Effect of non-surgical periodontal treatment on gingival crevicular fluid and serum leptin levels in periodontally healthy chronic periodontitis and chronic periodontitis patients with type 2 diabetes mellitus

The association between leptin and diabetes: A meta-analysis

PURPOSE

The study object was to determine the relationship between leptin and diabetes.

METHODS

We searched for the literature on the relationship between leptin and diabetes from PubMed, EMBASE, Cochrane Library, and CNKI databases. We carried out the meta-analysis by calculating the Std. Mean Difference (SMD) and 95% confidence intervals (CIs) to study the relationship between leptin and diabetes. We performed the Chi-square-based Q test and I2 statistics to evaluate the potential heterogeneity, and the sensitivity analysis was performed to evaluate the stability of our results. Moreover, Begg's test was performed to evaluate the publication bias.

RESULTS

There are 10 studies in this study for meta-analysis, which include 1879 patients (diabetic (n = 1024); and nondiabetic patients (n = 855)). The results indicated that the levels of serum leptin were significantly increased in patients with diabetes (SMD = 1.78, 95% CI [0.81, 2.76]), especially those with gestational diabetes mellitus compared with controls (SMD = 3.03, 95% CI [1.21, 4.86]). However, the results showed that there was no difference in serum leptin levels between type 2 diabetes and controls (SMD = 0.34, 95% CI [-1.06, 1.74]).

CONCLUSIONS

Our analysis indicated that the levels of serum leptin were significantly elevated in patients with diabetes especially those with gestational diabetes mellitus compared with controls.

The relationship between leptin and periodontitis: a literature review

Leptin is a peptide hormone that regulates energy balance, immune inflammatory response, and bone metabolism. Several studies have demonstrated a relationship between leptin and periodontitis, a local inflammatory disease that progressively weakens the supporting structures of the teeth, eventually leading to tooth loss. This article reviews the existing literature and discusses leptin's basic characteristics, its relationship with periodontitis, and its effects on periodontal tissue metabolism.

Diabetes mellitus promotes susceptibility to periodontitis-novel insight into the molecular mechanisms

Diabetes mellitus is a main risk factor for periodontitis, but until now, the underlying molecular mechanisms remain unclear. Diabetes can increase the pathogenicity of the periodontal microbiota and the inflammatory/host immune response of the periodontium. Hyperglycemia induces reactive oxygen species (ROS) production and enhances oxidative stress (OS), exacerbating periodontal tissue destruction. Furthermore, the alveolar bone resorption damage and the epigenetic changes in periodontal tissue induced by diabetes may also contribute to periodontitis. We will review the latest clinical data on the evidence of diabetes promoting the susceptibility of periodontitis from epidemiological, molecular mechanistic, and potential therapeutic targets and discuss the possible molecular mechanistic targets, focusing in particular on novel data on inflammatory/host immune response and OS. Understanding the intertwined pathogenesis of diabetes mellitus and periodontitis can explain the cross-interference between endocrine metabolic and inflammatory diseases better, provide a theoretical basis for new systemic holistic treatment, and promote interprofessional collaboration between endocrine physicians and dentists.

IgA Levels among Type 2 Diabetic and Non-Diabetic Patients with Periodontitis: A Prospective Clinical Study

OBJECTIVES

 To estimate gingival crevicular immunoglobulin A(IgA) using enzyme-linked immunosorbent assay (ELISA) among type II diabetic patients with periodontitis.

MATERIALS AND METHODS

 A non-randomized study was done of 40 periodontitis subjects with a mean age of 50 years and were recruited into two groups, Group A (Type II controlled diabetics with HbA1c < 7%) and Group B (non-diabetics with HbA1c between 4 and 6%). Both the groups underwent nonsurgical periodontal therapy (NSPT). The clinical parameters were recorded at baseline, 1, and 3 months. GCF sample was collected for the estimation of crevicular IgA at baseline and at 3 months.

STATISTICAL ANALYSIS

 Results were analyzed using parametric tests paired t-test and Student's t-test for every assessment point. The level of significance was set at p < 0.05.

RESULTS

 Difference in IgA levels and clinical parameters was seen between diabetic and non-diabetic groups, which was statistically significant.

CONCLUSION

 Changes in crevicular IgA levels in patients with diabetic periodontitis can be used as a novel biomarker in assessing the inflammatory status.

Periodontitis as a promoting factor of T2D: current evidence and mechanisms

Periodontitis is an infectious disease caused by an imbalance between the local microbiota and host immune response. Epidemiologically, periodontitis is closely related to the occurrence, development, and poor prognosis of T2D and is recognized as a potential risk factor for T2D. In recent years, increasing attention has been given to the role of the virulence factors produced by disorders of the subgingival microbiota in the pathological mechanism of T2D, including islet β-cell dysfunction and insulin resistance (IR). However, the related mechanisms have not been well summarized. This review highlights periodontitis-derived virulence factors, reviews how these stimuli directly or indirectly regulate islet β-cell dysfunction. The mechanisms by which IR is induced in insulin-targeting tissues (the liver, visceral adipose tissue, and skeletal muscle) are explained, clarifying the influence of periodontitis on the occurrence and development of T2D. In addition, the positive effects of periodontal therapy on T2D are overviewed. Finally, the limitations and prospects of the current research are discussed. In summary, periodontitis is worthy of attention as a promoting factor of T2D. Understanding on the effect of disseminated periodontitis-derived virulence factors on the T2D-related tissues and cells may provide new treatment options for reducing the risk of T2D associated with periodontitis.

Effect of Gender on Serum Leptin in Type 2 Diabetes Mellitus: A System Review and Meta-Analysis

Objective

To assess the effect of gender factors on serum leptin levels in patients with diabetes mellitus.

Methods

To remove any studies that indicated a relationship between leptin-based inflammatory variables and the prevalence of type 2 diabetes in particular patient categories, a comprehensive search of all articles published between July 2019 and June 2021 was performed on PubMed/MEDLINE, Web of Science, Scopus, and EBSCO Host, including Academic Search Premier, Africa-Wide Information, and Cumulative Index to Nursing and Allied Health Literature. A summary description of the combined analysis across multiple centers, regions, and continents will help us better understand the effect of gender on serum leptin levels in patients with diabetes. The meta-analysis was performed using RevMan 5.2 software on the literature that satisfied the inclusion and exclusion criteria.

Results

Plasma CRP levels in women with type 2 diabetes were found to be no different from those in males with type 2 diabetes, with an OR of 0.12, 95 percent confidence interval (CI) of 0.12 to 0.12, P = 0.01. There was no statistically significant difference in the plasma level of interleukin-6 (IL-6) between women with type 2 diabetes and males with type 2 diabetes However, the “inverted funnel” diagram is asymmetrical, indicating a publication bias in the included studies, despite the fact that there was no statistically significant difference in abnormal leptin levels between men with type 2 diabetes and women patients (OR = −0.69, 95 percent CI (0.88, 1.00), P < 0.05).

Conclusion

Gender factors did not affect the level of inflammatory factors and leptin level in type 2 diabetes.

Leptin Aggravates Periodontitis by Promoting M1 Polarization via NLRP3

Periodontitis is characterized by periodontal pocket formation, loss of attachment, and alveolar bone resorption. Both innate and adaptive immunity are involved in the pathogenesis of this oral chronic inflammatory disease. Accumulating evidence indicates a critical role of leptin in periodontal diseases. However, the mechanism by which leptin promotes periodontitis pathogenesis remains unclear. In the present study, we observed an elevated expression of leptin in the serum of periodontitis mice compared to that in healthy controls. There was a higher extent of M1 phenotype macrophage infiltration in mice periodontitis samples than in healthy controls. A positive correlation was observed between the serum leptin levels and M1 macrophages. Treatment with leptin increased M1 macrophage polarization and decreased M2 macrophage polarization in RAW 264.7 cells. Moreover, leptin facilitated lipopolysaccharide (LPS)-induced M1 phenotype macrophage polarization in RAW 264.7 cells. In bone marrow-derived macrophages (BMDMs) generated from leptin-deficient obese (ob/ob) mice, M1 macrophage polarization was significantly attenuated after LPS stimulation compared to the healthy controls. With regards to the molecular mechanism, we found that leptin activated the NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome and promoted M1 polarization via the NLRP3 inflammasome in vitro. In BMDMs generated from Nlrp3^-/- mice, M1 macrophage polarization was significantly attenuated after synchronous stimulation with leptin and LPS compared with BMDMs produced by healthy controls. The NLRP3 inhibitor MCC950 also prevented leptin-mediated M1 macrophage polarization in RAW 264.7 cells. Nlrp3^-/- periodontitis models indicated that leptin aggravates the periodontal response to the ligature by promoting M1 macrophage polarization via the NLRP3 inflammasome. Taken together, we show that leptin promotes the progression of periodontitis via proinflammatory M1 macrophage skewing, and targeting leptin/NLRP3 signaling may be a feasible approach for treating periodontitis.

Influence of Adjunctive Photodynamic Therapy on Interleukin-6, Interleukin-8, and Interleukin-10 Gingival Crevicular Fluid Levels in Chronic Periodontitis - A Randomized Controlled Trial

Background:

Numerous studies have assessed the effect of photodynamic therapy (PDT) both as a primary mode of treatment and as an adjunct to scaling and root planing in the treatment of periodontitis. Some results were nondefinitive and, in part, inconsistent with respect to the clinical and biochemical effects. Hence, the aim of this study was to evaluate the effect of PDT as an adjunct to nonsurgical periodontal therapy (NSPT) on the gingival crevicular fluid (GCF) interleukin-6 (IL-6), IL-8, and IL-10 levels in the treatment of chronic periodontitis (CP).

Materials and Methods:

In 21 patients with CP, two contralateral sites (premolar and molar) were randomly divided into: control sites (treated with NSPT only) and test sites (treated with NSPT + PDT). Clinical parameters including bleeding on probing (BOP), probing pocket depth, clinical attachment level were evaluated at baseline, 1- and 3 months and biochemical parameters of GCF levels of IL-6, IL-8, and IL-10 were evaluated at baseline and 3-month post-therapy through enzyme-linked immunosorbant assay.

Results:

A greater improvement in BOP score at 1 month (41.10% ± 3.58%) and 3-months (38.00% ± 3.62%) posttherapy was found in the test site as compared to control site. Regarding cytokines, test sites exhibited significant reductions in IL-6 (4.29 ± 0.67 pg/ml) and IL-8 (308.16 ± 36.04 pg/ml) levels and increase in IL-10 (14.25 ± 0.83 pg/ml) level at 3 months (P < 0.0001).

Conclusion:

Additional application of PDT, adjunctive to NSPT, resulted in a significant reduction in BOP score as well as GCF pro-inflammatory cytokine levels along with an increase in anti-inflammatory cytokine levels, compared to NSPT alone.

Evaluation and association of periodontal status with levels of Porphyromonas gingivalis in chronic periodontitis with and without Type 2 diabetes mellitus following nonsurgical periodontal therapy using quantitative polymerase chain reaction: An interventional study

Background:

The aim of the present study was to detect and correlate the levels of Porphyromonas gingivalis with clinical parameters after nonsurgical periodontal therapy (NSPT) in chronic periodontitis patients with or without Type 2 diabetes mellitus (T2DM), using quantitative polymerase chain reaction (Q-PCR) method.

Materials and Methods:

Sixty patients equally divided into three groups, i.e., periodontally healthy (Group I), chronic periodontitis (CP) (Group II), and CP with T2DM patients (Group III) were assessed through clinical parameters of probing pocket depth (PPD) and clinical attachment level (CAL) and were correlated for the presence of P. gingivalis in the respective groups. PPD, CAL, and saliva samples for microbiological evaluation were assessed at baseline, 1-, and 3-month post-NSPT.

Results:

Significant reduction of PPD was found 1.26 ± 0.22 versus 0.43 ± 0.33 mm in Group I, 4.62 ± 0.78 versus 2.58 ± 0.60 mm in Group II, and 6.28 ± 1.52 versus 4.01 ± 1.38 mm in Group III post-NSPT at 3 months. Similarly, a notable reduction of CAL was exhibited in both Group II (5.28 ± 0.80 vs. 3.12 ± 0.77 mm) and Group III (7.14 ± 1.59 vs. 4.51 ± 1.38 mm) patients after NSPT at 3 months. A greater reduction of P. gingivalis concentrations was observed in both Group II and Group III at 3-month post-NSPT.

Conclusion:

The substantial improvement of clinical parameters was found to be in correlation with the load of P. gingivalis, which was reduced more in Group II than in Group III, emphasizing the applicability and sensitivity of Q-PCR method for its assessment.

Salivary Biomarkers and Oral Health in Liver Transplant Recipients, with an Emphasis on Diabetes

Salivary biomarkers have been linked to various systemic diseases. We examined the association between salivary biomarkers, periodontal health, and microbial burden in liver transplant (LT) recipients with and without diabetes, after transplantation. We hypothesized that diabetic recipients would exhibit impaired parameters. This study included 84 adults who received an LT between 2000 and 2006 in Finland. Dental treatment preceded transplantation. The recipients were re-examined, on average, six years later. We evaluated a battery of salivary biomarkers, microbiota, and subjective oral symptoms. Periodontal health was assessed, and immunosuppressive treatments were recorded. Recipients with impaired periodontal health showed higher matrix metalloproteinase-8 (MMP-8) levels (p < 0.05) and MMP-8/tissue inhibitor of matrix metalloproteinase 1 (TIMP1) ratios (p < 0.001) than recipients with good periodontal health. Diabetes post-LT was associated with impaired periodontal health (p < 0.05). No difference between groups was found in the microbial counts. Salivary biomarker levels did not seem to be affected by diabetes. However, the advanced pro-inflammatory state induced by and associated with periodontal inflammation was reflected in the salivary biomarker levels, especially MMP-8 and the MMP-8/TIMP-1 molar ratio. Thus, these salivary biomarkers may be useful for monitoring the oral inflammatory state and the course of LT recipients.