Gingival inflammation and leukocyte-endothelium cell interactions in women with polycystic ovary syndrome

Gingival inflammation and leukocyte-endothelium cell interactions in women with polycystic ovary syndrome

BACKGROUND

Given the link between chronic inflammation and periodontal pathologies and increased cardiovascular risk, this study aims to investigate if gingivitis exacerbates the inflammatory response and subclinical atherosclerotic markers in women with polycystic ovary syndrome (PCOS).

METHODS

For this case-control study, women were assigned to three groups: two PCOS groups (with and without gingivitis) and a control group. Anthropometric and biochemical variables were determined, along with periodontal parameters (probing pocket depth [PPD], clinical attachment level [CAL], bleeding on probing [BOP], plaque index, calculus index, and tooth loss), systemic and neutrophil inflammatory markers (tumor necrosis factor alpha [TNFα], C-reactive protein [CRP], and c-Jun N-terminal kinase [JNK]), systemic oxidative stress mediators (myeloperoxidase [MPO] and glutathione), soluble cellular adhesion molecules, and neutrophil-endothelium cell interactions (rolling flux, velocity, and adhesion).

RESULTS

Of 104 women recruited, 68 had PCOS, 24 of whom presented gingivitis, and 36 were controls. PCOS patients presented altered sexual hormone, lipid, and carbohydrate profiles. Levels of systemic inflammatory markers, MPO, and soluble platelet selectin (sP-selectin) were higher, and glutathione levels were lower in PCOS patients. BOP, plaque, and calculus index values were higher in PCOS patients with gingivitis. Neutrophils from PCOS patients showed increased JNK and decreased adhesion under flow conditions, with reduced rolling velocity and increased rolling flux and cellular adhesion, all of which were more pronounced in those with gingivitis. BOP was independently associated with rolling velocity, rolling flux, and cellular adhesion.

CONCLUSION

Neutrophils of PCOS patients with gingivitis exhibit hyperactivity, promoting interaction with the endothelium and potentially contributing to atherosclerotic disease.

PLAIN LANGUAGE SUMMARY

Currently, there is a high prevalence of diseases that affect tooth-supporting tissues (periodontal diseases) and negatively influence the oral health and quality of life of the adult population. These pathologies lead to movement of the teeth and impairment of chewing function, eventually resulting in the loss of teeth. In recent years, the concept of periodontal medicine has arisen and consists of studying how periodontal diseases can influence our general inflammatory system and how systemic inflammatory pathologies can affect our oral health. In the present study, we evaluate a group of women with polycystic ovary syndrome (PCOS), a condition characterized by alterations of sex hormones and lipid profile and weight gain (body mass index). Our results show a high prevalence of gum inflammation among women with PCOS, which affects the interaction of their leukocytes and endothelial cells. The leukocytes of these women are hyper-responsive, presenting greater endothelial adhesion, lower flow velocity and enhanced rolling compared to those in a PCOS group without gum inflammation or controls. This study has generated a new line of research to analyze how neutrophils from patients with gingivitis exhibit hyperactivity, which promotes their interaction with the endothelium, thus contributing to the development of atherosclerotic disease.

The Association Between Periodontal Disease and Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

Background: Periodontal disease (PD) and polycystic ovary syndrome (PCOS) are two prevalent conditions that have been independently associated with systemic inflammation and hormonal dysregulation. Emerging evidence suggests a potential bidirectional relationship between these conditions, but the nature and strength of this association remain unclear. Objective: This systematic review aimed to evaluate and synthesize the existing evidence on the association between periodontal disease and polycystic ovary syndrome, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methods: A comprehensive literature search was conducted in multiple databases, including PubMed, Scopus, and Web of Science, from 1990 to 2025. Studies investigating the association between PD and PCOS in terms of prevalence, severity, and shared pathophysiological mechanisms were included. Two independent reviewers screened studies for eligibility, extracted data, and assessed methodological quality using validated tools. Discrepancies were resolved through consensus. Meta-analysis was conducted where appropriate. Results: A total of nine studies were included. Most studies reported a higher prevalence and severity of periodontal disease among women with PCOS compared to controls. Shared mechanisms, including systemic inflammation, insulin resistance, and hormonal dysregulation, were frequently proposed as underlying factors. However, heterogeneity in study designs, diagnostic criteria, and confounding adjustments limited the comparability of findings. Conclusions: This systematic review supports a potential association between periodontal disease and polycystic ovary syndrome, likely mediated by common inflammatory and metabolic pathways. However, the evidence is limited by heterogeneity and methodological biases. Further well-designed longitudinal studies are needed to clarify causal relationships and explore the clinical implications of integrating periodontal health management into PCOS care.

Gingival Inflammation Modulates NLRP3 Inflammasome Signalling in Peripheral Blood Mononuclear Cells of PCOS Patients: A Case-Control Study

Polycystic ovary syndrome (PCOS) is a complex condition associated with chronic inflammation and oxidative stress and is often linked to periodontal diseases. This study aimed to determine whether gingivitis modulates the NLRP3 inflammasome in peripheral blood mononuclear cells (PBMCs) from women with PCOS. Following a case-control design, 104 women were divided into three groups: controls (n = 36), PCOS without gingivitis (PCOS, n = 44) and PCOS with gingivitis (PCOS+, n = 24). Periodontal parameters, proinflammatory regulators (NFκB p65, JNK), NLRP3 components (NLRP3, ASC, procaspase-1, caspase-1) and oxidative stress markers (superoxide, NRF2, GCLC and GSR) were determined. The PCOS+ group presented elevated values for bleeding on probing (BOP) and plaque and calculus indices, both of which were associated with increased protein levels of NFκB p65 and JNK, thus indicating NLRP3 inflammasome priming. Higher protein levels of NLRP3, ASC, procaspase-1 and caspase-1 in the PCOS+ group confirmed that priming had occurred, suggesting an engagement in assembly. When potential assembly signals of inflammasome were evaluated, the patients with PCOS generally presented enhanced total superoxide and an impaired antioxidant response (NRF2, GCLC and GSR). Moreover, BOP was independently associated with JNK, ASC and procaspase-1. These findings suggest that gingival inflammation modulates the innate immune response in leukocytes of women with PCOS via the NLRP3 inflammasome pathway, which is regulated by proinflammatory factors and oxidative damage.