Salivary-Soluble CD44 Levels in Smokers and Non-Smokers With Chronic Periodontitis: A Pilot Study

Evaluation of salivary Thy-1 in health, periodontitis, and obesity

OBJECTIVES

Thy-1 (CD90) is a glycosylphosphatidyl-anchored protein belonging to the immunoglobulin family and is known to control mesenchymal stromal cells differentiation into osteoblasts or adipocytes. The study aimed to investigate the salivary levels of Thy-1 in health, periodontitis, obesity, and any potential association.

MATERIALS AND METHODS

Seventy-one participants were divided into four groups: healthy (H), subjects with periodontitis (P), obese individuals (O), and obese individuals having periodontitis (PO). Unstimulated whole saliva was collected from participants who were evaluated for periodontal parameters. The levels of Thy-1 were measured with a commercially available ELISA kit. The data were statistically analyzed.

RESULTS

A significant difference in salivary Thy-1 levels among different groups was observed. Periodontitis patients had the maximum, and obese individuals had the minimum Thy-1 levels. Significant differences between H and P, H and PO, P and O, and O and PO were observed. Overall correlations between Thy-1 and periodontal parameters and a positive correlation with pocket depth in group PO were noted.

CONCLUSION

Thy-1 could be detected in the saliva of all study participants. It is implied that a local inflammatory condition like periodontitis elevates the salivary levels of Thy-1 with, and without obesity.

Salivary biomarkers as key to monitor personalized oral healthcare and precision dentistry: A scoping review

Personalized Oral Healthcare has recently become the new trend word in medicine and dentistry. In this context, saliva diagnostics using various biomarkers seem to be the gateway to personalized dental diagnostics and therapy. But the terminology is not (yet) uniformly defined, furthermore it is unclear to what extent which salivary markers play a relevant role in the therapeutic decision making. In this Scoping Review, an electronic search was conducted in PubMed and Web of Science databases using medical subject headings (MESH terms) “saliva”, “biomarker”, “personality/persons”, and “dentistry”. Only human studies were included, in which repeated salivary measurements were performed to analyze monitoring effects with at least ten patients per group. PRISMA-ScR and Tricco guidelines were followed: (i) to examine what salivary biomarkers have been explored in terms of personalized oral healthcare and precision dentistry, (ii) to investigate the clinical relevance for oral health and its correlation to systemic health, and (iii) to summarize an outlook for future developments based on these results. Out of 899 studies, a total of 57 were included for data extraction in this Scoping Review, mainly focusing on periodontal therapy and patient monitoring. Salivary biomarkers have shown the potential to change the field of dentistry in all dental disciplines as a key for personalized workflows. The increasing interest in dental research is obvious, demonstrated by the growing number of publications in recent years. At this time, however, the predominant discipline is periodontology, which allows biomarker-based monitoring of the disease prevention and progression. The studies included showed heterogeneous methods using manifolds biomarkers. Therefore, no uniformly accepted concept can be presented today. Further clinical research with well-defined outcomes including standardized procedures is necessary.

Decreased Levels of Soluble CD44 in a High-Risk Population following a Smoking Cessation Program

Tobacco is a risk factor of head and neck cancer (HNC) and smoking cessation alone may reduce HNC risk by 70%. Soluble CD44 (solCD44), a cell surface receptor linked to cell proliferation and migration, and total protein (TP) levels can detect early HNC. This study aims to determine whether salivary solCD44 and TP levels in oral rinses change following a smoking cessation program. 150 smokers provided oral rinse samples at baseline and at a 12-month follow-up after participation in a smoking cessation program. Assays to measure levels of solCD44, TP, and cotinine, a metabolite used as a biomarker of tobacco exposure, were completed. A paired-samples t-test was used to determine whether there was a statistically significant (p < 0.05) mean difference in biomarker levels before and after the program. Baseline and at 12-month follow-up data were available for 88 subjects, 21 of whom quit smoking entirely. Mean levels of solCD44 significantly decreased by 0.412 ng/mL from baseline to the 12-month follow-up, p = 0.010. There was no significant difference in mean TP levels, p = 0.975. Mean cotinine levels decreased significantly by 74.7 ng/mL, p = 0.035. This is the first work demonstrating an association between smoking cessation and decreased solCD44 levels in oral rinses. Decreased expression of the tumorigenic CD44 may be one mechanism by which smoking cessation lowers cancer risk.

Correlation of Soluble CD44 Expression in Saliva and CD44 Protein in Oral Leukoplakia Tissues

The aim of this study was to determine whether and how pan-CD44 protein expression in leukoplakia tissues correlates with positive SolCD44 test presence and their role in oral leukoplakia. SolCD44 and total protein expression in saliva were determined using an OncAlert^® Oral Cancer Rapid test. Comparison of paired associations of total protein, SolCD44, mean number of CD44 expressed epithelial layers in leukoplakia tissue, and macrophages below the basement membrane between control group and patients with leukoplakia showed statistically significant results (p < 0.0001). It is shown that the total protein indicates low or elevated risk of possible malignant transformation processes in leukoplakia. Statistically significant differences between higher total protein level and clinical forms of oral leukoplakia (p < 0.0001), as well as CD44-labeled epithelial cell layer decrease (p < 0.0001), were found. This possibly points to the onset of the stemness loss in leukoplakia tissue. CD9 antigen expression in the exosomes of the oral epithelium explained the intercellular flow of SolCD44 and other fluids in the leukoplakia area. We conclude that the OncAlert^® Oral Cancer Rapid test is a valuable screening method in daily clinical practice, in terms of complementing clinical diagnostics methods and to assess the potential for early malignancy.

Salivary and serum markers of angiogenesis in periodontitis in relation to smoking

OBJECTIVE

Angiogenesis is essential in maintenance of periodontal homeostasis, and it is regulated by growth factors and cytokines, including basic fibroblast growth factor (b-FGF), endoglin, platelet and endothelial cell adhesion molecule (PECAM-1), vascular endothelial growth factor (VEGF), soluble intercellular adhesion molecule-1 (sICAM-1), and soluble vascular cell adhesion molecule-1 (sVCAM-1). In this study, the salivary and serum concentrations of these angiogenesis-related proteins in relation to smoking and periodontitis were examined.

MATERIAL AND METHODS

Full-mouth periodontal status together with unstimulated whole saliva and serum samples was collected from 78 individuals, including 40 periodontitis patients (20 smokers and 20 nonsmokers) and 38 periodontally healthy controls (20 smokers and 18 nonsmokers). The Luminex®-xMAP™ technique was used for protein analyses.

RESULTS

Concentrations of all tested proteins in saliva as well as VEGF in serum were significantly higher in periodontitis patients than in healthy controls. In smokers, serum concentrations of endoglin (p = 0.017) and sICAM-1 (p = 0.001) were elevated in comparison to nonsmokers. After adjusting for smoking and gender, periodontitis associated significantly with salivary concentrations of b-FGF, PECAM-1, VEGF, sICAM-1, and sVCAM-1 (p < 0.01).

CONCLUSION

Taken together, salivary concentrations of b-FGF, PECAM-1, and VEGF associate with periodontitis. The suppressive effect of smoking on salivary marker levels is limited to periodontitis patients only.

CLINICAL RELEVANCE

Smoking-related suppression of salivary marker levels is observed only in periodontitis patients.

CD44 mediates stem cell mobilization to damaged lung via its novel transcriptional targets, Cortactin and Survivin

Beyond their role in bone and lung homeostasis, mesenchymal stem cells (MSCs) are becoming popular in cell therapy. Various insults may disrupt the repair mechanisms involving MSCs. One such insult is smoking, which is a major risk factor for osteoporosis and respiratory diseases. Upon cigarette smoke-induced damage, a series of reparatory mechanisms ensue; one such mechanism involves Glycosaminoglycans (GAG). One of these GAGs, namely hyaluronic acid (HA), serves as a potential therapeutic target in lung injury. However, much of its mechanisms of action through its major receptor CD44 remains unexplored. Our previous studies have identified and functionally validated that both cortactin (CTTN: marker of motility) and Survivin (BIRC5: required for cell survival) act as novel HA/CD44-downstream transcriptional targets underpinning cell motility. Here, human MSCs were treated with "Water-pipe" smoke to investigate the effects of cigarette smoke condensate (CSC) on these HA-CD44 novel signaling pathways. Our results show that CSC decreased the expression of both CD44 and its downstream targets CTTN and BIRC5 in MSCs, and that HA reversed these effects. Interestingly, CSC inhibited migration and invasion of MSCs upon CD44-targeted RNAi treatment. This shows the importance of CD44-HA/CTTN and CD44-HA/BIRC5 signaling pathways in MSC motility, and further suggests that these signaling pathways may provide a novel mechanism implicated in migration of MSCs during repair of lung tissue injury. These findings suggest that one should use caution before utilizing MSC from donors with history of smoking, and further pave the way towards the development of targeted therapeutic approaches against CD44-associated diseases.

VEGF, Microvessel Density, and CD44 as Inflammation Markers in Peri-implant Healthy Mucosa, Peri-implant Mucositis, and Peri-implantitis: Impact of Age, Smoking, PPD, and Obesity

Several biologic processes affect the supporting peri-implant tissue leading to implant failure and complications, mainly referred to inflammation that is still poorly investigated in the peri-implant soft tissues. Our aim was to investigate in peri-implant healthy mucosa, peri-implant mucositis, and peri-implantitis the expression of some angiogenesis markers highly associated with inflammation, and evaluate its relationships with age, smoking, peri-implant pocket depth (PPD), and body max index (BMI). Moreover, we wanted to study the impact of these clinical parameters in the disease pathogenesis. Forty-eight total patients were recruited. Sixteen had at least one successfully osteointegrated dental implant (group A) and 32 had at least one osseointegrated implant in need of a peri-implant treatment for inflammatory/infectiveous reasons: precisely 16 for mucositis (group B) and 16 for peri-implantitis (group C). VEGF, CD34, and CD44 immunohistochemical expression was evaluated in the interproximal biopsies of marginal peri-implant tissue and correlated with the clinical parameters. A significant difference between groups in mean PPD was found, while the distribution by age, gender, smoking, and BMI resulted similar. Group C had significantly higher levels of VEGF, CD34, and CD44 expression compared to the other groups. VEGF, CD34, CD44, and peri-implant pocket depth were all positively correlated. Our study revealed that peri-implantitis is a condition characterized by unique and distinctive features. Our results supported that PPD has a great impact on the peri-implantitis and it is closely related to the inflammation marker expression. The identification of specific biomarkers might help in choosing distinct treatment approaches for target individuals.

The Effect of Tobacco Smoking on Musculoskeletal Health: A Systematic Review

This systematic review explored associations between smoking and health outcomes involving the musculoskeletal system. AMSTAR criteria were followed. A comprehensive search of PubMed, Web of Science, and Science Direct returned 243 articles meeting inclusion criteria. A majority of studies found smoking has negative effects on the musculoskeletal system. In research on bones, smoking was associated with lower BMD, increased fracture risk, periodontitis, alveolar bone loss, and dental implant failure. In research on joints, smoking was associated with increased joint disease activity, poor functional outcomes, and poor therapeutic response. There was also evidence of adverse effects on muscles, tendons, cartilage, and ligaments. There were few studies on the musculoskeletal health outcomes of secondhand smoke, smoking cessation, or other modes of smoking, such as waterpipes or electronic cigarettes. This review found evidence that suggests tobacco smoking has negative effects on the health outcomes of the musculoskeletal system. There is a need for further research to understand mechanisms of action for the effects of smoking on the musculoskeletal system and to increase awareness of healthcare providers and community members of the adverse effects of smoking on the musculoskeletal system.

Blood Groups in Infection and Host Susceptibility

Blood group antigens represent polymorphic traits inherited among individuals and populations. At present, there are 34 recognized human blood groups and hundreds of individual blood group antigens and alleles. Differences in blood group antigen expression can increase or decrease host susceptibility to many infections. Blood groups can play a direct role in infection by serving as receptors and/or coreceptors for microorganisms, parasites, and viruses. In addition, many blood group antigens facilitate intracellular uptake, signal transduction, or adhesion through the organization of membrane microdomains. Several blood groups can modify the innate immune response to infection. Several distinct phenotypes associated with increased host resistance to malaria are overrepresented in populations living in areas where malaria is endemic, as a result of evolutionary pressures. Microorganisms can also stimulate antibodies against blood group antigens, including ABO, T, and Kell. Finally, there is a symbiotic relationship between blood group expression and maturation of the gastrointestinal microbiome.

Prevalence of human papillomavirus in oral lichen planus in an Iranian cohort

CONTEXT

Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disease with female predominance with the potential for malignant transformation. Human papillomavirus (HPV) is associated with both malignant and benign disease in the head and neck region.

AIMS

The present study assesses the prevalence of high-risk HPV-16 and HPV-18 in tissue and saliva samples from an Iranian population diagnosed with OLP.

SUBJECTS AND METHODS

Deoxyribonucleic acid was extracted and investigated using polymerase chain reaction from tissue and saliva samples of the same individuals from 40 OLP cases and saliva samples of 40 healthy controls.

STATISTICAL ANALYSIS

The prevalence of data was compared using the Chi-square test and inter-group differences were analyzed using Fisher's exact test.

RESULTS

OLP specimens were HPV-positive in 11 of 40 (27.5%) cases compared with three of 40 (7.5%) saliva specimens, representing a statistically significant difference (P = 0.0367). HPV-16 and HPV-18 were positive in eight of 40 (20%) OLP tissues and three of 40 (7.5%) saliva samples. Five of the 40 healthy saliva samples were positive for HPV-16. In the OLP patients with dysplasia, four of seven tissue samples were HPV-positive; threeof these four were HPV-16- positive in comparision with seven of 33 HPV-positive samples from OLP patients without dysplasia.

CONCLUSIONS

Biopsies were more accurate than saliva analysis for evaluating HPV prevalence in OLP patients. HPV prevalence was higher in dysplastic than nondysplastic OLP lesions in this Iranian cohort.

Comparative evaluation of salivary soluble CD44 levels in periodontal health and disease

CONTEXT

Inflammation, immunoactivation, and malignant diseases are associated with increased plasma levels of soluble CD44 (sCD44). Serum sCD44 has been recognized as a diagnostic marker in smoking-induced diseases.

AIM

(1) To assess the levels of salivary sCD44 in periodontal health and disease. (2) To compare the levels of salivary sCD44 in smokers and nonsmokers. (3) To assess if salivary sCD44 levels could be used as a diagnostic marker for periodontitis.

SETTING AND DESIGN

A total of 60 patients were divided into three groups viz. Group A - healthy, Group B - aggressive periodontitis and Group C - chronic periodontitis (Subdivided into C1 - chronic periodontitis smokers and C2 - chronic periodontitis nonsmokers).

MATERIALS AND METHODS

The plaque index, gingival index (GI), probing depth and clinical attachment level; along with the radiographs were recorded. The saliva sample collected at baseline was stored at -80°C. The sCD44 levels were analyzed using ELISA.

STATISTICAL ANALYSIS USED

ANOVA test and Mann-Whitney's test was used to compare readings between all the groups and Pearson correlation was calculated for CD44 and all the clinical parameters in each group.

RESULTS

Highest mean sCD44 was recorded in Group C2 followed by Group C1. The GI was positively correlated with CD44 levels in chronic periodontitis group. Contrary to previous reports nonsmokers subjects had higher CD44 levels as compared to smoker.

CONCLUSION

Soluble CD44 levels were positively correlated with periodontal disease. Thus, salivary sCD44 could be considered as a one of the biomarker for periodontitis that is, aggressive and chronic periodontitis.

Prioritization of candidate genes for periodontitis using multiple computational tools

BACKGROUND

Both genetic and environmental factors contribute to the development of periodontitis. Genetic studies identified a variety of candidate genes for periodontitis. The aim of the present study is to identify the most promising candidate genes for periodontitis using an integrative gene ranking method.

METHODS

Seed genes that were confirmed to be associated with periodontitis were identified using text mining. Three types of candidate genes were then extracted from different resources (expression profiles, genome-wide association studies). Combining the seed genes, four freely available bioinformatics tools (ToppGene, DIR, Endeavour, and GPEC) were integrated for prioritization of candidate genes. Candidate genes that identified with at least three programs and ranked in the top 20 by each program were considered the most promising.

RESULTS

Prioritization analysis resulted in 21 promising genes involved or potentially involved in periodontitis. Among them, IL18 (interleukin 18), CD44 (CD44 molecule), CXCL1 (chemokine [CXC motif] ligand 1), IL6ST (interleukin 6 signal transducer), MMP3 (matrix metallopeptidase 3), MMP7, CCR1 (chemokine [C-C motif] receptor 1), MMP13, and TLR9 (Toll-like receptor 9) had been associated with periodontitis. However, the roles of other genes, such as CSF3 (colony stimulating factor 3 receptor), CD40, TNFSF14 (tumor necrosis factor receptor superfamily, member 14), IFNB1 (interferon-β1), TIRAP (toll-interleukin 1 receptor domain containing adaptor protein), IL2RA (interleukin 2 receptor α), ETS1 (v-ets avian erythroblastosis virus E26 oncogene homolog 1), GADD45B (growth arrest and DNA-damage-inducible 45 β), BIRC3 (baculoviral IAP repeat containing 3), VAV1 (vav 1 guanine nucleotide exchange factor), COL5A1 (collagen, type V, α1), and C3 (complement component 3), have not been investigated thoroughly in the process of periodontitis. These genes are mainly involved in bacterial infection, immune response, and inflammatory reaction, suggesting that further characterizing their roles in periodontitis will be important.

CONCLUSIONS

A combination of computational tools will be useful in mining candidate genes for periodontitis. These theoretical results provide new clues for experimental biologists to plan targeted experiments.

Host-derived diagnostic markers related to soft tissue destruction and bone degradation in periodontitis

BACKGROUND

A major challenge in clinical periodontics is to find a reliable molecular marker of periodontal tissue destruction with high sensitivity, specificity and utility.

OBJECTIVES

The aim of this systematic review is to evaluate available literature on 'the utility of molecular markers of soft and hard periodontal tissue destruction'.

MATERIALS AND METHODS

Based on the focused question, 'What is the utility of molecular markers of soft and hard periodontal tissue destruction', an electronic and manual search was conducted for human studies presenting clinical data for the potential of molecular markers of tissue destruction in biofluids; gingival crevicular fluid (GCF), saliva, and serum.

RESULTS

Papers fulfilling the inclusion criteria were selected. All relevant data from the selected papers were extracted and recorded in separate tables for molecules in GCF, saliva, and serum.

CONCLUSION

Within the defined limits of the Problem/Population, Intervention, Comparison, Outcome, the present analysis reveals that (a) no single or combination of markers exists that can disclose periodontal tissue destruction adequately; (b) while the most fruitful source of biomarkers for periodontal destruction appears to be in molecules tightly related to bone and soft tissue destruction, this remains to be objectively demonstrated. Currently, clinical measurements are still the most reliable.

Levels of salivary IFN-gamma, TNF-alfa, and TNF receptor-2 as prognostic markers in (erosive) oral lichen planus

To explore the feasibility of detecting salivary levels of IFN-γ, TNF-α, and sTNFR-2 from erosive oral lichen planus (ELP) patients for clinical application, 20 ELP patients were enrolled in the study as were 20 age-sex-matched controls. From all subjects, saliva level of the tested biomarkers was determined by ELISA. Salivary profiles were assessed in ELP patients by ELISA after being treated with prednisone. A significantly higher level of IFN-γ (P ≤ .01), TNF-α (P ≤ .0001), and sTNFR-2 (P ≤ .01) was detected in ELP patients before treatment than in controls. Following treatment, the salivary levels of IFN-γ (P ≤ .01), TNF-α (P ≤ .05), and sTNFR-2 (P ≤ .01) decreased significantly when compared to their pretreatment levels. This study demonstrated that salivary IFN-γ, TNF-α, and sTNFR-2 can be detectable in ELP patients and decreased significantly after treatment with prednisone, which may reveal the possibility of using these disease-related biomarkers in diagnosis and monitoring.