Control of tissue homeostasis by the extracellular matrix: Synthetic heparan sulfate as a promising therapeutic for periodontal health and bone regeneration

Proteoglycans are core proteins associated with carbohydrate/sugar moieties that are highly variable in disaccharide composition, which dictates their function. These carbohydrates are named glycosaminoglycans, and they can be attached to proteoglycans or found free in tissues or on cell surfaces. Glycosaminoglycans such as hyaluronan, chondroitin sulfate, dermatan sulfate, keratan sulfate, and heparin/heparan sulfate have multiple functions including involvement in inflammation, immunity and connective tissue structure, and integrity. Heparan sulfate is a highly sulfated polysaccharide that is abundant in the periodontium including alveolar bone. Recent evidence supports the contention that heparan sulfate is an important player in modulating interactions between damage associated molecular patterns and inflammatory receptors expressed by various cell types. The structure of heparan sulfate is reported to dictate its function, thus, the utilization of a homogenous and structurally defined heparan sulfate polysaccharide for modulation of cell function offers therapeutic potential. Recently, a chemoenzymatic approach was developed to allow production of many structurally defined heparan sulfate carbohydrates. These oligosaccharides have been studied in various pathological inflammatory conditions to better understand their function and their potential application in promoting tissue homeostasis. We have observed that specific size and sulfation patterns can modulate inflammation and promote tissue maintenance including an anabolic effect in alveolar bone. Thus, new evidence provides a strong impetus to explore heparan sulfate as a potential novel therapeutic agent to treat periodontitis, support alveolar bone maintenance, and promote bone formation.

Periodontal Status as Mediator of the Association between Socioeconomic Status and Oral Health-Related Quality of Life in Pregnant Women

OBJECTIVE

To test periodontal status as a mediator between socioeconomic status (SES) and oral health-related quality of life (OHRQoL) in pregnant women.

BASIC RESEARCH DESIGN

Secondary cross-sectional analysis of baseline data from a randomised clinical trial with 303 pregnant women.

MAIN OUTCOME MEASURES

Demographic variables, SES, smoking, interproximal hygiene, and self-reported gingival bleeding were collected as independent variables. The Oral Health Impact Profile-14 was used to assess OHRQoL. The relationship between SES, periodontal status and OHRQoL was investigated in structural equation modelling.

RESULTS

There was a moderate association of SES with periodontal status (standardised coefficient SC = -0.26, p⟨0.01) and number of teeth (SC = 0.24, p⟨0.01). Periodontal status and the number of teeth were also associated with OHRQoL (respectively, SC = 0.25, p⟨0.01 and SC = -0.31, p⟨0.01), but SES was only indirectly related to OHRQoL (SC = -0.17, p⟨0.01). Socioeconomic inequalities in quality of life were mainly explained by the remaining number of teeth, contributing to about 47%, and periodontal status, contributing to about 41%.

CONCLUSIONS

There was no direct effect of SES on OHRQoL in pregnant women. Periodontal status and missing teeth each explained almost half of the total indirect association.