The Influence of TLR4, CD14, OPG, and RANKL Polymorphisms in Periodontitis: A Case-Control Study

Advances in molecular agents targeting toll-like receptor 4 signaling pathways for potential treatment of sepsis

Sepsis is a systemic inflammatory response syndrome caused by an infection. Toll-like receptor 4 (TLR4) is activated by endogenous molecules released by injured or necrotic tissues. Additionally, TLR4 is remarkably sensitive to infection of various bacteria and can rapidly stimulate host defense responses. The TLR4 signaling pathway plays an important role in sepsis by activating the inflammatory response. Accordingly, as part of efforts to improve the inflammatory response and survival rate of patients with sepsis, several drugs have been developed to regulate the inflammatory signaling pathways mediated by TLR4. Inhibition of TLR4 signal transduction can be directed toward either TLR4 directly or other proteins in the TLR4 signaling pathway. Here, we review the advances in the development of small-molecule agents and peptides targeting regulation of the TLR4 signaling pathway, which are characterized according to their structural characteristics as polyphenols, terpenoids, steroids, antibiotics, anthraquinones, inorganic compounds, and others. Therefore, regulating the expression of the TLR4 signaling pathway and modulating its effects has broad prospects as a target for the treatment of lung, liver, kidneys, and other important organs injury in sepsis.

Polymorphisms in Genes Involved in Inflammation and Periodontitis: A Narrative Review

Current evidence pinpoints that the variability in periodontitis traits in humans may be attributable to genetic factors. Different allelic variants can result in alterations in tissue structure, antibody responses and inflammatory mediators. Consequently, genetic variations may act as protective or risk factors for periodontal diseases. A number of features of the inflammatory and immune response that seem to play a role in the development of periodontitis have a clearly established genetic basis. Identifying genes that contribute to the pathogenesis of periodontitis may be utilized for risk assessment in both aggressive and chronic periodontitis. The aim of this narrative review is to summarize the role of polymorphisms in genes involved in inflammation and periodontitis, including cellular receptors, tissue compatibility antigens, antibodies and cytokines.

Association of IL-17A Polymorphism with Chronic Periodontitis in Type 1 Diabetic Patients

STATEMENT OF THE PROBLEM

The association of genetic polymorphisms with periodontitis has been studied extensively. The interleukin -17 (IL-17) is a group of cytokines, which comprises six different molecules (IL-17A, B, C, D, E & F). Among these, IL-17A & F are the most commonly understood cytokine, which plays a critical role in inflammatory diseases and periodontal inflammation.

PURPOSE

To evaluate whether IL-17A gene polymorphism is associated with increased risk of chronic periodontitis in type 1 diabetes patients.

MATERIALS AND METHOD

This quantitative case- control study was carried out in 60 subjects in 4 groups. The study groups included group A: 15 type 1 diabetes patients (T1DM) with chronic periodontitis (CP), group B: 15 T1DM patients without CP, group C: 15 Non-diabetic patients with CP, group D: 15 Non-diabetic patients without CP. Blood samples were drawn from the subjects and analyzed for IL-17A polymorphism by using the polymerase chain reaction-restriction fragment length polymorphism method.

RESULTS

There was no statistical significant difference seen in the genotype distribution among CP patients with or without T1DM and healthy controls. Odds ratio and p value indicated that increased risks for CP were associated with IL-17A allele (G) in patients with T1DM. This allele was correlated with worse clinical parameters of CP in T1DM patients.

CONCLUSION

The present study revealed that IL-17A (rs2275913) polymorphism was not associated with increased risk for CP in T1DM patients.

Polymorphism of CD14 Gene Is Associated with Adverse Outcome among Patients Suffering from Cardiovascular Disease

Background

The biological link between severe periodontitis and cardiovascular disease is well established. Both complex inflammatory diseases are influenced by genetic background. Therefore, the impact of genetic variations of receptors of the innate immune system-(Toll-like receptors (TLRs)) TLR2, TLR4, cluster of differentiation 14 (CD14), and the transcription factor nuclear factor-κΒ (NF-κB)-was investigated.

Materials and Methods

In this study (ClinicalTrials.gov identifier: NCT01045070), 1002 cardiovascular (CV) patients were included. In a 3-year follow-up period, new vascular events were assessed. SNPs in CD14 (rs2569190), NF-κΒ (rs28362491), TLR2 (rs5743708), and TLR4 (rs4986790) were genotyped. The impact of these genetic variants on severe periodontitis as well as on CV outcome was assessed.

Results

All investigated genetic variants were not associated with preexisting CV events or severe periodontitis in CV patients. In Kaplan-Meier survival analyses, the CT genotype of CD14 single-nucleotide polymorphism (SNP) rs2569190 was shown to be an independent predictor for combined CV endpoint (log rank: p = 0.035; cox regression; hazard ratio: 1.572; p = 0.044) as well as cardiovascular death (log rank: p = 0.019; cox regression; hazard ratio: 1.585; p = 0.040) after three years of follow-up.

Conclusions

SNPs in CD14, NF-κΒ, TLR2, and TLR4 are no risk modulators for preexisting CV events or severe periodontitis in CV patients. The CT genotype of CD14 SNP rs2569190 provides prognostic value for further CV events within 3 years of follow-up.

Influence of inflammasome NLRP3, and IL1B and IL2 gene polymorphisms in periodontitis susceptibility

The pathogenesis of periodontitis (PD) involves several molecules of the immune system that interact in a network to eliminate the periodontopathogens, yet, they contribute to periodontal tissue destruction. The different mechanisms that lead to periodontal tissue damage are not clear. Despite this, immune response genes have been related to the development of PD previously, such as those involved in inflammasomes which are multiprotein complexes and cytokines including Interleukin-1. The aim of the study was to evaluate the polymorphisms in NLRP3 inflammasome, cytokine and receptor of cytokines genes in the development of periodontitis. This case-control study was conducted in 186 patients with PD (stage II and III and grade B) and 208 controls (localized gingivitis and periodontally healthy individuals). Genotyping was performed using PCR-RFLP for the SNP rs4612666 in NLRP3 and using PCR-SSP for IL1A, IL1B, IL1R, IL1RN, IL4RA, INFG, TGFB1, TNF, IL2, IL4, IL6, and IL10. Cytokine serum levels were measured using Luminex technology. SNPStats and OpenEpi software were used to perform statistical analysis. The higher frequencies of NLRP3 T/C and IL1B -511 T/T genotypes and IL2 (+166, -330) GT haplotype were observed in patients with PD compared to controls. The SNPs in NLRP3, IL1R +1970, IL6–174, TNF -308, IL2 +166 and -330, TGFB1 +869 and +915, IL4RA +1902, IL4–1098 and -590 were associated to PD in men. In conclusion, polymorphisms in NLRP3, IL1B and IL2 genes were associated to PD susceptibility. Men carrying the NLRP3, IL1R, IL6, TNF, IL2, TGFB1, IL4RA and IL4 polymorphisms had greater susceptibility than women for developing PD.

Salvianolic Acid C Attenuates LPS-Induced Inflammation and Apoptosis in Human Periodontal Ligament Stem Cells via Toll-Like Receptors 4 (TLR4)/Nuclear Factor kappa B (NF-κB) Pathway

BACKGROUND Periodontitis is a chronic inflammatory disease that causes gingival detachment and disintegration of alveolar bone. Salvianolic acid C (SAC) is a polyphenol compound with anti-inflammatory and antioxidant activities that is isolated from Danshen, a traditional Chinese medicine made from the roots of Salvia miltiorrhiza Bunge. The aim of this study was to investigate the mechanisms of underlying its protective effects and its inhibition effect on inflammation and apoptosis in human periodontal ligament stem cells (hPDLSCs). MATERIAL AND METHODS LPS-induced hPDLSCs, as a model mimicking an inflammatory process of periodontitis in vivo, were established to investigate the therapeutic effect of SAC in periodontitis. The inflammatory cytokines secretion and oxidative stress status were measured by use of specific commercial test kits. The hPDLSCs viability was analyzed by Cell Counting Kit-8 assay. The cell apoptosis and cell cycle were assayed with flow cytometry. Expressions levels of proteins involved in apoptosis, osteogenic differentiation, and TLR4/NF-kappaB pathway were evaluated by Western blotting. Alkaline phosphatase (ALP) activity was detected by ALP assay kit and ALP staining. The mineralized nodules formation of hPDLSCs was checked by Alizarin Red S staining. RESULTS Our results showed that LPS induced increased levels of inflammatory cytokines and oxidative stress and mediated the phosphorylation and nuclear translocation of NF‑kappaB p65 in hPDLSCs. SAC reversed the abnormal secretion of inflammatory cytokines and inhibited the TLR4/NF‑kappaB activation induced by LPS. SAC also upregulated cell viability, ALP activity, and the ability of osteogenic differentiation. The anti-inflammation and TLR4/NF‑kappaB inhibition effects of SAC were reversed by TLR4 overexpression. CONCLUSIONS Taken together, our results revealed that SAC effectively attenuates LPS-induced inflammation and apoptosis via the TLR4/NF-kappaB pathway and that SAC is effective in treating periodontitis.