Comparative Evaluation of Salivary Neopterin Levels and Its Effects to Periodontal Therapy in Pre- and Post-Menopausal Women

Neopterin, 7,8-dihydroneopterin, total neopterin levels and their ratio in periodontitis: New dilemma

OBJECTIVE

Determine the saliva and serum levels of neopterin (NP) and 7,8-dihydroneopterin (7,8NP) in periodontitis patients and to reveal the relationship of these data with clinical periodontal parameters.

MATERIALS AND METHODS

Twenty-three patients with stage III/grade B periodontitis and 23 periodontally healthy individuals were included. Clinical periodontal measurements were recorded (plaque index, pocket depth, clinical attachment loss & bleeding on probing). Saliva and serum levels of NP and 7,8NP were analyzed by high-performance liquid chromatography.

RESULTS

Saliva NP, 7,8NP and Total Neopterin (TNP) levels were significantly elevated in the periodontitis than the control group (p < 0.001).ROC analyses of saliva NP, 7,8NP and TNP yielded areas under the curves of 0.873-0.938 for discriminating periodontitis from health, and saliva TNP was found the most accurate biomarker (AUC = 0.938).There was no significant difference among the periodontitis and control groups for saliva TNP/NP and TNP/7,8NP ratios and serum NP, 7,8NP and TNP levels (p > 0.05).

CONCLUSION

Increased saliva TNP, NP and 7,8NP levels in periodontitis may suggest these biomarkers are regulating immune activation and oxidative stress mechanism in periodontal inflammation. Additionally, together with these results, equivalence of the TNP/NP ratio in intergroups may suggest that the effects of immune activation and oxidative stress mechanisms are equal in the periodontitis.

Systemic Factors Affecting Prognosis and Outcomes in Periodontal Disease

This review delves into the effects of autoimmune conditions like rheumatoid arthritis, inflammatory disorders such as irritable bowel syndrome, cardiovascular disease, diabetes, infectious ailments like human immunodeficiency virus, and their medications on periodontal therapy outcomes. It also explores the influence of hormones. Understanding these systemic factors is crucial for optimizing periodontal health and treatment efficacy. The review underscores the necessity of considering these variables in periodontal care. Other vital systemic factors are addressed elsewhere in this special edition.

Neopterin, the Cell-Mediated Immune Response Biomarker, in Inflammatory Periodontal Diseases: A Narrative Review of a More than Fifty Years Old Biomarker

Neopterin is a biomarker of the activation of cellular immunity. The purpose of this review is to summarise neopterin metabolism, methods of its detection, and its role in inflammation, focusing on periodontal inflammatory diseases. This derivative of guanosine is a non-enzymatic product of 7,8-dihydroneopterin oxidation caused by free radicals which protect activated macrophages from oxidative stress. Various methods, usually based on enzyme-linked immunosorbent essay, high-performance liquid chromatography, or radioimmunoassay were developed for the isolation of neopterin. A wide spectrum of diseases and conditions are known to affect neopterin levels, including cardiovascular, bacterial, viral, and degenerative diseases, as well as malignant tumours. Neopterin levels were found to increase in subjects with periodontitis, especially when the oral fluid and gingival crevicular fluid were evaluated. These findings confirm the role of activated macrophages and cellular immunity in periodontal inflammatory diseases. The gingival crevicular fluid and the oral fluid appear to be the most valuable biologic fluids for the evaluation of neopterin levels in periodontitis. For gingival crevicular fluid, neopterin can be determined as the concentration or the so-called total amount. Nonsurgical periodontal treatment was associated with a decrease in neopterin levels, but an increase was also reported, suggesting the possible role of macrophages in the resolution of the periodontal lesion.

Neopterin Levels in Periodontitis and after Nonsurgical Periodontal Therapy: Evaluation of Gingival Crevicular Fluid, Oral Fluid, Serum and Urinary Samples-A Case-Control Study

Periodontitis is a chronic inflammatory disease that leads to the destruction of the tooth-supporting tissues with complex immune response. Neopterin (Np), secreted via activated macrophages, is considered a biomarker of cellular immunity. The aim of this study was to evaluate the impact of periodontitis and nonsurgical periodontal therapy. Np gingival crevicular fluid (GCF), oral fluid, serum and urine levels were compared in subjects with periodontitis before periodontal treatment, three months after and in a healthy control. Np GCF concentrations in the study group after treatment were significantly higher than the control group (p = 0.038). The GCF total amount (amount of substance) was significantly higher in the study group before periodontal treatment than in the control group (p = 0.001) and higher than the levels taken after treatment collection (p = 0.024). The oral fluid Np concentrations in the study group after treatment were significantly increased compared to the before treatment concentrations (p = 0.020). The same trend was observed in the urine samples. Significant correlation was found between the serum and oral fluid Np concentrations (p = 0.001, ρ = 0.40). Our results confirm the impact of cellular immunity and macrophages on periodontitis and on the resolution of periodontal inflammation. The presence of neopterin in oral fluid most likely originates in the serum.

C, Venkata RKS, Penmetsa GS, Koneru S, Pasupuleti S. Estimation of Salivary Neopterin Levels in Aggressive and Chronic Periodontitis After Nonsurgical Periodontal Therapy: A Cohort Study

Aim:

Neopterin is a marker associated with cell-mediated immunity produced by interferon-Ɣ-stimulated macrophages. The levels of neopterin in body fluids are elevated in infections, autoimmune diseases, malignancies, and allograft rejections. Recently, it was shown to be associated with the initiation and progression of periodontal disease. This investigation was designed to explore the use of salivary neopterin in predicting the outcome of nonsurgical periodontal therapy (NSPT) in aggressive and chronic periodontitis patients.

Materials and Methods:

This case-control study with stratified sampling comprised 45 subjects divided into three groups: a control group of 15 periodontally healthy participants, a test Group A of 15 participants with chronic periodontitis, and a test Group B of 15 participants with aggressive periodontitis. Periodontal parameters, including plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL), were recorded at baseline and three months after scaling and root planing (SRP). An enzyme-linked immunosorbent assay (ELISA) analysis was performed to measure neopterin levels in saliva in study groups before and after SRP. Kruskal–Wallis analysis of variance and Mann–Whitney U tests were done for intra- and intergroup comparisons. The correlation between salivary neopterin levels with clinical parameters was done by Karl Pearson’s correlation coefficient.

Results:

Baseline salivary neopterin levels were least in the control group (5 62 nmol/L), higher in test Group A (9.30 nmol/L), and highest in test Group B (9.76 nmol/L). Three months after SRP, there was a significant reduction in all the clinical parameters, and the reduction in mean salivary neopterin levels were 2.79 and 2.57 in test Group A and test Group B, respectively; the difference was not statistically significant.

Conclusion:

Salivary neopterin levels have the potential to be utilized as a diagnostic tool for detecting the presence, activity of the disease, and the course of the lesions. It cannot, however, be utilized to distinguish between chronic and aggressive periodontitis.

Pro-inflammatory and (Epi-)genetic markers in saliva for disease risk in childhood obesity

BACKGROUND AND AIM

Childhood obesity is an emerging problem often leading to earlier onset of non-communicable diseases in later life. Biomarkers to identify individual risk scores are insufficient in routine clinical practice, which is related to the need for easily sampled, non-invasive survey methods in children. We aimed to investigate and strengthen possible pro-inflammatory markers and epigenetic risk factors in saliva of obese children compared to lean controls.

METHODS AND RESULTS

19 overweight/obese (OC, 10.1 ± 1.9 years, BMI 27.7 ± 3.2 kg/m²) and 19 lean control children (CC, 9.7 ± 2.5 years, BMI 16.4 ± 1.8 kg/m²) participated in this explorative pilot study. Anthropometric measures, saliva and cheek swab samples were taken. Saliva profiles were examined for acute phase proteins (CRP and neopterin) and pro-inflammatory cytokines (IL-17a/IL-1β/IL-6). Cheek swabs were analyzed to investigate DNA methylation differences with subsequent hierarchical cluster and principal component analyses (PCA). Saliva analysis showed significant increased CRP concentrations in OC compared to CC (p < 0.001). There were no significant differences, but high intra-individual values in neopterin, IL-17a, IL-1β and IL-6. An unsupervised PCA of CpG loci with high variance (σ/σ_max > 0.2) clearly separated OC and CC according to their methylation pattern. Furthermore, a supervised approach revealed 7125 significantly differentially methylated loci, whose corresponding genes were significantly enriched for genes playing roles in e.g., cellular signalling, cytoskeleton organization and cell motility.

CONCLUSIONS

CRP and methylation status determinations in saliva are suitable as non-invasive methods for early detection of risks for non-communicable diseases in children/adolescents and might be a useful supplementary approach in the routine clinical practice/monitoring.

Estimation of neopterin as a biomarker in biofluids of pre and post-menopausal women after initial periodontal therapy: A biochemical assay

Context:

Periodontitis (PDD) is a chronic inflammatory condition by nature which destroys the surrounding tooth structures. Menopause (pre and post) worsens the inflammatory state. Biofluids could serve as sources of biomarkers that could diagnose or indicate the intensity and extent of both conditions.

Aims:

This study aimed to guestimate the various biofluids of neopterin (NP) levels in premenopause (pre-m) and postmenopausal (post-m) women with PDD after initial periodontal therapy (IPT).

Settings and Design:

This was an interventional cross-sectional study.

Materials and Methods:

Based on menstrual history, within the age range of 40–60 years, 30 female patients having PDD participated, who were grouped into pre-m and post-m, each group comprised 15 subjects. A biochemical test of NP levels was done at the initial and three months following IPT. Statistics used: Group comparisons and percentage decrement using independent sample t-test and paired t-test for intragroup comparison were done with the version 21, IBM SPSS software.

Results:

Intragroup NP analysis at different time points showed significant improvement. Intergroup comparison, however, has shown significant improvement in the premenopausal group (Group I) only.

Conclusions:

Reduced levels of NP were found in pre-m and post-m groups 3 months after IPT, inferring that IPT is a paragon in periodontal therapy and NP might be a good diagnostic marker to detect PDD.

Chromatographic method for the determination of inflammatory biomarkers and uric acid in human saliva

Determination of concentration of biomarkers of the activation of immune system, uric acid, and creatinine in the saliva can be useful tool for the diagnosis and monitoring of early manifestations of diseases such as malignant, inflammatory, and periodontal disorders. We have developed and validated a high-performance liquid chromatographic method coupled with fluorescence and diode array detection for the separation and quantification of neopterin, tryptophan, creatinine, uric acid, and kynurenine in the human saliva. A separation of these analytes was achieved within 9 min by using second-generation monolithic stationary phase and elution with phosphate buffer. The present method involves very simple sample preparation requiring small amount of sample matrix. The internal standard 3-nitro-l-tyrosine was used for a more precise quantification. The sensitivity of the present method was demonstrated with lower limits of quantification of 0.6 × 10^-3 μmol/L for neopterin, 0.725 μmol/L for tryptophan, 0.12 μmol/L for creatinine, 0.18 μmol/L for uric acid, and 0.135 μmol/L for kynurenine. The method was validated with 67 real-life saliva samples collected from patients suffering from breast, ovarian, colorectal, and renal cancer, and 19 saliva samples from patients with periodontal diseases and allowed monitoring of inflammatory response.

Biochemical Analysis of Three Biological Fluids and its Response to Non-Surgical Periodontal Therapy in Pre and Postmenopausal Women with Periodontitis

Objectives

Periodontitis is a common chronic inflammatory disease characterized by the destruction of the supporting structures of the teeth. The stages of menopause also worsen inflammatory condition. Biomarkers from biological fluids can be used as a diagnostic indicator to correlate these two conditions of present and future disease activity. The aim of the present study was to evaluate the neopterin levels in three biological fluids obtained from pre- and postmenopausal women with periodontitis following non-surgical periodontal therapy (NSPT, that is, scaling).

Methods

This was a cross-sectional interventional study. Thirty women, aged 40–60 years, with periodontitis were selected according to their menstrual history. They were divided into the pre- and postmenopausal groups, with each group including 15 participants. The neopterin levels were measured in both groups at baseline and 3 months after NSPT. Intergroup comparison and percentage decrement analysis were performed using the independent sample t test, and intragroup comparison was performed using the paired t test.

Results

There were statistically significant reductions in the mean values of saliva, urine, and plasma from baseline to 3 months after NSPT in the groups. Intergroup comparison showed no significant values in the postmenopausal group, and a significant reduction was seen in the mean values was seen in the mean values.

Conclusions

Neopterin levels decreased at 3 months after NSPT in both the groups, suggesting that NSPT can be a gold standard therapy and that the neopterin level could be a indicator to identify periodontal destruction.

Rapid liquid chromatography tandem mass spectrometry method for targeted quantitation of human performance metabolites in saliva

Saliva is increasingly being targeted for metabolic studies due to its non-invasive collection methods. Tracing levels of certain metabolites within biofluids can provide indications for a myriad of physiological conditions. This study was performed on a panel of eight analytes found in saliva that have shown associations with physiological conditions of human performance, such as stress, inflammation, and circadian rhythm. This dual polarity liquid chromatography tandem mass spectrometric (LCMS/MS) method was developed to accommodate a diverse group of analytes including steroids, alkaloids, and neurotransmitters. Samples collected during field exercises from soldiers were compared to those of civilians and baseline levels of each of these compounds was determined in saliva. Although most analytes showed no significant differences between the two populations, relative cortisol levels were higher for soldiers than for civilians. This developed dual polarity LCMS/MS method can be applied to very diverse groups of salivary analytes simultaneously.