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Osteopontin as a means to cope with
environmental insults:
Regulation of inflammation, tissue
remodeling and cell survival
David
T. Denhardt1, Masaki Noda2, Anthony W. O’Regan3,
Dubravko
Pavlin4, and Jeffrey S. Berman3
1Department
of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ USA
2Medical
Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
3The
Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
4Departments
of Orthodontics and Cellular and Structural Biology, University of Texas Health
Science Center at San Antonio, San Antonio, Texas USA
Osteopontin
(OPN) is a phosphorylated acidic glycoprotein that has been implicated in a
number of physiological and pathological events, including maintenance or
reconfiguration of tissue integrity during inflammatory processes. As such, it
is required for stress-induced bone remodeling and certain types of
cell-mediated immunity. It also acts in dystrophic calcification, coronary
restenosis and tumor cell metastasis. An RGD-containing protein, OPN exists both
as an immobilized extracellular matrix (ECM) molecule in mineralized tissues and
as a cytokine in body fluids; it is not a significant part of typical
nonmineralized ECM.
OPN
can engage a number of receptors, including the integrins av(ß1,
ß3, or ß5) and (a4, a5, a8, or a9)ß1,
and it may also be a ligand for certain variant forms of CD44, specifically v6
and/or v7, but possibly only in conjunction with a ß1 integrin (1).
These receptors directly or indirectly activate cellular signaling pathways,
allowing OPN to mediate cell-matrix, and possibly cell-cell, interactions.
Several studies have demonstrated that OPN delivers a pro-survival,
anti-apoptotic signal to the cell. Here, we argue that OPN influences cellular
functions in a unique manner, by mimicking key aspects of an ECM signal outside
the confines of the ECM. We will explore this idea by reviewing recent data
concerning OPN signaling and the consequences of OPN deficiency in several
settings, notably inflammatory processes involving immune cells and bone cells.
OPN-integrin interactions: Consequences of
cleavage by thrombin
Figure
1 illustrates some of the features of the OPN molecule. The presence of a
conserved thrombin cleavage site suggests that certain physiological processes
employing OPN depend upon its cleavage by thrombin. Some of these adhesive
interactions involve the RGD sequence, which is found in various ECM proteins
and binds directly to many integrins. Both RGD-dependent and RGD-independent OPN-receptor
interactions are modulated by thrombin cleavage of OPN. For instance,
thrombin-cleaved OPN, but not intact OPN, can support RGD-dependent migration of
melanoma cells (2). Likewise, K562 erythroleukemia cells bind via activated a5ß1 to the RGD sequence in thrombin-cleaved
OPN. A non-RGD-dependent interaction with a9ß1
offers yet another example: only after cleavage by thrombin can human OPN
interact with a9ß1
via the sequence SVVYGLR, which is located between the RGD sequence
and the thrombin cleavage site (3). This binding motif is also responsible for
the RGD-independent binding of the J6 T-cell line to activated a4ß1,
but in the latter case, cleavage by thrombin is not required for binding of OPN
by activated integrin (4). Adhesion of B lymphocytes via avß3 also occurs via a cryptic binding site
masked in intact OPN, and TPA-activated B lymphocytes attach more effectively to
thrombin-cleaved OPN than to full-length OPN (5). In contrast, binding of
activated platelets via avß3 to the RGD sequence occurs to an
equivalent extent with full-length or thrombin-cleaved OPN.
Senger
and colleagues (6) demonstrated that interaction of thrombin-cleaved OPN with avß3
mediates endothelial cell migration during angiogenesis. They showed that
vascular endothelial growth factor/vascular permeability factor not only induces
OPN and avß3 expression in microvascular endothelial
cells but also stimulates cleavage of OPN by thrombin. As a result of thrombin cleavage, the receptor binding sites found
on the N-terminal side of intact OPN are separated from interacting sites on the
C-terminal side, thus exposing cryptic binding sites. These structural changes
in the protein would be expected also to alter the signal transduction pathways
stimulated in the cell, and indeed, the resulting OPN fragments are strongly
chemotactic for the endothelial cells and may help promote new blood vessel
formation. Because thrombin cleavage unmasks alternate cryptic sites, we suggest
that the intact protein is a better mimic of ECM-generated signals than the
cleaved protein.
Another
role for thrombin-mediated cleavage of OPN may be seen in the coordination of
inflammation with blood coagulation. The coagulation cascade is active at sites
of inflammation, where thrombin appears to be activated.
The level of procoagulant activity may influence on the severity of
inflammation, perhaps mediated by OPN. For
example, mouse strains that are deficient in procoagulant activity exhibit
decreased granuloma formation during delayed-type hypersensitivity (DTH)
reactions (7). Heparin, which inactivates thrombin, also inhibits DTH responses
in humans and rats, in part perhaps because it blocks the cleavage of OPN.
In
addition to proteolytic cleavage, OPN-receptor interactions
may also be determined at the transcriptional and post-translational
levels, since three splice variants have been identified and OPN is subject to
both phosphorylation and glycosylation at multiple sites; some studies suggest
that specific forms of OPN may have distinct functions (For reviews, see refs.
8, 9).
The emerging role of CD44 variants as OPN
receptors
CD44,
a cell surface glycoprotein that serves as an adhesion molecule in
cell-substrate or cell-cell interactions, is strongly upregulated in acute and
chronic inflammation. Its ligands include OPN and the ECM molecules hyaluronic
acid and chondroitin sulfate, all of which can inhibit the cell-cell
interactions that lead to macrophage fusion (10). The widely expressed standard form of this transmembrane
protein is CD44s, but a number of splice variants are known that differ in the
combinations of additional exons represented in their extracellular region.
These CD44 isoforms serve diverse functions. CD44v6 expression on multiple
myeloma cells is increased in the bone marrow microenvironment, where it aids in
the homing and adhesion of the cells (11). The CD44v7 variant isoform appears to
mediate inflammatory bowel disease (12). In an experimental colitis model, a
reduction in the initial inflammatory response in CD44v7-null mice correlates
with increased cell apoptosis in the inflamed mucosa, and it has been suggested
that upregulation of CD44v7 in response to CD40 ligation protects leukocytes
from activation-induced cell death. It is particularly intriguing that CD44v6
and CD44v7, which can both act in DTH reactions, appear to be the principal
isoforms able to bind OPN (1). These data suggest that the region encoded by
v6/v7 promotes effector lymphocyte survival, thus prolonging inflammatory
processes. We propose therefore that OPN is an activator of the CD44v6/v7
survival signal-- a signal that may also be delivered by the ECM, for instance
by hyaluronic acid.
In
an effort to identify anti-apoptotic genes, Lin and colleagues found that OPN is
induced in hematopoietic cells by IL-3 and GM-CSF signaling, both of which are
dependent upon a common b subunit shared by the IL-3 and GM-CSF receptors (13).
They then showed that recombinant OPN can synergize with GM-CSF to promote the
survival and growth of IL-3-dependent mouse bone marrow cells and the pro-B cell
line Ba/F3. This effect seems to involve paracrine or autocrine signaling by OPN
through CD44, since it can be blocked using antibodies to CD44, but not to the av
integrin. The survival pathway activated by OPN in BA/F3 cells does not involve
activation of NF-kB, as has been reported in endothelial cells (see 8).
OPN functions in inflammation and immunity
Recent
research has defined a role for OPN in regulating inflammatory cell accumulation
and function at sites of inflammation and repair (rev: 7). A variety of
inflammatory mediators and growth factors, including IL-1, TNF-a and PDGF, stimulate OPN transcription, often via
activation of protein kinase C (rev: 14). While the exact role of OPN in immune
responses in vivo is unclear, it appears to be critical for macrophage
recruitment and production of certain cytokines during cell-mediated immunity.
Other studies suggest that OPN exerts anti-inflammatory effects and influences
tissue repair at sites of inflammatory responses.
OPN
is widely expressed by a variety of inflammatory cells in culture, including T
cells, macrophages, and NK cells (revs: 14, 15). It was identified as early T
cell activation gene-1 (Eta-1), whose mRNA transcript is abundant in mouse T
cells activated by concanavalin-A. Expression
of OPN is enhanced in a variety of inflammatory processes, ranging from
infection of macrophages by mycobacteria to the granulomas of tuberculosis to
atherosclerosis. In particular, extensive OPN expression is found in T cells and
macrophages in granulomatous diseases such as sarcoidosis.
As
diagrammed in figure 2, OPN has both pro- and anti-inflammatory actions. As a
pro-inflammatory agent, it is chemotactic for, supports adhesion of, and
modulates the function of T cells and monocytes/macrophages. OPN induces
chemotaxis and haptotaxis of T cells and macrophages in vitro, functioning as a
typical chemoattractant (15). OPN injected subcutaneously results in the
accumulation of macrophages at the site of injection. Interestingly, a similar
cutaneous response to subcutaneous injection of the formyl-peptide fMLP is
associated with significant expression of OPN by recruited macrophages and can
be inhibited by pre-treatment with anti-OPN antibodies (cited in ref 7),
suggesting that, in addition to its own direct chemoattractant effects, OPN can
facilitate macrophage migration to other chemoattractants. The basis of this
latter effect is unknown, but, as discussed below, recent studies suggest that
OPN interacts directly with the intracellular machinery of cell migration and
modulates the expression of matrix metalloproteases required for movement
through the ECM. These findings reveal an essential role for OPN in macrophage
motility.
Polarization
of T helper cells to the Th1 or Th2 phenotypes, a critical aspect of cell-
mediated immunity, is influenced by production of early cytokines, including OPN.,
which interacts with integrins and CD44 to enhance Th1 and inhibit Th2 cytokine
expression. Ashkar et al. (16) report that
in cultured mouse peritoneal macrophages, OPN-integrin interaction induces
IL-12, a cytokine that drives Th1 responses.
In the same cells, interaction of OPN with CD44 prevents
lipopolysaccharide-stimulated production of the Th2 cytokine IL-10 (16). The
integrin-mediated response, but not the CD44-mediated response, requires that
OPN be phosphorylated. O'Regan et al. (17)
show that OPN can enhance T-cell-dependent IL-12 production from human
peripheral blood mononuclear cells, in part via its ability to regulate
CD3-induced expression of interferon-g
and CD40L by T cells. Coupled with the in vivo data described below, these
results suggest that OPN acts as a Th1 cytokine and is important in early Th1
responses.
OPN exerts an anti-inflammatory effect by inhibiting the
expression of nitric oxide. In vitro, OPN down-regulates inducible nitric oxide
synthase (iNOS) and reduces NO production by macrophages and kidney tubule
epithelial cells (8, 18). During sepsis, OPN expression is increased in the
vasculature, where it attentuates iNOS activity and blocks the production of NO
metabolites (19). NO stimulates expression of OPN, which, in turn, inhibits iNOS
transcription and reduces NO production , thus establishing an autoregulatory
loop (20).
Both
in rheumatoid arthritis and, to a lesser extent, in osteoarthritis, OPN
expression is elevated in the synovial fluid of the joints (21, 22), where it
represses production of NO and prostaglandin E2. In the inflammed
joint, macrophages are present in abundance, but only some of them express OPN.
Among the agents that might be responsible for increased OPN expression are NO
and IL-1. In rheumatoid arthritis, OPN is expressed predominantly by synovial
fibroblasts attached to the cartilage at sites of invasion. Proinflammatory
actions of OPN include its ability to stimulate collagenase 1 (matrix
metalloproteinase 1) expression and activate invasive behavior of macrophages
and articular chondrocytes. In addition, however, OPN may act in an
anti-inflammatory fashion, by virtue of its ability to inhibit production of the
pro-inflammatory mediators NO and prostaglandin E2 and may thus
reduce the extent of cartilage damage and help maintain tissue integrity.
Compared
to wild-type mice, OPN-null mice have a defective Th-1 response and are more
sensitive to infection by Herpes simplex and
Listeria monocytogenes (16). Although
DTH, as assessed in the footpad following ocular infection with Herpes
simplex, appeared to be impaired in one set of studies, Bonvini et al. (23)
found no such effect. In the latter study, mice were immunized with rabbit IgG
to induce anti-GBM nephritis; subsequent challenge to the footpad resulted in
comparable responses from both wild-type and OPN-null animals. These conflicting
results suggest that some but not all cellular immune reactions are dependent
upon OPN.
OPN
is expressed in human and murine granulomatous responses of diverse etiology
(15, 16), and work with OPN-null mice suggests that this protein is required for
functional granuloma formation. Macrophages
from these mutant mice fail to form
skin granulomas when challenged intradermally with polyvinyl pyrrolidone or to
accumulate normal levels of macrophages in pulmonary granulomas. M.
bovis bacille Calmette-Guerin (BCG) proliferates more aggressively in
granulomas and in macrophages from OPN-null mice compared to wild-type controls,
indicating that OPN helps blunt the course of the infection (24). Similarly, in
humans with a defective interferon-g receptor
1, OPN expression in mycobacterial granulomas is impaired. In these patients, as
in OPN-null mice, mycobacterial infection takes a much more severe course (25).
OPN in
tissue and bone remodeling.
Mice
deficient in OPN exhibit aberrant wound healing, characterized by normal wound
strength but abnormal macrophage debridement and abnormal maturation of collagen
bundles (26). OPN-null mice also exhibit less macrophage infiltration and
collagen deposition in the kidney in a model of interstitial renal fibrosis
(rev: 8). The progressive hypertrophy of rat pulmonary arteries in organ
culture, resulting from the induction of tenascin-C by matrix metalloproteinases
and consequent enhanced smooth muscle cell proliferation, can be reversed by
inhibition of metalloproteinase activity (27). Further, apoptosis of the smooth
muscle cells, which results from the inhibition
of matrix metalloproteinase activity, is suppressed by OPN, suggesting that OPN
suppresses fibrosis following inflammation, perhaps because of its ability to
support cell survival. In addition, as in mineralized tissues, the presence of
OPN may be a pivotal regulator of dystrophic calcification, a deleterious
consequence of inflammatory remodeling.
Injury
to the endothelial lining of the vasculature may lead to pathological
calcification. During inflammation resulting from such injury, growth factors
and inflammatory mediators released by platelets induce leukocyte invasion and
the proliferation of resident cells. Various cytokines, OPN included, are
upregulated by smooth muscle cells and macrophages (rev: 7). Although tissue
integrity is generally restored, occasionally the process becomes pathological,
resulting in excessive cell proliferation and the deposition of an ECM that in
time becomes calcified. What, if any, contribution OPN might make to this
process remains to be established, but since OPN can function as a negative
regulator of calcification (9), it is possible that calcification of
atherosclerotic lesions is augmented in its absence.
Although
it is not required for normal bone formation and development, the presence of
OPN on the bone surface is critical for the remodeling of mature bone. The
abundance and distribution of aspartate and phosphorylated serine residues in
OPN causes it to bind strongly to the calcium phosphate crystals in mineralized
tissues and to inhibit crystal growth (9, 28). Certain functions of OPN require
it to be phosphorylated, a fact of interest because OPN phosphorylation may be
controlled by extracellular phosphatases and kinases. Extracellular phosphate
induces OPN expression in the osteoblast-like MC3T3 cells (29). This regulation
may be a control mechanism that ties an increase in OPN expression to the
cessation of osteoblast proliferation and the onset of differentiation, events
that coincide with the induction of alkaline phosphatase. Induction by phosphate
could also account for high levels of OPN expression in osteoclasts involved in
resorbing bone matrix and solubilizing bone mineral.
Using
an OPN-null mouse model (8), Noda and colleagues (30) have shown that
ovariectomized mice do not lose bone mineral to nearly the same extent as
control animals. Four weeks after ovariectomy, the wild-type mice had lost 58%
of their trabecular bone volume in the proximal tibia, while the OPN-null mice
had lost only 12%. Resorption of ectopic bone is also substantially impaired in
the absence of OPN (31). Calvaria bone discs from wild-type mice implanted
intramuscularly in wild-type mice are resorbed much more rapidly than bone discs
from OPN-null mice implanted in OPN-null mice. Vascularization of the implanted
bone discs and the number of adherent osteoclasts are also much reduced in the
absence of OPN. In a tail-suspension model of disuse osteoporosis, the OPN-null
femur is resistant to the loss of bone mineral, and these mice do not exhibit
the reduction in bone formation rate seen in wild-type, tail-suspended mice,
suggesting that they are defective not just in osteoclast function, but also in
the coupling of mechanical stress to osteoblast function (32).
Osteopontin signaling and CD44.
Osteoclasts
share their lineage with macrophages, and both cell types are specialized for
resorption, producing and responding to many of the same factors, including OPN.
Osteoclast motility on bone is impaired in the absence of OPN (33), apparently
as a result of decreased surface expression of CD44 and the absence of an
association between the actin-binding protein gelsolin and mDia1, a Rho effector
protein and transcriptional activator that mediates some of the effects of serum
response factor. This association normally occurs during the formation of podosomes and is
responsible for the avß3-mediated
activation by OPN of gelsolin-associated Src, which in turn results in enhanced
phosphatidylinositol 3-kinase activity and actin filament formation.
The
involvement of CD44 is intriguing in light of the evidence that OPN found in
migrating fibroblasts can associate with CD44 and the ERM (ezrin, radixin, moesin)
proteins just inside the plasma membrane, notably at the leading edge in
filopodia-like structures (34). This perimembranous distribution is distinct
from the perinuclear and punctate cytoplasmic staining pattern seen in
non-migrating cells, which is presumed to represent OPN protein in the secretory
pathway. The ERM proteins mediate interactions between the plasma membrane and
cortical actin filaments, regulating formation of surface structures such as
microvilli, filopodia and membrane ruffles. Their activity is controlled by
phosphatidyl inositol 4,5-bisphosphate and by phosphorylation by various
tyrosine and serine/threonine kinases. The CD44/OPN/ERM complex appears
necessary for cell migration, since fibroblasts from CD44-null or OPN-null mice
exhibit impaired migration and attach less efficiently to hyaluronan-coated
beads. Intracellular OPN fails to localize to the perimembranous regions in the
absence of CD44, suggesting that CD44 is required for OPN to form the
perimembranous complex. The perinuclear and perimembranous localizations appear
to be mutually exclusive, but it remains unclear whether the perimembranous pool
of OPN is free in the cytoplasm or contained within secretory vesicles.
Regulation of OPN expression in bone.
In
some bone cell types OPN expression is strongly enhanced by mechanical stimuli
(35). In cultured osteoblastic cells, OPN is expressed early during
differentiation, and expression is maintained at a high level throughout the
later stages of in vitro
mineralization. OPN is also produced by osteoblasts involved in endochondral
ossification during development. However, in
vivo osteoinduction in mouse alveolar bone during tooth movement results in
down-regulation of OPN in osteoblasts that are stimulated to differentiate and
synthesize matrix by mechanical loading (36-38). A study of experimental tooth
movement in rats showed a rapid enhancement of OPN expression in osteocytes and
osteoblasts on the pressure (compression) side followed by osteoclast
recruitment and bone resorption (39).
Figure
3 shows the effect of mechanical loading on OPN expression in three mouse cell
types in the region where the tooth root is anchored to bone. In a steady-state
situation, in situ hybridization
(shown in Fig. 3a) reveals low and
modest levels of OPN mRNA in cementoblasts and osteoblasts respectively. In
osteoblasts at sites of bone formation (Fig. 3b) OPN mRNA is down-regulated,
whereas it is up-regulated within the layer of cells on the bone surface in
resorption sites (Fig. 3c), perhaps as a result of increased local free
phosphate. Similarly, OPN synthesis in human femoral heads occurs in osteoblasts
engaged in de novo bone formation, but not adaptive bone remodeling (40). To
date, OPN is the only known osteoblast-associated gene whose expression is
reduced in mature, bone matrix-producing osteoblasts; expression of other
markers (such as osteocalcin, alkaline phosphatase, type I collagen and bone
sialoprotein) is enhanced (36, 37).
OPN
mRNA levels are augmented, possibly by mechanical strain, in osteocytes in both
sites of bone formation and bone resorption (Fig. 3b, c). This effect parallels
inhibition of expression in the osteoblasts in bone formation sites, and also
stimulation of expression in osteoclasts and mononuclear cells in resorption
sites. These results are consistent with a reciprocally coordinated regulation
of OPN in the two cell types as a mechanism for coupling of bone resorption and
formation (38). The simultaneous increase in OPN mRNA expression in bone
osteocytes adjacent to both resorption and formation sites suggests that OPN
exerts a reciprocal paracrine effect on cells on the bone surface, leading to
stimulation and repression of its synthesis in osteoclasts and osteoblasts,
respectively. The dendritic network between osteocytes and bone lining cells may
help to integrate these opposing effects. Additional mechanisms, possibly
including mineral exposure, may be necessary to determine which phase of the
remodeling cycle-- resorption or formation-- will prevail on a particular area
of bone surface exposed to an OPN-mediated signal initiated by osteocytes.
Summary
OPN
is a multifunctional cytokine and adhesion protein that contains an integrin-binding
RGD sequence and additional sequences that interact with CD44v6/7 or other
adhesive receptors.Its expression is increased in response to early
pro-inflammatory cytokines and to mechanical strain in bone. The function of the
secreted protein may be altered by extracellular enzymes, including thrombin and
kinases. The study of OPN-null mice has revealed roles for OPN in a broad range
of homeostatic (bone remodeling, tissue debridement) and pathologic (cellular
immunity, wound healing, cancer metastasis) processes. While these processes
seem disparate, they are linked by several common themes, including enhanced
expression of OPN in response to stress or tissue injury, and stimulation of
cell motility and cell survival pathways via interactions of OPN with adhesive
receptors.
OPN
is chemotactic for various cell types, notably monocytes/macrophages, which are
attracted to sites of infection and inflammation. It is essential for
cell-mediated immmunity and a normal Th1 cytokine response during granuloma
formation. OPN serves both to attach bone cells to bone matrix and to generate
intracellular signals essential for normal osteoclast motility on bone; it may
mediate osteocyte recognition of bone strain. OPN activates intracellular
signaling pathways and regulates gene expression as a consequence of its
interactions with its various receptors. The best characterized is the integrin-stimulated
FAK-Src-Rho pathway, which alters gelsolin function and podosome formation in
osteoclasts. Identification and dissection of the signal transduction pathways
and their targets is complicated by the fact that OPN can engage more than one
type of receptor on the cell. For this reason, it is important to ascertain
which receptors are in play in any given experimental system.
There
is compelling evidence that soluble OPN can in a variety of situations help
cells survive an otherwise lethal insult. Remarkably, this survival signaling is
mediated by receptors that are generally considered to be receptors for ECM
components. We suggest that OPN delivers an anti-apoptotic “ECM-like” signal
via multiple ligand-receptor interactions to cells, both adherent and
nonadherent.
Acknowledgments
Research
in the authors’ laboratories has been generously supported by grants from the
US National Institutes of Health (ES06897 and AR44434 to DTD, P50-HL56386 and HL
63339 to JSB, HL04343 to AO, and
DE11005 to DP) and the Japanese Ministry of Education to MN.
Sincere
apologies to those whose papers have not been cited because of space
constraints.
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Figure
legends
Fig. 1: Some
features of the OPN protein. Indicated sites of O-glycosylation and
phosphorylation are intended to be representative; both vary (phosphorylation in
particular) with the source of the protein. Numbering of the amino acids is
based on the human protein, and the signal sequence is not illustrated.
Fig. 2: Pro- and
anti-inflammatory actions of OPN in cell injury and infection. The left side of
the diagram summarizes pro-inflammatory and anti-inflammatory events believed to
be regulated by OPN. The right side of the diagram summarizes known or predicted
events in the OPN-null mouse. The center illustrates the wounding of the
epithelium or endothelium, which is followed by macrophage(M)-mediated
containment of an infecting agent and, finally, repair of the injury. (MMP-2, matrix metalloproteinase 2.) See
text for further details.
Fig. 3. OPN
mRNA expression during tooth relocation as assessed by in situ hybridization with an OPN mRNA probe in sections of a mouse
dento-alveolar complex. (a) shows a control, untreated site. The tooth
was moved for 3 days by a controlled orthodontic force, resulting in bone
formation in distal periodontal sites (b) and direct resorption in mesial sites
(c) of the first molar. Following relocation, the OPN mRNA hybridization signal
decreased in periodontal osteoblasts in bone formation sites (b, right side),
and increased in cells (osteoblasts, osteoclasts and their precursors) lining
alveolar bone surface in resorption sites (c). The mechanically induced OPN
hybridization signal is present in alveolar osteocytes within the bone adjacent
to both resorption and formation sites (b, c). A control sense OPN probe did not
yield any signal above background. F, direction of orthodontic force and tooth
movement; TR, tooth root; PD, periodontium; AB, alveolar bone; OB, osteoblasts;
OCY, osteocytes; CBL, cementoblasts; OCL and MN, osteoclasts and their
mononuclear precursors. Note that the PD is enlarged in (b), where the TR is
being pulled away from the AB, but that it is reduced in (c), where the PD is
being compressed between the TR and the AB.