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Andriankaja OM, Adatorwovor R, Kantarci A, Hasturk H, Shaddox L, Levine MA. Periodontal Disease, Local and Systemic Inflammation in Puerto Ricans with Type 2 Diabetes Mellitus. Biomedicines 2023; 11:2770. [PMID: 37893143 PMCID: PMC10604368 DOI: 10.3390/biomedicines11102770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
Periodontal disease (PD) is prevalent in type 2 diabetic condition (T2DM). OBJECTIVES We assessed the associations between serum or gingival crevicular fluid (GCF) endothelial and inflammatory mediators and chronic PD among T2DM Hispanic adults. METHODS We enrolled 248 Puerto Rican residents with T2DM aged 40-65 years. The exposures included serum inflammatory mediators (IL-1b, IL-6, IL-10, and TNF-α), endothelial adhesion molecules, RANKL levels, and the GCF content of these analytes from a subset of 158 samples. The outcomes included the percent of sites with a probing pocket depth (PPD) ≥ 4 mm and clinical attachment loss ≥ 4 mm. Adjusted logistic regression models were fit to the categorized outcomes. RESULTS Increased serum IL-10 (Adj. OR: 1.10, p = 0.04), sICAM-1 (Adj. OR: 1.01; p = 0.06), and elevated serum IL-1β (Adj. OR: 1.93; p = 0.06) were statistically significant or close to being significantly associated with a percent of sites with PPD ≥ 4 mm. An increase in GCF IL-1α (Adj. OR: 1.16; p < 0.01) and IL-1β (Adj: 2.40; p = 0.02) was associated with periodontal parameters. CONCLUSIONS Our findings suggested that oral and systemic endothelial and inflammatory mediators are associated with periodontal clinical parameters among Hispanic adults with T2DM.
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Affiliation(s)
- Oelisoa M. Andriankaja
- Center for Oral Health Research (COHR), University of Kentucky College of Dentistry, Lexington, KY 40536, USA;
| | - Reuben Adatorwovor
- College of Public Health, University of Kentucky, Lexington, KY 40536, USA;
| | | | - Hatice Hasturk
- Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, MA 02142, USA;
| | - Luciana Shaddox
- Center for Oral Health Research (COHR), University of Kentucky College of Dentistry, Lexington, KY 40536, USA;
| | - Michael A. Levine
- Center for Bone Health, Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
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Valenzuela F, Fernández J, Jiménez C, Cavagnola D, Mancilla JF, Astorga J, Hernández M, Fernández A. Identification of IL-18 and Soluble Cell Adhesion Molecules in the Gingival Crevicular Fluid as Novel Biomarkers of Psoriasis. Life (Basel) 2021; 11:life11101000. [PMID: 34685372 PMCID: PMC8538479 DOI: 10.3390/life11101000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 12/21/2022] Open
Abstract
Psoriasis is a chronic immunoinflammatory skin disease. Although its diagnosis is clinical, differences in the appearance and severity of lesions pose a challenge for clinicians worldwide. The use of accessible biomarkers for psoriasis could aid in the early diagnosis and treatment of the disease. To date, evidence on the analysis of gingival crevicular fluid (GCF) molecules as novel, accessible, and reliable biomarkers for psoriasis is limited. This cross-sectional study compared the GCF levels of IL-18, soluble (s)ICAM-1, and sE-selectin in psoriatic patients (n = 42) and healthy controls (n = 39). Individuals with psoriasis not undergoing treatment and healthy individuals were included independent of periodontal status. GCF samples were collected, and a multiplex bead immunoassay was performed to quantify the levels of the target molecules. Psoriatic patients presented higher concentrations of IL-18 and lower concentrations of sE-selectin compared to controls (p < 0.05). No differences were found in the levels of sICAM-1 between the two groups (p > 0.05). Psoriasis was associated with IL-18 and E-selectin levels regardless of periodontal status, age, and smoking habit (p < 0.05). The areas under the receiver operating characteristic curve (ROC) for IL-18 and sE-selectin were 0.77 and 0.68, respectively. In conclusion, IL-18 and sE-selectin levels in the GCF could be promising biomarker for psoriasis.
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Affiliation(s)
- Fernando Valenzuela
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile
- Centro Internacional de Estudios Clínicos, Probity Medical Research, Santiago 8420383, Chile;
- Correspondence: (F.V.); (A.F.); Tel.: +56-2-29788173 (F.V.); +56-2-2661-5834 (A.F.)
| | - Javier Fernández
- Centro Internacional de Estudios Clínicos, Probity Medical Research, Santiago 8420383, Chile;
- Dermatology Unit, San José Hospital, Santiago 8380419, Chile
| | - Constanza Jiménez
- Department of Oral Pathology, Faculty of Dentistry, Universidad Andres Bello, Santiago 8370133, Chile; (C.J.); (D.C.); (J.F.M.)
| | - Daniela Cavagnola
- Department of Oral Pathology, Faculty of Dentistry, Universidad Andres Bello, Santiago 8370133, Chile; (C.J.); (D.C.); (J.F.M.)
| | - Juan Felipe Mancilla
- Department of Oral Pathology, Faculty of Dentistry, Universidad Andres Bello, Santiago 8370133, Chile; (C.J.); (D.C.); (J.F.M.)
| | - Jessica Astorga
- Laboratory of Periodontal Biology, Faculty of Dentistry, Universidad de Chile, Santiago 8380544, Chile; (J.A.); (M.H.)
| | - Marcela Hernández
- Laboratory of Periodontal Biology, Faculty of Dentistry, Universidad de Chile, Santiago 8380544, Chile; (J.A.); (M.H.)
- Department of Oral Pathology and Medicine, Faculty of Dentistry, Universidad de Chile, Santiago 8380544, Chile
| | - Alejandra Fernández
- Department of Oral Pathology, Faculty of Dentistry, Universidad Andres Bello, Santiago 8370133, Chile; (C.J.); (D.C.); (J.F.M.)
- Laboratory of Periodontal Biology, Faculty of Dentistry, Universidad de Chile, Santiago 8380544, Chile; (J.A.); (M.H.)
- Correspondence: (F.V.); (A.F.); Tel.: +56-2-29788173 (F.V.); +56-2-2661-5834 (A.F.)
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3
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Silva H. Tobacco Use and Periodontal Disease-The Role of Microvascular Dysfunction. Biology (Basel) 2021; 10:441. [PMID: 34067557 PMCID: PMC8156280 DOI: 10.3390/biology10050441] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 12/30/2022]
Abstract
Periodontal disease consists in highly prevalent wide-ranging inflammatory conditions that affect the supporting apparatus of teeth. Tobacco use is the most important risk factor for periodontal disease as it increases disease severity and periodontal surgery complications. Tobacco use is harmful for the vasculature by causing microvascular dysfunction, which is known to negatively affect periodontal disease. To the author's knowledge this paper is the first comprehensive review on the mechanisms by which tobacco use affects oral microcirculation and impacts the pathophysiology of periodontal disease. In healthy subjects, acute nicotine administration or tobacco use (smoking/smokeless forms) increases the blood flow in the oral mucosa due to local irritation and increased blood pressure, which overcome neural- and endocrine-mediated vasoconstriction. Chronic tobacco smokers display an increased gingival microvascular density, which is attributed to an increased capillary recruitment, however, these microcirculatory units show higher tortuosity and lower caliber. These morphological changes, together with the repetitive vasoconstrictive insults, contribute to lower gingival perfusion in chronic smokers and do not completely regress upon smoking cessation. In periodontal disease there is considerable gingival inflammation and angiogenesis in non-smokers which, in chronic smokers, are considerably suppressed, in part due to local immune suppression and oxidative stress. Tobacco exposure, irrespective of the form of use, causes long-term microvascular dysfunction that increases the risk of complications due to the natural disease course or secondary therapeutic strategies.
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Affiliation(s)
- Henrique Silva
- Informetrics Research Group, Ton Duc Thang University, Ho Chi Minh City 758307, Vietnam;
- Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City 758307, Vietnam
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Sanari AA, Alsolami BA, Abdel-Alim HM, Al-Ghamdi MY, Meisha DE. Effect of smoking on patient-reported postoperative complications following minor oral surgical procedures. Saudi Dent J 2020; 32:357-363. [PMID: 33132664 PMCID: PMC7588501 DOI: 10.1016/j.sdentj.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 11/24/2022] Open
Abstract
Objective This study evaluated the effect of smoking on patient-reported postoperative complications after minor oral surgical procedures by comparing the post-extraction symptoms between smokers and nonsmokers. Materials and methods Patients undergoing minor oral surgical procedures were recruited and followed up prospectively on the first, second, seventh, and twenty-first days after simple dental extractions. Results A total of 85 patients completed the study. Postoperative pain, measured with a visual analog scale, was consistently higher among smokers than nonsmokers (P < 0.0001). Patient-reported experience of bleeding events was significantly less among nonsmokers (P = 0.009) only on the first postoperative day. Facial swelling was more common in smokers than in nonsmokers (P = 0.04) on the second postoperative day. Postoperative infection was reported more by smokers than nonsmokers (P > 0.05). Trismus did not vary with time according to smoking status. On the 21st postoperative day, there were no statistically significant differences in postoperative complications between the groups. Conclusions The patient-reported pain score was consistently higher among smokers. The study’s findings suggested that initial differences in patient-reported complications between smokers and nonsmokers undergoing minor oral surgical procedures diminished after a week.
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Affiliation(s)
- Alaa A Sanari
- Internship Training Program (formerly), Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Bushra A Alsolami
- Dental Department, King Fahad General Hospital, Ministry of Health, Jeddah, Saudi Arabia
| | - Hala M Abdel-Alim
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Y Al-Ghamdi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Dalia E Meisha
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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Yılmaz Şaştım Ç, Gürsoy M, Könönen E, Kasurinen A, Norvio S, Gürsoy UK, Doğan B. Salivary and serum markers of angiogenesis in periodontitis in relation to smoking. Clin Oral Investig 2020; 25:1117-1126. [PMID: 32643086 DOI: 10.1007/s00784-020-03411-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Angiogenesis is essential in maintenance of periodontal homeostasis, and it is regulated by growth factors and cytokines, including basic fibroblast growth factor (b-FGF), endoglin, platelet and endothelial cell adhesion molecule (PECAM-1), vascular endothelial growth factor (VEGF), soluble intercellular adhesion molecule-1 (sICAM-1), and soluble vascular cell adhesion molecule-1 (sVCAM-1). In this study, the salivary and serum concentrations of these angiogenesis-related proteins in relation to smoking and periodontitis were examined. MATERIAL AND METHODS Full-mouth periodontal status together with unstimulated whole saliva and serum samples was collected from 78 individuals, including 40 periodontitis patients (20 smokers and 20 nonsmokers) and 38 periodontally healthy controls (20 smokers and 18 nonsmokers). The Luminex®-xMAP™ technique was used for protein analyses. RESULTS Concentrations of all tested proteins in saliva as well as VEGF in serum were significantly higher in periodontitis patients than in healthy controls. In smokers, serum concentrations of endoglin (p = 0.017) and sICAM-1 (p = 0.001) were elevated in comparison to nonsmokers. After adjusting for smoking and gender, periodontitis associated significantly with salivary concentrations of b-FGF, PECAM-1, VEGF, sICAM-1, and sVCAM-1 (p < 0.01). CONCLUSION Taken together, salivary concentrations of b-FGF, PECAM-1, and VEGF associate with periodontitis. The suppressive effect of smoking on salivary marker levels is limited to periodontitis patients only. CLINICAL RELEVANCE Smoking-related suppression of salivary marker levels is observed only in periodontitis patients.
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Affiliation(s)
- Çiğdem Yılmaz Şaştım
- Department of Periodontology, Faculty of Dentistry, University of Marmara, 34854 Maltepe, Istanbul, Turkey
| | - Mervi Gürsoy
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Eija Könönen
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
- Oral Health Care, Welfare Division, City of Turku, Turku, Finland
| | - Akseli Kasurinen
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Susanna Norvio
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Ulvi Kahraman Gürsoy
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Başak Doğan
- Department of Periodontology, Faculty of Dentistry, University of Marmara, 34854 Maltepe, Istanbul, Turkey.
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Schmidt JC, Jajjo E, Berglundh T, Zitzmann NU. Periodontitis lesions in smokers and non-smokers. Eur J Oral Sci 2020; 128:196-203. [PMID: 32304269 DOI: 10.1111/eos.12693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 11/27/2022]
Abstract
Differences in the progression of periodontitis have been observed between smokers and non-smokers. The aim of the present study was to compare vascular and inflammatory cell densities in periodontitis lesions from smokers and non-smokers to gain further understanding of the influence of smoking on histopathological characteristics of the disease. Two groups of patients with generalized severe periodontitis were recruited. One group consisted of 25 current smokers, aged 33-69 yr, while the second group comprised 21 non-smokers, aged 35-76 yr. From each patient, gingival biopsies were harvested from one periodontitis site (probing pocket depth ≥6 mm and bleeding on probing) and one site without clinical signs of gingival inflammation (reference site). Immunohistochemical analyses were performed to assess the density of vessels and inflammatory cells. Small differences existed between smokers and non-smokers regarding the size, proportion, number, and density of cells in periodontitis lesions. However, the vascular density in periodontitis lesions was significantly higher in non-smokers than in smokers. In clinically healthy reference sites, lesions were considerably smaller than in periodontitis sites and presented with similar vascular densities in smokers and non-smokers.
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Affiliation(s)
- Julia C Schmidt
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine, University of Basel, Basel, Switzerland
| | - Elias Jajjo
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicola U Zitzmann
- Department of Reconstructive Dentistry, University Center for Dental Medicine, University of Basel, Basel, Switzerland
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Gu Z, Singh S, Niyogi RG, Lamont GJ, Wang H, Lamont RJ, Scott DA. Marijuana-Derived Cannabinoids Trigger a CB2/PI3K Axis of Suppression of the Innate Response to Oral Pathogens. Front Immunol 2019; 10:2288. [PMID: 31681262 PMCID: PMC6804395 DOI: 10.3389/fimmu.2019.02288] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 09/10/2019] [Indexed: 12/18/2022] Open
Abstract
Cannabis use is an emergent risk factor for periodontitis, a chronic bacterial-induced disease of the supporting structures of the teeth. However, the mechanisms by which marijuana exposure predisposes to periodontal tissue destruction have yet to be elucidated. Therefore, we examined the influence of physiologically relevant doses of major marijuana-derived phytocannabinoid subtypes (cannabidiol [CBD]; cannabinol [CBN]; and tetrahydrocannabinol [THC], 1.0 μg/ml) on the interactions of three ultrastructurally variant oral pathogens, Porphyromonas gingivalis, Filifactor alocis, and Treponema denticola with the immune system. CBD, CBN, and THC each suppressed P. gingivalis-induced IL-12 p40, IL-6, IL-8, and TNF release while enhancing the anti-inflammatory cytokine, IL-10, from human innate cells. Similar phenomena were observed in F. alocis- and T. denticola-exposed human monocytes and human gingival keratinocytes. Higher phytocannabinoid doses (≥5.0 μg/ml) compromised innate cell viability and inhibited the growth of P. gingivalis and F. alocis, relative to unexposed bacteria. T. denticola, however, was resistant to all cannabinoid doses tested (up to 10.0 μg/ml). Pharmaceutical inhibition and efficient gene silencing indicated that a common CB2/PI3K axis of immune suppression is triggered by phytocannabinoids in vitro. This pathway does not appear to perpetuate through the canonical GSK3β-dependent cholinergic anti-inflammatory pathway, the predominant endogenous inflammatory control system. In a repetitive, transient oral infection model, CBD also suppressed P. gingivalis-induced innate immune markers in wild-type mice, but not in CB2−/− mice. If such phenomena occur in humans in situ, environmental cannabinoids may enhance periodontitis via direct toxic effects on specific oral bacteria; by compromising innate cell vitality; and/or through a suppressed innate response to periodontal pathogens involving a CB2/PI3K signaling lineage.
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Affiliation(s)
- Zhen Gu
- Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, United States
| | - Shilpa Singh
- Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, United States
| | - Rajarshi G Niyogi
- Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, United States
| | - Gwyneth J Lamont
- Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, United States
| | - Huizhi Wang
- Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, United States
| | - Richard J Lamont
- Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, United States
| | - David A Scott
- Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, United States
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Zeller I, Malovichko MV, Hurst HE, Renaud DE, Scott DA. Cigarette smoke reduces short chain fatty acid production by a Porphyromonas gingivalis clinical isolate. J Periodontal Res 2019; 54:566-571. [PMID: 30982987 PMCID: PMC6776670 DOI: 10.1111/jre.12660] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 02/13/2019] [Accepted: 03/18/2019] [Indexed: 01/13/2023]
Abstract
Objectives We hypothesized that short chain fatty acid (SCFA) production by oral pathogens is suppressed by exposure to cigarette smoke extract (CSE). Background Tobacco smoking is a major risk factor for plaque‐induced periodontal diseases. Despite increased disease susceptibility, overt oral inflammation is suppressed in smokers, presenting a diagnostic conundrum. Bacterial‐derived SCFAs can penetrate into oral tissues where they influence multiple components of immune and healing responses. Indeed, the SCFA burden has been correlated with the inflammatory condition of the gingiva. However, the influence of cigarette consumption on SCFA production is unknown. Methods GC/MS was employed to monitor the production of several SCFAs (propionic acid, isobutyric acid, butyric acid, and isovaleric acid) by representative anaerobic oral pathogens (Filifactor alocis 35896, Fusobacterium nucleatum 25586, Porphyromonas gingivalis 33277) that were exposed, or not, to a physiologically relevant dose of CSE (2000 ng/ml nicotine equivalents) generated from 3R4F reference cigarettes. Results The growth of all three bacterial species was unaffected by CSE. The capacity to produce SCFAs by these bacteria was highly varied. F alocis produced the highest concentration of a specific SCFA (butyrate); P gingivalis provided the most robust overall SCFA signal, while F alocis and F nucleatum did not release detectable levels of isobutyrate or isovalerate. As P gingivalis 33277 was the broadest SCFA producer, three low‐passage clinical isolates (10208C, 5607, and 10512) were also examined. Compared to unconditioned microbes, reduced SCFA release was apparent in CSE‐exposed low‐passage clinical isolates of P gingivalis which reached significance for one of the three isolates (propionic, isobutyric, butyric, and isovaleric acids, all P < 0.05). Conclusions There is high disparity in the SCFA profiles of variant chronic periodontitis‐associated bacteria, while CSE exposure reduces SCFA production by a specific clinical strain of P gingivalis. If the latter phenomenon occurs in vivo, a reduced SCFA burden may help explain the reduced vascular response to dental plaque in tobacco smokers.
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Affiliation(s)
- Iris Zeller
- Departments of Oral Immunology and Infectious Diseases, University of Louisville, Louisville, Kentucky
| | - Marina V Malovichko
- University of Louisville Superfund Research Center and Envirome Institute, University of Louisville, Louisville, Kentucky.,American Heart Association Tobacco Regulatory Science and Addiction Center, University of Louisville, Louisville, Kentucky
| | - Harrell E Hurst
- Pharmacology and Toxicology, University of Louisville, Louisville, Kentucky
| | - Diane E Renaud
- Departments of Oral Immunology and Infectious Diseases, University of Louisville, Louisville, Kentucky
| | - David A Scott
- Departments of Oral Immunology and Infectious Diseases, University of Louisville, Louisville, Kentucky
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Abstract
Cigarette smoking presents oral health professionals with a clinical and research conundrum: reduced periodontal vascular responsiveness to the oral biofilm accompanied by increased susceptibility to destructive periodontal diseases. This presents a significant problem, hampering diagnosis and complicating treatment planning. The aim of this review is to summarize contemporary hypotheses that help to explain mechanistically the phenomenon of a suppressed bleeding response to dysbiotic plaque in the periodontia of smokers. The influence of smoke exposure on angiogenesis, innate cell function, the production of inflammatory mediators including cytokines and proteases, tobacco-bacteria interactions, and potential genetic predisposition are discussed.
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Affiliation(s)
| | - David A. Scott
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, Louisville, KY, USA
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Kinane DF, Zhang P, Benakanakere M, Singleton J, Biesbrock A, Nonnenmacher C, He T. Experimental gingivitis, bacteremia and systemic biomarkers: a randomized clinical trial. J Periodontal Res 2015; 50:864-9. [PMID: 25960104 DOI: 10.1111/jre.12280] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Bacteremia and systemic inflammatory markers are associated with periodontal and systemic diseases and may be linking mechanisms between these conditions. We hypothesized that in the development of gingival inflammation, systemic markers of inflammation and bacteremia would increase. MATERIAL AND METHODS To study the effect of bacteremia on systemic inflammatory markers, we recruited 80 subjects to participate in an experimental gingivitis study. Subjects were stratified based on gender, smoking and the number of bleeding sites and then randomized to one of two groups: control group (n = 40) or experimental gingivitis group (n = 40). Subjects in the control group conducted an oral hygiene regimen: brushing twice daily with a regular sodium fluoride cavity protection dentifrice and a standard manual toothbrush, flossing twice daily, and mouth rinsing with an anti-cavity fluoride rinse once daily. The experimental group stopped brushing and flossing, and used only the fluoride anti-cavity mouth rinse for 21 d. RESULTS Seventy-nine of 80 subjects were evaluable. One subject in the control group was excluded from the results due to antibiotic use during the study. Our data showed the experimental gingivitis group exhibited a significant (p < 0.05) increase in dental plaque level and gingival inflammatory indices relative to baseline and the control group but a decrease in bacteremia and soluble intercellular adhesion molecule-1 levels vs. baseline. Bacteremia was negatively correlated with gingival inflammatory indices and soluble intercellular adhesion molecule-1 levels in the experimental gingivitis group, thus negating our hypothesis. CONCLUSION We conclude that there are marked differences in systemic cytokine levels over the course of short-term experimentally induced gingivitis and further conclude that a long-term periodontitis study must be considered to address mechanisms whereby oral diseases may affect systemic diseases.
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Affiliation(s)
- D F Kinane
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - P Zhang
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M Benakanakere
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - J Singleton
- Department of Periodontics, Endodontics and Dental Hygiene, Center for Oral Health and Systemic Disease, University of Louisville School of Dentistry, Louisville, KY, USA
| | - A Biesbrock
- Health Care Research Center, Procter & Gamble Company, Mason, OH, USA
| | - C Nonnenmacher
- Institute of Medical Microbiology and Hygiene, Philipps University Marburg, Marburg, Germany
| | - T He
- Health Care Research Center, Procter & Gamble Company, Mason, OH, USA
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Abstract
BACKGROUND This study evaluates possible effects of smoking on the following: 1) biochemical content in gingival crevicular fluid (GCF) samples from sites of gingival recession and saliva; and 2) clinical outcomes of coronally advanced flap (CAF) for root coverage. METHODS Eighteen defects in 15 patients were included in each of the smoker and non-smoker groups. Baseline cotinine, basic fibroblast growth factor, vascular endothelial growth factor, platelet-derived growth factor, interleukin (IL)-8, IL-10, IL-12, tumor necrosis factor-α, matrix metalloproteinase (MMP)-8, MMP-9, and plasminogen activator inhibitor-1 levels were determined in GCF and saliva samples. CAF with microsurgery technique was applied. Plaque index, papilla bleeding index, recession depth (RD), recession width (RW), and root surface area were evaluated at baseline and postoperative months 1, 3, and 6. Probing depth, clinical attachment level (CAL), and keratinized gingival width (KGW) was recorded at baseline and month 6. Percentage of root coverage and complete root coverage were calculated at postoperative months 1, 3, and 6. RESULTS All biochemical parameters were similar in the two groups apart from the definite difference in salivary cotinine concentrations (P = 0.000). Compared with the baseline values, RD, RW, CAL, and root surface area decreased, and KGW increased, with no significant difference between the study groups. CAL gain, percentage of root coverage, and complete root-coverage rates were similar in the study groups. CONCLUSION Similar baseline biochemical data and comparably high success rates of root coverage with CAF in systemically and periodontally healthy smokers versus non-smokers suggest lack of adverse effects of smoking on clinical outcomes.
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Affiliation(s)
- Başak Kaval
- Department of Periodontology, School of Dentistry, Ege University, ızmir, Turkey
| | - Diane E. Renaud
- University of Louisville, School of Dentistry, Oral Health and Systemic Disease Research Group, Louisville, KY
| | - David A. Scott
- University of Louisville, School of Dentistry, Oral Health and Systemic Disease Research Group, Louisville, KY
| | - Nurcan Buduneli
- Department of Periodontology, School of Dentistry, Ege University, ızmir, Turkey
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Matsunaga Y, Vardavas CI, Plada M, Wärnberg J, Gómez-Martinez S, Tzatzarakis MN, Tsatsakis AM, Díaz EL, Marcos A, Kafatos AG. The relationship between cotinine concentrations and inflammatory markers among highly secondhand smoke exposed non-smoking adolescents. Cytokine 2013; 66:17-22. [PMID: 24548420 DOI: 10.1016/j.cyto.2013.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 11/18/2013] [Accepted: 12/09/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND Secondhand smoke (SHS) exposure is a risk factor of respiratory, cardiovascular and inflammatory diseases, however its association with inflammatory markers among highly SHS exposed adolescents has not yet been explored. METHODS Participants included in this study were a subset of 68 non-smoking adolescents, aged 12.5-17.5 from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, recruited from Crete Greece. Smoking and SHS exposure was assessed via serum cotinine concentrations. Cytokines (Interleukin-1β, 2, 4, 5 and 6, tumor necrosis factor-α, interferon-γ, tumor growth factor-β1), immunoglobulins IgG, IgA, IgM, complement factors C3, C4, high sensitivity C-reactive protein, and endothelial inflammatory markers [soluble E-selectin, soluble L-selectin, soluble intercellular adhesion molecules (sICAM-1) and soluble vascular cell adhesion molecules-1 (sVCAM-1)] were assessed. Inflammatory markers in the lower 25th percentile and upper 75th percentile groups of cotinine levels were compared and multivariate linear regression analysis was performed controlling for age, sex and BMI. RESULTS Cotinine concentrations were notably elevated (geometric mean 0.82ng/ml, 95%CI 0.62-1.07) in this study population. A significant decrease in IL-4 (130.09 vs. 25.77pg/ml, p=0.014) and IL-6 (19.52 vs. 5.52pg/ml, p=0.008) concentrations between the upper 75th percentile cotinine level group and lower 25th percentile cotinine level group was observed. In a multivariate linear regression analysis, cotinine concentrations had a weak inverse association with IL-4 and IL-6 (p=0.028 and p=0.06) which was not statistically significant when adjusted for multiple comparisons (modified Bonferroni, p>0.016). No differences in the other variables was noted. CONCLUSIONS Among highly SHS exposed adolescents, cotinine levels had weak inverse association with IL-4 and IL-6, which did not achieve statistical significance. However, our results potentially indicate an immunosuppressive role of SHS. Further research is warranted to explore this hypothesis.
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Affiliation(s)
- Yuko Matsunaga
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, USA.
| | - Constantine I Vardavas
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, USA; Department of Social Medicine, University of Crete, Greece
| | - Maria Plada
- Department of Social Medicine, University of Crete, Greece
| | - Julia Wärnberg
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain; Unit for Nutrition Epidemiology, Department of Preventive Medicine, University of Málaga, Málaga, Spain
| | - Sonia Gómez-Martinez
- Immunonutrition Research Group, Instituto de Ciencia y Tecnología de los alimentos y Nutrición, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | | | | | - Esperanza-Ligia Díaz
- Immunonutrition Research Group, Instituto de Ciencia y Tecnología de los alimentos y Nutrición, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Ascensión Marcos
- Immunonutrition Research Group, Instituto de Ciencia y Tecnología de los alimentos y Nutrición, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
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Leishman SJ, Seymour GJ, Ford PJ. Local and systemic inflammatory responses to experimentally induced gingivitis. Dis Markers 2013; 35:543-9. [PMID: 24227893 DOI: 10.1155/2013/948569] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 09/10/2013] [Accepted: 09/30/2013] [Indexed: 11/25/2022]
Abstract
This study profiled the local and systemic inflammatory responses to experimentally induced gingivitis. Eight females participated in a 21-day experimental gingivitis model followed by a 14-day resolution phase. Bleeding on probing and plaque index scores were assessed before, during, and after resolution of gingival inflammation, and samples of saliva, GCF, and plasma were collected. Samples were assessed for biomarkers of inflammation using the BioPlex platform and ELISA. There were no significant changes in GCF levels of cytokines during the experimental phase; however, individual variability in cytokine profiles was noted. During resolution, mean GCF levels of IL-2, IL-6, and TNF-α decreased and were significantly lower than baseline levels (P = 0.003, P = 0.025, and P = 0.007, resp.). Furthermore, changes in GCF levels of IL-2, IL-6, and TNF-α during resolution correlated with changes in plaque index scores (r = 0.88, P = 0.004; r = 0.72, P = 0.042; r = 0.79, P = 0.019, resp.). Plasma levels of sICAM-1 increased significantly during the experimental phase (P = 0.002) and remained elevated and significantly higher than baseline levels during resolution (P < 0.001). These results support the concept that gingivitis adds to the systemic inflammatory burden of an individual.
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Naqvi AR, Fordham JB, Khan A, Nares S. MicroRNAs responsive to Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis LPS modulate expression of genes regulating innate immunity in human macrophages. Innate Immun 2013; 20:540-51. [PMID: 24062196 DOI: 10.1177/1753425913501914] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 07/26/2013] [Indexed: 12/27/2022] Open
Abstract
MicroRNAs (miRNAs) are a class of small, noncoding RNAs that regulate post-transcriptional expression of their respective target genes and are responsive to various stimuli, including LPS. Here we examined the early (4 h) miRNA responses of THP1-differentiated macrophages challenged with LPS derived from the periodontal pathogens, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis or environmentally-modified LPS obtained from P. gingivalis grown in cigarette smoke extract. Predicted miRNA-gene target interactions for LPS-responsive miR-29b and let-7f were confirmed using dual-luciferase assays and by transfection experiments using miRNA mimics and inhibitors. Convergent and divergent miRNA profiles were observed in treated samples where differences in miRNA levels related to the type, concentration and incubation times of LPS challenge. Dual-luciferase experiments revealed miR-29b targeting of interleukin-6 receptorα (IL-6Rα) and IFN-γ inducible protein 30 and let-7f targeting of suppressor of cytokine signaling 4 and thrombospondin-1. Transfection experiments confirmed miR-29b and let-7f modulation of IL-6Rα and SOCS4 protein expression levels, respectively. Thus, we have demonstrated convergent/divergent miRNA responses to wild type LPS and its environmentally-modified LPS, and demonstrate miRNA targeting of key genes linked to inflammation and immunity. Our data indicate that these LPS-responsive miRNAs may play a key role in fine-tuning the host response to periodontal pathogens.
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Affiliation(s)
- Afsar R Naqvi
- Department of Periodontology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Currently at Department of Periodontics, University of Illinois at Chicago, Chicago, IL, USA
| | - Jezrom B Fordham
- Department of Periodontology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Currently at Department of Periodontics, University of Illinois at Chicago, Chicago, IL, USA
| | - Asma Khan
- Department of Endodontics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Salvador Nares
- Department of Periodontology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Currently at Department of Periodontics, University of Illinois at Chicago, Chicago, IL, USA
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Bondy-Carey JL, Galicia J, Bagaitkar J, Potempa JS, Potempa B, Kinane DF, Veillard F, Scott DA. Neutrophils alter epithelial response to Porphyromonas gingivalis in a gingival crevice model. Mol Oral Microbiol 2013; 28:102-13. [PMID: 23193955 PMCID: PMC3594541 DOI: 10.1111/omi.12008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2012] [Indexed: 11/27/2022]
Abstract
A gingival crevice model (epithelial cell-Porphyromonas gingivalis-neutrophil) was established and used to profile gingipain, matrix metalloproteinase (MMP), MMP mediators [neutrophil gelatinase-associated lipocalin (NGAL) and tissue inhibitor of metalloproteinases 1 (TIMP-1)] and cytokine networks. Smoking is the primary environmental risk factor for periodontitis. Therefore, the influence of cigarette smoke extract (CSE) was also monitored in the same model. Porphyromonas gingivalis alone induced low levels of interleukin-1β and interleukin-8 from epithelial cells, but high levels of both cytokines were produced on the addition of neutrophils. Exposure to CSE (100 and 1000 ng ml(-1) nicotine equivalency) significantly compromised P. gingivalis-induced cytokine secretion (both P < 0.05). P. gingivalis induced impressive secretion of NGAL (P < 0.05) that was not influenced by CSE. The influence of CSE on gingipain production was strain-specific. Purified gingipains effectively and rapidly degraded both TIMP-1 and MMP-9. Induction of large amounts of NGAL, degradation of TIMP-1, and increased gingipain activity would each be expected to prolong collagen degradation and promote disease progression. However, gingipains also degrade MMP-9. Hence, P. gingivalis exerts a complex influence on the proteolytic balance of a gingival crevice model. Exposure to CSE reduces the proinflammatory cytokine burden, which may be expected to promote P. gingivalis survival. In addition to novel findings that provide mechanistic insight into periodontal disease progression, these results are in keeping with the recognized clinical dogma of decreased inflammation/increased disease in smokers. This straightforward gingival crevice model is established as a suitable vehicle for the elucidation of mechanisms that contribute to susceptibility to periodontitis.
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Affiliation(s)
- Jessica L. Bondy-Carey
- Centre for Oral Health and Systemic Disease, University of Louisville, 501 S. Preston St., Louisville, KY, USA
| | - Johnah Galicia
- School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Juhi Bagaitkar
- Department of Pediatric Hematology, Washington University, St. Louis, MO, USA
| | - Jan S. Potempa
- Centre for Oral Health and Systemic Disease, University of Louisville, 501 S. Preston St., Louisville, KY, USA
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Barbara Potempa
- Centre for Oral Health and Systemic Disease, University of Louisville, 501 S. Preston St., Louisville, KY, USA
| | - Denis F. Kinane
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Florian Veillard
- Centre for Oral Health and Systemic Disease, University of Louisville, 501 S. Preston St., Louisville, KY, USA
| | - David A. Scott
- Centre for Oral Health and Systemic Disease, University of Louisville, 501 S. Preston St., Louisville, KY, USA
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Bagaitkar J, Daep CA, Patel CK, Renaud DE, Demuth DR, Scott DA. Tobacco smoke augments Porphyromonas gingivalis-Streptococcus gordonii biofilm formation. PLoS One 2011; 6:e27386. [PMID: 22110637 PMCID: PMC3215692 DOI: 10.1371/journal.pone.0027386] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 10/14/2011] [Indexed: 11/29/2022] Open
Abstract
Smoking is responsible for the majority of periodontitis cases in the US and smokers are more susceptible than non-smokers to infection by the periodontal pathogen Porphyromonas gingivalis. P. gingivalis colonization of the oral cavity is dependent upon its interaction with other plaque bacteria, including Streptococcus gordonii. Microarray analysis suggested that exposure of P. gingivalis to cigarette smoke extract (CSE) increased the expression of the major fimbrial antigen (FimA), but not the minor fimbrial antigen (Mfa1). Therefore, we hypothesized that CSE promotes P. gingivalis-S. gordonii biofilm formation in a FimA-dependent manner. FimA total protein and cell surface expression were increased upon exposure to CSE whereas Mfa1 was unaffected. CSE exposure did not induce P. gingivalis auto-aggregation but did promote dual species biofilm formation, monitored by microcolony numbers and depth (both, p<0.05). Interestingly, P. gingivalis biofilms grown in the presence of CSE exhibited a lower pro-inflammatory capacity (TNF-α, IL-6) than control biofilms (both, p<0.01). CSE-exposed P. gingivalis bound more strongly to immobilized rGAPDH, the cognate FimA ligand on S. gordonii, than control biofilms (p<0.001) and did so in a dose-dependent manner. Nevertheless, a peptide representing the Mfa1 binding site on S. gordonii, SspB, completely inhibited dual species biofilm formation. Thus, CSE likely augments P. gingivalis biofilm formation by increasing FimA avidity which, in turn, supports initial interspecies interactions and promotes subsequent high affinity Mfa1-SspB interactions driving biofilm growth. CSE induction of P. gingivalis biofilms of limited pro-inflammatory potential may explain the increased persistence of this pathogen in smokers. These findings may also be relevant to other biofilm-induced infectious diseases and conditions.
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Affiliation(s)
- Juhi Bagaitkar
- Department of Microbiology and Immunology, University of Louisville, Louisville, Kentucky, United States of America
| | - Carlo A. Daep
- Department of Microbiology and Immunology, University of Louisville, Louisville, Kentucky, United States of America
| | - Carol K. Patel
- Center of Oral Health and Systemic Disease, University of Louisville, Louisville, Kentucky, United States of America
| | - Diane E. Renaud
- Center of Oral Health and Systemic Disease, University of Louisville, Louisville, Kentucky, United States of America
| | - Donald R. Demuth
- Department of Microbiology and Immunology, University of Louisville, Louisville, Kentucky, United States of America
- Center of Oral Health and Systemic Disease, University of Louisville, Louisville, Kentucky, United States of America
| | - David A. Scott
- Department of Microbiology and Immunology, University of Louisville, Louisville, Kentucky, United States of America
- Center of Oral Health and Systemic Disease, University of Louisville, Louisville, Kentucky, United States of America
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Özçakır-Tomruk C, Chiquet M, Mericske-Stern R. Tenascin-C and matrix metalloproteinase-9 levels in crevicular fluid of teeth and implants. Clin Implant Dent Relat Res 2011; 14:672-81. [PMID: 21429069 DOI: 10.1111/j.1708-8208.2010.00319.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The role of and interaction between bacterial infection and biomechanical impact in the development of peri-implant inflammatory processes is not clear. OBJECTIVE To determine the amount and concentration of tenascin-C (TNC) in gingival crevicular fluid (GCF) around teeth and in peri-implant sulcus fluid from healthy implants and implants with peri-implantitis, and to correlate it with matrix metalloproteinase-9 (MMP-9) levels. MATERIALS AND METHODS Seven control individuals and 18 patients with 41 implants with/without peri-implantitis were included. GCF was collected with filter strips and volumes were measured with a Periotron device. The amount of serum albumin per sample was quantified by densitometric analysis of Coomassie-stained sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Relative activity of MMP-9 was determined from the densitometry of zymograms. Amounts and concentrations of TNC were evaluated by ELISA. RESULTS Relative MMP-9 activity was increased in peri-implantitis. A tendency was observed to measure higher TNC concentrations at teeth than at implants. The amount of TNC in GCF collected from healthy implant sites and the peri-implantitis sites was significantly different. Based on immunoblotting, TNC in GCF seemed degraded. In contrast to TNC, MMP-9 was significantly related to the PD and the volume of GCF. CONCLUSION TNC is known to be induced in inflammation. The increase found in peri-implantitis was less than expected. In the context of peri-implantitis, TNC might be a marker of bone remodelling rather than inflammation and infection. A possible proteolytic degradation of TNC during peri-implantitis needs to be studied.
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Affiliation(s)
- Ceyda Özçakır-Tomruk
- Department of Prosthodontics, School of Dentistry, University of Bern, Bern, Switzerland
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18
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Bagaitkar J, Demuth DR, Daep CA, Renaud DE, Pierce DL, Scott DA. Tobacco upregulates P. gingivalis fimbrial proteins which induce TLR2 hyposensitivity. PLoS One 2010; 5:e9323. [PMID: 20454607 PMCID: PMC2864253 DOI: 10.1371/journal.pone.0009323] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 01/29/2010] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Tobacco smokers are more susceptible to periodontitis than non-smokers but exhibit reduced signs of clinical inflammation. The underlying mechanisms are unknown. We have previously shown that cigarette smoke extract (CSE) represents an environmental stress to which P. gingivalis adapts by altering the expression of several virulence factors - including major and minor fimbrial antigens (FimA and Mfa1, respectively) and capsule - concomitant with a reduced pro-inflammatory potential of intact P. gingivalis. METHODOLOGY/PRINCIPAL FINDINGS We hypothesized that CSE-regulation of capsule and fimbrial genes is reflected at the ultrastructural and functional levels, alters the nature of host-pathogen interactions, and contributes to the reduced pro- inflammatory potential of smoke exposed P. gingivalis. CSE induced ultrastructural alterations were determined by electron microscopy, confirmed by Western blot and physiological consequences studied in open-flow biofilms. Inflammatory profiling of specific CSE-dysregulated proteins, rFimA and rMfa1, was determined by quantifying cytokine induction in primary human innate and OBA-9 cells. CSE up-regulates P. gingivalis FimA at the protein level, suppresses the production of capsular polysaccharides at the ultrastructural level, and creates conditions that promote biofilm formation. We further show that while FimA is recognized by TLR2/6, it has only minimal inflammatory activity in several cell types. Furthermore, FimA stimulation chronically abrogates the pro-inflammatory response to subsequent TLR2 stimulation by other TLR-2-specific agonists (Pam3CSK4, FSL, Mfa1) in an IkappaBalpha- and IRAK-1-dependent manner. CONCLUSIONS/SIGNIFICANCE These studies provide some of the first information to explain, mechanistically, how tobacco smoke changes the P. gingivalis phenotype in a manner likely to promote P. gingivalis colonization and infection while simultaneously reducing the host response to this major mucosal pathogen.
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Affiliation(s)
- Juhi Bagaitkar
- Department of Microbiology and Immunology, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
| | - Donald R. Demuth
- Department of Microbiology and Immunology, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
- Oral Health and Systemic Disease Research Group, Department of Oral Health and Rehabilitation, School of Dentistry, University of Louisville, Louisville, Kentucky, United States of America
| | - Carlo Amorin Daep
- Department of Microbiology and Immunology, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
| | - Diane E. Renaud
- Oral Health and Systemic Disease Research Group, Department of Oral Health and Rehabilitation, School of Dentistry, University of Louisville, Louisville, Kentucky, United States of America
| | - Deanne L. Pierce
- Oral Health and Systemic Disease Research Group, Department of Oral Health and Rehabilitation, School of Dentistry, University of Louisville, Louisville, Kentucky, United States of America
| | - David A. Scott
- Department of Microbiology and Immunology, School of Medicine, University of Louisville, Louisville, Kentucky, United States of America
- Oral Health and Systemic Disease Research Group, Department of Oral Health and Rehabilitation, School of Dentistry, University of Louisville, Louisville, Kentucky, United States of America
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Abstract
BACKGROUND AND OBJECTIVE Periodontitis is currently diagnosed almost entirely on gross clinical manifestations that have been in situ for more than 50 years without significant improvement. The general objective of this study was, therefore, to evaluate whether mid-infrared spectroscopy can be used to identify disease-specific molecular alterations to the overall biochemical profile of tissues and body fluids. MATERIAL AND METHODS A total of 190 gingival crevicular fluid samples were obtained from periodontitis (n = 64), gingivitis (n = 61) and normal sites (n = 65). Corresponding infrared absorption spectra of gingival crevicular fluid samples were acquired and processed, and the relative contributions of key functional groups in the infrared spectra were analysed. The qualitative assessment of clinical relevance of these gingival crevicular fluid spectra was interpreted with the multivariate statistical analysis-linear discriminant analysis. RESULTS Using infrared spectroscopy, we have been able to identify four molecular signatures (representing vibrations in amide I, amide II/tyrosine rings and symmetric and asymmetric PO2- stretching vibrations of phosphodiester groups in DNA) in the gingival crevicular fluid of subjects with periodontitis or gingivitis and healthy control subjects that clearly demarcate healthy and diseased periodontal tissues. Furthermore, the diagnostic accuracy for distinction between periodontally healthy and periodontitis sites revealed by multivariate classification of gingival crevicular fluid spectra was 98.4% for a training set of samples and 93.1% for a validation set. CONCLUSION We have established that mid-infrared spectroscopy can be used to identify periodontitis-specific molecular signatures in gingival crevicular fluid and to confirm clinical diagnoses. Future longitudinal studies will assess whether mid-infrared spectroscopy represents a potential prognostic tool, recognized as key to advancement of periodontics.
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Affiliation(s)
- X M Xiang
- Institute for Biodiagnostics, National Research Council of Canada, Winnipeg, MB, Canada
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Ojima M, Hanioka T. Destructive effects of smoking on molecular and genetic factors of periodontal disease. Tob Induc Dis 2010; 8:4. [PMID: 20170537 PMCID: PMC2836317 DOI: 10.1186/1617-9625-8-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Accepted: 02/20/2010] [Indexed: 11/29/2022] Open
Abstract
Many epidemiological evidences have proven the association between smoking and periodontal disease. The causality can be further established by linking findings of traditional epidemiological studies with the developments in molecular techniques that occurred in the last decade. The present article reviews recent studies that address the effect of smoking on molecular and genetic factors in periodontal disease. Most findings support the fact that tobacco smoking modulates destruction of the periodontium through different pathways: microcirculatory and host immune systems, connective tissue, and bone metabolism. Although smokers experience an increased burden of inflammatory responses to microbial challenges compared to non-smokers, understanding the association between smoking and periodontal diseases involves substantial problems with respect to accuracy of measurements, and particularly, sampling of many subjects. It remains unclear whether genetic susceptibility to periodontal disease is influenced by exposure to smoking or the effect of smoking on periodontal disease is influenced by genetic susceptibility. Employment of molecular techniques may play a key role in further elucidation of mechanisms linking smoking and periodontal destruction, the direct relationship as environmental factors and indirect relationship through genetic factors.
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Affiliation(s)
- Miki Ojima
- Department of Preventive and Public Health Dentistry, Fukuoka Dental College, 2-15-1 Tamura, Sawara-ku, Fukuoka 814-0193, Japan.
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Bagaitkar J, Williams LR, Renaud DE, Bemakanakere MR, Martin M, Scott DA, Demuth DR. Tobacco-induced alterations to Porphyromonas gingivalis-host interactions. Environ Microbiol 2009; 11:1242-53. [PMID: 19175666 DOI: 10.1111/j.1462-2920.2008.01852.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Smokers are more susceptible than non-smokers to persistent infection by Porphyromonas gingivalis, a causative agent of periodontitis. Patients who smoke exhibit increased susceptibility to periodontitis and are more likely to display severe disease and be refractory to treatment. Paradoxically, smokers demonstrate reduced clinical inflammation. We show that P. gingivalis cells exposed to cigarette smoke extract (CSE) induce a lower proinflammatory response (tumour necrosis factor-alpha, interleukin-6, interleukin-12 p40) from monocytes and peripheral blood mononuclear cells than do unexposed bacteria. This effect is reversed when CSE-exposed bacteria are subcultured in fresh medium without CSE. Using microarrays representative of the P. gingivalis genome, CSE-exposure resulted in differential regulation of 6.8% of P. gingivalis genes, including detoxification and oxidative stress-related genes; DNA repair genes; and multiple genes related to P. gingivalis virulence, including genes in the major fimbrial and capsular operons. Exposure to CSE also altered the expression of outer membrane proteins, most notably by inducing the virulence factors RagA and RagB, and a putative lipoprotein cotranscribed with the minor fimbrial antigen. Therefore, CSE represents an environmental stress to which P. gingivalis adapts by altering gene expression and outer membrane proteins. These changes may explain, in part, the altered virulence and host-pathogen interactions that have been documented in vivo in smokers with periodontal disease.
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Affiliation(s)
- Juhi Bagaitkar
- Microbiology and Immunology, University of Louisville, Louisville, KY 40292, USA
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22
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Shimazaki Y, Saito T, Kiyohara Y, Kato I, Kubo M, Iida M, Yamashita Y. The Influence of Current and Former Smoking on Gingival Bleeding: The Hisayama Study. J Periodontol 2006; 77:1430-5. [PMID: 16881812 DOI: 10.1902/jop.2006.050422] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Previous studies have shown that smoking is a risk factor for periodontitis and that it has a suppressive effect on gingival bleeding. This study examined the relationship between smoking, including past smoking, and periodontal conditions, mainly gingival bleeding, in a community-based health investigation. METHODS Smoking status was examined in 958 subjects, along with the quantity of tobacco currently or previously smoked (never, former light, former heavy, current light, and current heavy). We analyzed the influence of smoking on probing depth (PD), clinical attachment loss (CAL), and gingival bleeding on probing (BOP). RESULTS In multivariate logistic regression analyses, current heavy smokers were at a significantly greater risk for having a higher proportion of teeth with PD > or =4 mm and a higher proportion of teeth with CAL > or =5 mm; however, they had a lower risk for having a high BOP than did those who had never smoked. Moreover, both former light and former heavy smokers had significantly lower risks for high BOP. When the analysis was limited to subjects with PD > or =4 mm, former heavy and current heavy smokers showed a significant suppression of high BOP compared to never smokers. CONCLUSION This study suggests that smoking is significantly associated with PD and CAL and that current and past smoking has a suppressive effect on BOP.
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Affiliation(s)
- Yoshihiro Shimazaki
- Department of Preventive Dentistry, Kyushu University Faculty of Dental Science, Fukuoka, Japan
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Abstract
The expression of intercellular adhesion molecule-1 (ICAM-1) and vascular adhesion molecule-1 (VCAM-1) on human gingival fibroblasts (HGF) may be important for migration and retention of inflammatory cells in periodontally diseased tissue. This study aimed to assess which cytokines regulate ICAM-1 and VCAM-1 expression on HGF. Tumour necrosis factor (TNF)-alpha and interferon (IFN)-gamma enhanced both ICAM-1 and VCAM-1 expression on HGF. Interleukin (IL)-1beta mainly up-regulated ICAM-1 expression. On the other hand, IL-4 and IL-13 enhanced only VCAM-1 expression on HGF. IL-10 did not modulate both ICAM-1 and VCAM-1 expression. Transforming growth factor (TGF)-beta1 enhanced ICAM-1 expression. However, TGF-beta1 inhibited the VCAM-1 expression induced by TNF-alpha or IL-4. Both ICAM-1 and VCAM-1 expression by HGF was inhibited by nuclear factor-kappaB (NF-kappaB) activation inhibitor (MG-132). Mitogen-activated protein kinases (MAPK) inhibitors did not influence ICAM-1 expression induced by TNF-alpha. Interestingly, VCAM-1 expression was enhanced by MEK inhibitor (PD98059) and c-Jun NH2-terminal kinase (JNK) inhibitor (SP600125). These results mean that the balance of cytokines in periodontally diseased tissue may be essential for control of ICAM-1 and VCAM-1 expression on HGF, and the balance of ICAM-1 and VCAM-1 expression might be important for regulation of leucocytes infiltration and retention in periodontally diseased tissue.
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Affiliation(s)
- Y Hosokawa
- Department of Conservative Dentistry, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Tokushima, Japan.
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Oezcakir C, Fekry-Khedr M, Mericske-Stern R. Detection and measurements of soluble intercellular adhesion molecules at implants and teeth: a comparative study. Clin Implant Dent Relat Res 2005; 7:173-9. [PMID: 16219248 DOI: 10.1111/j.1708-8208.2005.tb00062.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adhesion molecules on endothelial cells and in the periodontal tissues control the immigration and retention of cells. The level of soluble intercellular adhesion molecules (sICAMs) has been used as a marker of the severity and/or extent of the inflammatory process in a wide range of pathologies, including periodontitis. PURPOSE This study was designed to detect and compare sICAM-1 at teeth and implants in relation to clinical periodontal and periimplant parameters. METHOD Regular recall patients with (1) implants and teeth, (2) implants, and (3) teeth were examined. Samples of sulcus fluid were collected from teeth and implants. The concentration of sICAM-1 was measured by enzyme-linked immunoabsorbent assay. Periodontal parameters were recorded after sampling. RESULTS The range of measured sICAM-1 was large (from below 100 to 1,200 ng/mL). The concentration of sICAM-1 was not different for teeth and implants but was significantly elevated in sites with positive bleeding on probing (BoP), namely, 571 ng/mL at teeth and 529 ng/mL at implants compared with 150 ng/mL and 169 ng/mL, respectively, with negative BoP. The regression analysis showed that the concentration of sICAM-1 was highly associated with positive BoP but was not dependent on the fluid volume. CONCLUSIONS A similarity of the sulcus fluid at teeth and implants was observed with regard to the detection of sICAM-1.
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Affiliation(s)
- Ceyda Oezcakir
- Department of Prosthodontics, University of Bern, Bern, Switzerland
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Teughels W, Van Eldere J, van Steenberghe D, Cassiman JJ, Fives-Taylor P, Quirynen M. Influence of Nicotine and Cotinine on Epithelial Colonization by Periodontopathogens. J Periodontol 2005; 76:1315-22. [PMID: 16101364 DOI: 10.1902/jop.2005.76.8.1315] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Since smoking is an established risk factor for the development of periodontitis, the present study investigated whether nicotine and cotinine can make epithelial cells more prone to colonization by periodontopathogens. METHODS Primary epithelial cell mono-layers were inoculated with nicotine and cotinine prior to adhesion experiments with Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. The number of bacteria associated with cells inoculated or not with nicotine or cotinine were assessed by an indirect culture viability assay. The same experimental set-up was used for assessing HeLa cells exposed to cigarette smoke extract (CSE). RESULTS Primary epithelial cells inoculated with concentrations of nicotine and cotinine, found in smokers and non smokers, did not show significant differences (P>0.05) in colonization susceptibility to A. actinomycetemcomitans. When these concentrations were increased to 1 mg/ml, a significant (P<0.05) and species-specific effect of the colonization susceptibility of epithelial cells was observed: It increased for A. actinomycetemcomitans, while it decreased for P. gingivalis. For both species the effects were more pronounced for nicotine, although this was not statistically significant. The change in colonization susceptibility did not result from alterations of the bacterial viability due to nicotine or cotinine. Treatment of HeLa cells with CSE also led to a species-specific variation in colonization tendency; i.e., increased for A. actinomycetemcomitans (P<0.05), but not for P. gingivalis. CONCLUSIONS The susceptibility of epithelial cells to become colonized by either A. actinomycetemcomitans or P. gingivalis could be altered by nicotine, cotinine, or CSE in a time-dependent, species-specific manner. Whether these findings that support the hypothesis of an increased patient susceptibility for bacterial adhesion to epithelial cells in smokers are clinically relevant remains to be proven.
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Affiliation(s)
- Wim Teughels
- Department of Periodontology, Catholic University Leuven, Leuven, Belgium
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Abstract
OBJECTIVE The central effects of nicotine on gingival blood flow and vascular conductance were investigated. BACKGROUND Nicotine is absorbed in cigarette smoking, which is a risk factor for periodontal disease. Although studies have shown peripheral effects of nicotine on gingival blood flow and gingival vascular conductance, little is known about its central effects. METHODS We used laser Doppler flow measurements to investigate the changes of gingival blood flow produced by 5 min intracerebroventricular (i.c.v.) injection of (-)-nicotine ditartrate in rats anesthetized by urethane and alpha-chloralose, along with occasional measurements of the blood pressure from the femoral artery. RESULTS The i.c.v. injection of nicotine at 15, 50, and 150 microg reduced the gingival blood flow significantly, compared with saline. The maximal reduction was dose-dependent. Next, we measured the blood pressure and gingival blood flow in the i.c.v. injection of nicotine at 50 microg, to calculate the gingival vascular conductance. The blood pressure was reduced, along with the change of gingival blood flow immediately after the injection, whereas the gingival vascular conductance fell with a time-lag. CONCLUSION These results suggest that the reduction of gingival blood flow by central nicotinic stimulation is accompanied in part by a change of vascular tonus in the gingiva.
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Affiliation(s)
- Taiji Nakamura
- Department of Physiology, Kyushu Dental College, Kitakyushu, Japan.
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Kuru L, Kirby AC, Griffiths GS, Petrie A, Olsen I. Changes in Soluble Adhesion Molecules in Gingival Crevicular Fluid Following Periodontal Surgery. J Periodontol 2005; 76:526-33. [PMID: 15857092 DOI: 10.1902/jop.2005.76.4.526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Inflammation of periodontal tissues during postoperative wound healing is mediated by cell surface adhesion molecules. Soluble forms of these antigens have also been identified and shown to be important in immunoregulatory processes, but have previously not been investigated during periodontal repair and regeneration. The present study has examined the presence and possible changes in soluble intercellular adhesion molecule-1 (sICAM-1; CD54) and lymphocyte function-associated antigen-3 (sLFA-3; CD58) in gingival crevical fluid (GCF) following periodontal surgery. METHODS GCF samples were collected from four groups: 1) a guided tissue regeneration (GTR) test; 2) a GTR control, at least one complete tooth unit away from the periodontal defect; 3) a conventional flap (CF) surgery; and 4) a crown lengthening (CL). Sandwich enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of sICAM-1 and sLFA-3 in the GCF samples. RESULTS A marked increase in GCF volumes was found in all sites after surgery, although a persistent increase was associated only with the period of membrane retention at the GTR test sites. In addition, sICAM-1 and sLFA-3 were found in the GCF of healthy as well as diseased sites prior to treatment and the total amounts of both increased transiently following surgical intervention, especially sLFA-3. However, the concentrations of these GCF components, particularly sICAM-1, tended to decrease. CONCLUSIONS The temporal decrease in the concentration of sICAM-1 and sLFA-3 in GCF may serve to enhance inflammatory reactions at surgically-treated periodontal sites, thereby limiting repair and regeneration in the periodontium. These soluble adhesion molecules may thereby be of potential therapeutic value and might also be useful markers for monitoring periodontal wound healing.
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Affiliation(s)
- Leyla Kuru
- Department of Periodontology, Faculty of Dentistry, Marmara University, Istanbul, Turkey
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Abstract
AIM To review the potential biological mechanisms underlying the effects of tobacco smoking on periodontitis. MAIN FINDINGS Smoking has major effects on the host response, but there are also a number of studies that show some microbiological differences between smokers and non-smokers. Smoking has a long-term chronic effect on many important aspects of the inflammatory and immune responses. Histological studies have shown alterations in the vasculature of the periodontal tissues in smokers. Smoking induces a significant systemic neutrophilia, but neutrophil transmigration across the periodontal microvasculature is impeded. The suppression of neutrophil cell spreading, chemokinesis, chemotaxis and phagocytosis have been described. Protease release from neutrophils may be an important mechanism in tissue destruction. Tobacco smoke has been found to affect both cell-mediated immunity and humoral immunity. Research on gingival crevicular fluid has demonstrated that there are lower levels of cytokines, enzymes and possibly polymorphonuclear cells in smokers. In vitro studies have shown detrimental effects of nicotine and some other tobacco compounds on fibroblast function, including fibroblast proliferation, adhesion to root surfaces and cytotoxicity. CONCLUSION Tobacco smoking has widespread systemic effects, many of which may provide mechanisms for the increased susceptibility to periodontitis and the poorer response to treatment.
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Affiliation(s)
- Richard M Palmer
- King's College London, Guy's Hospital Campus, London Bridge, London SE1 9RT, UK.
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Scott DA, Palmer RM. The influence of tobacco smoking on adhesion molecule profiles. Tob Induc Dis 2002; 1:7-25. [PMID: 19570245 PMCID: PMC2671531 DOI: 10.1186/1617-9625-1-1-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2001] [Revised: 02/18/2002] [Accepted: 02/19/2002] [Indexed: 12/02/2022] Open
Abstract
Sequential interactions between several adhesion molecules and their ligands regulate lymphocyte circulation and leukocyte recruitment to inflammatory foci. Adhesion molecules are, therefore, central and critical components of the immune and inflammatory system. We review the evidence that tobacco smoking dysregulates specific components of the adhesion cascade, which may be a common factor in several smoking-induced diseases. Smoking causes inappropriate leukocyte activation, leukocyte-endothelial adhesion, and neutrophil entrapment in the microvasculature, which may help initiate local tissue destruction. Appropriate inflammatory reactions may thus be compromised. In addition to smoke-induced alterations to membrane bound endothelial and leukocyte adhesion molecule expression, which may help explain the above phenomena, smoking has a profound influence on circulating adhesion molecule profiles, most notably sICAM-1 and specific sCD44 variants. Elevated concentrations of soluble adhesion molecules may simply reflect ongoing inflammatory processes. However, increasing evidence suggests that specific soluble adhesion molecules are immunomodulatory, and that alterations to soluble adhesion molecule profiles may represent a significant risk factor for several diverse diseases. This evidence is discussed herein.
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Affiliation(s)
- D A Scott
- Department of Oral Biology, Faculty of Dentistry, University of Manitoba, 780 Bannatyne Ave, Winnipeg, MB, R3E 0W2, Canada.
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