Expressão do interferon-γ em biópsias gengivais de pacientes com periodontite crônica severa

O objetivo desse estudo foi analisar a expressão do interferon-gamma (INF-) em biópsias gengivais de sítios rasos e profundos de pacientes com periodontite crônica severa. O objetivo secundário foi correlacionar a expressão do INF- no fluido gengival com os sítios onde foram coletadas as biópsias gengivais. Foram coletadas biópsias de 22 pacientes portadores de periodontite crônica generalizada ou localizada severas (idade média 45,5  DP 8,9 anos), sendo 22 sítios profundos e 18 sítios rasos. O grupo controle foi composto por 14 pacientes clinicamente saudáveis (idade média 39,35  DP 16,5 anos). No total, foram 54 biópsias coletadas de 36 pacientes. As amostras do fluido gengival foram coletadas de alguns dos mesmos sítios de onde foram realizadas as biópsias, totalizando 12 sítios profundos, 8 sítios rasos e 4 sítios controle. Foram utilizados os parâmetros clínicos de avaliação de profundidade de bolsa à sondagem (PB); nível de inserção clínica (NIC); índice de placa visível (IPV) e índice de sangramento gengival (ISG). O tecido foi removido com punch de 2 mm de diâmetro, na área cirúrgica (grupo controle) ou na consulta para raspagem subgengival com ou sem acesso cirúrgico (grupo teste) e armazenados em Eppendorffs com 1 ml de solução de formaldeído a 10% para posterior análise morfológica e imuno-histoquímica. A intensidade da marcação do INF- foi avaliada semiquantitativamente nas células epiteliais, plasmócitos, macrófagos, fibroblastos e células endoteliais, considerando-se marcação forte (escore 2), marcação fraca (escore 1) ou ausência de marcação (escore 0). O teste de Kruskal-Wallis foi utilizado para comparar a expressão do INF- nos tecidos epitelial e conjuntivo, entre os três grupos (sítios profundos e rasos da periodontite e sítios controle). Observamos uma tendência a um padrão de marcação similar nos sítios rasos e profundos, com predomínio de marcação fraca nos sítios profundos. Nos sítios controle a marcação do epitélio demonstrou ser predominante. Porém, não foi possível demonstrar diferenças estatisticamente significativas entre a expressão do INF- nos tecidos epitelial e conjuntivo nos grupos analisados. A análise da correlação de Spearman revelou uma forte correlação entre a expressão imuno-histoquímica do INF- no epitélio com macrófagos, fibroblastos e células endoteliais (r ≥ 0,6 e p ≤ 0,01). A expressão do INF- nos tecidos demostrou não ter correlação significante com os dados clínicos apresentados e com o fluido gengival. Concluímos que não foi possível observar diferenças na expressão do INF- em biópsias gengivais nos sítios rasos e profundos de pacientes com periodontite quando comparados à indivíduos saudáveis, o que pode ser atribuído ao caráter bifásico do INF-. A baixa detecção do INF- no fluido gengival, dentro das limitações do estudo, pode sugerir que este talvez não seja o método de eleição para a detecção do INF-Y.

Efeito do movimento dentário nos níveis de metaloproteinases da matriz no fluido gengival de pacientes com periodontite controlada

O objetivo deste trabalho foi examinar o impacto da movimentação dentária de dentes periodontalmente comprometidos no volume do fluido gengival crevicular (FGC) e nos níveis de expressão das metaloproteinases de matriz (MMPs) -1, -2, -3, -7, -8, -12 e -13 no FGC. Dez pacientes periodontalmente controlados (8 do sexo feminino e 2 do sexo masculino, média de idade de 46,2 10,4 anos) com incisivos projetados labialmente foram submetidos a tratamento ortodôntico. Uma arcada dentária foi submetida a movimentação ortodôntica e a arcada oposta foi usada como controle. Amostras de FGC foram coletadas da face lingual de dois incisivos do lado movimento e dois do lado controle uma semana antes da ativação ortodôntica (-7d), imediatamente após a ativação ortodôntica, e após 1 h, 24 h, e 7, 14 e 21 dias. A coleta do FGC foi feita utilizando-se tiras de papel absorvente e o volume foi calculado através do uso do Periotron. Todos os pacientes receberam orientações de higiene bucal e um kit contendo escova de dente, pasta de dente e bochecho de Chlorexidina 0,12% para ser usado durante todo o experimento. A técnica da multianálise imunoenzimática com microesferas foi usada para medir as MMPs no FGC. Os dados foram analisados utilizando-se os testes estatísticos Friedman e Mann-Whitney. Não foram encontradas diferenças estatisticamente significativas no volume do FGC. Em relação aos níveis de MMPs, a única diferença estatisticamente significativa encontrada no decorrer do tempo foi nos níveis de MMP-1 no grupo movimento (p<0,05). Quando os dois grupos foram comparados após a ativação, a única diferença estatisticamente significativa encontrada foi nos níveis de MMP-12 24 horas após a ativação (p<0,05). Estes achados sugerem que o volume de FGC não sofre alteração relacionada ao movimento dentário ortodôntico e que o movimento ortodôntico de dentes periodontalmente comprometidos não resultou em mudanças significativas nos níveis de MMPs no FGC.

Utilização de biópsias gengivais minimamente invasivas para o estudo da expressão de mediadores inflamatórios e sua correlação com a expressão do fluido gengival em pacientes com periodontite severa

O objetivo deste estudo foi utilizar biópsias minimamente invasivas para avaliar a expressão de mediadores inflamatórios e sua correlação com o fluido gengival em pacientes com periodontite severa. O grupo teste compreendeu 22 pacientes com periodontite severa (idade média 45,5  DP 8,9 anos), analisados por sítios rasos e profundos, e o grupo controle por 14 pacientes periodontalmente saudáveis (idade média 39,35  DP 16,5 anos). As amostras do fluido gengival foram coletadas com papel absorvente, nos mesmos sítios de onde foram realizadas as biópsias, e quantificadas, por Luminex, para IFN- γ, IL 1-β, IL-6, IL-21, IL-22, IL-23, IL-25, IL-31, IL-33, IL-4, IL-6, IL-10, IL-17A, IL-17F, sCD40L e TNFα. Foram coletadas biópsias, com um punch de 2mm de diâmetro nos grupos teste e controle. A avaliação imuno-histoquímica foi semiquantitativa, nas células epiteliais, plasmócitos, macrófagos, fibroblastos e células endoteliais, para a IL1-β, IFN-γ, IL-6 e IL-17. Foram observadas marcações imuno-histoquímicas, em todos os grupos celulares analisados, tanto nos pacientes com periodontite como nos controles, sem diferenças significativas entre eles. O fluido gengival apresentou maiores quantidades para os marcadores IL-1β e IL-23 nos sítios profundos. Não foram encontradas correlações significativas entre as marcações imuno-histoquímicas e o fluido gengival para os subgrupos analisados. Na análise comparativa entre as biópsias e o fluido gengival, a IL1-β mostrou alta concordância nos sítios rasos e profundos. Concluindo, a utilização padronizada de um punch de 2mm de diâmetro para biópsias em tecido periodontal mostrou- se viável, para estudos com imuno-histoquímica. O fluido gengival pode não expressar todos os marcadores do tecido correspondente, com variações dependendo do marcador analisado e das condições inflamatórias locais.

Neuropeptide Y (NPY) and NPY Y1 receptor in periodontal health and disease

Abstract
OBJECTIVES:
Neuropeptide Y (NPY) coordinates inflammation and bone metabolism which are central to the pathogenesis of periodontitis. The present study was designed to determine whether NPY was quantifiable in human gingival crevicular fluid (GCF) and to test the null hypothesis that GCF levels of NPY were the same in periodontal health and disease. A subsidiary aim was to determine the potential functionality of released NPY by detecting the presence of NPY Y1 receptors in gingival tissue.
DESIGN:
The periodontitis group consisted of 20 subjects (10 females and 10 males) mean age 41.4 (S.D. 9.6 years). The control group comprised 20 subjects (10 females and 10 males) mean age 37.4 (S.D. 11.7 years). NPY levels in GCF were measured in periodontal health and disease by radioimmunoassay. NPY Y1 receptor expression in gingival tissue was determined by Western blotting of membrane protein extracts from healthy and inflamed gum.
RESULTS:
Healthy sites from control subjects had significantly higher levels of NPY than diseased sites from periodontitis subjects. NPY Y1 receptor protein was detected in both healthy and inflamed gingival tissue by Western blotting.
CONCLUSIONS:
The significantly elevated levels of NPY in GCF from healthy compared with periodontitis sites suggests a tonic role for NPY, the functionality of which is indicated by the presence of NPY Y1 receptors in local gingival tissue.

Identification of MRP-8 (calgranulin A) as a major responsive protein in chronic periodontitis

The purpose of the study was to analyse how the protein composition of the inflammatory exudate associated with chronic periodontitis differed from the exudate in periodontal health. Gingival crevicular fluid (GCF) was collected from sites with chronic periodontal inflammation and from non-diseased sites in healthy control subjects. Microbore HPLC analysis revealed one major difference in GCF protein profiles between healthy controls and periodontitis patients. The protein enhanced in periodontitis patients was identified as migration inhibitory factor-related protein-8 (MRP-8) by a combination of N-terminal amino acid sequencing, mass spectrometry, and SDS-PAGE. Together, these data demonstrate, for the first time, the presence of monomeric MRP-8 in an inflammatory exudate. Whether monomeric MRP-8 is a unique feature of chronic periodontal inflammation is not yet clear, but the chemotactic properties of this peptide support a functional role for MRP-8 in periodontal inflammation. Copyright (C) 2000 John Wiley & Sons, Ltd.

Mapping biological to clinical phenotypes during the development (21 days) and resolution (21 days) of experimental gingivitis

Aim: To characterize and map temporal changes in the biological and clinical phenotype during a 21-day experimental gingivitis study. Materials and Methods: Experimental gingivitis was induced over 21 days in healthy human volunteers (n = 56), after which normal brushing was resumed (resolution phase). Gingival and plaque indices were assessed. Gingival crevicular fluid was collected from four paired test and contra-lateral control sites in each volunteer during induction (Days 0, 7, 14 and 21) and resolution (Days 28 and 42) of experimental gingivitis. Fluid volumes were measured and a single analyte was quantified from each site-specific, 30s sample. Data were evaluated by analysis of repeated measurements and paired sample tests. Results: Clinical indices and gingival crevicular fluid volumes at test sites increased from Day 0, peaking at Day 21 (test/control differences all p

Physicochemical characterization and preliminary in vivo efficacy of bioadhesive, semisolid formulations containing flurbiprofen for the treatment of gingivitis

In this study, the physicochemical properties and preliminary in vivo clinical performance of formulations containing hydroxyethylcellulose (HEC; 3, 5, 10% w/w, poly(vinylpyrrolidone) (PVP; 3, 5% w/w), polycarbophil (PC; 1, 3, 5% w/w), and flurbiprofen (5% w/w) were examined. Flurbiprofen release into PBS pH 7.4 was performed at 37 degrees C. The mechanical properties (hardness, compressibility, adhesiveness, initial stress) and syringeability of formulations were determined using a texture analyzer in texture profile analysis (TPA) and compression modes, respectively. In general, the time required for release of 10 and 30% of the original mass of flurbiprofen (t(10%), t(30%)) increased as the concentration of each polymeric component increased. However, in the presence of either 5 or 10% HEC and 5% PC, increased PVP concentration decreased both t(10%), t(30%) due to excessive swelling land disintegration) of these formulations. Increased concentrations of HEC, PVP, and PC significantly increased formulation hardness, compressibility, work of syringe expression, and initial stress due to the effects of these polymers on formulation viscoelasticity. Similarly, increased concentrations of PC (primarily), HEC, and PVP increased formulation adhesiveness-due to the known bioadhesive properties of these polymers. Clinical efficacies of formulations containing 3% HEC, 3% PVP, 3% PC, and either 0% (control) of 5% (test) flurbiprofen, selected to offer optimal drug release and mechanical properties, were evaluated and clinically compared in an experimental gingivitis model. The test (flurbiprofen-containing) formulation significantly reduced gingival inflammation, as evaluated using the gingival index, and the gingival crevicular fluid volume, whereas, these clinical parameters were generally increased in volunteers who had received the control formulation. There were no observed differences in the plaque indices of the two subject groups, confirming that the observed differences in gingival inflammation could not be accredited to differences in plaque accummulation. This study has shown both the applicability of the in vitro methods used, particularly TPA, for the rational selection of formulations for clinical evaluation and, additionally, the clinical benefits of the topical application of a bioadhesive semisolid flurbiprofen-containing formulation for the treatment of experimental gingivitis.

Neuropeptides in GCF in Experimental Gingivitis

Objectives: To investigate changes in the levels of the neuropeptides substance P (SP)and vasoactive intestinal peptide (VIP) in gingival crevicular fluid (GCF) during the development of gingival inflammation. Methods: Ten female volunteers completed an experimental gingivitis study. Clinical indices were recorded during an 18-day period of plaque accumulation after a further 10 days following the restoration of normal oral hygiene. 30-second GCF samples were taken periodically from two test and two control sites per subject using periopaper and stored at -70C prior to analysis. Radioimmunoassay was used to quantify SP- and VIP-like immunoreactivity (SP-LI, VIP-LI). Results: Gingival inflammation developed at test sites with increases in the plaque index, gingival index and bleeding on probing. Gingival health was restored following resumption of normal oral hygiene measures. At control sites SP-LI and VIP-LI remained low throughout the study period. At experimental gingivitis sites the mean amounts of SP-LI/30s rose from 3.9pg on day 0 to 37.7 pg, 64.9 pg and 61.8 pg by days 7, 14 and 18, before falling to 5.6 pg on day 28. Mean amounts of VIP-LI/30s rose from 102.8pg on day 2 to 727.6 pg and 853.5 pg on days 11 and 16, before falling to 371.4 pg by day 28. VIP was present in higher levels than SP in the GCF from both healthy and inflamed sites. SP levels rose more rapidly than VIP. Conclusions: There was a significant increase in SP and VIP in GCF paralleling the development of gingival inflammation.

Neuropeptide Y in GCF in periodontal health and disease

Objectives: To determine whether neuropeptide Y (NPY) is present in gingival crevicular fluid (GCF) in both periodontal health and disease and to study the relationship of NPY with periodontal inflammation. Methods: GCF samples (30 s) were collected from one site with both pocket depth (>4mm) and loss of periodontal attachment (>4mm) in 20 patients with chronic periodontitis (mean age 41.4, SD 9.6 yrs; 10 m, 10 f). GCF was also collected from clinically healthy sites (< 3mm, no bleeding on probing) in 20 subjects with no periodontitis (mean age 37.4, SD 11.7; 10 m, 10 f). GCF was collected using the periopaper strip method, diluted in 500 ul of phosphate-buffered saline and stored at –70°C. Samples were analysed in duplicate for NPY by radioimmunoassay. NPY levels were compared using the Mann-Whitney test. Results: Measurable NPY was present in all the GCF samples collected from healthy subjects. NPY was below the level of detection in 4 (20%) of the diseased subjects. There was considerable variability in the amount of NPY collected from both groups. There were no differences between the levels of NPY measured in males compared with females in either the healthy or diseased groups. Significantly more (P< 0.0001) NPY (pg) was collected from healthy subjects (Median 165, IQR 80; mean 161, SD 64) than diseased subjects (Median 37.5, IQR 56.3; mean 39.8, SD 35.1). There was more variability in the NPY concentration (pg/ul) which was also significantly higher in healthy (Median 575.7, IQR 562.3; mean 645.7, SD 416.7) compared with diseased subjects (Median 43.6, IQR 117.4; mean 96.4, SD 124.5). Conclusions: It is concluded that the levels of NPY in GCF sampled

The role of LL-37 in periodontal wound healing

Introduction: As a result of chronic inflammation during periodontal disease the junctional epithelium becomes micro-ulcerated. The inflammatory process is mediated by both bacterial and host cell products. Host defence peptides such as defensins, secretory leucocyte protease inhibitor (SLPI) and the sole human cathelicidin, LL-37, are secreted by both periodontal cells and neutrophils into gingival crevicular fluid (GCF). They have the ability to modulate the immune response in periodontitis and are thought to have a potential role in periodontal wound healing. Objectives: The aims of this study were to determine the role of LL-37 in the production of Interleukin (IL)-8, IL-6, hepatocyte growth factor (HGF) and basic-fibroblast growth factor (bFGF) by gingival fibroblasts. The role of LL-37 in modulating total matrix metalloproteinase (MMP) activity and expression of tissue inhibitors of metalloproteinase (TIMP)-1 and -2 by gingival fibroblasts was also investigated. Methods: Primary gingival fibroblasts were co-cultured with concentrations of LL-37 (1, 5 and 10µg/ml) for 24 hours and their supernatants tested for levels of IL-8 and IL-6, HGF, bFGF, TIMP-1 and TIMP-2 by ELISA. Rates of MMP turnover in the supernatants were tested by fluorogenic assay using fluorescence resonance energy transfer (FRET) peptide substrates. Cytotoxicity was measured by MTT assay. Statistical significance was measured using the independent t-test and p<0.05 was considered significant. Results: LL-37 significantly upregulated levels of IL-8, IL-6, HGF, bFGF and TIMP-1 (p<0.05) in a dose-dependent fashion. LL-37 significantly decreased the total MMP activity (p<0.05). None of the LL-37 concentrations tested were cytotoxic to gingival fibroblasts. Conclusion: These results indicate that LL-37 is involved in periodontal wound healing. LL-37 increased levels of proinflammatory cytokines and increased levels of growth factors involved in re-epithelialisation. LL-37 has the ability to regulate remodelling of the periodontium by controlling MMP overactivity both directly and by stimulating production of inhibitors by gingival fibroblasts.

MMP-8 Activity Profiling In GCF Samples

Background: In healthy tissues a family of enzymes known as matrix metalloproteinases (MMPs) play an important role in regulating turnover and metabolism of connective tissue collagen. MMPs have been implicated in a wide variety of pathological conditions including periodontal disease. MMP-8 has been extensively studied in periodontal health and disease using enzyme-linked immunosorbent assay (ELISA). Although ELISA quantifies the presence of the MMP-8 protein, it is not possible to determine enzyme activity using this method. Furthermore, since members of the MMP family have poor substrate sequence specificity, a peptide substrate alone cannot differentiate the activity of MMP-8 from other MMPs that may be present in biological samples. Objectives: In the present study, a method to specifically measure MMP-8 activity in gingival crevicular fluid (GCF) samples was developed. Methods: GCF was collected from healthy patients and those with periodontal disease using Perio paper strips. Samples were stored frozen until required for analysis. A specific MMP-8 antibody was used to coat 96 well microtitre plates to selectively remove MMP-8 from the GCF samples. Following a washing step, the activity of bound MMP-8 was measured over 70 minutes using a fluorogenic (FRET) substrate. Results: GCF from healthy subjects exhibited basal MMP-8 activity but in diseased samples MMP-8 activity was significantly higher. Minimal binding of other recombinant MMPs to the specific MMP-8 antibody was observed in cross-reactivity studies. Conclusion: We show for the first time that MMP-8 activity was significantly increased in GCF from periodontitis sites compared with activity levels in healthy sites. Further studies of MMP-8 activity in GCF samples should improve our understanding of its destructive role in periodontal disease.

Design, synthesis and validation of an inhibitor of CGRP degradation

Introduction: In addition to their afferent role in detection and signalling noxious stimuli, neuropeptide-containing sensory nerves may initiate and maintain chronic inflammation in diseases such as periodontitis by an efferent process known as neurogenic inflammation. Neuropeptides are susceptible to cleavage by peptidases, and therefore, the exact location and level of expression of peptidases are major determinants of neuropeptide action. Previous studies in our laboratory showed that enzyme components of gingival crevicular fluid (GCF) from periodontitis sites selectively inactivated the neuropeptide calcitonin gene-related peptide (CGRP), known to have a role in inhibiting osteoclastic bone resorption. Objectives: The aim of this study was to design and synthesise a specific inhibitor to prevent the degradation of CGRP by components of GCF. Methods: A hydroxamate-based inhibitor with a biotinylated tag was designed to ensure selectivity for CGRP and ease of use for future purification strategies. The biotinylated peptide hydroxamate contained the P1-P4 amino acid sequence of the potential CGRP cleavage site and was synthesised by solid-phase methods using standard Fmoc chemistry. Inhibition of CGRP metabolism by GCF was determined by MALDI-mass spectrometry (MALDI-MS) using pooled GCF samples from periodontitis patients as a crude source of the CGRP-degrading enzyme. Results: MALDI-MS analysis of CGRP degradation showed almost complete inhibition in the presence of the biotinylated inhibitor. Our results showed that the rate-limiting step in the cleavage of CGRP is endopeptidase cleavage, followed by carboxypeptidase attack. Conclusion: This study demonstrates that the enzyme component of GCF responsible for the degradation of CGRP can be inhibited by a biotinylated hydroxamate modelled on a potential endopeptidase cleavage site. The biotin tag on the inhibitor will facilitate our future purification of the CGRP-cleavage enzyme using a streptavidin-agarose column.

LL-37 Degradation by GCF: A Role for Porphyromonas gingivalis Proteinases?

Background: LL-37, composed of 37 amino acid residues, is an innate host defence peptide of the cathelicidin family. It is expressed by neutrophils, monocytes and epithelial cells and exhibits both anti-bacterial and immunomodulatory properties. LL-37 is however prone to proteolytic degradation by proteinases, thus potentially limiting its inherent host defence properties in the inflammatory milieu. Objectives: The present study was designed to determine whether LL-37 was degraded by components of gingival crevicular fluid (GCF) from healthy subjects or those with periodontitis. In addition, we aimed to deduce whether degradation of the peptide was accelerated in GCF samples which were determined to be positive for the periodontopathic bacterium Porphyromonas gingivalis. Methods: GCF and bacterial plaque samples, pre- and post non-surgical periodontal treatment, were collected from 4 individual sites in patients presenting with advanced periodontitis. In healthy subjects, GCF samples only were collected. Plaque samples were analysed by QPCR for the presence or absence of P. gingivalis. Pooled GCF samples from healthy sites; periodontitis sites which were P. gingivalis negative (Pg-); or periodontitis sites which were P. gingivalis positive (Pg+), were incubated with synthetic LL-37 for 0 – 180 min. The degradation products were then analysed by matrix-assisted laser desorption/ionisation time of flight mass spectrometry (MALDI-TOF MS). Results: LL-37 was not degraded when incubated with GCF from healthy subjects. In contrast, LL-37 was degraded after 30 min when incubated with Pg- GCF. However degradation of LL-37 was apparent after only 2 min incubation with Pg+ GCF and the parent molecule was almost completely degraded after 30 min. Conclusions: The rapid degradation of LL-37, particularly in Pg+ sites, highlights the limited role which this host defence peptide may play in the presence of biologically active proteinases. It also underscores a potent virulence mechanism of P. gingivalis used to circumvent innate host responses.

CGRP-cleavage enzyme detection using a biotinylated hydroxymate affinity probe

Introduction: Neuropeptides contribute to the pathophysiology of peripheral inflammation and a neurogenic component has been described for many inflammatory diseases, including periodontitis. Neuropeptides are susceptible to cleavage by peptidases and therefore the exact location and level of expression of peptidases are major determinants of neuropeptide action. Previous studies by our research group suggested that levels of the neuropeptide calcitonin gene-related peptide (CGRP) may be regulated by peptidases present in gingival crevicular fluid (GCF). Objectives: The aim of this work was to purify and partially characterize the GCF enzyme responsible for CGRP degradation using a biotinylated hydroxymate affinity probe (based on the P1-P4 amino acid sequence of the observed cleavage site) which we previously showed to inhibit CGRP degradation. Methods: Pooled healthy and pooled periodontitis GCF samples were subject to a pre-clear step with magnetic streptavadin beads. Healthy and diseased samples were incubated with the biotinylated hydroxymate probe (20 uM) after which biotinylated proteins were purified from the sample using magnetic streptavadin beads. Bound proteins were subjected to SDS-PAGE and western blotting. Biotin incorporated proteins were disclosed using a streptavadin horse radish peroxidase conjugate. Results: A band was disclosed in the periodontitis pooled sample at a molecular weight of approximately 60 kDa. The band was absent in the pooled healthy samples. As expected, when periodontitis samples were pre-boiled to denature proteins before the addition of the hydroxymate probe, no biotin incorporated band was present. Conclusions: This work demonstrates the purification and disclosure of a protein found specifically in periodontitis which binds to the specific biotinylated hydroxymate affinity probe based on the cleavage site of CGRP only when in its native form. We intend to scale up the sample size thus allowing the identification of the putative CGRP degrading peptidase using MALDI-mass spectrometry.
Funded by an IADR/GlaxoSmithKline Innovation in Oral Care Award

Salivary Interleukin-6, Matrix Metalloproteinase-8, and Osteoprotegerin in Patients With Periodontitis and Diabetes

Background: Diabetes and periodontitis produce a protein discharge that can be reflected in saliva. This study evaluates the salivary concentrations of interleukin (IL)-6, matrix metalloproteinase (MMP)-8, and osteoprotegerin (OPG) in patients with periodontitis with type 2 diabetes. Methods: Whole saliva samples were obtained from 90 subjects who were divided into four groups: healthy (control; n = 22), untreated periodontitis (UPD; n = 24), diabetes mellitus (DM; n = 20), and UPD + DM (n = 24) groups. Clinical and metabolic data were recorded. Salivary IL-6, MMP-8, and OPG concentrations were determined by a standard enzyme-linked immunosorbent assay. Results: The UPD and UPD + DM groups exhibited higher salivary IL-6 than the control and DM groups (P <0.01). The salivary MMP-8 concentrations in all diseased groups (UPD, DM, and UPD + DM) were higher than in the control group (P <0.01). The salivary OPG concentrations in the DM group were higher than in the UPD and control groups (P<0.05). In the UPD + DM group, salivary IL-6 was correlated with glycated hemoglobin (HbA1c) levels (r = 0.60; P<0.05). The regression analysis indicated that the number of remaining teeth, clinical attachment level, and IL-6 might have influenced the HbA1c levels in patients with diabetes. Conclusions: Salivary 1L-6 concentrations were elevated in patients with periodontitis with or without diabetes. Salivary MMP-8 and OPG concentrations were elevated regardless of periodontal inflammation in patients with diabetes. Therefore, periodontitis and diabetes are conditions that may interfere with protein expression and should be considered when using saliva for diagnoses. J Periodontol 2010;81:384-391.