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Alarcón-Sánchez MA, Heboyan A. Cytokines profile in gingival crevicular fluid of subjects wearing fixed dental prostheses: a systematic review and meta-analysis. Eur J Med Res 2024; 29:437. [PMID: 39210386 PMCID: PMC11360320 DOI: 10.1186/s40001-024-02031-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Fixed dental prostheses (FDP) can affect the production of inflammatory cytokines causing damage to periodontal tissues. A systematic review and meta-analysis was carried out with the following two objectives: (1) to determine the prevalence and function of the different inflammatory cytokines present in gingival crevicular fluid (GCF) of teeth with metal-ceramic (M/C) and all-ceramic (A-Cs) prostheses, and (2) to analyze and compare the levels of inflammatory cytokines in GCF of teeth with M/C and A-Cs prostheses. METHODS The protocol followed PRISMA and Cochrane guidelines and was registered in the OSF:10.17605/OSF.IO/RBHJU. A digital search was conducted in the databases PubMed/MEDLINE, Cochrane Library, Dentistry & Oral Sciences Source, Scopus, Web of Science, ScienceDirect, and Google Scholar, from July 15th, 2000 to March 1st, 2024. Study quality was assessed using the JBI tool for cross-sectional and longitudinal studies. A meta-analysis was performed using a random-effects model to evaluate the concentration of IL-1β in GCF of teeth with FDP of M/C and A-Cs. RESULTS The search strategy provided a total of 8,172 articles, of which 14 investigations met the inclusion criteria. The total number of patients studied was 468 of whom 53% were women and the rest (47%) were men. The ages of the patients ranged from 19 to 73 years, with a mean age ± standard deviation (SD) of 38,5 ± 12,8 years. A total of 843 fixed dental prostheses were studied, of which 407 (48,27%) were M/C prostheses and 410 (48,63%) were A-Cs prostheses. We found that the levels of IL-1β, IL-1α, PGE2, NKA, CGRP, and CX3CL1 were increased in teeth with M/C prostheses compared to teeth with A-Cs prostheses. Meta-analysis revealed that there are no significant differences between IL-1β levels in GCF in teeth with M/C prostheses compared to teeth with A-Cs prostheses (SMD = 13.89 pg/ml (CI = -14.29-42.08), p = > 0.05). CONCLUSIONS A trend toward increased levels of inflammatory cytokines was found in GCF of teeth with M/C prostheses compared to teeth with A-Cs prostheses.
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Affiliation(s)
- Mario Alberto Alarcón-Sánchez
- Biomedical Science, Faculty of Chemical-Biological Sciences, Autonomous University of Guerrero, 39090, Chilpancingo de los Bravo, Guerrero, Mexico.
| | - Artak Heboyan
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, 600 077, India.
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Str. Koryun 2, 0025, Yerevan, Armenia.
- Department of Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, North Karegar St, Tehran, Iran.
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Alarcón-Sánchez MA, Romero-Castro NS, Becerra-Ruiz JS, Romero-Servin S, Heboyan A. Increased of IL-18 levels are associated with periodontitis: a systematic review and meta-analysis. BMC Oral Health 2024; 24:981. [PMID: 39179998 PMCID: PMC11342503 DOI: 10.1186/s12903-024-04747-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 08/14/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND The presence of a polymicrobial dysbiotic film in direct and constant contact with periodontal tissues initiates the host immune response. Interleukin 18 (IL-18) triggers up-regulates the production of other proinflammatory cytokines (TNF-α, IL-1β, IL-6), creating a vicious cycle that expands the inflammatory and destructive process in the periodontal tissue. A systematic review and meta-analysis was carried out with the main propose to investigate IL-18 expression in different biological samples from subjects with chronic periodontitis. METHODS The protocol followed PRISMA guidelines and was registered in Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/BS9GM . A digital search was conducted in the databases PubMed, ScienceDirect, Google Scholar, Web of Science and Dentistry & Oral Sciences Source databases were consulted from March 15th, 2005 to February 10th, 2023. Study quality was assessed using the JBI tool for cross-sectional studies and clinical trials. A meta-analysis was performed using a random/fixed effects model to evaluate the concentration of IL-18 in serum, plasma, saliva, gingival tissue and GCF of exposure group compared to control group. RESULTS The search strategy provided a total of 3,156 articles, of which 18 investigations met the inclusion criteria and 15 articles were quantitatively analyzed. The total number of patients studied was 1,275 (682 cases and 593 controls). The meta-analysis revealed significantly elevated IL-18 levels of serum, saliva and GCF of subjects with chronic periodontitis compared to healthy subjects (Serum: SMD = 62.73, 95%CI: 25.43-100.03, Z = 3.29, p = 0.001*; Saliva: SMD = 243.63, 95%CI: 8.68-478.59, Z = 2.03, p = 0.042*; GCF: SMD = 150.26, 95%CI: 56.86-243.66, Z = 3.15, p = 0.02*). CONCLUSION IL-18 levels in serum, saliva and GCF could have the potential to be used as complementary diagnostic tools to the clinical and radiographic parameters in subjects with periodontitis.
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Affiliation(s)
- Mario Alberto Alarcón-Sánchez
- Biomedical Science, Faculty of Chemical-Biological Sciences, Autonomous University of Guerrero, Chilpancingo de los Bravo 39090, Guerrero, 39090, Mexico.
| | - Norma Samanta Romero-Castro
- Department of Implantology and Oral Rehabilitation, Faculty of Dentistry, Autonomous University of Guerrero, Acapulco de Juarez 39610, Guerrero, Mexico
| | - Julieta Sarai Becerra-Ruiz
- Institute of Research of Bioscience, University Center of Los Altos, University of Guadalajara, Tepatitlán de Morelos 47600, Jalisco, Mexico
| | - Selenne Romero-Servin
- Oral and Maxillofacial Pathology, Leon Unit, National School of Higher Studies, National Autonomous University of Mexico, Leon, 37689, Guanajuato, Mexico
| | - Artak Heboyan
- Department of Research Analytics, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospitals, Saveetha University, Chennai, 600 077, India.
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Str. Koryun 2, Yerevan, 0025, Armenia.
- Department of Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, North Karegar St, Tehran, Iran.
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Bertolini M, Clark D. Periodontal disease as a model to study chronic inflammation in aging. GeroScience 2024; 46:3695-3709. [PMID: 37285008 PMCID: PMC11226587 DOI: 10.1007/s11357-023-00835-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/20/2023] [Indexed: 06/08/2023] Open
Abstract
Periodontal disease is a chronic inflammatory condition that results in the destruction of the teeth supporting tissues, eventually leading to the loss of teeth and reduced quality of life. In severe cases, periodontal disease can limit proper nutritional intake, cause acute pain and infection, and cause a withdrawal from social situations due to esthetic and phonetic concerns. Similar to other chronic inflammatory conditions, periodontal disease increases in prevalence with age. Research into what drives periodontal disease pathogenesis in older adults is contributing to our general understanding of age-related chronic inflammation. This review will present periodontal disease as an age-related chronic inflammatory disease and as an effective geroscience model to study mechanisms of age-related inflammatory dysregulation. The current understanding of the cellular and molecular mechanisms that drive inflammatory dysregulation as a function of age will be discussed with a focus on the major pathogenic immune cells in periodontal disease, which include neutrophils, macrophages, and T cells. Research in the aging biology field has shown that the age-related changes in these immune cells result in the cells becoming less effective in the clearance of microbial pathogens, expansion of pathogenic subpopulations, or an increase in pro-inflammatory cytokine secretions. Such changes can be pathogenic and contribute to inflammatory dysregulation that is associated with a myriad of age-related disease including periodontal disease. An improved understanding is needed to develop better interventions that target the molecules or pathways that are perturbed with age in order to improve treatment of chronic inflammatory conditions, including periodontal disease, in older adult populations.
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Affiliation(s)
- Martinna Bertolini
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
| | - Daniel Clark
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA.
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Dinu A, Antonescu OR. Clinical Study on the Implications of Immunological Markers in the Diagnosis of Periodontitis in People with Diabetes Mellitus. Dent J (Basel) 2024; 12:149. [PMID: 38920850 PMCID: PMC11202785 DOI: 10.3390/dj12060149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/29/2024] [Accepted: 05/17/2024] [Indexed: 06/27/2024] Open
Abstract
The basic idea from which the working hypothesis for this study started is the fact that the only systemic disease today that is clearly linked to periodontal disease by biochemical mechanisms is diabetes mellitus, as well as the clinical finding that diabetes causes a number of specific periodontal changes. Highlighting the biochemical markers of inflammation during periodontal disease in patients diagnosed with type 2 diabetes is the main aim of the study. To achieve this objective, we used the human ELISA kit from Boster Biological Technology Co., Ltd. (Pleasanton, CA, USA), for the detection of IL-1β, IL-4, IL-8 and TNF-α. The data analysis shows that plasma levels of these cytokines are associated with the progression of periodontitis. In conclusion, we can state that the involvement of immunological markers is evident in the pathogenesis of periodontal disease.
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Affiliation(s)
- Andreea Dinu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania;
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Xiao K, Chen L, Mao Y, Bao H, Chen W, Li X, Wu Y. Expression of visfatin in gingival crevicular fluid and gingival tissues in different periodontal conditions: a cross-sectional study. BMC Oral Health 2024; 24:514. [PMID: 38698364 PMCID: PMC11064311 DOI: 10.1186/s12903-024-04299-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/26/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Studies have shown that visfatin is an inflammatory factor closely related to periodontitis. We examined the levels of visfatin in gingival crevicular fluid (GCF) and gingival tissues under different periodontal conditions, in order to provide more theoretical basis for exploring the role of visfatin in the pathogenesis of periodontitis. METHODS We enrolled 87 subjects, with 43 in the chronic periodontitis (CP) group, 21 in the chronic gingivitis (CG) group, and 23 in the periodontal health (PH) group. Periodontal indexes (PD, AL, PLI, and BI) were recorded. GCF samples were collected for visfatin quantification, and gingival tissues were assessed via immunohistochemical staining. RESULTS Visfatin levels in GCF decreased sequentially from CP to CG and PH groups, with statistically significant differences (P < 0.05). The CP group exhibited the highest visfatin levels, while the PH group had the lowest. Gingival tissues showed a similar trend, with significant differences between groups (P < 0.001). Periodontal indexes were positively correlated with visfatin levels in both GCF and gingival tissues (P < 0.001). A strong positive correlation was observed between visfatin levels in GCF and gingival tissues (rs = 0.772, P < 0.001). CONCLUSION Greater periodontal destruction corresponded to higher visfatin levels in GCF and gingival tissues, indicating their potential collaboration in damaging periodontal tissues. Visfatin emerges as a promising biomarker for periodontitis and may play a role in its pathogenesis.
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Affiliation(s)
- Kang Xiao
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
- Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Ling Chen
- Stomatological Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Stomatological Center, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Yudian Mao
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
- Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Han Bao
- Fujian Key Laboratory of Oral Diseases & Fujian Provincial Engineering Research Center of Oral Biomaterial & Stomatological Key Lab of Fujian College and University, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
- Institute of Stomatology & Research Center of Dental and Craniofacial Implants, School and Hospital of Stomatology, Fujian Medical University, Fuzhou, China
| | - Weirong Chen
- Stomatological Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Stomatological Center, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Xiang Li
- Stomatological Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Stomatological Center, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Yun Wu
- Stomatological Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
- Stomatological Center, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
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Alarcón-Sánchez MA, Guerrero-Velázquez C, Becerra-Ruiz JS, Rodríguez-Montaño R, Avetisyan A, Heboyan A. IL-23/IL-17 axis levels in gingival crevicular fluid of subjects with periodontal disease: a systematic review. BMC Oral Health 2024; 24:302. [PMID: 38431633 PMCID: PMC10909298 DOI: 10.1186/s12903-024-04077-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/26/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The IL-23/IL-17 axis plays an important role in the immunopathogenesis of periodontal disease. A systematic review was conducted to synthesize all research reporting on the levels of the IL-23/IL-17 axis in gingival crevicular fluid (GCF) from subjects with gingivits, and periodontitis, compared to healthy controls. METHODS The protocol followed the PRISMA, and Cochrane guidelines, and was registered with the Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/7495V . A search was conducted in the electronic databases PubMed/MEDLINE, Scopus, Google Schoolar, and Cochrane from November 15th, 2005, to May 10th, 2023. The quality of the studies was assessed using the JBI tool for cross-sectional studies. RESULTS The search strategy provided a total of 2,098 articles, of which 12 investigations met the inclusion criteria. The total number of patients studied was 537, of which 337 represented the case group (subjects with gingivitis, and chronic periodontitis), and 200 represented the control group (periodontally healthy subjects). The ages of the patients ranged from 20 to 50 years, with a mean (SD) of 36,6 ± 4,2, of which 47% were men, and 53% were women. 75% of the investigations collected GCF samples with absorbent paper strips, and analyzed cytokine IL-17 levels individually. In addition, qualitative analysis revealed that there are differences between IL-23/IL-17 axis levels in subjects with chronic periodontitis, gingivitis and healthy controls. CONCLUSIONS Thus, IL-23/IL-17 axis levels could be used in the future as a diagnostic tool to distinguish between periodontal diseases.
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Affiliation(s)
- Mario Alberto Alarcón-Sánchez
- Biomedical Science, Faculty of Chemical-Biological Sciences, Autonomous University of Guerrero, Chilpancingo de los Bravo, Guerrero 39090, Mexico
| | - Celia Guerrero-Velázquez
- Research Institute of Dentistry, Department of Integrated Dentistry Clinics, University of Guadalajara (CUCS-UdeG), 950 Sierra Mojada, Guadalajara 44340, Jalisco, Mexico.
| | - Julieta Sarai Becerra-Ruiz
- Institute of Research of Bioscience, University Center of Los Altos, University of Guadalajara, Tepatitlán de Morelos 47600, Jalisco, Mexico
| | - Ruth Rodríguez-Montaño
- Department of Health and Illness as an Individual and Collective Process, University Center of Tlajomulco, University of Guadalajara (CUTLAJO-UdeG), Tlajomulco, Santa Fé Highway Km 3.5 No. 595, Lomas de Tejeda, Tlajomulco de Zuñiga 45641, Jalisco, Mexico
| | - Anna Avetisyan
- Department of Therapeutic Stomatology, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Str. Koryun 2, Yerevan, 0025, Armenia
| | - Artak Heboyan
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, 600 077, India.
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Str. Koryun 2, Yerevan, 0025, Armenia.
- Department of Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, North Karegar St, Tehran, Iran.
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Vongsakulpaisarn P, Sangkhamanee SS, Rassameemasmaung S, Sritanaudomchai H. Effect of Periodontal Ligament Stem Cells-Derived Conditioned Medium on Gene Expression and Differentiation of Tumor Necrosis Factor-α-Challenged Osteoblasts. Eur J Dent 2024; 18:378-386. [PMID: 37562430 PMCID: PMC10959631 DOI: 10.1055/s-0043-1771337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVES Tumor necrosis factor-α (TNF-α) causes bone resorption in periodontitis. It induces the production of receptor activator of NF-κB ligand (RANKL) from osteoblasts, leading to the disturbance of bone homeostasis through RANKL, RANK, and osteoprotegerin (OPG) axis. This study aimed to explore the effect of periodontal ligament stem cells-derived conditioned medium (PDLSCs-CM) on gene expression related to bone homeostasis and the differentiation of TNF-α-challenged osteoblasts. MATERIALS AND METHODS Human osteoblasts were cultured with 50 ng/mL of TNF-α and 0, 1, 10, and 100 µg/ mL of PDLSCs-CM. Osteoblasts cultured without TNF-α and PDLSCs-CM were served as control. Gene expression of RANKL, OPG, and interleukin-1β (IL-1β) was evaluated by reverse transcription quantitative polymerase chain reaction at 48 hours. The early-stage and late-stage differentiation of TNF-α-challenged osteoblasts without or with PDLSCs-CM was explored by alkaline phosphatase (ALP) activity and alizarin red staining, respectively, at day 1, 3, 6, 9, and 12. STATISTICAL ANALYSIS Mann-Whitney U test was used to analyze the differences in gene expression of TNF-α-challenged osteoblasts at 24 and 48 hours, and Kruskal-Wallis test was used to analyze the effect of PDLSCs-CM on gene expression and ALP activity among all experimental groups using SPSS software version 21.0. Statistical significance was considered with p-value less than 0.05. RESULTS Expression of RANKL, OPG and IL-1β was significantly upregulated in TNF-α-challenged osteoblasts compared to the untreated control. The PDLSCs-CM at 1 and 10 μg/mL downregulated gene expression of TNF-α-challenged osteoblasts compared to the group without PDLSCs-CM, but the difference did not reach statistical significance. The ALP activity was decreased in TNF-α-challenged osteoblasts. The addition of PDLSCs-CM did not alter ALP activity of TNF-α-challenged osteoblasts. Alizarin red staining was comparable in the TNF-α-challenged osteoblasts cultured without or with PDLSCs-CM. CONCLUSIONS The PDLSCs-CM did not alter gene expression involved in bone homeostasis and differentiation of TNF-α-challenged osteoblasts.
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Affiliation(s)
- Poranee Vongsakulpaisarn
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | - Supanee Rassameemasmaung
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Deng Q, Wong HM, Peng S. Salivary and gingival crevicular fluid biomarkers of periodontal health and/or obesity among children and adolescents: A systematic review and meta-analysis. Heliyon 2024; 10:e23782. [PMID: 38226238 PMCID: PMC10788453 DOI: 10.1016/j.heliyon.2023.e23782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 11/30/2023] [Accepted: 12/13/2023] [Indexed: 01/17/2024] Open
Abstract
Objectives To investigate the association of salivary and gingival crevicular fluid (GCF) biomarkers with periodontal status and obesity in children and adolescents. Data/sources A literature search up to July 2023 was conducted through PubMed, Web of Science, Embase, ProQuest Medical Database, ProQuest SciTech Premium Collection, and the Cochrane Library. Observational studies comparing salivary and GCF biomarkers in children and adolescents with compromised periodontal status and/or obesity were included for data extraction. A meta-analysis was performed to estimate the overall standardised mean difference. Study selection Fifteen observational studies met the inclusion criteria and were included in this systematic review. Meta-analysis was only applicable in synthesising the dyadic relationship between GCF biomarkers and obesity. The results demonstrated that children and adolescents with obesity had significantly higher GCF levels of tumour necrosis factor-alpha (SMD:0.56; 95% CI:0.07, 1.04), adiponectin (SMD:0.33; 95% CI:0.06, 0.60), leptin (SMD:0.52; 95% CI:0.15, 0.90), and interleukin-1 beta (SMD:0.71; 95% CI:0.44, 0.99) than those with normal weight. Conclusion To date, no study has well addressed the triadic association between salivary or GCF biomarkers, periodontal status, and obesity among children and adolescents. Further in-depth, high-quality studies are required to investigate these associations. Clinical significance Periodontal disease and obesity are growing public health crises worldwide. Their relationship has been intensively studied. Investigating the salivary or GCF biomarkers alterations could help better understand the relationship between periodontal disease and obesity, which would assist in tailoring future oral health promotion programs.
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Affiliation(s)
- Qianyi Deng
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Hai Ming Wong
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Simin Peng
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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Gür B, Afacan B, Çevik Ö, Köse T, Emingil G. Gingival crevicular fluid periodontal ligament-associated protein-1, sclerostin, and tumor necrosis factor-alpha levels in periodontitis. J Periodontol 2023; 94:1166-1175. [PMID: 37006132 DOI: 10.1002/jper.22-0750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND In periodontitis, the equilibrium between bone formation and resorption skews in favor of bone loss. Periodontal ligament-associated protein-1 (PLAP-1) and sclerostin play a significant role in the suppression of bone formation. Tumor necrosis factor-alpha (TNF-α) is a central proinflammatory cytokine related to periodontal bone loss. This study aims to assess gingival crevicular fluid (GCF) PLAP-1, sclerostin, and TNF-α levels in individuals with periodontal disease. METHODS Seventy-one individuals diagnosed with generalized stage III grade C periodontitis (n = 23), gingivitis (n = 24), and periodontal health (n = 24) were included in the study. Full-mouth clinical periodontal measurements were performed. PLAP-1, sclerostin, and TNF-α total amounts in GCF were quantified by ELISA. Nonparametric methods were used for the data analyses. RESULTS Periodontitis group exhibited significantly higher GCF PLAP-1, sclerostin and TNF-α levels compared with gingivitis and periodontally healthy groups (p < 0.05). GCF PLAP-1 and TNF-α levels of gingivitis group were higher than healthy controls (p < 0.05) whereas GCF sclerostin levels were similar in two groups (p > 0.05). Significant positive correlations were found between GCF PLAP-1, sclerostin and TNF-α levels and all clinical parameters (p < 0.01). CONCLUSIONS To our knowledge, this is the first study showing GCF PLAP-1 levels in periodontal health and disease. Increased GCF PLAP-1 and sclerostin levels and their correlations with TNF-α in periodontitis imply that those molecules might be involved in the pathogenesis of periodontal disease. Further studies in larger mixed cohorts are needed to enlighten the possible role of PLAP-1 and sclerostin in periodontal bone loss.
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Affiliation(s)
- Berkay Gür
- Department of Periodontology, Faculty of Dentistry, Aydın Adnan Menderes University, Aydın, Turkey
| | - Beral Afacan
- Department of Periodontology, Faculty of Dentistry, Aydın Adnan Menderes University, Aydın, Turkey
| | - Özge Çevik
- Department of Biochemistry, School of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Timur Köse
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, İzmir Ege University, İzmir, Turkey
| | - Gülnur Emingil
- Department of Periodontology, Faculty of Dentistry, İzmir Ege University, İzmir, Turkey
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Molecular Basis beyond Interrelated Bone Resorption/Regeneration in Periodontal Diseases: A Concise Review. Int J Mol Sci 2023; 24:ijms24054599. [PMID: 36902030 PMCID: PMC10003253 DOI: 10.3390/ijms24054599] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/19/2023] [Accepted: 02/06/2023] [Indexed: 03/02/2023] Open
Abstract
Periodontitis is the sixth most common chronic inflammatory disease, destroying the tissues supporting the teeth. There are three distinct stages in periodontitis: infection, inflammation, and tissue destruction, where each stage has its own characteristics and hence its line of treatment. Illuminating the underlying mechanisms of alveolar bone loss is vital in the treatment of periodontitis to allow for subsequent reconstruction of the periodontium. Bone cells, including osteoclasts, osteoblasts, and bone marrow stromal cells, classically were thought to control bone destruction in periodontitis. Lately, osteocytes were found to assist in inflammation-related bone remodeling besides being able to initiate physiological bone remodeling. Furthermore, mesenchymal stem cells (MSCs) either transplanted or homed exhibit highly immunosuppressive properties, such as preventing monocytes/hematopoietic precursor differentiation and downregulating excessive release of inflammatory cytokines. In the early stages of bone regeneration, an acute inflammatory response is critical for the recruitment of MSCs, controlling their migration, and their differentiation. Later during bone remodeling, the interaction and balance between proinflammatory and anti-inflammatory cytokines could regulate MSC properties, resulting in either bone formation or bone resorption. This narrative review elaborates on the important interactions between inflammatory stimuli during periodontal diseases, bone cells, MSCs, and subsequent bone regeneration or bone resorption. Understanding these concepts will open up new possibilities for promoting bone regeneration and hindering bone loss caused by periodontal diseases.
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Alayash Z, Baumeister SE, Holtfreter B, Kocher T, Baurecht H, Ehmke B, Reckelkamm SL, Nolde M. Inhibition of tumor necrosis factor receptor 1 and the risk of periodontitis. Front Immunol 2023; 14:1094175. [PMID: 36845132 PMCID: PMC9949605 DOI: 10.3389/fimmu.2023.1094175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Aim To investigate the effect of genetically proxied inhibition of tumor necrosis factor receptor 1 (TNFR1) on the risk of periodontitis. Materials and methods Genetic instruments were selected from the vicinity of TNFR superfamily member 1A (TNFRSF1A) gene (chromosome 12; base pairs 6,437,923-6,451,280 as per GRCh37 assembly) based on their association with C-reactive protein (N= 575,531). Summary statistics of these variants were obtained from a genome-wide association study (GWAS) of 17,353 periodontitis cases and 28,210 controls to estimate the effect of TNFR1 inhibition on periodontitis using a fixed-effects inverse method. Results Considering rs1800693 as an instrument, we found no effect of TNFR1 inhibition on periodontitis risk (Odds ratio (OR) scaled per standard deviation increment in CRP: 1.57, 95% confidence interval (CI): 0.38;6.46). Similar results were derived from a secondary analysis that used three variants (rs767455, rs4149570, and rs4149577) to index TNFR1 inhibition. Conclusions We found no evidence of a potential efficacy of TNFR1 inhibition on periodontitis risk.
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Affiliation(s)
- Zoheir Alayash
- Institute of Health Services Research in Dentistry, University of Münster, Münster, Germany
| | | | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Hansjörg Baurecht
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Benjamin Ehmke
- Clinic for Periodontology and Conservative Dentistry, University of Münster, Münster, Germany
| | - Stefan Lars Reckelkamm
- Institute of Health Services Research in Dentistry, University of Münster, Münster, Germany
| | - Michael Nolde
- Institute of Health Services Research in Dentistry, University of Münster, Münster, Germany
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12
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Gard AL, Luu RJ, Maloney R, Cooper MH, Cain BP, Azizgolshani H, Isenberg BC, Borenstein JT, Ong J, Charest JL, Vedula EM. A high-throughput, 28-day, microfluidic model of gingival tissue inflammation and recovery. Commun Biol 2023; 6:92. [PMID: 36690695 PMCID: PMC9870913 DOI: 10.1038/s42003-023-04434-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/05/2023] [Indexed: 01/24/2023] Open
Abstract
Nearly half of American adults suffer from gum disease, including mild inflammation of gingival tissue, known as gingivitis. Currently, advances in therapeutic treatments are hampered by a lack of mechanistic understanding of disease progression in physiologically relevant vascularized tissues. To address this, we present a high-throughput microfluidic organ-on-chip model of human gingival tissue containing keratinocytes, fibroblast and endothelial cells. We show the triculture model exhibits physiological tissue structure, mucosal barrier formation, and protein biomarker expression and secretion over several weeks. Through inflammatory cytokine administration, we demonstrate the induction of inflammation measured by changes in barrier function and cytokine secretion. These states of inflammation are induced at various time points within a stable culture window, providing a robust platform for evaluation of therapeutic agents. These data reveal that the administration of specific small molecule inhibitors mitigates the inflammatory response and enables tissue recovery, providing an opportunity for identification of new therapeutic targets for gum disease with the potential to facilitate relevant preclinical drug efficacy and toxicity testing.
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Affiliation(s)
| | | | - Ryan Maloney
- Bioengineering Division, Draper, Cambridge, MA, USA
| | | | - Brian P Cain
- Bioengineering Division, Draper, Cambridge, MA, USA
| | | | | | | | - Jane Ong
- Colgate-Palmolive Company, Piscataway, NJ, USA
| | | | - Else M Vedula
- Bioengineering Division, Draper, Cambridge, MA, USA.
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13
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Saremi L, Shafizadeh M, Ghaffari ME, Aliniagerdroudbari E, Amid R, Kadkhodazadeh M. Evaluation of interleukin 10, interleukin 1-beta, and tumor necrosis factor-alpha gene polymorphisms in patients with periodontitis and healthy controls. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2022. [DOI: 10.1186/s43042-022-00371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Chronic periodontitis (CP) is a prevalent infectious disease caused by an interplay between pathogens and immune responses. Gene polymorphisms are among the factors that affect susceptibility to CP. This study aimed to assess the association between CP and single nucleotide polymorphisms (SNPs) of interleukin-10 (IL-10), interleukin 1ß (IL-1ß), and tumor necrosis factor-α (TNF-α) genes.
Methods
A total of 87 patients with CP and 89 healthy controls were included in this study. Venous blood samples were obtained, and DNA was extracted and purified. Segments containing the relevant genes were amplified by polymerase chain reaction (PCR). Electrophoresis was performed after restriction fragment length polymorphism (RFLP) to determine genotype and allele frequencies.
Results
The CP group showed significantly different allele and genotype frequencies for three out of five SNPs: IL-10 ─ 592 C/A, IL-10 ─ 819 C/T, and IL-1ß + 3954 C/T (p < 0.05). Additionally, the frequency of the TNF-α ─ 857 AA genotype was significantly lower in patients compared with controls (p = 0.034); however, no significant differences were found in allele frequencies (p > 0.05). Logistic regression analysis revealed that carriers of IL-10 ─ 592 A allele and IL-1ß + 3954 T allele are at higher risk of CP (p < 0.001). Allele and genotype frequencies for TNF-α ─ 308 G/A did not differ significantly between patients and controls (p > 0.05).
Conclusions
This study showed specific genotypes of IL-10 ─ 592 C/A, IL-10 ─ 819 C/T, IL-1ß + 3954 C/T, and TNF-α ─ 857 G/A SNPs may be associated with an increased risk of CP development.
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14
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Azab E, Elfasakhany FM. Effect of Tumor Necrosis Factor Alpha (TNF-α) -308 and -1031 Gene Polymorphisms on Periodontitis among Saudi Subjects. Saudi Dent J 2022; 34:226-231. [PMID: 35935718 PMCID: PMC9346946 DOI: 10.1016/j.sdentj.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/30/2022] [Accepted: 02/08/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives Materials and methods Results Conclusion
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15
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Liu X, Li H. A Systematic Review and Meta-Analysis on Multiple Cytokine Gene Polymorphisms in the Pathogenesis of Periodontitis. Front Immunol 2022; 12:713198. [PMID: 35046930 PMCID: PMC8761621 DOI: 10.3389/fimmu.2021.713198] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/10/2021] [Indexed: 12/30/2022] Open
Abstract
Aim Periodontitis is an inflammatory disease that destroys both soft and hard periodontal tissues. However, a complex periodontal cytokine network remains unclear. This systematic review explored multiple cytokine gene polymorphisms in the pathogenesis of periodontitis. Material and Methods A systematic search was performed using the databases from previous publications, which indicated the association between cytokine polymorphisms and periodontitis pathogenesis. Meta-analysis was conducted using fixed or randomized models to calculate the significance of multiple cytokine polymorphisms. A total of 147 articles were analyzed with polymorphisms in 12 interleukins [Th1 (IL-2, IFN-γ, and TNF-α), Th2 (IL-4 and IL-13), Th17 (IL-1α, IL-1β, IL-6, and IL-17), and Treg cytokines (IL-10 and TGF-β)]. Doi plot was used to probe the occurrence of publication bias. Results The polymorphisms of IL-2 and TNF-α of Th1 cytokine family may be associated with the pathogenesis or the prevention of periodontitis risk, while the polymorphism of IFN-γ is not related to periodontitis risk. The polymorphisms for IL-4 and IL-13 of Th2 cytokine family are not found to be associated with the pathogenesis of periodontitis. For the polymorphisms of the members of Th17 cytokine family, different IL-1α polymorphisms may have inverse actions in the pathogenesis of periodontitis. IL-1β is a noteworthy cytokine biomarker in periodontitis development and progression. IL-6 may have a protective function in the inflammatory responses of periodontitis, and IL-17 has a weak relationship the inflammatory responses. The polymorphisms for the members of Treg cell cytokines may have a protective function against periodontitis risk. LFK indexes show the major asymmetry due to publication bias. Conclusion IL-1β is a notable cytokine biomarker in periodontitis risk. Treg cytokines favor an anti-inflammatory and protective environment. Further data are needed to confirm the present conclusion due to publication bias.
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Affiliation(s)
- Xin Liu
- Department of Stomatology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hui Li
- Department of Stomatology, China-Japan Union Hospital of Jilin University, Changchun, China
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16
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Taheri M, Gholami L, Nicknafs F, Hussen BM, Arsang-Jang S, Sayad A, Ghafouri-Fard S. Transcript levels of cytokine coding genes in peripheral blood and tissues of patients with periodontitis. Hum Antibodies 2021; 30:47-55. [PMID: 34864655 DOI: 10.3233/hab-211507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Periodontal diseases are common conditions in almost all age groups and a public health problem. Numerous risk factors have been demonstrated for this condition. The main mechanism of tissue destruction in the periodontitis is the functional interactions between microbial pathogens and host immune responses, thus cytokines have crucial roles in the pathogenesis periodontitis. Our previous study has demonstrated the susceptibility role of HLA-DRB1*04 allele in development of this disease. So, the individuals who were positive for HLA-DRB1*04 allele were excluded. We aimed to appraise the function of cytokines in the pathogenesis of periodontitis via assessment of tissue and blood levels of a number of cytokine coding genes, namely IL-1B, CXCL8, IL-17, IFNG, TGFB and TNFA1. Expressions of IFNG, IL-17, TGFB and TNFA1 were significantly higher in the peripheral blood of individuals with periodontitis compared with unaffected persons (Posterior beta = 1.91, P value = 0.043; Posterior beta = 1.84, P value = 0.033; Posterior beta = 0.713, P value = 0.009 and Posterior beta = 2.85, P value = 0.001, respectively). Moreover, expression of IL-17 was higher in females compared with males (Posterior beta = 1.47, P value = 0.036). As the interaction effect between gender and group was remarkable for IL-17 expression, we further conducted subgroup analysis within gender group. Expression of IL-17 was higher in male patients compared with unaffected males (Posterior beta = 1.9, P value = 0.048). We did not detect any significant difference in the expression of these cytokines in tissues obtained from affected individuals and unaffected controls. Therefore, our results imply dysregulation of cytokine coding genes in patients with periodontitis and warrant further mechanistical studies.
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Affiliation(s)
- Mohammad Taheri
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Gholami
- Department of Periodontics, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fwad Nicknafs
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bashdar Mahmud Hussen
- Department of Pharmacognosy, College of Pharmacy, Hawler Medical University, Kurdistan Region, Iraq
| | - Shahram Arsang-Jang
- Cancer Gene therapy Research Center, Zanjan University of Medical Science, Zanjan, Iran
| | - Arezou Sayad
- Dental Research Center, Research Institute of Dental Science, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soudeh Ghafouri-Fard
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Soubiya, Madaiah H, Tarannum F, Faizuddin M. Association of adipocyte fatty acid-binding protein and tumor necrosis factor alpha with periodontal health and disease: A cross-sectional investigation. Dent Res J (Isfahan) 2021; 18:79. [PMID: 34760070 PMCID: PMC8543096 DOI: 10.4103/1735-3327.326652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/30/2021] [Accepted: 03/17/2021] [Indexed: 11/04/2022] Open
Abstract
Background Adipocyte fatty acid binding protein (A-FABP) is a novel biomarker of inflammation for various chronic systemic diseases. Since periodontitis is a chronic inflammatory disease, this study explores the association of A-FABP with periodontal disease parameters and tumor necrosis factor-alpha (TNF-α) levels in gingival crevicular fluid in periodontal health and disease. Materials and Methods This original research article describes a cross-sectional study conducted at the Department of Periodontics, M. R. Ambedkar Dental College and Hospital, Bangalore, India. This cross-sectional investigation was conducted on sixty subjects which were divided into three groups of twenty subjects each - healthy, gingivitis, and chronic periodontitis. Clinical parameters - plaque index, bleeding index, probing depth, and clinical attachment loss were recorded. Gingival crevicular fluid samples were analyzed for A-FABP and TNF-α levels using ELISA. One-way analysis of variance was used to find the significance of study parameters on a continuous scale between three groups. Pearson's correlation has been used to find the relationship between Gingival crevicular fluid concentration of markers and periodontal parameters. Multiple linear regression analysis was applied to the study. The statistical significance was considered at P < 0.05. Results Mean concentration of A-FABP (6.43 ± 2.51) and TNF-α (3454.82 ± 1566.44) was highest in the periodontitis group, and the difference among the groups was statistically significant (P < 0.05). A positive correlation was observed between clinical attachment loss and the two markers among all groups. The correlation between A-FABP and TNF-α in periodontitis groups was positive and statistically significant (P < 0.05). Multiple linear regression model was statistically significant (P < 0.05) indicating that there is a significant relationship between the set of predictors and the clinical attachment loss. Conclusion A-FABP and TNF-α levels in GCF were significantly elevated in the presence of inflammation. A-FABP has a probable stimulatory effect on TNF-α; however, its role needs to be explored. A-FABP could serve as a novel inflammatory biomarker of periodontitis and the scope of using A-FABP inhibition as a treatment modality could be investigated with interventional studies.
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Affiliation(s)
- Soubiya
- Department of Periodontics, M. R. Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India
| | - Hemalata Madaiah
- Department of Periodontics, M. R. Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India
| | - Fouzia Tarannum
- Department of Periodontics, M. R. Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India
| | - Mohamed Faizuddin
- Department of Periodontics, M. R. Ambedkar Dental College and Hospital, Bengaluru, Karnataka, India
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18
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Association Between Tumor Necrosis Factor-α (G-308A) Polymorphism and Chronic Periodontitis, Aggressive Periodontitis, and Peri-implantitis: A Meta-analysis. J Evid Based Dent Pract 2021; 21:101528. [PMID: 34479676 DOI: 10.1016/j.jebdp.2021.101528] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/14/2020] [Accepted: 11/22/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Chronic periodontitis (CP), aggressive periodontitis (AP), and peri-implantitis (PI) are chronic inflammatory diseases. Tumor necrosis factor-α (TNF-a) is an effective immune inflammatory mediator. Several studies have been conducted to explore the association between the TNF-α (G-308A) polymorphism and susceptibility to CP, AP, and PI. Our objective was to examine whether the TNF-α (G-308A) polymorphism is related to these diseases. METHODS We conducted a meta-analysis to investigate the association between the TNF-α (G-308A) polymorphism and CP, AP, and PI. The PubMed, Embase, CNKI, and Web of Science electronic databases were searched for studies published from inception to August 11, 2020; the reference lists of included studies were also searched. The included studies were assessed in the following genetic models: dominant model, recessive model, allelic model, heterozygous model, and homozygous model. RESULTS Forty articles (50 comparisons) with 2243 CP, 824 AP, 615 PI, 795 healthy peri-implant, and 3575 healthy controls were considered for the TNF-α (G-308A) polymorphism in this meta-analysis. Variant A of TNF-α (G-308A) was associated with increased AP risk in the general population, especially in Asians, and this polymorphism was significantly associated with elevated risk of CP in Asians and Caucasians. There was no association between the A allele and PI risk. None of the contrasts of the genetic model yielded a significant finding in Latin Americans. Different genotyping methods may affect the association between the TNF-α (G-308A) polymorphism and these diseases. CONCLUSION These findings supported that variant A of the TNF-α (G-308A) polymorphism may contribute to CP and AP susceptibility, particularly in Asians and Caucasians. More efforts and further studies with larger sample sizes will be required to validate the risk of CP, AP, and PI.
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19
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Nicola D, Crystal M, Francesco S, Raffaele M, Fiorino F, Donata M, Gianni P, Marco F, Simone G. Impact of interproximal composite restorations on periodontal tissue health: Clinical and cytokine profiles from a pre-post quasi-experimental study. J Periodontol 2021; 93:911-923. [PMID: 34453748 DOI: 10.1002/jper.21-0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aim of this study is to clinically and molecularly evaluate the effect of an interproximal iuxta/subgingival direct composite restoration on periodontal tissue healing. METHODS Individuals in need of a posterior iuxta/subgingival interproximal restoration were consecutively enrolled. After enrollment, a test (site with tooth decay) and a control site (intact contralateral tooth) were identified. After a periodontal examination (probing depth [PD], clinical attachment level, recession, plaque, and bleeding on probing [BOP]) and a sampling of gingival crevicular fluid, the composite restoration was performed (T0 ). Clinical and molecular assessments were repeated at 3 (T3 ), 6 (T6 ), and 12 (T12 ) months after the restoration. Intragroup pre-post comparisons for quantitative variables were performed either through one-way ANOVA or Kruskal-Wallis test. A multivariate linear regression analysis was then modeled. With α = 0.05, a power of 80% will be reached with the inclusion of 41 individuals. RESULTS Biometric parameters demonstrated an increased mean PD (ΔPDT0 -T12 = -0.83 mm; P = 0.001) and loss of attachment (AL) (ΔCALT0 -T12 = -0.91 mm; P = 0.005) in the test site at 12 months. Accordingly, in the final multivariate regression model the radiographic distance between the bone crest and the restorative margin at baseline accounted for the dependent variable "attachment loss (AL)" (ΔCALT0 -T12 ) (P <0.05). CONCLUSIONS Iuxta/subgingival interproximal restorative margins jeopardized clinically and molecularly the periodontal tissue healing at least up to 1 year of follow-up.
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Affiliation(s)
- Discepoli Nicola
- Unit of Periodontics, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Marruganti Crystal
- Unit of Periodontics, Department of Medical Biotechnologies, University of Siena, Siena, Italy.,Unit of Endodontics and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Santoro Francesco
- Department of Medical Biotechnologies, Laboratory of Molecular Microbiology and Biotechnology (LAMMB), University of Siena, Siena, Italy
| | - Mirra Raffaele
- Unit of Periodontics, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Fabio Fiorino
- Department of Medical Biotechnologies, Laboratory of Molecular Microbiology and Biotechnology (LAMMB), University of Siena, Siena, Italy
| | - Medaglini Donata
- Department of Medical Biotechnologies, Laboratory of Molecular Microbiology and Biotechnology (LAMMB), University of Siena, Siena, Italy
| | - Pozzi Gianni
- Department of Medical Biotechnologies, Laboratory of Molecular Microbiology and Biotechnology (LAMMB), University of Siena, Siena, Italy
| | - Ferrari Marco
- Unit of Dental Materials and Fixed Prosthodontics, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Grandini Simone
- Unit of Endodontics and Restorative Dentistry, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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Söderlin MK, Persson GR, Renvert S, Sanmartin Berglund J. Cytokines in gingival crevicular fluid in elderly rheumatoid arthritis patients in a population-based cross-sectional study: RANTES was associated with periodontitis. J Periodontal Res 2021; 56:907-916. [PMID: 33954982 PMCID: PMC8518573 DOI: 10.1111/jre.12887] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/09/2021] [Accepted: 04/10/2021] [Indexed: 12/13/2022]
Abstract
Objective We studied cytokines in gingival crevicular fluid (GCF) in a cross‐sectional population‐based cohort of rheumatoid arthritis (RA) patients ≥61 years of age with and without a diagnosis of periodontitis. Background data Earlier studies on cytokines in GCF in RA patients have not given clear results. Methods In a population‐based cross‐sectional study of patients ≥61 years of age, 233 RA patients were identified. 132 (57%) dentate RA patients participated. All participants received rheumatological and dental examinations, and had a panoramic radiograph taken. GCF was sampled on each patient. Interleukins 1‐β (IL‐1β), IL‐4, IL‐6, IL‐10, IL‐17A, tumor necrosis factor alpha (TNF‐α), interferon gamma (IFN‐γ), and chemokines RANTES/CCL5, eotaxin and monocyte chemoattractant protein (MCP‐1) were analyzed in GCF. These cytokines were stratified for periodontitis, age, gender, body mass index (BMI), smoking, and anti‐cyclic citrullinated protein (anti‐CCP) status. Binary logistic regression analyses with periodontitis as outcome were performed adjusting for the above mentioned confounding factors including anti‐rheumatic medication, disease duration and the cytokine in question. Results Periodontitis was diagnosed in 80/132 (61%) of study participants. The 110 RA patients not participating were older, had a higher mean erythrocyte sedimentation rate (ESR), had a higher mean DAS28ESR (Disease Activity Score 28 using ESR) and were less often on biologic treatment. Only RANTES was associated with periodontitis (p = .049, OR 1.001, 95% CI 1.000–1.002) in the binary logistic regression analyses. Conclusion In this population‐based elderly RA cohort, neither pro‐inflammatory nor anti‐inflammatory cytokines in GCF were clearly associated with a diagnosis of periodontitis.
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Affiliation(s)
- Maria K Söderlin
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
| | - Gösta Rutger Persson
- Department of Periodontics, and the Department of Oral Medicine, University of Washington, Seattle, WA, USA
| | - Stefan Renvert
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden.,Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.,School of Dental Science, Trinity College, Dublin, Ireland.,Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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21
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Ben Lagha A, Yang Y, Trivedi HM, Masters JG, Grenier D. A Dual Zinc plus Arginine formulation protects against tumor necrosis factor-alpha-induced barrier dysfunction and enhances cell proliferation and migration in an in vitro gingival keratinocyte model. Arch Oral Biol 2021; 126:105126. [PMID: 33872861 DOI: 10.1016/j.archoralbio.2021.105126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the effects of Dual Zinc plus Arginine formulations (aqueous solution and dentifrice) on tumor necrosis factor-alpha (TNF-α)-induced barrier dysfunction as well as on cell proliferation and migration in an in vitro gingival keratinocyte model. DESIGN Gingival keratinocytes were seeded onto the membrane of a double-chamber system in the absence and presence of recombinant TNF-α and the formulations under investigation. The barrier function was assessed by determination of transepithelial electrical resistance (TER) and paracellular transport of fluorescein isothiocyanate (FITC)-dextran. The distribution of zonula occludens-1 (ZO-1) and occludin was visualized by immunofluorescence microscopy. The effects of the formulations on keratinocyte cell proliferation were determined using a fluorescent cell tracker dye, while a migration assay kit was used to investigate their effects on cell migration. RESULTS Under conditions where TNF-α induces loss of keratinocyte barrier integrity, the Dual Zinc plus Arginine formulations (aqueous solution and dentifrice) protected the keratinocyte tight junction against the damages since they prevented the TNF-α-induced drop in TER and increase in FITC-dextran paracellular flux in the in vitro model. The treatment of keratinocytes with the formulations markedly mitigated the altered distribution of ZO-1 and occludin. Both formulations increased the proliferation of keratinocytes and alleviated the negative impact caused by TNF-α. Lastly, the formulations increased the migration capacity of keratinocytes. CONCLUSIONS The ability of the Dual Zinc plus Arginine formulations to protect the barrier integrity of gingival keratinocytes from TNF-α-induced damage and to promote their proliferation and migration suggests that they may offer benefits for oral health.
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Affiliation(s)
- Amel Ben Lagha
- Oral Ecology Research Group, Faculty of Dentistry, Université Laval, Quebec City, QC, Canada
| | - Ying Yang
- Colgate-Palmolive Technology Center, Piscataway, NJ, USA
| | | | | | - Daniel Grenier
- Oral Ecology Research Group, Faculty of Dentistry, Université Laval, Quebec City, QC, Canada.
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22
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Aleksandrowicz P, Brzezińska-Błaszczyk E, Kozłowska E, Żelechowska P, Borgonovo AE, Agier J. Analysis of IL-1β, CXCL8, and TNF-α levels in the crevicular fluid of patients with periodontitis or healthy implants. BMC Oral Health 2021; 21:120. [PMID: 33726736 PMCID: PMC7968186 DOI: 10.1186/s12903-021-01478-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 03/03/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Our study aimed to assess the level of IL-1β, CXCL8, and TNF-α in peri-implant sulcular fluid (PISF) collected from patients with no clinical symptoms of mucositis or peri-implantitis and compare them with cytokine concentration in gingival crevicular fluid (GCF) acquired from patients with healthy periodontium and those with varying severity of periodontitis. METHODS A total of 189 subjects were included in the study, and GCF/PISF samples were checked for IL-1β, CXCL8, and TNF-α levels using an ELISA test. RESULTS The IL-1β level in PISF in patients with implants was significantly lower than in GCF in patients with mild, moderate, or severe periodontitis. The CXCL8 level in PISF was considerably lower than in patients with moderate periodontitis. The TNF-α level in PISF in patients with implants was markedly higher compared to subjects with healthy periodontium or patients with mild periodontitis. CONCLUSION Analysis of cytokine levels may help describe the pathogenesis and early diagnosis of peri-implantitis and prevision in high-risk patients.
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Affiliation(s)
| | | | - Elżbieta Kozłowska
- Department of Experimental Immunology, Medical University of Lodz, Lodz, Poland
| | - Paulina Żelechowska
- Department of Experimental Immunology, Medical University of Lodz, Lodz, Poland
| | | | - Justyna Agier
- Department of Experimental Immunology, Medical University of Lodz, Lodz, Poland.
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Filifactor alocis and Tumor Necrosis Factor-Alpha Stimulate Synthesis of Visfatin by Human Macrophages. Int J Mol Sci 2021; 22:ijms22031235. [PMID: 33513808 PMCID: PMC7865436 DOI: 10.3390/ijms22031235] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/18/2021] [Accepted: 01/24/2021] [Indexed: 12/18/2022] Open
Abstract
There is little known about the effect of the periodontopathogen Filifactor alocis on macrophages as key cells of the innate immune defense in the periodontium. Therefore, the aim of the present study was to investigate the effect of F. alocis and additionally of the pro-inflammatory cytokine tumor necrosis factor-alpha (TNFα) on visfatin and other pro-inflammatory and proteolytic molecules associated with periodontitis in human macrophages. The presence of macrophage markers CD14, CD86, CD68, and CD163 was examined in gingival biopsies from healthy individuals and periodontitis patients. Human macrophages were incubated with F. alocis and TNFα for up to 2 d. The effects of both stimulants on macrophages were determined by real-time PCR, ELISA, immunocytochemistry, and immunofluorescence. F. alocis was able to significantly stimulate the synthesis of visfatin by human macrophages using TLR2 and MAPK pathways. In addition to visfatin, F. alocis was also able to increase the synthesis of cyclooxygenase 2, TNFα, and matrix metalloproteinase 1. Like F. alocis, TNFα was also able to stimulate the production of these proinflammatory and proteolytic molecules. Our results highlight the pathogenetic role of F. alocis in periodontal diseases and also underline the involvement of visfatin in the aetiopathogenesis of periodontitis.
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Ben Lagha A, Azelmat J, Vaillancourt K, Grenier D. A polyphenolic cinnamon fraction exhibits anti-inflammatory properties in a monocyte/macrophage model. PLoS One 2021; 16:e0244805. [PMID: 33439867 PMCID: PMC7806150 DOI: 10.1371/journal.pone.0244805] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/16/2020] [Indexed: 11/19/2022] Open
Abstract
Periodontal diseases are bacteria-induced inflammatory disorders that lead to the destruction of the tooth-supporting tissues. Active compounds endowed with a capacity to regulate the inflammatory response are regarded as potential therapeutic agents for the treatment of periodontal diseases. The aim of this study was to characterize the anti-inflammatory properties of a polyphenolic cinnamon fraction. Chromatographic and mass spectrometry analyses of the polyphenolic composition of the cinnamon fraction revealed that phenolic acids, flavonoids (flavonols, anthocyanins, flavan-3-ols), and procyanidins make up 9.22%, 0.72%, and 10.63% of the cinnamon fraction, respectively. We used a macrophage model stimulated with lipopolysaccharides (LPS) from either Aggregatibacter actinomycetemcomitans or Escherichia coli to show that the cinnamon fraction dose-dependently reduced IL-6, IL-8, and TNF-α secretion. Evidence was brought that this inhibition of cytokine secretion may result from the ability of the fraction to prevent LPS-induced NF-κB activation. We also showed that the cinnamon fraction reduces LPS binding to monocytes, which may contribute to its anti-inflammatory properties. Lastly, using a competitor assay, it was found that the cinnamon fraction may represent a natural PPAR-γ ligand. Within the limitations of this in vitro study, the cinnamon fraction was shown to exhibit a therapeutic potential for the treatment of periodontal diseases due to its anti-inflammatory properties.
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Affiliation(s)
- Amel Ben Lagha
- Oral Ecology Research Group, Faculty of Dentistry, Université Laval, Quebec City, QC, Canada
| | - Jabrane Azelmat
- Oral Ecology Research Group, Faculty of Dentistry, Université Laval, Quebec City, QC, Canada
| | - Katy Vaillancourt
- Oral Ecology Research Group, Faculty of Dentistry, Université Laval, Quebec City, QC, Canada
| | - Daniel Grenier
- Oral Ecology Research Group, Faculty of Dentistry, Université Laval, Quebec City, QC, Canada
- * E-mail:
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Romano F, Del Buono W, Bianco L, Arena M, Mariani GM, Di Scipio F, Berta GN, Aimetti M. Gingival Crevicular Fluid Cytokines in Moderate and Deep Sites of Stage III Periodontitis Patients in Different Rates of Clinical Progression. Biomedicines 2020; 8:biomedicines8110515. [PMID: 33218047 PMCID: PMC7698864 DOI: 10.3390/biomedicines8110515] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023] Open
Abstract
Clinical criteria are inappropriate to measure the degree of susceptibility to progression of periodontal damage. Thus, the aim of this study was to assess whether gingival crevicular fluid (GCF) levels of cytokines could discriminate patients suffering from stage III periodontitis with moderate (Grade B) and rapid rates of progression (Grade C) prior to and 6 months after non-surgical periodontal treatment. GCF samples were obtained from moderate and deep sites of 20 patients diagnosed as Grade B and 20 patients as grade C stage III periodontitis and analyzed for interleukin (IL)-1β, IL-9, tumor necrosis factor (TNF)-α, and vascular endothelial growth factor (VEGF) using a high-sensitivity Bio-Plex Suspension Array System. At baseline, higher IL-1β but lower IL-9 GCF levels were observed in moderate sites of the grade C compared to the grade B group. In spite of comparable clinical improvement, this difference maintained after treatment, suggesting a residual pro-inflammatory state. In deep sites, no differences were observed between periodontitis groups except for VEGF levels that decreased more in Grade B periodontitis at 6 months post-therapy. A mathematical model was constructed to identify Grade C periodontitis patients based on the subjects’ GCF levels of IL-1β and IL-9, which achieved an area under the receiver-operating characteristic (ROC) curve of 0.94. This study can contribute to the early assessment of risk of future breakdown in periodontitis patients.
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Affiliation(s)
- Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, 10126 Turin, Italy; (F.R.); (W.D.B.); (L.B.); (M.A.); (G.M.M.)
| | - Wilma Del Buono
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, 10126 Turin, Italy; (F.R.); (W.D.B.); (L.B.); (M.A.); (G.M.M.)
| | - Laura Bianco
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, 10126 Turin, Italy; (F.R.); (W.D.B.); (L.B.); (M.A.); (G.M.M.)
| | - Martina Arena
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, 10126 Turin, Italy; (F.R.); (W.D.B.); (L.B.); (M.A.); (G.M.M.)
| | - Giulia Maria Mariani
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, 10126 Turin, Italy; (F.R.); (W.D.B.); (L.B.); (M.A.); (G.M.M.)
| | - Federica Di Scipio
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy;
| | - Giovanni Nicolao Berta
- Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy;
- Correspondence: (G.N.B.); (M.A.)
| | - Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School, Section of Periodontology, University of Turin, 10126 Turin, Italy; (F.R.); (W.D.B.); (L.B.); (M.A.); (G.M.M.)
- Correspondence: (G.N.B.); (M.A.)
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Regulation of Cyclooxygenase 2 by Filifactor alocis in Fibroblastic and Monocytic Cells. Mediators Inflamm 2020; 2020:4185273. [PMID: 32089643 PMCID: PMC7023199 DOI: 10.1155/2020/4185273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/14/2019] [Accepted: 12/06/2019] [Indexed: 12/13/2022] Open
Abstract
Periodontitis is a prevalent chronic inflammatory disease triggered by a synergistic and dysbiotic microbiota present in the oral biofilm. This in vitro study is aimed at evaluating the regulation of cyclooxygenase (COX)2 expression and production by the periodontopathogen Filifactor alocis in human gingival fibroblastic (HGF-1) and monocytic (THP-1) cells and also at investigating the underlying cellular pathway mechanisms. HGF-1 and THP-1 cells were exposed either to F. alocis or to the proinflammatory cytokine tumor necrosis factor alpha (TNFα) for 1 and 2 d to examine the COX2 expression by qPCR. COX2 protein levels were evaluated by ELISA in F. alocis-stimulated cells. Both types of cells were also stimulated with a blocking toll-like receptor (TLR)2 antibody or specific inhibitors against MAPKs. F. alocis significantly (p < 0.05) increased COX2 at both transcriptional and protein levels in both HGF-1 and THP-1 cells. Moreover, the stimulatory effect of F. alocis on COX2 was more pronounced in HGF-1 cells in comparison to THP-1 cells. F. alocis upregulated the COX2 expression in a dose-dependent manner in both type cells at 1 d. TNFα also significantly (p < 0.05) increased the COX2 expression in both cells. After preincubation of HGF-1 and THP-1 cells either with a neutralizing anti-TLR2 antibody or with specific MAPK inhibitors, the F. alocis-upregulated COX2 expression was significantly (p < 0.05) suppressed at 1 d. Our in vitro study provides original evidence that F. alocis stimulates COX2 production in fibroblastic and monocytic cells through TLR2 and MAPK mechanisms, suggesting a role of this periodontopathogen in the etiopathogenesis of periodontitis.
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Pan W, Wang Q, Chen Q. The cytokine network involved in the host immune response to periodontitis. Int J Oral Sci 2019; 11:30. [PMID: 31685798 PMCID: PMC6828663 DOI: 10.1038/s41368-019-0064-z] [Citation(s) in RCA: 313] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023] Open
Abstract
Periodontitis is an inflammatory disease involving the destruction of both soft and hard tissue in the periodontal region. Although dysbiosis of the local microbial community initiates local inflammation, over-activation of the host immune response directly activates osteoclastic activity and alveolar bone loss. Many studies have reported on the cytokine network involved in periodontitis and its crucial and pleiotropic effect on the recruitment of specific immunocytes, control of pathobionts and induction or suppression of osteoclastic activity. Nonetheless, particularities in the stimulation of pathogens in the oral cavity that lead to the specific and complex periodontal cytokine network are far from clarified. Thus, in this review, we begin with an up-to-date aetiological hypothesis of periodontal disease and summarize the roles of cytokines in the host immune response. In addition, we also summarize the latest cytokine-related therapeutic measures for periodontal disease.
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Affiliation(s)
- Weiyi Pan
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qingxuan Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qianming Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Romero-Castro NS, Vázquez-Villamar M, Muñoz-Valle JF, Reyes-Fernández S, Serna-Radilla VO, García-Arellano S, Castro-Alarcón N. Relationship between TNF-α, MMP-8, and MMP-9 levels in gingival crevicular fluid and the subgingival microbiota in periodontal disease. Odontology 2019; 108:25-33. [DOI: 10.1007/s10266-019-00435-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 06/04/2019] [Indexed: 12/11/2022]
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