Serum levels of inflammatory markers in type 2 diabetes patients with chronic periodontitis

Periodontitis and diabetes in pregnant rats: Maternal-fetal outcomes

Aim

To evaluate the repercussions of periodontitis and diabetes association on rat pregnancy and newborns.

Methods

Diabetes was induced in female Wistar rats 24 h after birth through the administration of Streptozotocin. The diabetic condition of the rats was further confirmed in adulthood. After mating, the pregnant rats were distributed into four experimental groups (n = 12 rats/group): nondiabetic and diabetic with and without periodontitis. Periodontitis was induced by a ligature inserted into the first molar on day 0 of pregnancy. Body weight, water and feed consumption were evaluated weekly, and an oral glucose tolerance test was performed on day 17 of pregnancy. On day 21 of pregnancy, the animals were anesthetized and killed for organ removal. The hemimandibles were collected to analyze alveolar bone loss. Immunological and biochemical parameters were evaluated in the maternal blood samples, and reproductive performance was analyzed. The newborns were weighed, and anomalies evaluated.

Results

The group with diabetes and periodontitis had a greater degree of alveolar bone loss, along with higher relative pancreatic weight, blood glucose levels, triglyceride and inflammatory cytokine levels, hepatic transaminase activity, and embryonic losses. In addition, these newborns had increased body weight, placental weight, a greater number of ossification centers, and a higher rate of visceral and skeletal anomalies.

Conclusion

The combination of maternal diabetes and periodontitis negatively impacts maternal parameters and fetal development. The findings reinforce the importance of maintaining maternal oral health to ensure the general health of the offspring, especially in cases where diabetes is present.

Pathogenic Mechanisms That May Link Periodontal Disease and Type 2 Diabetes Mellitus-The Role of Oxidative Stress

Given the posited role of oxidative stress in the pathogenesis of both periodontitis and type 2 diabetes mellitus (T2DM), it may also serve as a link between these highly prevalent chronic inflammatory diseases. This view is supported by an ample body of evidence indicating that the severity and progression of periodontitis is in part driven by diabetes, while periodontal infection may hinder the attainment of adequate glycemic control in diabetic patients. Thus, this review focuses on the potential synergistic interactions along the oxidative stress-inflammation pathway characterizing both conditions. Because periodontitis and T2DM share the same risk factors and compromise patients' quality of life, to develop effective strategies for combatting both conditions, their mutual influence needs to be explored.

Improvement of post-periodontitis-therapy inflammatory state in diabetics: a meta-analysis of randomized controlled trials

OBJECTIVES

This systematic review aimed to evaluate the impact of periodontal therapy on systemic biomarkers of inflammation and oxidative stress in patients with type 2 diabetes mellitus (T2DM) and periodontitis.

MATERIALS AND METHODS

An electronic search without restriction on dates or languages was performed in six electronic databases, protocol records and other sources until May 2024. To develop the search strategy, clinical question was formulated using the PICOD method. Eligibility criteria included randomized controlled trials on the effects of periodontitis-therapy on the inflammatory parameters of T2DM patients. Risk of bias and certainty of evidence were assessed by RoB2 and GRADE tools, respectively. The review protocol was registered in PROSPERO platform (CRD42020206295).

RESULTS

Of 1,062 records screened, the authors determined that 14 studies enrolling 1223 participants proved eligible. Moderate-quality evidence suggested a positive effect of periodontitis-therapy on serum levels of c-reactive protein [0.39 (CI95%: 0.27-0.5)], even without the use of antibiotics [0.34 (CI95%: 0.22-0.46)], in T2DM patients. The significant reduction in C-reactive protein (CRP) among smokers in favor of periodontitis-therapy was greatest at six months of follow-up.

CONCLUSIONS

Non-surgical periodontal therapy improved short-term biomarkers of systemic inflammation in T2DM patients, with moderate evidence of improvement in serum levels of high sensitivity-CRP.

CLINICAL RELEVANCE

Systemic inflammation in T2DM patients can be reduced after non-surgical periodontal therapy, which also has the potential to reduce the risk of other important systemic outcomes, such as cardiovascular disease.

Relationship between salivary levels of interleukin-8 and HbA1c in patients with type 2 diabetes

INTRODUCTION

Diabetes mellitus is a metabolic disease, which genetic and environmental factors play a role in its pathogenesis. Cytokines as important elements in the immune system have diverse expressions in different individuals and societies and are effective in the pathogenesis of diabetes. This study investigated the relationship between blood sugar control and salivary levels of interleukin-8 (IL-8) in patients with type 2 diabetes.

METHODS

This cross-sectional study was conducted on 73 subjects (35 diabetic and 38 healthy individuals). Unstimulated saliva samples were collected and the correlation between IL-8, as an inflammatory marker and HbA1c (Haemoglobin A1C) was studied.

RESULTS

The levels of IL-8 and HbA1c were significantly higher in the patient group than control group (p < .001, p < .001, respectively). There was not any relationship between salivary IL-8 levels and glycemic control levels (p = .629). Also, there was no remarkable difference between men and women in terms of the levels of IL-8 and HbA1c saliva (p = .524, p = .998, respectively).

CONCLUSION

Although the salivary IL-8 levels were higher in the diabetic patients, blood sugar control did not significantly affect cytokine concentrations. Increased salivary levels of IL-8 in patients with type 2 diabetes could be a basis for risk assessment, prevention and treatment of diabetes-related complications.

Periodontal Disease, Local and Systemic Inflammation in Puerto Ricans with Type 2 Diabetes Mellitus

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.

Investigation of the Correlation Between the Polymorphism/Expression Level of RANTES and Its Receptor CCR5 Gene Promoter and Type 2 Diabetes Mellitus

BACKGROUND

This study aimed to explore relationship among RANTES -28 (rs2280788) C/G polymorphism or CCR5 59029 (rs1799987) A/G polymorphism, level of self-expression, and type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

Clinical data were collected from 92 subjects with normal blood glucose (NC) and 97 patients with T2DM (DM). CCR5 levels on the surface of monocyte/lymphocyte and plasma RANTES levels were detected by flow cytometry. TaqMan real-time fluorescent quantitative PCR was used to detect genetic polymorphisms of RANTES rs2280788 and CCR5 rs1799987.

RESULTS

There were no significant differences in frequencies of CCR5 rs1799987 genotype and A/G allele and frequencies of RANTES rs2280788 genotype and C/G allele, between subjects in NC and DM group (P > 0.05). Plasma RANTES level in DM group was significantly lower than NC group (P < 0.05), and difference came from patients with T2DM using insulin and subjects with normal blood glucose. CCR5 levels on the surface of monocytes and lymphocytes of patients in DM group were higher than NC group (P < 0.05). There was no significant difference in CCR5 level on the surface of monocytes and lymphocytes (or plasma RANTES level) among different genotypes of CCR5 rs1799987 (or RANTES rs2280788) (P > 0.05). RANTES level was positively correlated with age and TC and negatively correlated with diabetes course and HbA1c. CCR5 level on the surface of monocytes was positively correlated with drinking years, HbA1c, course of diabetes, and negatively correlated with TC. CCR5 on lymphocyte surface was positively correlated with diabetes course, smoking years, HbA1c, and negatively correlated with LDL, TC, HDL (P < 0.05).

CONCLUSION

RANTES -28 (rs2280788) C/G polymorphism or CCR5 59029 (rs1799987) A/G polymorphism may not be associated with T2DM of Han nationality in Kunming and cannot affect RANTES and CCR5 expression. RANTES and CCR5 levels may be related to T2DM but may also be affected by age, blood lipids, HbA1c, diabetes course, drugs, and other factors.

Expression of inflammatory mediators in periodontitis and T2D patients: a systematic review and meta-analysis

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.

Association between metabolic syndrome and periodontitis: The role of lipids, inflammatory cytokines, altered host response, and the microbiome

Periodontitis has been associated with many systemic diseases and conditions, including metabolic syndrome. Metabolic syndrome is a cluster of conditions that occur concomitantly and together they increase the risk of cardiovascular disease and double the risk of type 2 diabetes. In this review, we focus on the association between metabolic syndrome and periodontitis; however, we also include information on diabetes mellitus and cardiovascular disease, since these two conditions are significantly intertwined with metabolic syndrome. With regard to periodontitis and metabolic syndrome, to date, the vast majority of studies point to an association between these two conditions and also demonstrate that periodontitis can contribute to the development of, or can worsen, metabolic syndrome. Evaluating the effect of metabolic syndrome on the salivary microbiome, data presented herein support the hypothesis that the salivary bacterial profile is altered in metabolic syndrome patients compared with healthy patients. Considering periodontitis and these three conditions, the vast majority of human and animal studies point to an association between periodontitis and metabolic syndrome, diabetes, and cardiovascular disease. Moreover, there is evidence to suggest that metabolic syndrome and diabetes can alter the oral microbiome. However, more studies are needed to fully understand the influence these conditions have on each other.

What is the future of Periodontal Medicine?

In the last five decades, considerable progress has been made towards understanding the etiology and pathogenesis of periodontal diseases and their interactions with the host. The impact of an individual periodontal condition on systemic homeostasis became more evident because of this knowledge and prompted advances in studies that associate periodontitis with systemic diseases and conditions. The term Periodontal Medicine describes how periodontal infection/inflammation can affect extraoral health. This review presents the current scientific evidence on the most investigated associations between periodontitis and systemic diseases and conditions, such as cardiovascular diseases, diabetes, preterm birth and low birth weight, and pneumonia. Additionally, other associations between periodontitis and chronic inflammatory bowel disease, colorectal cancer, and Alzheimer's disease that were recently published and are still poorly studied were described. Thus, the aim of this review was to answer the following question: What is the future of Periodontal Medicine? Epidemiological evidence and the evidence of biological plausibility between periodontitis and general health reinforce the rationale that the study of Periodontal Medicine should continue to advance, along with improvements in the epidemiological method, highlighting the statistical power of the studies, the method for data analysis, the case definition of periodontitis, and the type of periodontal therapy to be applied in intervention studies.

Hyperglycemia accelerates inflammaging in the gingival epithelium through inflammasomes activation

BACKGROUND AND OBJECTIVE

Diabetes accelerates inflammaging in various tissue with an increase in senescent cell burden and senescence-associated secretory phenotype (SASP) secretion, which is a significant cause of tissue dysfunction and contributes to the diabetic complications. Recently, inflammasomes are thought to contribute to inflammaging. Here, utilizing diabetic models in vivo and in vitro, we investigated the potential association between hyperglycemia-induced inflammaging and gingival tissue dysfunction and the mechanism underlying inflammasome-associated inflammaging.

MATERIALS AND METHODS

Gingival epithelium and serum were collected from control and diabetic patients and mice. The expression of p16, p21, and inflammasomes in the gingival epithelium, SASP factors in serum, and the molecular factors associated with gingival epithelial barrier function were assessed. Human oral keratinocyte (HOK) was stimulated with normal and high glucose, and pre-treated with Z-YVAD-FMK (Caspase-1 inhibitor) prior to evaluating cellular senescence, SASP secretion, and inflammasome activation.

RESULTS

In vivo, hyperglycemia significantly elevated the local burden of senescent cells in the gingival epithelium and SASP factors in the serum and simultaneously reduced the expression levels of Claudin-1, E-cadherin, and Connexin 43 in the gingival epithelium. Interestingly, the inflammasomes were activated in the gingival epithelium. In vitro, high glucose-induced the inflammaging in HOK, and blocking inflammasome activation through inhibiting Caspase-1 and glucose-induced inflammaging.

CONCLUSIONS

Hyperglycemia accelerated inflammaging in the gingival epithelium through inflammasomes activation, which is potentially affiliated with a decline in the gingival epithelial barrier function in diabetes. Inflammasomes-related inflammaging may be the crucial mechanism underlying diabetic periodontitis and represents significant opportunities for advancing prevention and treatment options.

Increased metformin dosage suppresses pro-inflammatory cytokine levels in systemic circulation and might contribute to its beneficial effects

Type 2 Diabetes Mellitus (T2DM) is a metabolic disorder, characterized by persistent elevation of blood glucose either due to insulin resistance or insulin insufficiency. Metformin is the recommended first choice of drug for the management of T2DM and is known to improve insulin sensitivity and prevents hyperglycemia by reducing chronic inflammation. T-helper type 1 (Th1) and type 17 (Th17) cells, are important pro-inflammatory CD4⁺ T cell subsets secreting TNF-α, and INF-γ (Th1), and interleukin 17 (Th17). These cytokines have been shown to play a crucial role in inflammation, insulin resistance, and the development of T2DM. Here, we explore the effect of different metformin dosages on pro-inflammatory cytokine (TNF-α, INF-γ, GM-CSF and IL-17) levels in systemic circulation among T2DM patients in Ghana, since inflammatory responses and cytokines play significant roles in the pathogenesis and progression of T2DM patients on metformin. Two hundred and nine (209) consenting T2DM patients receiving treatment at the Diabetic unit of the Komfo Anokye Teaching Hospital (KATH) in the Ashanti region of Ghana were recruited in a hospital-based cross-sectional study design. Blood samples were collected and serum obtained from each participant were analyzed for the concentrations of TNF-α, INF-γ, GM-CSF and IL-17 cytokine levels by solid-phase sandwich ELISA. We observed that participants on 3000 mg/day dose of metformin had significantly lower levels of TNF-α (p < .001) and IFN-γ (p = .014) compared to those on other dosages (1000 mg and 2000 mg/day). However, GM-CSF and IL-17 levels were not affected by increased metformin dosages. After adjusting for age, gender, dose and duration of metformin use, we observed that participants who took higher doses of metformin had significantly reduced levels of TNF-α (β = -0.0297, 95% CI = (-0.005 to -0.002) p < .001. Metformin dosage independently predicted reduced TNF-α levels with 14.4% variations in the metformin dosage levels. Increased metformin dosage suppresses TNF-α levels in systemic circulation and hence might contribute to its beneficial effects.

Chemokines and cytokines profile in whole saliva of patients with periodontitis

Clinical features suggest differences in immune response among periodontitis forms, albeit a large number of cytokines and chemokines remain to be evaluated. The saliva is an available source of mediators and its analysis would be valuable in order to understand pathophysiological differences. The objective of this study was analyze chemokines/cytokines profile in whole saliva of individuals with severe periodontitis (Stage III) presenting moderate [Grade B; GB] or rapid progression rate with a localized incisor-molar pattern [Grade C; GC/IMP]. A case-control study was designed for each periodontitis group. GB (n = 9) and GC/IMP (n = 7) patients and their healthy controls (C-GB, n = 9 and C-GC, n = 7) were evaluated. Non-stimulated saliva samples were assessed by a multiplex assay for a total of 40 cytokines, C-C and C-X-C motif chemokines. GC/IMP group presented higher levels of CCL17 and CCL27 (p = 0.04, FDR > 0.05), and lower levels of CCL2 (p = 0.04, FDR > 0.05) and CCL25 (p = 0.006, FDR < 0.05) when compared to its control. GB patients had higher levels of IL-6, IL-1β (p = 0.04, FDR > 0.05), and elevated pro-inflammatory (TNF-α,IL-1β,INF-γ,IL-6, IL-16): anti-inflammatory (IL-2, IL-4, IL-10) ratio (p = 0.01, FDR < 0.05) compared to its control [p-values by Mann-Whitney test, and False Discovery Rate (FDR) by Benjamini-Hochburg corrections]. CCL-chemokines and cytokines contributed to differences between GC/C-GC and GB/C-GB, respectively (p < 0.05, PERMANOVA test). These preliminary data revealed that each periodontitis phenotype presented distinct immune profiles differentially expressed in saliva compared to their related controls, suggesting differences in the etiopathogenesis of GB and GC/IMP.

Molecular Signature of the Immune Response to Yoga Therapy in Stress-related Chronic Disease Conditions: An Insight

The world Health Organization defines health as complete well-being in terms of physical, mental and social, and not merely the absence of disease. To attain this, individual should adapt and self-mange the social, physical and emotional challenges of life. Exposure to chronic stress due to urbanization, work stress, nuclear family, pollution, unhealthy food habits, lifestyle, accidental death in the family, and natural calamities are the triggering factors, leading to hormonal imbalance and inflammation in the tissue. The relationship between stress and illness is complex; all chronic illnesses such as cardiovascular disease and asthma have their root in chronic stress attributed by inflammation. In recent times, yoga therapy has emerged as an important complementary alternative medicine for many human diseases. Yoga therapy has a positive impact on mind and body; it acts by incorporating appropriate breathing techniques and mindfulness to attain conscious direction of our awareness of the present moment by meditation, which helps achieve harmony between the body and mind. Studies have also demonstrated the important regulatory effects of yoga therapy on brain structure and functions. Despite these advances, the cellular and molecular mechanisms by which yoga therapy renders its beneficial effects are inadequately known. A growing body of evidence suggests that yoga therapy has immunomodulatory effects. However, the precise mechanistic basis has not been addressed empirically. In this review, we have attempted to highlight the effect of yoga therapy on immune system functioning with an aim to identify important immunological signatures that index the effect of yoga therapy. Toward this, we have summarized the available scientific evidence showing positive impacts of yoga therapy. Finally, we have emphasized the efficacy of yoga in improving physical and mental well-being. Yoga has been a part of Indian culture and tradition for long; now, the time has come to scientifically validate this and implement this as an alternative treatment method for stress-related chronic disease.

Hyperglycemia-induced inflamm-aging accelerates gingival senescence via NLRC4 phosphorylation

Inflamm-aging was recently affiliated with the progression of diabetic complications. Local cellular senescence together with senescence-associated secretory phenotype (SASP) are the main contributors to inflamm-aging. However, little is known about their involvement in diabetic periodontitis. Gingiva is the first line of host defense in the periodontium, and macrophages are key SASP-carrying cells. Here, we explored the molecular mechanism by which hyperglycemia drives the inflamm-aging in the gingival tissue of diabetic mice and macrophages. We demonstrated that hyperglycemia increased the infiltrated macrophage senescence in gingival tissue of diabetic mice. Simultaneously, hyperglycemia elevated the local burden of senescent cells in gingival tissue and induced the serum secretion of SASP factors in vivo Moreover, in vitro, high glucose induced macrophage senescence and SASP factors secretion through phosphorylation of NLRC4, which further stimulated the NF-κB/Caspase-1 cascade via an IRF8-dependent pathway. Deletion of NLRC4 or IRF8 abolished hyperglycemia-induced cellular senescence and SASP in macrophages. In addition, we found that treatment with metformin inhibited NLRC4 phosphorylation and remarkably decreased cellular senescence and SASP in the context of hyperglycemia. Our data demonstrated that hyperglycemia induces the development of inflamm-aging in gingival tissue and suggested that NLRC4 is a potential target for treatment of diabetes-associated complications.

Hepatitis C Infection and Periodontal Disease: Is there a Common Immunological Link?

Hepatitis C virus (HCV) infections could have an important impact on the oral health status of patients, favoring conditions such as periodontal disease and oral cancer. The review of the existing scientific literature written in English was performed, searching for oral and periodontal manifestations of HCV infection and its impact on the oral fluids. HCV infection can determine direct extrahepatic manifestations at the oral and periodontal level including oral lichen planus, Sjögren-like sialadenitis, and oral cancer. The changes caused by the infection in the subjects' immune system, diet, and lifestyle can facilitate the development of oral conditions such as periodontal disease. Important changes also occur in the composition of the infected patients' saliva and gingival fluid. HCV-infected patients need to be carefully monitored in terms of oral health since the infection with the virus can result in oral complications. The cellular and molecular particularities of the gingival fluid of HCV-infected patients can answer some questions regarding its impact upon periodontium impairment and whether this refers to a possible bidirectional relationship, with hepatic biomarker adjustments being induced by the periodontal patients' inflammatory status.

Effect of scaling and root planing on gingival crevicular fluid level of YKL-40 acute phase protein in chronic periodontitis patients with or without type 2 diabetes mellitus: A clinico-biochemical study

BACKGROUND

The aim of the present study was to evaluate the gingival crevicular fluid (GCF) levels of YKL-40 acute phase protein in chronic periodontitis (CP) with and without type 2 diabetes and also to assess the effect of periodontal therapy (scaling and root planing [SRP]) on this GCF biomarker and the clinical parameters. YKL-40 is derived from tyrosine (Y), lysine (K), and leucine (L) with a molecular weight of 40 kDa.

MATERIALS AND METHODS

A total of 105 individuals (30-60 years) were grouped as 35 individuals each in three groups (Group I - healthy; Group II - CP with diabetes mellitus [DM]; and Group III - CP). Clinical parameters including plaque index, gingival index, probing pocket depth, and clinical attachment level followed by GCF sample collection from test sites were done at baseline and 6 weeks after SRP (among Group II and Group III patients). GCF YKL-40 level was determined by enzyme-linked immunosorbent assay.

RESULTS

The mean GCF YKL-40 level at baseline was significantly lower for Group I (309.81 ± 124.93 pg/ml) as compared to Group II (924.88 ± 415.28 pg/ml) and Group III (834.08 ± 270.42 pg/ml), respectively (P < 0.001). The level reduced significantly 6 weeks after SRP for Group II (507.6 ± 265.03 pg/ml) and Group III (499.54 ± 293.38 pg/ml) (P < 0.001).

CONCLUSION

The level of GCF YKL-40 in CP patients with or without DM is higher than healthy individuals and the level reduced 6 weeks post-SRP among Group II and Group III. Hence, YKL-40 can be considered as an important biomarker in the diagnosis of CP.

An update on the evidence for pathogenic mechanisms that may link periodontitis and diabetes

AIM

To provide an update of the review by Taylor (Journal of Clinical Periodontology, 2013, 40, S113) regarding the scientific evidence of the biological association between periodontitis and diabetes.

METHODS

Literature searches were performed using MeSH terms, keywords and title words and were published between 2012 and November 2016. All publications were screened for their relevance. The data from the articles were extracted and summarized in tables and a narrative review.

RESULTS

Small-scale molecular periodontal microbiome studies indicate a possible association between altered glucose metabolism in pre-diabetes and diabetes and changes in the periodontal microbiome, with no evidence for casual relationships. Clinical and animal studies found elevated gingival levels of IL1-β, TNF-α, IL-6, RANKL/OPG and oxygen metabolites in poorly controlled diabetes. In addition, individuals with diabetes and periodontitis exhibit high levels of circulating TNF-α, CRP and mediators of oxidative stress, and successful periodontal treatment reduces their levels.

CONCLUSIONS

The elevated pro-inflammatory factors in the gingiva of patients with poorly controlled diabetes suggest a biological pathway that may aggravate periodontitis. Some evidence suggests that the systemic inflammatory burden in periodontitis has the potential to affect diabetes control, but no studies addressed the impact of successful periodontal therapy on the pathophysiological mechanisms involved in systemic complications of diabetes.

Inflammatory markers in saliva as indicators of gingival inflammation in cerebral palsy children with and without cervical motor control

AIM

To evaluate the relation among gingival inflammation, salivary osmolality, levels of IL-1β, IL-6, IL-8, TNF-α, and s-IgA concentrations in children with spastic CP with or without cervical motor control in a cross-sectional study.

DESIGN

Unstimulated whole saliva and the gingival index were collected in 37 and 34 CP children with and without cervical motor control, respectively. The data were dichotomized as follows: (=0) absence of gingival inflammation and (≥0.1) presence of gingival inflammation.

RESULTS

The group without cervical control presented statistically higher mean values of salivary osmolality, s-IgA, and cytokines. In addition, statistically positive correlation between the gingival index and salivary cytokines was observed in the group with cervical control. Salivary osmolality, salivary cytokines, and s-IgA from both groups presented a significant positive correlation. Significant differences (P = 0.00336) in the values of salivary osmolality were observed between the CP individuals with (93.9 ± 32.7) and without gingival inflammation (74.4 ± 16.6). ROC analysis was performed, and values of salivary osmolality >80 indicated a sensitivity of 0.54 and a specificity of 0.79.

CONCLUSIONS

Children without cervical motor control presented a more pronounced oral inflammatory status that was characterized by higher levels of cytokines.

Collaborative Cross Mouse Population for Studying Alveolar Bone Changes and Impaired Glucose Tolerance Comorbidity After High-Fat Diet Consumption

BACKGROUND

High-fat diet (HFD), body weight (BW) gain, and impaired glucose tolerance development are associated with alveolar bone loss (ABL) in susceptible individuals. This report explores the Collaborative Cross (CC) mouse population for studying the impact of genetic background on comorbidity of alveolar bone change and glucose tolerance after HFD consumption.

METHODS

Seventy-eight mice from 19 different CC lines were maintained on rodent chow diet for 8 weeks and were subsequently transferred to an HFD (42% fat) for an additional 12 weeks. BW changes were assessed, and glucose tolerance was measured using an intraperitoneal glucose tolerance test (IPGTT). Six cytokines/chemokines were quantified by multiplex immunoassay, alveolar bone volume was quantified by microcomputed tomography, and the ABL phenotype was calculated relative to a control group (143 mice maintained on standard chow diet for 20 weeks).

RESULTS

The glucose tolerance response after HFD significantly varied among CC lines (P <0.01), with a significant effect of sex (P <0.01). Alveolar bone changes significantly varied among CC lines (P <0.01). Overall, there was no significant correlation between alveolar bone volume changes and increased BW or glucose tolerance response. However, individual CC lines were identified that showed type 2 diabetes mellitus (t2DM) development and significant alveolar bone volume change (P <0.05), whereas others showed t2DM development, regardless of periodontitis. Interleukin-6 significantly correlated with alveolar bone changes (P <0.05), whereas adipsin showed a negative correlation with IPGTT area under the curve values (P <0.05).

CONCLUSION

The present results demonstrate the power of CC mice for studying the genetic background impact between comorbidity of t2DM and bone loss.

Integrated biomarker profiling of smokers with periodontitis

BACKGROUND

In the context of precision medicine, understanding patient-specific variation is an important step in developing targeted and patient-tailored treatment regimens for periodontitis. While several studies have successfully demonstrated the usefulness of molecular expression profiling in conjunction with single classifier systems in discerning distinct disease groups, the majority of these studies do not provide sufficient insights into potential variations within the disease groups.

AIM

The goal of this study was to discern biological response profiles of periodontitis and non-periodontitis smoking subjects using an informed panel of biomarkers across multiple scales (salivary, oral microbiome, pathogens and other markers).

MATERIAL & METHODS

The investigation uses a novel ensemble classification approach (SVA-SVM) to differentiate disease groups and patient-specific biological variation of systemic inflammatory mediators and IgG antibody to oral commensal and pathogenic bacteria within the groups.

RESULTS

Sensitivity of SVA-SVM is shown to be considerably higher than several traditional independent classifier systems. Patient-specific networks generated from SVA-SVM are also shown to reveal crosstalk between biomarkers in discerning the disease groups. High-confidence classifiers in these network abstractions comprised of host responses to microbial infection elucidated their critical role in discerning the disease groups.

CONCLUSIONS

Host adaptive immune responses to the oral colonization/infection contribute significantly to creating the profiles specific for periodontitis patients with potential to assist in defining patient-specific risk profiles and tailored interventions.

Effects of metformin on blood and urine pro-inflammatory mediators in patients with type 2 diabetes

Background

Metformin has been used for the treatment of type 2 diabetes by suppressing hepatic gluconeogenesis. It has been shown that the subclinical inflammatory responses play important roles in the pathogenesis of type 2 diabetes. In the present study, we determined the effects of metformin on the levels of pro-inflammatory cytokines (i.e., IL-6, TNF-α, and MCP-1) and anti-inflammatory mediator IL-10 in blood and urine of patients with type 2 diabetes. There were 210 patients with type 2 diabetes, which were randomized into metformin (n = 112) and non-metformin (gliclazide, acarbose, and repaglinide, n = 98) groups. The levels of cytokines were measured by the ELISA.

Results

We found that metformin reduced the levels of IL-6 in blood and MCP-1 in urine, but increased IL-10 levels in blood of patients with type 2 diabetes. There were no significant differences of TNF-α between metformin and non-metformin groups. Furthermore, compared to individual drug treatment, metformin significantly reduced the levels of serum IL-6 and TNF-α, as well as urine MCP-1. When the patients were stratified based on the durations and doses of metformin, we found that there was only change (i.e., increase) in serum IL-10 levels in patients with metformin for more than 1 year compared to treatment for less than 1 year. Metformin (1.5 g) treatment reduced the urinary levels of MCP-1 as compared with dose of 1.0 g in patients with type 2 diabetes.

Conclusion

Metformin reduces inflammatory responses without influence on renal function in type 2 diabetic patients.

Toll-like receptor 2 and type 2 diabetes

Innate immunity plays a crucial role in the pathogenesis of type 2 diabetes and related complications. Since the toll-like receptors (TLRs) are central to innate immunity, it appears that they are important participants in the development and pathogenesis of the disease. Previous investigations demonstrated that TLR2 homodimers and TLR2 heterodimers with TLR1 or TLR6 activate innate immunity upon recognition of damage-associated molecular patterns (DAMPs). Several DAMPs are released during type 2 diabetes, so it may be hypothesized that TLR2 is significantly involved in its progression. Here, we review recent data on the important roles and status of TLR2 in type 2 diabetes and related complications.

L-Cysteine supplementation increases adiponectin synthesis and secretion, and GLUT4 and glucose utilization by upregulating disulfide bond A-like protein expression mediated by MCP-1 inhibition in 3T3-L1 adipocytes exposed to high glucose

Adiponectin is an anti-diabetic and anti-atherogenic adipokine; its plasma levels are decreased in obesity, insulin resistance, and type 2 diabetes. An adiponectin-interacting protein named disulfide bond A-like protein (DsbA-L) plays an important role in the assembly of adiponectin. This study examined the hypothesis that L-cysteine (LC) regulates glucose homeostasis through the DsbA-L upregulation and synthesis and secretion of adiponectin in diabetes. 3T3L1 adipocytes were treated with LC (250 and 500 µM, 2 h) and high glucose (HG, 25 mM, 20 h). Results showed that LC supplementation significantly (p < 0.05) upregulated the DsbA-L, adiponectin, and GLUT-4 protein expression and glucose utilization in HG-treated adipocytes. LC supplementation significantly (p < 0.05) promoted the secretion of total and HMW adiponectin secretion in HG-treated adipocytes. In addition, LC significantly (p < 0.05) decreased ROS production and MCP-1 secretion in HG-treated cells. We further investigated whether MCP-1 has any role of LC on DsbA-L expression and adiponectin levels in 3T3-L1 cells. Treatment with LC prevented the decrease in DsbA-L, adiponectin, and GLUT-4 expression in 3T3L1 adipocyte cells exposed to MCP-1. Thus, this study demonstrates that DsbA-L and adiponectin upregulation mediates the beneficial effects of LC on glucose utilization by inhibiting MCP-1 secretion in adipocytes and provides a novel mechanism by which LC supplementation can improve insulin sensitivity in diabetes.

Glycemic control and the production of cytokines in diabetic patients with chronic periodontal disease

Objective: To evaluate the association of glycemic control and cytokine production in type 2 diabetic subjects with chronic periodontitis. Methods: Gingival biopsies were performed in 40 patients, divided into four groups: systemically healthy subjects without periodontal disease (S); systemically healthy patients with chronic periodontitis (P); patients with well-controlled type 2 diabetes mellitus (DM) with chronic periodontitis (C); poorly controlled type 2 diabetes mellitus with chronic periodontitis (D). The production of interleukin (IL) -4, -6, -10, -17 and interferon (IFN) -g was quantified by ELISA. Results: The production of IL-4, IL-10, IL-17 and INF-g was higher on group D when compared to other groups (p <0.05), which in turn were similar (p ³0.05). In addition, there was no difference in the production of IL-6 in any of the evaluated groups (p³0.05). Conclusion: Were observed significantly elevated levels of pro-inflammatory and anti-inflammatory cytokines in patients with poorly controlled type 2 diabetes and chronic periodontitis, demonstrating that glycemic control may be associated to the immune inflammatory response of sites with chronic periodontitis.

The Influence of Glycated Hemoglobin on the Cross Susceptibility Between Type 1 Diabetes Mellitus and Periodontal Disease

BACKGROUND

Periodontal disease is a major complication of type 1 diabetes mellitus (T1DM). The aim of the present study is to investigate the relationship between glycated hemoglobin and circulating levels of interleukin (IL)-6, IL-8, and C-X-C motif chemokine ligand 5 (CXCL5) in non-smoking patients suffering from T1DM, with and without periodontitis. In addition, to determine the effect of advanced glycation end products (AGE) in the presence and absence of Porphyromonas gingivalis lipopolysaccharide (LPS) on IL-6, IL-8, and CXCL5 expression by THP-1 monocytes and OKF6/TERT-2 cells.

METHODS

There were 104 participants in the study: 19 healthy volunteers, 23 patients with periodontitis, 28 patients with T1DM, and 34 patients with T1DM and periodontitis. Levels of blood glucose/glycated hemoglobin (International Federation of Clinical Chemistry [IFCC]) were determined by high-performance liquid chromatography. Levels of IL-6, IL-8, and CXCL5 in plasma were determined by enzyme-linked immunosorbent assay (ELISA). In vitro stimulation of OKF6/TERT-2 cells and THP-1 monocytes was performed with combinations of AGE and P. gingivalis LPS. Changes in expression of IL-6, IL-8, and CXCL5 were monitored by ELISA and real-time polymerase chain reaction.

RESULTS

Patients with diabetes and periodontitis had higher plasma levels of IL-8 than patients with periodontitis alone. Plasma levels of IL-8 correlated significantly with IFCC units, clinical probing depth, and attachment loss. AGE and LPS, alone or in combination, stimulated IL-6, IL-8, and CXCL5 expression in both OKF6/TERT-2 cells and THP-1 monocytes.

CONCLUSIONS

Elevated plasma levels of IL-8 potentially contribute to the cross-susceptibility between periodontitis and T1DM. P. gingivalis LPS and AGE in combination caused significantly greater expression of IL-6, IL-8, and CXCL5 from THP-1 monocytes and OKF6/TERT-2 cells than LPS alone.

Influence of type 2 diabetes on local production of inflammatory molecules in adults with and without chronic periodontitis: a cross-sectional study

Background

Pathological changes in periodontal tissues are mediated by the interaction between microorganisms and the host immune-inflammatory response. Hyperglycemia may interfere with this process. The aim of this study was to compare the levels of 27 inflammatory molecules in the gingival crevicular fluid (GCF) of patients with type 2 diabetes, with and without chronic periodontitis, and of chronic periodontitis subjects without diabetes. A putative correlation between glycated haemoglobin (HbA1c) and levels of the inflammatory molecules was also investigated.

Methods

The study population comprised a total of 108 individuals, stratified into: 54 with type 2 diabetes and chronic periodontitis (DM + CP), 30 with chronic periodontitis (CP) and 24 with type 2 diabetes (DM). Participants were interviewed with the aid of structured questionnaire. Periodontal parameters (dental plaque, bleeding on probing and periodontal pocket depth) were recorded. The GCF levels of the 27 inflammatory molecules were measured using multiplex micro-bead immunoassay. A glycated haemoglobin (HbA1c) test was performed for patients with diabetes by boronate affinity chromatography.

Results

After adjustment for potential confounders, the DM + CP group had higher levels of IL-8 and MIP-1β, and lower levels of TNF-α, IL-4, INF-γ, RANTES and IL-7 compared to the CP group. Moreover, the DM + CP group had lower levels of IL-6, IL-7 and G-CSF compared to the DM group. The DM group had higher levels of IL-10, VEGF, and G-CSF compared to the CP group. The levels of MIP-1α and FGF were lower in diabetes patients (regardless of their periodontal status) than in chronic periodontitis subjects without diabetes. Diabetes patients (DM + CP and DM) had higher Th-2/Th-1 ratio compared to the CP group. HbA1c correlated positively with the pro-inflammatory cytokines (Pearson correlation coefficient = 0.27, P value: 0.02).

Conclusion

Type 2 diabetes and chronic periodontitis may influence the GCF levels of inflammatory molecules synergistically as well as independently. Type 2 diabetes was associated with high Th-2/Th-1 ratio, and modulated the local expression of molecules involved in the anti-inflammatory and healing processes.

The MCP-1 Gene A-2518G Polymorphism Confers an Increased Risk of Vascular Complications in Type 2 Diabetes Mellitus Patients

OBJECTIVE

We aimed to evaluate the correlation of the monocyte chemoattractant protein 1 (MCP-1) A-2518G polymorphism with type 2 diabetes mellitus (T2DM) and vascular complications in T2DM, to aid in understanding its role in pathogenesis.

METHODS

A total of 150 T2DM patients and 50 healthy controls (group A) were enrolled. The T2DM patients were divided into three groups based on the absence of complications (group B) presence of microvascular disease (group C) or macrovascular disease (group D). DNA of all enrolled subjects was genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for the MCP-1 A-2518G polymorphism. Serum MCP-1 levels were measured by an enzyme-linked immunosorbent assay (ELISA).

RESULTS

Participants in group D had increased serum MCP-1 levels relative to group B, group C, and group A (all p<0.01). Compared with group A, the frequencies of the MCP-1 A-2518G G/G genotype and G allele were significantly higher in group C and group D (all p<0.05). In contrast to group B, group C had higher frequencies of the G/G genotype and G allele, while group D had higher G allele frequencies (all p<0.05). Logistic regression analysis showed that lower body-mass index (BMI) and free cholesterol (FC), as well as higher high-density lipoprotein cholesterol (HDL-C) levels may be the protective factors for T2DM, while higher levels of triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and G/G genotype frequency were independent risk factors for T2DM.

CONCLUSIONS

Our data indicates a correlation between the MCP-1 A-2518G polymorphism with macrovascular complications in T2DM patients; lower BMI and FC, as well as higher HDL-C levels may be the protective factors for T2DM, while higher levels of TG, LDL-C, and G/G genotype frequency were independent risk factors for T2DM.

Evaluation of biochemical parameters and local and systemic levels of osteoactive and B-cell stimulatory factors in gestational diabetes in the presence or absence of gingivitis

BACKGROUND

Gestational diabetes mellitus (GDM) is defined as varying glucose intolerance, with first onset or recognition in pregnancy. This study evaluates clinical and biochemical parameters in a possible association between GDM and gingivitis.

METHODS

A total of 167 pregnant females was included in the study. There were 101 females with GDM and 66 females without GDM. Subgroups were created according to the presence or absence of gingival inflammation. Plaque index, bleeding on probing, and probing depth were recorded at four sites per tooth. Serum, saliva, and gingival crevicular fluid (GCF) levels of interleukin (IL)-6, IL-8, soluble receptor activator of nuclear factor-kappa B ligand (sRANKL), osteoprotegerin (OPG), B-cell activating factor (BAFF), and a proliferation-inducing ligand (APRIL) were determined by enzyme-linked immunosorbent assay. Data were analyzed by Kruskal-Wallis and Mann-Whitney U tests and Spearman correlation analysis.

RESULTS

Age and anthropometric indices were higher in the GDM than non-GDM group (P <0.0001). Clinical periodontal recordings, serum BAFF, IL-8, and saliva sRANKL levels were higher in the GDM group (P <0.05). Saliva IL-6 level was higher in the GDM with gingivitis group than non-GDM with gingivitis group (P = 0.044). Serum and GCF BAFF (P <0.0001), serum, saliva, and GCF APRIL (P <0.0001; P <0.0001; P = 0.032, respectively), GCF OPG (P = 0.036), and serum and saliva sRANKL (P <0.0001) were higher in the GDM with gingivitis group than GDM without gingivitis group.

CONCLUSIONS

The inflammatory response seems to be more pronounced in females with GDM. The observed increase in both local and systemic levels of inflammatory cytokines may suggest an interaction between gingivitis and GDM.

Effect of chronic stress on ligature-induced periodontitis in inbred and noninbred rats: a radiographic study

AIM

The aim was to compare the effect of chronic stress on ligature-induced periodontitis in inbred and noninbred female rats by means of a radiographic study.

MATERIALS AND METHODS

Adult Lewis (inbred) and Wistar (non-inbred) rats were used and divided into the following groups: Ligature/Stress Lewis Group (LSLG, n = 8); Ligature/Stress Wistar Group (LSWG, n = 8); Ligature Lewis Group (LLG, n = 8) and Ligature Wistar Group (LWG, n = 8). The animals were anesthetized and a silk thread was continuously kept around their second upper right molar. Then, groups LSLG and LSWG were subjected to physical stress test (physical restraint for 12 hours). After 15 days of ligature placement, the animals were euthanized. The right hemimaxilla was kept in formalin solution for 48 hours. Radiographs of the hemimaxillae were obtained using the parallelism technique and subsequently submitted to a standardized radiographic processing. The examiner was blinded to the groups and calibrated. The bone height level was measured and the data were subjected to statistical analysis (ANOVA, Tukey, p < 0.05).

RESULTS

LSWG showed bone destruction significantly higher than that of LSLG (32.1 ± 1.45 mm and 23.6 mm ± 2.13, respectively). Similarly, LWG showed bone destruction significantly higher than that of LLG (28.6 ± 1.18 mm and 25.2 ± 2.76 mm, respectively).

CONCLUSION

Inbred rats (Lewis) are less susceptible to the effects of chronic stress than are noninbred rats (Wistar) in relation to ligature-induced periodontitis.

CLINICAL SIGNIFICANCE

Epidemiological studies have shown a relationship between stress and periodontitis. One of the major difficulties of this type of research is the bias of the exact diagnosis of the patient's emotional state. Inbred lines animals have standards-specific neuroendocrine, this allows answers about the susceptibility of periodontal disease, making knowledge applicable in future clinical trials.