorption, shifting focus from macroscopic observations to cellular and molecular intricacies.^[21] This evolution solidified "resorption" as a specialized term for targeted biological breakdown, distinct from earlier generic applications in pathology.

Bone Resorption

Physiological Process

Bone resorption is a fundamental physiological process in skeletal homeostasis, involving the coordinated breakdown of bone matrix by osteoclasts to release minerals and maintain calcium balance in the bloodstream. This process is tightly coupled with bone formation by osteoblasts, forming the basis of the bone remodeling cycle, which replaces old or damaged bone tissue while adapting the skeleton to mechanical stresses as described by Wolff's law—wherein bone architecture remodels in response to applied loads to optimize strength and efficiency.^[3] In healthy adults, this balanced turnover ensures skeletal integrity without net bone loss, with approximately 10% of the total skeleton remodeled annually, though rates vary by bone type and age.^[22] The process begins with the recruitment and differentiation of osteoclast precursors, stimulated by factors such as RANKL from osteoblasts or osteocytes, leading to mature multinucleated osteoclasts migrating to bone surfaces targeted for resorption.^[23] Upon arrival, osteoclasts attach to the bone surface via integrin receptors, particularly αvβ3, forming a tight sealing zone that creates an isolated resorption compartment beneath the ruffled border membrane.^[24] Within this compartment, the osteoclasts acidify the environment using vacuolar H⁺-ATPase proton pumps on the ruffled border, lowering the pH to around 4.5 to dissolve the mineral phase of bone, primarily hydroxyapatite.^[25] This demineralization is followed by enzymatic degradation of the exposed organic matrix, mainly type I collagen, by lysosomal enzymes like cathepsin K and matrix metalloproteinases (MMPs) such as MMP-9, which are secreted into the compartment.^[23] The dissolution of hydroxyapatite can be represented by the following simplified equation:

\mathrm{Ca}_{10}(\mathrm{PO_4})_6(\mathrm{OH})_2 + 8\mathrm{H}^+ \rightarrow 10\mathrm{Ca}^{2+} + 6\mathrm{HPO_4}^{2-} + 2\mathrm{H_2O}

^[26] This reaction mobilizes calcium and phosphate ions, which are endocytosed at the ruffled border, transported across the cell via transcytosis in vesicles, and released by exocytosis at the basolateral membrane into the extracellular fluid and bloodstream to support systemic mineral homeostasis.^[27] The resorbed products are endocytosed and digested within the osteoclast, completing the cycle before the cell detaches and undergoes apoptosis, allowing osteoblasts to refill the resorption pit.^[28] Quantitative aspects of physiological resorption highlight its efficiency: in adults, cortical bone (comprising about 80% of the skeleton) turns over at 2-3% per year, while trabecular bone exhibits higher rates of 25-30% annually due to greater surface area exposure, resulting in the overall 10% skeletal turnover.^[29] These rates decline with age, particularly after peak bone mass in the third decade, reflecting reduced remodeling activity to preserve bone stock.^[30] This controlled process not only regulates serum calcium levels but also enables skeletal adaptation to physical demands, preventing accumulation of microdamage.^[3]

Pathological Aspects

Pathological bone resorption refers to the excessive or imbalanced activity of osteoclasts that outpaces bone formation, leading to net bone loss and structural weakening in various diseases. This imbalance disrupts normal skeletal homeostasis, often driven by dysregulated signaling pathways, and results in clinically significant morbidity. Unlike physiological resorption, which maintains bone integrity, pathological processes amplify resorption through specific molecular and environmental triggers, contributing to a range of skeletal disorders. Major conditions associated with pathological bone resorption include osteoporosis, hyperparathyroidism, Paget's disease of bone, and osteolytic metastases from cancers such as breast cancer and multiple myeloma. In postmenopausal osteoporosis, estrogen deficiency accelerates osteoclast activation, leading to rapid bone loss primarily at trabecular sites like the spine and hip. Senile osteoporosis, prevalent in the elderly, involves age-related declines in bone formation coupled with sustained resorption, resulting in diffuse skeletal fragility. Primary hyperparathyroidism features elevated parathyroid hormone (PTH) levels that stimulate osteoclasts, causing preferential cortical bone loss and potential vertebral fractures. Paget's disease is characterized by focal, intense osteoclastic hyperactivity followed by disorganized bone formation, often affecting the pelvis, skull, or long bones, with risks of deformity and sarcoma development. Osteolytic metastases occur when tumor cells, such as those from breast cancer, secrete factors that enhance osteoclast-mediated destruction, leading to lytic lesions in up to 75% of advanced cases. Key causes of pathological bone resorption encompass hormonal imbalances, inflammatory cytokines, and genetic factors. Excess RANKL, often upregulated by PTH or tumor-derived signals, binds RANK on osteoclast precursors to promote differentiation and activation, overwhelming the inhibitory effects of osteoprotegerin (OPG). Inflammatory cytokines like TNF-α and IL-6, elevated in postmenopausal states or chronic inflammation, further amplify RANKL expression and osteoclast survival. Genetic mutations, such as deletions in the OPG gene, disrupt the RANKL/OPG axis, as seen in juvenile Paget's disease, leading to unchecked resorption. Consequences of pathological bone resorption include bone fragility, increased fracture risk, and systemic effects like hypercalcemia. Excessive resorption erodes bone matrix, reducing density and mechanical strength, which predisposes individuals to fragility fractures—vertebral in osteoporosis and hyperparathyroidism, pathologic in Paget's and metastases. Hypercalcemia arises from mobilized skeletal calcium, particularly in hyperparathyroidism and lytic metastases, causing symptoms like fatigue and renal impairment. These outcomes are quantified using biomarkers: elevated serum C-terminal telopeptide (CTX) reflects resorption activity in osteoporosis and cancer, while N-terminal propeptide of type I procollagen (PINP) indicates coupled formation, often imbalanced in these conditions. Diagnostic approaches focus on imaging and histomorphometry to assess resorption extent. Dual-energy X-ray absorptiometry (DEXA) measures bone mineral density (BMD) at sites like the hip and spine, with T-scores below -2.5 indicating osteoporosis-related resorption. Bone histomorphometry, via iliac crest biopsy, quantifies resorption parameters such as eroded surface (ES/BS) and osteoclast surface, confirming high-turnover states in Paget's disease or hyperparathyroidism.

Dental Resorption

Types and Mechanisms

Dental resorption is classified into two primary categories: internal and external, distinguished by the origin of the resorptive process and the affected tooth surfaces.^[5] Internal resorption originates from the pulp side of the tooth, typically involving the dentin adjacent to the pulp chamber or root canal, and is often idiopathic or linked to pulpal pathology.^[31] In contrast, external resorption begins on the outer surface of the tooth, affecting the cementum or enamel, and progresses inward.^[5] Subtypes of internal resorption include internal inflammatory resorption, characterized by progressive dentin loss due to chronic pulpal inflammation, and internal replacement resorption, a rarer form where resorbed dentin is gradually replaced by metaplastic tissue resembling bone.^[31] External resorption encompasses several subtypes: external inflammatory resorption, which includes apical (at the root apex) and lateral or cervical (along the root side) variants driven by infection or trauma; external replacement resorption, where lost tooth structure is substituted by bone-like tissue; and external invasive resorption, an aggressive, idiopathic form often starting in the cervical region and spreading extensively.^[32] These subtypes highlight the involvement of both root and crown structures, with cervical and apical forms commonly affecting the root, while invasive resorption may extend to the crown.^[5] The mechanisms of dental resorption involve the activation of odontoclasts, multinucleated cells analogous to osteoclasts that adhere to the tooth surface and resorb mineralized tissues.^[33] Triggers such as dental trauma, orthodontic forces, or bacterial infection from pulpal or periodontal sources initiate this process by disrupting the protective layers of predentin or cementum, allowing odontoclast recruitment via signaling pathways like RANKL.^[31] Once activated, odontoclasts demineralize dentin via acidification mediated by carbonic anhydrase and V-ATPase to dissolve the hydroxyapatite matrix, followed by enzymatic degradation of the organic matrix, including by tartrate-resistant acid phosphatase (TRAP) and proteases.^[33] Diagnosis relies on radiographic imaging, which reveals characteristic radiolucencies: internal resorption appears as a continuity with the pulp canal borders, while external shows irregular, bowl-shaped defects on the root surface.^[32] Vitality testing, such as electric pulp testing or thermal response, helps assess pulpal health—vital pulp often indicates external resorption without necrosis, whereas non-vital responses suggest inflammatory involvement.^[31] Differentiation from caries is key, as resorption lacks bacterial penetration from the enamel surface and instead shows odontoclastic activity without carious demineralization patterns on radiographs.^[32] The prevalence of dental resorption in permanent teeth is relatively low, with internal inflammatory resorption occurring in approximately 0.01-1% of cases; rates are higher following trauma, such as in reimplanted avulsed teeth where replacement resorption can affect up to 87%.^[34]^[35]

Clinical Management

Diagnosis of dental resorption typically involves advanced imaging techniques such as cone-beam computed tomography (CBCT), which provides a three-dimensional assessment of the extent and location of resorptive lesions, allowing for precise evaluation of root integrity and surrounding structures.^[36] Histopathology serves as a confirmatory method, correlating histological findings with radiographic evidence to identify the nature of the resorptive tissue, such as odontoclastic activity.^[36] Prevention strategies focus on vigilant orthodontic monitoring through periodic radiographic evaluations to detect early signs of root resorption, enabling timely adjustments in treatment force to minimize risk.^[37] In cases of tooth avulsion, prompt management is crucial; storing the avulsed tooth in milk as a transport medium preserves periodontal ligament viability, facilitating successful replantation and reducing the incidence of subsequent inflammatory resorption.^[38] Treatment approaches vary by type and severity. For slow-progressing cases, regular monitoring with imaging suffices to track progression without immediate intervention. Internal resorption is primarily managed with endodontic therapy, which involves disinfection and sealing of the root canal to halt the resorptive process and promote repair. Recent advances include regenerative endodontic procedures using stem cells to revitalize affected teeth in early resorption stages.^[39]^[40] Advanced external resorption often necessitates extraction followed by dental implant placement to restore function, as the structural integrity is compromised beyond repair. Emerging biologic therapies, such as RANKL inhibitors, show promise in suppressing osteoclast-mediated resorption by blocking the RANKL-RANK pathway, potentially preserving tooth structure in select cases.^[41] Prognosis improves significantly with early intervention, achieving success rates of approximately 70% in preserving tooth vitality and function, particularly when resorption is identified and treated promptly via imaging and targeted therapies.^[42] Common complications include ankylosis, which can lead to tooth immobility and further resorption if replantation occurs after prolonged extraoral time.^[43]

Other Biological Contexts

Embryological Resorption

Embryological resorption refers to the programmed degeneration and elimination of transient structures during fetal development, essential for proper organ formation and sexual differentiation. This process ensures the removal of rudimentary tissues that are no longer needed, preventing developmental anomalies and allowing space for maturing organs. It primarily involves coordinated cellular mechanisms such as apoptosis and phagocytosis, occurring within specific gestational windows to align with embryonic milestones.^[44] A prominent example is the regression of the Müllerian ducts in male embryos, which are precursors to female reproductive structures including the uterus and fallopian tubes. In genetic males (46,XY), these ducts form around weeks 6-7 of gestation but undergo rapid resorption starting in weeks 8-9, triggered by anti-Müllerian hormone (AMH) secreted by Sertoli cells in the developing testes. The process combines programmed cell death via apoptosis in the ductal epithelium with epithelial-to-mesenchymal transition, typically completing by week 10. This ensures the absence of female internal genitalia in males, highlighting the precision of sex-specific developmental pathways.^[45]^[46]^[44] Another key instance occurs with the yolk sac, a vital early nutrient and hematopoietic structure that regresses in late gestation as the placenta assumes dominance. In human embryos, the primary yolk sac forms by week 4 and transitions to a secondary yolk sac by week 5-6; resorption begins around week 10 with shrinkage and is largely complete by approximately week 14, when it becomes undetectable on ultrasound. This resorption liberates space in the chorionic cavity and recycles nutrients, with the embryo absorbing residual tissues. Disruptions can impair early blood cell production or lead to embryonic growth delays.^[47]^[48] Genetic regulation of these events relies on transcription factors and signaling cascades, including Hox genes for initial duct patterning and elongation, and Wnt pathways for executing regression. Hox genes, such as Hoxa9-11, establish anterior-posterior polarity in the Müllerian ducts during weeks 6-8, while their dysregulation can halt proper formation or resorption. Wnt signaling, particularly through β-catenin stabilization downstream of AMH, promotes mesenchymal apoptosis and inhibits duct maintenance in males; Wnt4 expression in the mesenchyme is upregulated by AMH to drive this breakdown. These pathways integrate with brief macrophage involvement for debris clearance, as detailed in cellular regulation contexts.^[49]^[50]^[51] Failure in embryological resorption often results in persistent structures and associated disorders, such as persistent Müllerian duct syndrome (PMDS), where incomplete duct regression in males leads to retained uterus and fallopian tubes alongside male external genitalia. PMDS arises from mutations in the AMH gene (type I, ~45% of cases) or AMHR2 receptor gene (type II, ~40%), impairing signaling and causing bilateral cryptorchidism in ~90% of affected individuals; diagnosis typically occurs postnatally via imaging, with surgical intervention required to mitigate infertility and cancer risks. Such abnormalities underscore the clinical importance of precise temporal and molecular control during gestation.^[52]^[53]

Resorption in Soft Tissues

Resorption in soft tissues refers to the breakdown and clearance of accumulated fluids, cellular debris, or extracellular matrix (ECM) components in non-skeletal structures, primarily during inflammatory responses and wound healing processes. This phenomenon is essential for restoring tissue homeostasis and preventing chronic damage, involving coordinated cellular activities that degrade and remove pathological accumulations. Unlike resorption in hard tissues, soft tissue resorption focuses on fluid dynamics and ECM remodeling in dynamic environments such as inflamed synovium or healing wounds.^[54] One key context is the resolution of edema, where lymphatic vessels facilitate the resorption of interstitial fluid to alleviate tissue swelling. Lymphangiogenesis in inflammatory settings enhances lymphatic drainage, promoting the uptake and transport of excess fluid back into the circulation, thereby resolving edema during immune responses. Macrophages contribute by modulating lymphatic function through cytokine signaling, ensuring efficient fluid clearance in edematous tissues.^[55]^[56] In chronic inflammation, granuloma resorption involves the programmed clearance of organized immune cell clusters, preventing persistent tissue damage. Macrophages, particularly those adopting an M2-like phenotype, drive this process by phagocytosing necrotic debris and modulating inflammatory signals to facilitate granuloma dissolution. For instance, in pulmonary models, M2a macrophages expressing anti-inflammatory markers accelerate granuloma resolution by 60 days post-induction.^[54]^[57] Tumor necrosis absorption represents another critical context, where macrophages engulf and degrade necrotic cancer cells to limit secondary inflammation and support tissue remodeling. This phagocytosis targets necrotic debris specifically, distinguishing it from viable cells, and relies on receptor-mediated recognition to prevent autoimmunity.^[58] The primary mechanisms underlying soft tissue resorption include the activity of macrophages and neutrophils, which employ lysosomal enzymes and proteases to break down ECM components. Macrophages release cathepsins and matrix metalloproteinases (MMPs), such as MMP9 and MMP12, from lysosomes to degrade collagen and other matrix proteins during the resolution phase of inflammation. Neutrophs complement this by secreting elastase and other lysosomal hydrolases, aiding in the initial breakdown of fibrin-rich exudates. These enzymes collectively enable the solubilization and clearance of ECM barriers, facilitating tissue repair. Inflammatory cytokines briefly coordinate this activity, transitioning macrophages toward pro-resolving states.^[59]^[60]^[61] Representative examples illustrate these processes in clinical settings. Post-surgical seroma resorption occurs through lymphatic reabsorption and macrophage-mediated clearance of serous fluid accumulations in dead space, typically resolving within weeks via natural drainage and enzymatic degradation. In atherosclerosis, plaque regression involves macrophage efferocytosis of lipid-laden foam cells and cholesterol efflux, reducing plaque volume by up to approximately 18% in certain clinical trials in response to lipid-lowering therapies, thereby stabilizing vascular soft tissues.^[62]^[63] Pathologically, excessive resorption in the rheumatoid arthritis synovium contributes to joint damage by overactive macrophage-driven ECM degradation. Synovial macrophages produce elevated levels of MMPs and lysosomal enzymes, eroding the synovial lining and perichondrial tissues, which correlates with disease severity and erosive progression. This uncontrolled breakdown exacerbates inflammation and impairs joint integrity, highlighting the need for targeted therapies to balance resorptive activity.^[64]^[65]

Molecular and Cellular Regulation

Key Cellular Players

Osteoclasts are the primary cellular mediators of bone resorption, functioning as large, multinucleated giant cells derived from the monocyte-macrophage lineage.^[23] These cells exhibit specialized membrane structures, including a ruffled border that facilitates the secretion of acid and proteolytic enzymes into the resorption compartment, enabling the degradation of bone matrix.^[66] Osteoclasts characteristically express tartrate-resistant acid phosphatase (TRAP) as a marker of their activity and calcitonin receptors, which mediate inhibitory responses to the hormone calcitonin, thereby regulating resorption rates.^[67] Their attachment to bone surfaces occurs via a sealing zone formed by podosome belts, creating an isolated microenvironment for efficient matrix dissolution.^[68] In dental contexts, odontoclasts play an analogous role in tooth resorption, particularly targeting dentin and cementum.^[69] These multinucleated cells share structural and functional similarities with osteoclasts, including ruffled borders for enzyme secretion, but are specialized for resorbing dental hard tissues and are often activated following trauma or inflammation that exposes root surfaces.^[70] Odontoclasts infiltrate resorption lacunae on dentin, where they release hydrolytic enzymes and acids to break down the mineralized matrix, contributing to both physiological root resorption during tooth exfoliation and pathological cases.^[71] Macrophages contribute to resorption processes in soft tissues and embryological development by clearing cellular debris through efferocytosis, the phagocytosis of apoptotic cells and fragments.^[72] In these non-skeletal contexts, tissue-resident macrophages engulf and degrade extracellular matrix remnants or dying cells, preventing inflammation and maintaining homeostasis during tissue remodeling, such as in developmental regression of structures like the Müllerian ducts.^[73] Unlike osteoclasts, macrophages lack the specialized ruffled borders but employ lysosomal pathways for degradation, supporting resorption indirectly by preparing sites for regenerative processes.^[74] The differentiation of these resorptive cells, particularly osteoclasts and odontoclasts, originates from monocyte-macrophage precursors and is driven by signaling from osteoblasts or stromal cells.^[75] Key factors include macrophage colony-stimulating factor (M-CSF), which promotes precursor survival and proliferation via the c-Fms receptor, and receptor activator of nuclear factor kappa-B ligand (RANKL), which binds to RANK on precursors to induce fusion into multinucleated cells and activation of resorption machinery.^[76] This process involves sequential expression of receptors and transcription factors like NFATc1, with M-CSF priming cells for RANKL responsiveness; further details on the RANKL pathway are covered in the section on hormonal and molecular factors.^[77]

Hormonal and Molecular Factors

Parathyroid hormone (PTH) plays a central role in regulating bone resorption by binding to the PTH1 receptor (PTH1R), a G protein-coupled receptor that activates the cAMP/protein kinase A (PKA) pathway in osteoblasts and osteocytes, leading to increased expression of receptor activator of nuclear factor kappa-B ligand (RANKL) and subsequent osteoclast activation.^[78] Continuous exposure to PTH favors catabolic effects, enhancing bone resorption to mobilize calcium, while intermittent administration promotes anabolic actions.^[79] Estrogen inhibits bone resorption primarily by suppressing RANKL expression in osteoblasts and directly attenuating RANKL-induced osteoclast differentiation through estrogen receptor-mediated mechanisms.^[80]^[81] Vitamin D, particularly its active form 1,25-dihydroxyvitamin D3, enhances calcium mobilization from bone by upregulating RANKL in osteoblasts and supporting osteoclast maturation, thereby maintaining systemic calcium homeostasis during periods of dietary deficiency.^[82]^[83] The RANK/RANKL/OPG system serves as a key molecular pathway controlling osteoclastogenesis and resorption rates across tissues. RANKL, expressed by osteoblasts and stromal cells, binds to RANK on osteoclast precursors to promote their differentiation and activation via downstream signaling cascades.^[84] Osteoprotegerin (OPG), a soluble decoy receptor produced by osteoblasts, binds RANKL to prevent its interaction with RANK, thereby inhibiting osteoclast formation.^[85] The balance of this system is often conceptualized by the ratio of RANKL to OPG concentrations, where resorption rate is proportional to [RANKL]/[OPG], influencing the extent of osteoclast differentiation and bone turnover.^[86]

\text{Resorption rate} \propto \frac{[\text{RANKL}]}{[\text{OPG}]}

This conceptual ratio highlights how shifts in ligand availability modulate cellular responses without direct quantitative measurement in all contexts. NF-κB signaling, activated downstream of RANKL-RANK binding, is essential for osteoclast activation by translocating to the nucleus to induce genes involved in differentiation, survival, and resorptive function, such as those encoding matrix metalloproteinases.^[87]^[88] Tissue-specific regulation further modulates resorption through inflammatory and developmental signals. In inflammatory contexts, interleukin-1 (IL-1) and prostaglandin E2 (PGE2) synergize to amplify bone resorption; IL-1 stimulates osteoblasts to produce RANKL and PGE2, while PGE2 enhances osteoclast formation via EP receptor signaling, contributing to pathological bone loss in conditions like arthritis.^[89]^[90] During embryological development, bone morphogenetic proteins (BMPs), particularly BMP-2 and BMP-7, regulate resorption by promoting osteoclast differentiation in coordination with RANKL pathways, facilitating tissue remodeling and skeletal patterning.^[91]^[92]

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[PDF] External Apical Root Resorption in Orthodontics
Clinical Strategies: • Minimize treatment time and force application. • Regular radiographic monitoring may detect early signs of resorption.
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ASSESSMENT OF DENTISTS' KNOWLEDGE IN ... - NIH
It can be used as a conservation medium for avulsed teeth for a period of 24 h. Milk is regarded as a convenient storage medium for an avulsed tooth because it ...
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Effects of anti-mouse RANKL antibody on orthodontic tooth ...
It has a beneficial effect on inhibition of the RANKL-RANK interaction, and consequently reduces pathological bone resorption.
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Serum AMH in Physiology and Pathology of Male Gonads - PMC
Müllerian ducts regress in the male fetus during the 8th and 9th week of gestation through apoptosis and epithelial-mesenchymal transformation occurring in a ...Missing: timeline | Show results with:timeline
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The mechanisms underlying the effects of AMH on Müllerian duct ...
Anti-Müllerian hormone (AMH) produced in the developing testis induces the regression of the Müllerian duct, which develops into the oviducts, uterus and upper ...
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Early detection and staging of spontaneous embryo resorption by ...
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The cell biology and molecular genetics of Müllerian duct development
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β-Catenin is essential for Müllerian duct regression during male ...
These data suggest that β-catenin mediates AMH signaling for Müllerian duct regression during male sexual differentiation. ... At embryonic day (E) 11.5 in mice, ...
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β-Catenin is essential for Müllerian duct regression during male ...
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Lymphangiogenesis: Molecular Mechanisms and Future Promise
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The M2a Macrophage Phenotype Accompanies Pulmonary ...
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We show that apoptotic and necrotic cells are recognized and phagocytosed by macrophages, whereas living cells are not. In both cases, phagocytosis occurred ...Missing: absorption | Show results with:absorption
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Macrophages as Multifaceted Orchestrators of Tissue Repair
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Macrophages, Foreign Body Giant Cells and Their Response ... - NIH
Macrophages, in addition to their function as phagocytes, are also involved in the extracellular biodegradation of biomaterial matrices such as collagen by the ...<|control11|><|separator|>
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Macrophage Polarization in Chronic Inflammatory Diseases - PMC
TAMs can regulate the extracellular matrix degradation by producing different types of enzymes and proteases, such as matrix metalloproteinases (MMPs), in ...Figure 1 · Figure 2 · Abbreviations<|control11|><|separator|>
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Plaque shrinkage is a coordinated process that involves the depletion of foam cells and extracellular cholesterol stores, a gradual decline in macrophage ...
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Cells of the synovium in rheumatoid arthritis. Macrophages - PMC
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Synovial macrophages drive severe joint destruction in established ...
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Osteoclasts and odontoclasts: signaling pathways to development ...
Osteoclasts and odontoclasts are necessary for tooth eruption ... dental compromise when associated with permanent tooth internal or external resorption.
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Dentin resorption mediated by odontoclasts in physiological root ...
The granulated tissues, which are rich in multinucleated odontoclasts and capillary vessels, formed various resorption lacunae on the resorbing dentin surfaces.
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The results of the present study suggest that odontoclasts resorbing enamel secrete acids as well as organic components, including hydrolytic enzymes, into the ...
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Macrophages and Bone Remodeling - PMC - NIH
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Osteal macrophages support physiologic skeletal remodeling and ...
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Osteoclast precursors express c-Fms (M-CSF receptor) and RANK (RANKL receptor) and differentiate into osteoclasts in the presence of M-CSF and RANKL.Role Of Il-34 In... · Wnt5a-Receptor Tyrosine... · Figure 3<|control11|><|separator|>
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Commitment and Differentiation of Osteoclast Precursor Cells by the ...
Both RANKL and M-CSF regulate the differentiation of osteoclasts. (A) R3 cells were cultured with IL-3 (100 U/ml) or M-CSF (30 ng/ml) for 72 h. A ...
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Aug 17, 2020 · Induction and activation of the transcription factor NFATc1 (NFAT2) integrate RANKL signaling in terminal differentiation of osteoclasts.
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PTH1R Actions on Bone Using the cAMP/Protein Kinase A Pathway
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Parathyroid hormone: anabolic and catabolic actions on the skeleton
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Estrogens suppress RANK ligand-induced osteoclast differentiation ...
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Vitamin D and Bone - PMC - NIH
The benefits of vitamin D on fracture prevention are a combination of increased intestinal calcium absorption [80], increased bone mineral density [81], and ...
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Vitamin D and bone - NIH
The vitamin rather directly regulates osteoblastic bone formation by inhibiting excessive bone formation and mineralization. Vitamin D mobilizes calcium from ...
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Minireview: The OPG/RANKL/RANK System - Oxford Academic
The OPG/RANKL/RANK system is a key mediator of osteoclastogenesis. RANKL binds to RANK on osteoclast cells, and OPG blocks this system.
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The regulatory role of the RANKL/RANK/OPG signaling pathway in ...
Sep 18, 2020 · The adequate balance between RANKL and OPG determines the rate of bone resorption [5]. An impaired OPG-to-RANKL ratio can be considered an ...
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Nuclear Factor-Kappa B Regulation of Osteoclastogenesis and ...
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The Effect of Inflammation on Bone - Frontiers
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The roles and regulatory mechanisms of TGF-β and BMP signaling ...
Jan 24, 2024 · BMPs promote osteogenesis, osteoclastogenesis, and chondrogenesis at all differentiation stages, while TGF-βs play different roles in a stage-dependent manner.
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The Bone Morphogenetic Protein Pathway: The Osteoclastic ...
Oct 15, 2020 · BMPs as Mediators Between Bone Resorption and Bone Formation. Initially, BMPs were reported to augment osteoclast development and activity ...