Nicotinamide Improves Delayed Tooth Eruption in Runx2+/− Mice

Patients with cleidocranial dysplasia (CCD) caused by mutations in RUNX2 have severe dental anomalies, including delayed or absent eruption of permanent teeth. This requires painful and expensive surgical/orthodontic intervention because of the absence of medicine for this condition. Here, we demonstrate that nicotinamide, a vitamin B3 and class III histone deacetylase inhibitor, significantly improves delayed tooth eruption in Runx2 +/− mice, a well-known CCD animal model, through the restoration of decreased osteoclastogenesis. We also found that Csf1 mRNA and protein levels were significantly reduced in Runx2 +/− osteoblasts as compared with wild type whereas RANKL and OPG levels had no significant difference between wild type and Runx2 +/− osteoblasts. The nicotinamide-induced restoration of osteoclastogenesis of bone marrow–derived macrophages in Runx2 +/− mice was due to the increased expression of RUNX2 and CSF1 and increased RANKL/OPG ratio. RUNX2 directly regulated Csf1 mRNA expression via binding to the promoter region of the Csf1 gene. In addition, nicotinamide enhanced the RUNX2 protein level and transacting activity posttranslationally with Sirt2 inhibition. Taken together, our study shows the potential and underlying molecular mechanism of nicotinamide for the treatment of delayed tooth eruption by using the Runx2 +/− murine model, suggesting nicotinamide as a candidate therapeutic drug for dental abnormalities in patients with CCD.