이재훈 연세치대병원 연구팀, 골다공증 환자 치과진료 위험성 줄여

전수환 기자 2015.04.03 20:55:03

비스포스포네이트 관련 악골괴사(Bisphosphonate-related osteonecrosis of the jaw·BRONJ)를 사전에 예측할 수 있는 유전자 검진법이 개발돼 이목을 끈다.

해당 연구팀은 “기존 골대사검진법 CTX 측정법보다 신뢰할 수 있는 결과를 얻을 수 있다”고 밝혀 BRONJ에 대한 치과의사들의 부담을 해소시킬 수 있을 것으로 기대된다.


한동후·이재훈·김지환 연세대학교 치과대학병원 보철과 연구팀은 최근 미국 공공과학 도서관 온라인 학술지 PLoS One에 ‘Genetic Investigation of Bisphosphonate-Related Osteonecrosis of Jaw (BRONJ) via Whole Exome Sequencing and Bioinformatics’라는 논문을 게재했다.


연구팀은 BRONJ 환자 17명을 대상으로 이들의 유전자를 포항공대 생명과학과 연구팀과의 협력을 통해 시스템생물학 기법으로 분석, BRONJ 환자들에게 특정 유전자군이 있으며 이 유전자군의 작용으로 비스포스포네이트를 복용하고 치과진료를 받을 경우 부작용이 발생한다는 사실을 밝혀냈다.


비스포스포네이트 제제의 기전은 뼈를 파괴하는 파골 세포의 작용에 필요한 ‘메발론산(Mevalonate)’이란 물질의 합성을 억제해 뼈의 파괴를 막는 것이다. 일반적인 사람의 경우 이렇게 메발론산의 합성이 억제돼 파골 세포 작용을 낮추면 골다공증이 치료되고 별다른 부작용이 생기지 않는다.


# 검진방법 타액 채취로 가능

그러나 특정 유전자군을 가진 사람들의 경우에는 비스포스포네이트를 복용할 경우 메발론산의 합성이 억제돼 골다공증을 치료하는 과정까지는 같으나, 치과시술 시 치조골 (alveolar bone)에 상처가 생길 경우 새 뼈를 다시 생성하는 역할을 하는 조골 세포의 기능에 문제가 생겨 악골괴사와 같은 부작용이 따른다.


이런 환자들의 뼈괴사 부작용은 악골에 한하는 특징이 있어 치과의사들의 발목을 잡고 있다.

비스포스포네이트 제제 복용환자가 치과치료를 받을 경우 BRONJ가 발생할 가능성은 0.12~7% 수준이다. 최근 골다공증환자가 증가 추세에 있는 점을 고려하면 향후 골다공증약 복용환자들의 치과시술에 더 큰 주의가 요구되는 상황이다.         


연세치대병원 연구팀의 이번 연구결과는 골다공증약 복용자들의 BRONJ 발현 가능성을 수치화해 위험성이 높을 경우 사전에 임플란트나 사랑니 발치 등의 치과진료를 피할 수 있는 여건을 형성한 것이다.    


특히, 검진 방법이 환자의 타액만을 채취하면 될 정도로 쉽고 비용도 높지 않아 대중화 될 경우 치과의사들에게 유용할 것으로 전망된다.


연구를 이끈 이재훈 교수는 “비스포스포네이트 제제의 부작용으로 턱뼈괴사가 발생하는 비율은 낮지만 한번 발생하면 피해가 크기 때문에 골다공증 환자들의 치과치료를 하는 데 큰 부담이 있다”며 “이번 연구결과가 새로운 검진법으로 활용될 경우 골다공증 환자의 치과치료계획을 세우는 데 도움이 될 뿐 아니라 추가연구를 통해 BRONJ 치료법 개발에도 큰 진전이 있을 것으로 기대된다”고 밝혔다.

2015/05/28 13:06 2015/05/28 13:06

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