Resolution of Crevicular Fluid Leukocyte Activity in Patients Treated for Aggressive Periodontal Disease

Microbial β-glucuronidases drive human periodontal disease etiology

Periodontitis is a chronic inflammatory disease associated with persistent oral microbial dysbiosis. The human β-glucuronidase (GUS) degrades constituents of the periodontium and is used as a biomarker for periodontitis severity. However, the human microbiome also encodes GUS enzymes, and the role of these factors in periodontal disease is poorly understood. Here, we define the 53 unique GUSs in the human oral microbiome and examine diverse GUS orthologs from periodontitis-associated pathogens. Oral bacterial GUS enzymes are more efficient polysaccharide degraders and processers of biomarker substrates than the human enzyme, particularly at pHs associated with disease progression. Using a microbial GUS-selective inhibitor, we show that GUS activity is reduced in clinical samples obtained from individuals with untreated periodontitis and that the degree of inhibition correlates with disease severity. Together, these results establish oral GUS activity as a biomarker that captures both host and microbial contributions to periodontitis, facilitating more efficient clinical monitoring and treatment paradigms for this common inflammatory disease.

Therapeutic significance of β-glucuronidase activity and its inhibitors: A review

The emergence of disease and dearth of effective pharmacological agents on most therapeutic fronts, constitutes a major threat to global public health and man's existence. Consequently, this has created an exigency in the search for new drugs with improved clinical utility or means of potentiating available ones. To this end, accumulating empirical evidence supports molecular target therapy as a plausible egress and, β-glucuronidase (βGLU) - a lysosomal acid hydrolase responsible for the catalytic deconjugation of β-d-glucuronides has emerged as a viable molecular target for several therapeutic applications. The enzyme's activity level in body fluids is also deemed a potential biomarker for the diagnosis of some pathological conditions. Moreover, due to its role in colon carcinogenesis and certain drug-induced dose-limiting toxicities, the development of potent inhibitors of βGLU in human intestinal microbiota has aroused increased attention over the years. Nevertheless, although our literature survey revealed both natural products and synthetic scaffolds as potential inhibitors of the enzyme, only few of these have found clinical utility, albeit with moderate to poor pharmacokinetic profile. Hence, in this review we present a compendium of exploits in the present millennium directed towards the inhibition of βGLU. The aim is to proffer a platform on which new scaffolds can be modelled for improved βGLU inhibitory potency and the development of new therapeutic agents in consequential.

Myeloperoxidase level around dental implants as an indicator of an inflammatory process

Aim:

Myeloperoxidase (MPO) has been widely used as an inflammatory marker of both acute and chronic conditions. The aim of the present study was to analyze MPO found in the peri-implant sulcus fluid of implants (PISF) and gingival cervicular fluid (GCF) of natural teeth in healthy or diseased states.

Material and Methods:

A total of 107 dental implant sites, either healthy/noninflamed, inflamed or affected by periodontitis, were classified and GCF/PISF samples were obtained. GCF/PISF MPO was spectrophotometrically determined.

Results:

Both the GCF and the PISF volumes exhibited a gradual increase with gingival inflammation (P < 0.05). PISF from inflamed sites (P = 0.0001) and GCF from the gingivitis and periodontitis sites showed significantly higher total MPO levels (P < 0.05) in comparison with the noninflamed sites. The volumetric similarities of PISF and GCF in terms of response to inflammation were seen in the present study. However, some differences in PISF and GCF were observed.

Conclusion:

PISF may be suggested to have a considerable diagnostic potential as it exhibits the biologic changes around load-bearing endosseous dental implants.

Periodontitis, Porphyromonas, and the pathogenesis of rheumatoid arthritis

Epidemiological data indicate a link between rheumatoid arthritis (RA) and periodontal disease (PD). In vitro and in vivo studies have sought to dissect potential mechanisms by which PD may contribute to initiation and progression of RA. However, these are both multifactorial, chronic diseases, and their complex etiologies and pathogenesis themselves remain incompletely understood. Could there really be an etiological link or does this simply represent a statistical coincidence muddied by common risk factors? This review seeks to provide background on these two diseases in the context of recent discoveries suggesting that their pathogenesis may be related. In particular, the process of citrullination, a post-translational protein modification, has been highlighted as a process common to both diseases. The evidence for a relationship between the diseases is explored and its potential mechanisms discussed.

Myeloperoxidase staining in the diagnosis of aggressive periodontitis

Aims:

To evaluate neutrophil myeloperoxidase (MPO) staining procedure as a reliable, affordable and easily available diagnostic assay for aggressive periodontitis.

Materials and Methods:

Fifteen subjects were recruited in the study wherein five each were diagnosed as aggressive periodontitis and chronic periodontitis respectively, and five were periodontally healthy. Three millilitres (ml) of venous blood was collected using Vacutainers containing ethylene diamine tetra acetate (EDTA) and was subjected to MPO staining procedure. Histological picture was evaluated using a visual analogue scale (VAS).

Results:

MPO stained specimen of all the patients showed positive MPO staining of the neutrophils. The intensity of the stain of MPO granules was more in aggressive periodontitis specimen as compared to the chronic periodontitis patient specimen and healthy subject specimen. The staining characteristics were comparable for chronic periodontitis patients and healthy subject.

Conclusions:

This study shows that there is a potential and probable place for MPO staining as an economical, relatively convenient and easily available assay in the diagnosis of aggressive periodontitis.

Augmented transforming growth factor-beta1 in gingival crevicular fluid of smokers with chronic periodontitis

BACKGROUND

Patients who smoke are at increased risk for chronic periodontitis (CP). Also, CP patients who smoke exhibit significantly less reduction of probing depths and gains in clinical attachment compared to non-smokers following periodontal therapy. Several studies suggest that the effects of smoking on the host response may be paramount in regulating the basal systemic inflammatory status and therapeutic outcomes in this cohort. Growth factors, specifically transforming growth factor beta1 (TGF-beta1), are critical in regulating the wound healing response by controlling cell division, differentiation, and motility. The hypothesis to be tested was that gingival crevicular fluid (GCF) TGF-beta1 production was altered in smokers compared to non-smokers with CP.

METHODS

GCF was collected from smokers and non-smokers with CP, both at baseline and 1 to 2 weeks after initial therapy. GCF volume was determined using an electronic device and TGF-beta1 concentration was measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS

Smokers exhibited a higher mean concentration of GCF TGF-beta1 at baseline compared to non-smokers (P = 0.03). After initial therapy, smokers exhibited significantly less reduction in mean GCF volume compared to non-smokers (P = 0.04).

CONCLUSIONS

Augmented constitutive production of GCF TGF-beta1 in smokers may explain the clinical appearance of fibrotic gingival tissue exhibited by this patient cohort. A diminished reduction in GCF volume in smokers following root instrumentation suggests a chronic inflammatory status in conjunction with an ineffective host response. These findings support the concept that smokers with CP display an altered local inflammatory response after initial therapy, perhaps symptomatic of colonization by residual periodontal pathogens.

Advances in periodontal disease markers

A computer-assisted medline search was conducted to find the relevant articles concerning the periodontal disease markers in gingival crevicular fluid (GCF) and saliva published during the 10-year period from 1993 to July 2003. This review suggests that certain diagnostic uses of saliva and GCF show promise. Although both fluids have been used to evaluate the risk for an individual to develop periodontal disease and to monitor of the host response to periodontal therapy, GCF has the chance of being closely approximated to the periodontal tissues where periodontal disease begins. The enzymes contributed to extracellular matrix (ECM) molecules and non-ECM molecules degradation and markers for polymorphonuclear leukocytes (PMN) activity and influx into the gingival tissue seem to provide valuable information regarding the periodontal disease diagnosis and prognosis. There is also an increasing evidence implicating reactive oxygen species and nitric oxide pathway in the pathogenesis of periodontal diseases. Although promising results have been achieved with the assays evaluating the markers in assessment of periodontal disease status, up to now, none of these tests are used routinely. Further, one commercially available genetic test has been reported to have the potential to be used to predict the periodontal disease, but there are controversial reports on this genetic susceptibility test.