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Multari S, Bergandi L, Alovisi M, Comba A, Scotti N, Charrier L, Silvagno F, Baima G, Berutti E, Pasqualini D. Endodontic treatment of chronic apical periodontitis ameliorates systemic inflammation and restores impaired cellular responses to insulin in an in vitro model. J Endod 2024:S0099-2399(24)00337-6. [PMID: 38821264 DOI: 10.1016/j.joen.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION A growing body of research supports an association between periapical inflammation and an increased risk of developing systemic diseases. There is currently no scientific evidence to support a causal effect of inflammation on the onset of insulin resistance (IR) in patients with apical periodontitis (AP). The aim of this in vitro study was to evaluate any association between AP and levels of serum inflammatory factors potentially associated with the onset of IR, and to investigate any the effect of root canal treatment (RCT) on these systemic inflammation markers and restoring on the response in vitro to insulin. METHODS A total of 27 control subjects and 27 patients with AP were enrolled. Patients with AP underwent RCT and were followed-up 6 and 12 months post-treatment. ELISAs were used to evaluate plasma serum levels of pro-inflammatory cytokines interleukin (IL)-1, IL-6, IL-8, and tumor necrosis factor (TNF)-α. The human pancreatic epithelioid carcinoma cell line (PANC-1) was used to assess t The response in vitro to insulin was assessed by measuring glucose consumption in a human pancreatic epithelioid carcinoma cell line (PANC-1) treated with sera from healthy and AP subjects. RESULTS At baseline AP was associated with significantly higher levels of IL-1, IL-6, and IL-8 in the serum of untreated (AP) patients with AP vs controls (p<0.001). Glucose consumption decreased in pancreatic cells incubated with baseline serum from patients with AP, in a manner proportional to total cytokines amount. Notably, endodontic treatment was associated with reduced levels of cytokines (p<0.001) and improved response to insulin in AP group (p<0.001). CONCLUSIONS Our findings suggest that AP may promote inflammatory-driven IR in an in-vitro model, and that RCT may ameliorate inflammatory mediators in vivo and the cellular response to insulin in vitro.
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Affiliation(s)
- Stefania Multari
- University of Turin, Department of Surgical Sciences, Dental School, Via Nizza 230, 10126, Turin, Italy
| | - Loredana Bergandi
- University of Turin, Department of Oncology, Via Santena 5 bis, 10126 Torino, Italy
| | - Mario Alovisi
- University of Turin, Department of Surgical Sciences, Dental School, Via Nizza 230, 10126, Turin, Italy
| | - Allegra Comba
- University of Turin, Department of Surgical Sciences, Dental School, Via Nizza 230, 10126, Turin, Italy
| | - Nicola Scotti
- University of Turin, Department of Surgical Sciences, Dental School, Via Nizza 230, 10126, Turin, Italy
| | - Lorena Charrier
- University of Turin, Department of Public Health and Pediatrics, Via Santena 5 bis, 10126 Torino, Italy
| | - Francesca Silvagno
- University of Turin, Department of Oncology, Via Santena 5 bis, 10126 Torino, Italy
| | - Gianmarco Baima
- University of Turin, Department of Surgical Sciences, Dental School, Via Nizza 230, 10126, Turin, Italy
| | - Elio Berutti
- University of Turin, Department of Surgical Sciences, Dental School, Via Nizza 230, 10126, Turin, Italy
| | - Damiano Pasqualini
- University of Turin, Department of Surgical Sciences, Dental School, Via Nizza 230, 10126, Turin, Italy.
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Schwartz J, Capistrano KJ, Gluck J, Hezarkhani A, Naqvi AR. SARS-CoV-2, periodontal pathogens, and host factors: The trinity of oral post-acute sequelae of COVID-19. Rev Med Virol 2024; 34:e2543. [PMID: 38782605 DOI: 10.1002/rmv.2543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/04/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
COVID-19 as a pan-epidemic is waning but there it is imperative to understand virus interaction with oral tissues and oral inflammatory diseases. We review periodontal disease (PD), a common inflammatory oral disease, as a driver of COVID-19 and oral post-acute-sequelae conditions (PASC). Oral PASC identifies with PD, loss of teeth, dysgeusia, xerostomia, sialolitis-sialolith, and mucositis. We contend that PD-associated oral microbial dysbiosis involving higher burden of periodontopathic bacteria provide an optimal microenvironment for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. These pathogens interact with oral epithelial cells activate molecular or biochemical pathways that promote viral adherence, entry, and persistence in the oral cavity. A repertoire of diverse molecules identifies this relationship including lipids, carbohydrates and enzymes. The S protein of SARS-CoV-2 binds to the ACE2 receptor and is activated by protease activity of host furin or TRMPSS2 that cleave S protein subunits to promote viral entry. However, PD pathogens provide additional enzymatic assistance mimicking furin and augment SARS-CoV-2 adherence by inducing viral entry receptors ACE2/TRMPSS, which are poorly expressed on oral epithelial cells. We discuss the mechanisms involving periodontopathogens and host factors that facilitate SARS-CoV-2 infection and immune resistance resulting in incomplete clearance and risk for 'long-haul' oral health issues characterising PASC. Finally, we suggest potential diagnostic markers and treatment avenues to mitigate oral PASC.
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Affiliation(s)
- Joel Schwartz
- Department of Oral Medicine and Diagnostic Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | | | - Joseph Gluck
- Department of Periodontics, University of Illinois Chicago, Chicago, Illinois, USA
| | - Armita Hezarkhani
- Department of Periodontics, University of Illinois Chicago, Chicago, Illinois, USA
| | - Afsar R Naqvi
- Department of Periodontics, University of Illinois Chicago, Chicago, Illinois, USA
- Department of Microbiology and Immunology, University of Illinois Chicago, Chicago, Illinois, USA
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3
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Zhao M, Xie Y, Gao W, Li C, Ye Q, Li Y. Diabetes mellitus promotes susceptibility to periodontitis-novel insight into the molecular mechanisms. Front Endocrinol (Lausanne) 2023; 14:1192625. [PMID: 37664859 PMCID: PMC10469003 DOI: 10.3389/fendo.2023.1192625] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/24/2023] [Indexed: 09/05/2023] Open
Abstract
Diabetes mellitus is a main risk factor for periodontitis, but until now, the underlying molecular mechanisms remain unclear. Diabetes can increase the pathogenicity of the periodontal microbiota and the inflammatory/host immune response of the periodontium. Hyperglycemia induces reactive oxygen species (ROS) production and enhances oxidative stress (OS), exacerbating periodontal tissue destruction. Furthermore, the alveolar bone resorption damage and the epigenetic changes in periodontal tissue induced by diabetes may also contribute to periodontitis. We will review the latest clinical data on the evidence of diabetes promoting the susceptibility of periodontitis from epidemiological, molecular mechanistic, and potential therapeutic targets and discuss the possible molecular mechanistic targets, focusing in particular on novel data on inflammatory/host immune response and OS. Understanding the intertwined pathogenesis of diabetes mellitus and periodontitis can explain the cross-interference between endocrine metabolic and inflammatory diseases better, provide a theoretical basis for new systemic holistic treatment, and promote interprofessional collaboration between endocrine physicians and dentists.
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Affiliation(s)
- Mingcan Zhao
- Department of Pediatric Dentistry, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Yuandong Xie
- Department of Pediatric Dentistry, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Wenjia Gao
- Department of Pediatric Dentistry, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Chunwang Li
- Department of Pediatric Dentistry, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Qiang Ye
- Department of Pediatric Dentistry, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
| | - Yi Li
- Department of Pediatric Dentistry, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
- Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Hospital of Stomatology, Jilin University, Changchun, Jilin, China
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4
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Zhang Z, Ji C, Wang D, Wang M, Song D, Xu X, Zhang D. The burden of diabetes on the soft tissue seal surrounding the dental implants. Front Physiol 2023; 14:1136973. [PMID: 36875028 PMCID: PMC9978121 DOI: 10.3389/fphys.2023.1136973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
Soft tissue seal around implant prostheses is considered the primary barrier against adverse external stimuli and is a critical factor in maintaining dental implants' stability. Soft tissue seal is formed mainly by the adhesion of epithelial tissue and fibrous connective tissue to the transmembrane portion of the implant. Type 2 diabetes mellitus (T2DM) is one of the risk factors for peri-implant inflammation, and peri-implant disease may be triggered by dysfunction of the soft tissue barrier around dental implants. This is increasingly considered a promising target for disease treatment and management. However, many studies have demonstrated that pathogenic bacterial infestation, gingival immune inflammation, overactive matrix metalloproteinases (MMPs), impaired wound healing processes and excessive oxidative stress may trigger poor peri-implant soft tissue sealing, which may be more severe in the T2DM state. This article reviews the structure of peri-implant soft tissue seal, peri-implant disease and treatment, and moderating mechanisms of impaired soft tissue seal around implants due to T2DM to inform the development of treatment strategies for dental implants in patients with dental defects.
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Affiliation(s)
- Zhanwei Zhang
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong Provincial Clinical Research Center for Oral, Shandong University , Jinan, China
| | - Chonghao Ji
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong Provincial Clinical Research Center for Oral, Shandong University , Jinan, China
| | | | - Maoshan Wang
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong Provincial Clinical Research Center for Oral, Shandong University , Jinan, China
| | - Dawei Song
- School of Stomatology, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, China
| | - Xin Xu
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong Provincial Clinical Research Center for Oral, Shandong University , Jinan, China
| | - Dongjiao Zhang
- Department of Implantology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong Provincial Clinical Research Center for Oral, Shandong University , Jinan, China
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5
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Li C, Yu R, Ding Y. Association between Porphyromonas Gingivalis and systemic diseases: Focus on T cells-mediated adaptive immunity. Front Cell Infect Microbiol 2022; 12:1026457. [PMID: 36467726 PMCID: PMC9712990 DOI: 10.3389/fcimb.2022.1026457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/25/2022] [Indexed: 12/01/2023] Open
Abstract
The association between periodontal disease and systemic disease has become a research hotspot. Porphyromonas gingivalis (P. gingivalis), a crucial periodontal pathogen, affects the development of systemic diseases. The pathogenicity of P. gingivalis is largely linked to interference with the host's immunity. This review aims to discover the role of P. gingivalis in the modulation of the host's adaptive immune system through a large number of virulence factors and the manipulation of cellular immunological responses (mainly mediated by T cells). These factors may affect the cause of large numbers of systemic diseases, such as atherosclerosis, hypertension, adverse pregnancy outcomes, inflammatory bowel disease, diabetes mellitus, non-alcoholic fatty liver disease, rheumatoid arthritis, and Alzheimer's disease. The point of view of adaptive immunity may provide a new idea for treating periodontitis and related systemic diseases.
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Affiliation(s)
- Cheng Li
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China
| | - Ran Yu
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China
| | - Yumei Ding
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China
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Aziz J, Vaithilingam RD, Radzi Z, Rahman MT. Inflammatory Responses in Periodontitis with or Without Rheumatoid Arthritis Alter Salivary Metallothionein and Zinc. Biol Trace Elem Res 2022; 201:3162-3174. [PMID: 36094693 DOI: 10.1007/s12011-022-03416-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022]
Abstract
Periodontitis (PD) and rheumatoid arthritis (RA) are causally linked by their common inflammatory responses, yet it is largely unknown if these inflammatory responses might have an impact on salivary metallothionein (MT), zinc (Zn), and calcium (Ca) content. In this study, we analysed salivary concentrations of pro-inflammatory (IFN-γ, IL-6, and IL-17) and anti-inflammatory (IL-4 and IL-10) cytokines, as well as MT, Zn, and Ca in four groups of participants, namely control (without PD or RA, n = 21), PD (n = 21), RA (n = 21), or RAPD (n = 19). As expected, an increased amount of salivary pro-inflammatory cytokines were observed in the PD, RA, and RAPD groups. While Ca concentration was not significantly different between the groups, Zn concentration was lower in the PD, RA, and RAPD groups compared to the control group (p < 0.05). These groups also expressed higher MT/Zn ratios compared to the control group (p < 0.05). Unlike the control group, concentrations of inflammatory cytokines, MT, Zn, and Ca correlated with each other in the PD, RA, and RAPD groups (p < 0.05). Additionally, comorbidity of PD and RA appears to have a cumulative immuno-pathological impact that warrants further investigation. This study suggests that, in addition to inflammatory cytokines, salivary MT and Zn could reflect the severity of PD with or without RA, hence providing an important biomarker for diagnosis.
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Affiliation(s)
- Jazli Aziz
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
- Department of Oral & Craniofacial Sciences, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Rathna Devi Vaithilingam
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Zamri Radzi
- Department of Paediatric Dentistry & Orthodontics, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
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7
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Tang B, Yan C, Shen X, Li Y. The bidirectional biological interplay between microbiome and viruses in periodontitis and type-2 diabetes mellitus. Front Immunol 2022; 13:885029. [PMID: 36131931 PMCID: PMC9483123 DOI: 10.3389/fimmu.2022.885029] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Periodontitis was an inflammatory disease associated with a dysbiosis of the oral flora characterized by a chronic sustained inflammation inducing the resorption of alveolar bone and leading to tooth loss. Type 2 diabetes mellitus (T2D) was a metabolic disease caused by impaired insulin action. The oral microbiome played a crucial role in modulating both the innate and adaptive immune system during the trigger and exacerbation of periodontitis and T2D. The bidirectional relationship of T2D and periodontitis had been the focus of intensive research, but those were not well explored. In this commentary, an in-depth analysis of the changes of microbiome and bacterial metabolites in periodontitis with or without diabetes was described. The promotion of periodontitis to T2D might involve inflammatory factors/receptors, oxidative stress, microRNA and so on. The effect of diabetes on periodontitis might involve adipose factor pathway, AGE/RAGE and RANK/RANKL pathway etc. Generally, periodontitis and diabetes are closely related to the microecological-epithelial interaction, soft tissue degradation, bone coupling disorder, immune regulation and gene transcription. The viruses, including HBV, HCV, HSV-1, Coronavirus, HCMV, EBV, HIV, phageome and so on, played an important role in the development of T2D and periodontitis. An in-depth understanding of the relationship between microbiome and host was of great significance to clarify the bidirectional mechanisms, suggesting that the periodontitis or T2D remission will have a positive impact on the other.
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Affiliation(s)
- Boyu Tang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Caixia Yan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xin Shen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yan Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- *Correspondence: Yan Li,
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de Oliveira Toledo SL, Ladeira VS, Nogueira LS, Ferreira LGR, Oliveira MM, de Oliveira Renó C, dos Santos HL, Coelho-dos-Reis JGA, Campi-Azevedo AC, Teixeira-Carvalho A, Martins-Filho OA, Rios DRA, Barros-Pinheiro M. Plasma immune mediators as laboratorial biomarkers for Sickle Cell Disease patients according to the hydroxyurea therapy and disease severity. Blood Cells Mol Dis 2022; 98:102703. [DOI: 10.1016/j.bcmd.2022.102703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/17/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
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Pan J, Liu J, Zhao L. The Expression of miR-34a in Gingival Crevicular Fluid of Chronic Periodontitis and Its Connection with the TLR/NF- κB Signaling Pathway. Appl Bionics Biomech 2022; 2022:8506856. [PMID: 36016920 PMCID: PMC9398852 DOI: 10.1155/2022/8506856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 12/01/2022] Open
Abstract
Objective This study analyzed the expression of miR-34a in gingival crevicular fluid (GCF) of patients with chronic periodontitis and its connection with the Toll-like receptor (TLR)/nuclear factor kappa-B (NF-κB) signaling pathway. Methods We collected the GCF of the two groups of subjects, using RT-PCR to detect the expression of miR-34a and NF-κB p65 mRNA and TLR4 mRNA and ELISA to detect the inflammatory factor degree in GCF, and performed periodontal examinations on both groups. Results The gingival index, bleeding index, probe depth, and attachment loss indexes of periodontal examination in the observation group were remarkably superior to those in the control group (P < 0.05). The levels of IL-1β, IL-6, and TNF-α in the GCF of the observation group were higher than those of the control group (P < 0.05). The mRNA relative expression levels of miR-34a, NF-κB p65, and TLR4 in the GCF of the observation group were dramatically higher than those of the control group (P < 0.05). Correlation analysis showed that miR-34a was highly expressed in patients with chronic periodontitis. Conclusion There is an abnormally high expression of miR-34a in GCF of chronic periodontitis. Its expression is associated with the degree of periodontal inflammation, periodontal tissue damage, and the activation of the TLR/NF-κB signaling pathway and could be used as a potential index for auxiliary diagnosis and severity of the disease.
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Affiliation(s)
- Jiaxin Pan
- Department of Stomatology, The First People's Hospital of Changzhou, Jiangsu 213000, China
| | - Jue Liu
- Department of Stomatology, The First People's Hospital of Changzhou, Jiangsu 213000, China
| | - Lu Zhao
- Department of Stomatology, The First People's Hospital of Changzhou, Jiangsu 213000, China
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10
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Mattos MCDO, Chagas LGADA, Stefani CM, Damé-Teixeira N, Grisi DC, Salles LP, Oliveira LAD, Carneiro VMDA, Guimarães MDCM. Expression of inflammatory mediators in periodontitis and T2D patients: a systematic review and meta-analysis. Braz Oral Res 2022; 36:e098. [PMID: 35830142 DOI: 10.1590/1807-3107bor-2022.vol36.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/19/2022] [Indexed: 11/22/2022] Open
Abstract
The high concentration of glucose in the blood in Type 2 diabetes (T2D) may be related to either insulin resistance or insulin deficiency. Moreover, the literature points to periodontitis as the main oral disease caused by glycemia imbalance. The quantification of inflammatory markers in blood or saliva samples of T2D patients may represent a valuable tool in revealing how well an individual's immune system can respond to injuries and periodontal treatment. In addition, an evaluation of the cytokine expression is extremely relevant to help understand the connection between periodontitis and T2D. This systematic review and meta-analysis aimed to evaluate the expression of inflammatory markers in T2D patients with periodontitis, compared with non-diabetic patients with periodontitis. A total of 3,894 studies were retrieved after a systematic literature search, 15 of which were included in the systematic review, and 4 of these 15, in the meta-analysis. The results did not indicate any statistical difference between the groups regarding TNF-α and IL-6 markers. T2D patients with periodontitis had increased levels of IL-10, compared with non-diabetic individuals with periodontitis (p = 0.003). On the other hand, the IL-4 concentration in non-diabetic individuals with periodontitis was high, compared with the T2D group (p< 0.001). Several studies did not include quantitative results and were excluded from the meta-analysis. The high IL-10 expression and low IL-4 expression in the T2D group suggest an association between the level of these markers and the impairment of the immune response in T2D patients with periodontitis.
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Affiliation(s)
| | | | - Cristine Miron Stefani
- Universidade de Brasília - UNB, School of Health Sciences, Department of Dentistry, Brasília, DF, Brazil
| | - Nailê Damé-Teixeira
- Universidade de Brasília - UNB, School of Health Sciences, Department of Dentistry, Brasília, DF, Brazil
| | - Daniela Correa Grisi
- Universidade de Brasília - UNB, School of Health Sciences, Department of Dentistry, Brasília, DF, Brazil
| | - Loise Pedrosa Salles
- Universidade de Brasília - UNB, School of Health Sciences, Department of Dentistry, Brasília, DF, Brazil
| | - Laudimar Alves de Oliveira
- Universidade de Brasília - UNB, School of Health Sciences, Department of Dentistry, Brasília, DF, Brazil
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11
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Qin H, Li G, Xu X, Zhang C, Zhong W, Xu S, Yin Y, Song J. The role of oral microbiome in periodontitis under diabetes mellitus. J Oral Microbiol 2022; 14:2078031. [PMID: 35694215 PMCID: PMC9176325 DOI: 10.1080/20002297.2022.2078031] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Periodontitis is among most common human inflammatory diseases and characterized by destruction of tooth-supporting tissues that will eventually lead to tooth loss. Diabetes mellitus (DM) is a group of metabolic disorders characterized by chronic hyperglycemia which results from defects in insulin secretion and/or insulin resistance. Numerous studies have provided evidence for the inter-relationship between DM and periodontitis that has been considered as the sixth most frequent complication of DM. However, the mechanisms are not fully understood yet. The impact of DM on periodontitis through hyperglycemia and inflammatory pathways is well described, but the effects of DM on oral microbiota remain controversial according to previous studies. Recent studies using next-generation sequencing technology indicate that DM can alter the biodiversity and composition of oral microbiome especially subgingival microbiome. This may be another mechanism by which DM risks or aggravates periodontitis. Thus, to understand the role of oral microbiome in periodontitis of diabetics and the mechanism of shifts of oral microbiome under DM would be valuable for making specific therapeutic regimens for treating periodontitis patients with DM or preventing diabetic patients from periodontitis. This article reviews the role of oral microbiome in periodontal health (symbiosis) and disease (dysbiosis), highlights the oral microbial shifts under DM and summarizes the mechanism of the shifts.
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Affiliation(s)
- Han Qin
- College of Stomatology, Chongqing Medical University, Chongqing, Unknown, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, Unknown, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, Unknown, China
| | - Guangyue Li
- College of Stomatology, Chongqing Medical University, Chongqing, Unknown, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, Unknown, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, Unknown, China
| | - Xiaohui Xu
- College of Stomatology, Chongqing Medical University, Chongqing, Unknown, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, Unknown, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, Unknown, China
| | - Chuangwei Zhang
- College of Stomatology, Chongqing Medical University, Chongqing, Unknown, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, Unknown, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, Unknown, China
| | - Wenjie Zhong
- College of Stomatology, Chongqing Medical University, Chongqing, Unknown, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, Unknown, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, Unknown, China
| | - Shihan Xu
- College of Stomatology, Chongqing Medical University, Chongqing, Unknown, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, Unknown, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, Unknown, China
| | - Yuanyuan Yin
- College of Stomatology, Chongqing Medical University, Chongqing, Unknown, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, Unknown, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, Unknown, China
| | - Jinlin Song
- College of Stomatology, Chongqing Medical University, Chongqing, Unknown, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, Unknown, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, Unknown, China
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12
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Vedula C, Reddy SHK, Madu C, Bathula H, Kunthsam V, Gupta KVSP. Effect of Covid and its Treatment Protocols on Chronic Generalized Periodontitis- A Prospective Study. JOURNAL OF INDIAN ACADEMY OF ORAL MEDICINE AND RADIOLOGY 2022. [DOI: 10.4103/jiaomr.jiaomr_38_] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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13
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Cai W, Marouf N, Said KN, Tamimi F. Nature of the Interplay Between Periodontal Diseases and COVID-19. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.735126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) is mostly a mild condition, however, in some patients, it could progress into a severe and even fatal disease. Recent studies have shown that COVID-19 infection and severity could be associated with the presence of periodontitis, one of the most prevalent chronic diseases. This association could be explained by the fact that periodontitis and COVID-19 share some common risk factors that included chronic diseases, such as diabetes and hypertension as well as conditions such as age, sex, and genetic variants. Another possible explanation could be the systemic inflammation and the aspiration of periodontopathogens seen in patients with periodontitis, which could have a synergism with the virus or compromise the reaction of the body against COVID-19. This narrative review explores the nature of these associations, the evidence behind them, and their implications.
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14
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Marouf N, Cai W, Said KN, Daas H, Diab H, Chinta VR, Hssain AA, Nicolau B, Sanz M, Tamimi F. Association between periodontitis and severity of COVID-19 infection: A case-control study. J Clin Periodontol 2021; 48:483-491. [PMID: 33527378 PMCID: PMC8014679 DOI: 10.1111/jcpe.13435] [Citation(s) in RCA: 169] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/18/2021] [Accepted: 01/24/2021] [Indexed: 12/18/2022]
Abstract
AIM COVID-19 is associated with an exacerbated inflammatory response that can result in fatal outcomes. Systemic inflammation is also a main characteristic of periodontitis. Therefore, we investigated the association of periodontitis with COVID-19 complications. MATERIALS AND METHODS A case-control study was performed using the national electronic health records of the State of Qatar between February and July 2020. Cases were defined as patients who suffered COVID-19 complications (death, ICU admissions or assisted ventilation), and controls were COVID-19 patients discharged without major complications. Periodontal conditions were assessed using dental radiographs from the same database. Associations between periodontitis and COVID 19 complications were analysed using logistic regression models adjusted for demographic, medical and behaviour factors. RESULTS In total, 568 patients were included. After adjusting for potential confounders, periodontitis was associated with COVID-19 complication including death (OR = 8.81, 95% CI 1.00-77.7), ICU admission (OR = 3.54, 95% CI 1.39-9.05) and need for assisted ventilation (OR = 4.57, 95% CI 1.19-17.4). Similarly, blood levels of white blood cells, D-dimer and C Reactive Protein were significantly higher in COVID-19 patients with periodontitis. CONCLUSION Periodontitis was associated with higher risk of ICU admission, need for assisted ventilation and death of COVID-19 patients, and with increased blood levels of biomarkers linked to worse disease outcomes.
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Affiliation(s)
- Nadya Marouf
- Department of DentistryOral Health InstituteHamad Medical CorporationDohaQatar
| | - Wenji Cai
- Faculty of DentistryMcGill UniversityMontrealQCCanada
| | - Khalid N. Said
- Department of DentistryOral Health InstituteHamad Medical CorporationDohaQatar
| | - Hanin Daas
- College of Dental MedicineQU HealthQatar UniversityDohaQatar
| | - Hanan Diab
- Department of DentistryOral Health InstituteHamad Medical CorporationDohaQatar
| | | | | | | | - Mariano Sanz
- ETEP Research GroupFaculty of OdontologyUniversity Complutense of MadridMadridSpain
| | - Faleh Tamimi
- College of Dental MedicineQU HealthQatar UniversityDohaQatar
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15
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Rangel TP, Reis AA, Caponi L, Pena LCS, Ruiz KGS, Santamaria MP, Mathias-Santamaria IF, Casati MZ, Casarin RCV. Subgingival endotoxin and lipoteichoic acid modulate cytokine production in diabetic subjects: A Case-control Study. Oral Dis 2020; 27:1325-1333. [PMID: 33012042 DOI: 10.1111/odi.13661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Periodontal disease and diabetes mellitus (DM) are highly prevalent and interrelated diseases, resulting in altered host response microbiota. Thus, this study aimed to evaluate the impact of DM on local levels of lipopolysaccharide (LPS) and lipoteichoic acid (LTA) and their relationship with cytokines and matrix metalloproteinases' (MMPs) profile. METHODS This case-control study included diabetic (n = 15) and non-diabetic (n = 15) subjects presenting Stage 3-4, Grade C, Periodontitis. Gingival crevicular fluid (GCF) was collected, and LPS and LTA levels were analyzed by enzyme-linked immunosorbent assay (ELISA), while IFN-γ, IL-10, IL-17, IL-1β, IL-4, MMP-2, and MMP-9 were measured by LUMINEX/MAGpix. Mann-Whitney and Spearman's correlation tests were used to compared and to correlate variables (p < 0.05). RESULTS Higher levels of LTA, LPS, IL-10, IL-1β, and MMP-2 (p < 0.05) and lower levels of IL-17 were found in the DM group (p < 0.05). Non-diabetic subjects presented higher LPS, IFN-γ, IL-17, and MMP-2 levels and lower IL-10 concentration (p < 0.05). No significant correlation was seen between LPS and cytokine profile in non-diabetic. Local levels of LTA were positively correlated with IL-17 and MMP-2 and negatively with IL-10. CONCLUSION LTA and LPS drove the inflammatory profile through the modulation of cytokines and MMPs in a different manner in DM and non-diabetic subjects.
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Affiliation(s)
- Thiago P Rangel
- Department of Prosthodontics and Periodontics, Dental School of Piracicaba, Campinas State University, Campinas, Brazil
| | - Aurelio A Reis
- Department of Prosthodontics and Periodontics, Dental School of Piracicaba, Campinas State University, Campinas, Brazil
| | - Lara Caponi
- Department of Prosthodontics and Periodontics, Dental School of Piracicaba, Campinas State University, Campinas, Brazil
| | - Larissa C S Pena
- Department of Prosthodontics and Periodontics, Dental School of Piracicaba, Campinas State University, Campinas, Brazil
| | - Karina G S Ruiz
- Department of Prosthodontics and Periodontics, Dental School of Piracicaba, Campinas State University, Campinas, Brazil
| | - Mauro P Santamaria
- Division of Periodontology, FOSJC, College of Dentistry, São Paulo State University, São Paulo, Brazil
| | | | - Marcio Z Casati
- Department of Prosthodontics and Periodontics, Dental School of Piracicaba, Campinas State University, Campinas, Brazil
| | - Renato C V Casarin
- Department of Prosthodontics and Periodontics, Dental School of Piracicaba, Campinas State University, Campinas, Brazil
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16
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Elazazy O, Amr K, Abd El Fattah A, Abouzaid M. Evaluation of serum and gingival crevicular fluid microRNA-223, microRNA-203 and microRNA-200b expression in chronic periodontitis patients with and without diabetes type 2. Arch Oral Biol 2020; 121:104949. [PMID: 33157494 DOI: 10.1016/j.archoralbio.2020.104949] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 12/11/2022]
Abstract
microRNA dysregulation is a reported feature of multiple pathologies, including periodontal disease, as demonstrated on cell lines, in animal models, and tissues biopsies, but serum and gingival crevicular fluid microRNA expression data in humans is scarce, especially with the diabetes (type 2) systemic complication. OBJECTIVE To assess serum and gingival crevicular fluid relative quantification levels of miR-223, miR-203, and miR-200b in chronic periodontitis and type 2 diabetic chronic periodontitis patients to address their possible implication in chronic periodontitis pathogenesis and its systemic complications and also to correlate their differential expression with some inflammatory (serum tumor necrosis factor-α and interleukin-10) parameters. METHODS Sixty subjects were recruited and divided into three groups; chronic periodontitis (n = 20), type 2 diabetic chronic periodontitis (n = 20), and healthy control (n = 20). Both serum and gingival crevicular fluid were collected from each participant for miRNA expression analysis and serum inflammatory parameters assessment. RESULTS A significant increase in the relative quantification levels of miR-223 and miR-200b were detected in patient groups along with a positive correlation with tumor necrosis factor-α. However, miR-203 was significantly decreased in patient groups associated with a negative correlation with tumor necrosis factor-α. CONCLUSIONS miR-223 and miR-200b have a potential role in chronic periodontitis pathogenesis associated with type 2 diabetes, with the ability to induce tumor necrosis factor-α secretion, while miR-203 might have a protective and healing role due to the negative correlation with the serum tumor necrosis factor-α levels found. Therefore, they may be considered as a promising therapeutic target and effective serum disease biomarkers.
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Affiliation(s)
- Ola Elazazy
- Department of Biochemistry, Faculty of Pharmacy, Badr University in Cairo (BUC), Cairo, Egypt.
| | - Khalda Amr
- Department of Medical Molecular Genetics, National Research Center, Cairo, Egypt
| | - Abeer Abd El Fattah
- Department of Biochemistry, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt
| | - Maha Abouzaid
- Department of Orodental Genetics, National Research Center, Cairo, Egypt
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17
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Abstract
The susceptibility and severity of periodontal diseases is made more severe by diabetes, with the impact on the disease process inversely proportional to the level of glycemic control. Although type 1 diabetes mellitus and type 2 diabetes mellitus have different etiologies, and their impact on bone is not identical, they share many of the same complications. Studies in animals and humans agree that both forms of diabetes increase inflammatory events in periodontal tissue, impair new bone formation, and increase expression of RANKL in response to bacterial challenge. High levels of glucose, reactive oxygen species, and advanced glycation end-products are found in the periodontium of diabetic individuals and lead to increased activation of nuclear factor-kappa B and expression of inflammatory cytokines such as tumor necrosis factor and interleukin-1. Studies in animals, moreover, suggest that there are multiple cell types in periodontal tissues that are affected by diabetes, including leukocytes, vascular cells, mesenchymal stem cells, periodontal ligament fibroblasts, osteoblasts, and osteocytes. The etiology of periodontal disease involves the host response to bacterial challenge that is affected by diabetes, which increases the expression of RANKL and reduces coupled bone formation. In addition, the inflammatory response also modifies the oral microbiota to render it more pathogenic, as demonstrated by increased inflammation and bone loss in animals where bacteria are transferred from diabetic donors to germ-free hosts compared with transfer from normoglycemic donors. This approach has the advantage of not relying upon limited knowledge of the specific bacterial taxa to determine pathogenicity, and examines the overall impact of the microbiota rather than the presumed pathogenicity of a few bacterial groups. Thus, animal studies have provided new insights into pathogenic mechanisms that identify cause-and-effect relationships that are difficult to perform in human studies.
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Affiliation(s)
- Dana T Graves
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zhenjiang Ding
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Pediatric Dentistry, School of Stomatology, China Medical University, Shenyang, China
| | - Yingming Yang
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Preventive Dentistry, West China School of Stomatology, Sichuan University, Chengdu, China
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18
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The ratios of pro-inflammatory to anti-inflammatory cytokines in the serum of chronic periodontitis patients with and without type 2 diabetes and/or smoking habit. Clin Oral Investig 2018; 23:641-650. [DOI: 10.1007/s00784-018-2471-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/23/2018] [Indexed: 12/14/2022]
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