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Kurtzman GM, Horowitz RA, Johnson R, Prestiano RA, Klein BI. The systemic oral health connection: Biofilms. Medicine (Baltimore) 2022; 101:e30517. [PMID: 36401454 PMCID: PMC9678577 DOI: 10.1097/md.0000000000030517] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 08/08/2022] [Indexed: 12/03/2022] Open
Abstract
Frequently, periodontal health and it's associated oral biofilm has not been addressed in those patients who have systemic health issues, especially those who are not responding to medical treatment via their physician. Oral biofilm may be present in the periodontal sulcus in the absence of clinical disease of periodontal disease (bleeding on probing, gingival inflammation) and periodontal reaction is dependent on the patient's immune response to the associated bacterial and their byproducts. Increasing evidence has been emerging the past decade connecting oral biofilm with systemic conditions, either initiating them or complicating those medical conditions. The patient's health needs to be thought of as a whole-body system with connections that may originate in the oral cavity and have distant affects throughout the body. To maximize total health, a coordination in healthcare needs to be a symbiosis between the physician and dentist to eliminate the oral biofilm and aid in prevention of systemic disease or minimize those effects to improve the patient's overall health and quality of life. Various areas of systemic health have been associated with the bacteria and their byproducts in the oral biofilm. Those include cardiovascular disease, chronic kidney disease, diabetes, pulmonary disease, prostate cancer, colon cancer, pancreatic cancer, pre-term pregnancy, erectile dysfunction Alzheimer's disease and Rheumatoid arthritis. This article will discuss oral biofilm, its affects systemically and review the medical conditions associated with the oral systemic connection with an extensive review of the literature.
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Affiliation(s)
| | - Robert A. Horowitz
- Private periodontal practice Scarsdale, New York, USA
- Adjunct Clinical Assistant Professor, Department of Periodontology and Implant Dentistry, New York University College of Dentistry
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2
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Bekelis K, Missios S, Ahmad J, Labropoulos N, Schirmer CM, Calnan DR, Skinner J, MacKenzie TA. Ischemic Stroke Occurs Less Frequently in Patients With COVID-19: A Multicenter Cross-Sectional Study. Stroke 2020; 51:3570-3576. [PMID: 33106109 PMCID: PMC7678670 DOI: 10.1161/strokeaha.120.031217] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Supplemental Digital Content is available in the text. The impact of coronavirus disease 2019 (COVID-19) on the occurrence of ischemic stroke has been the subject of increased speculation but has not been confirmed in large observational studies. We investigated the association between COVID-19 and stroke.
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Affiliation(s)
- Kimon Bekelis
- The Stroke and Brain Aneurysm Center of Long Island, Babylon, NY (K.B.).,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (K.B., J.S., T.A.M.).,Population Health Research Institute of New York, Melville, NY (K.B., S.M., J.A., T.A.M.).,Division of Neurosurgery, Good Samaritan Hospital Medical Center, West Islip, NY (K.B., S.M., J.A.)
| | - Symeon Missios
- Population Health Research Institute of New York, Melville, NY (K.B., S.M., J.A., T.A.M.).,Division of Neurosurgery, Good Samaritan Hospital Medical Center, West Islip, NY (K.B., S.M., J.A.)
| | - Javaad Ahmad
- Population Health Research Institute of New York, Melville, NY (K.B., S.M., J.A., T.A.M.).,Division of Neurosurgery, Good Samaritan Hospital Medical Center, West Islip, NY (K.B., S.M., J.A.)
| | - Nicos Labropoulos
- Department of Surgery, Stony Brook University Medical Center, NY (N.L.)
| | - Clemens M Schirmer
- Department of Neurosurgery and Neuroscience Institute, Geisinger Health System and Geisinger Commonwealth School of Medicine, Wilkes-Barre, PA and Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria (C.M.S.)
| | - Daniel R Calnan
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (D.R.C.)
| | - Jonathan Skinner
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (K.B., J.S., T.A.M.).,Department of Economics (J.S.), Dartmouth College, Hanover, NH
| | - Todd A MacKenzie
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (K.B., J.S., T.A.M.).,Population Health Research Institute of New York, Melville, NY (K.B., S.M., J.A., T.A.M.).,Department of Biomedical Data Science (T.A.M.), Dartmouth College, Hanover, NH
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3
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Zhao E, Wang C, Xie H, Du Y, Zhang Y. Association between the CD14-260C>T gene polymorphism and susceptibility to myocardial infarction: Evidence from case-control studies. Int J Immunogenet 2019; 46:419-426. [PMID: 31183977 DOI: 10.1111/iji.12445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/16/2019] [Accepted: 05/22/2019] [Indexed: 01/07/2023]
Abstract
Numerous published studies have investigated the relationship between the CD14-260C>T (rs2569190) polymorphism and the risk of myocardial infarction (MI). However, the results are still conflicting and inconclusive. Potentially eligible published articles were searched in four databases including PubMed, Web of Science, EMBASE and Chinese Biomedical Database (CBM). The odds ratio (OR) with its 95% confidence interval (CI) was used to estimate the strength of the associations. Thirteen papers including 17 case-control studies were included, reporting a total of 6,443 MI patients and 6,315 controls. A significant increase in overall MI susceptibility was identified in the homozygote model. In the subgroup analysis, with respect to the type of MI, a significantly increasing acute MI susceptibility was found in the homozygote model. In the subgroup analysis for ethnicity, a significant increased susceptibility was found in Asian populations in allele, homozygote, recessive and dominant models. However, no significant association was found among Caucasian populations. In conclusion, there may be a moderate association between the CD14-260C>T polymorphism and acute MI susceptibility. This association may be different between ethnicities with the CD14-260C>T polymorphism being a risk factor for myocardial infarction in Asian populations.
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Affiliation(s)
- Enfa Zhao
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chaoliang Wang
- Department of Cardiology, Taihe Traditional Chinese Medicine Hospital, Taihe, China
| | - Hang Xie
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yajuan Du
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yushun Zhang
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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4
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Haque M, Sartelli M, Haque SZ. Dental Infection and Resistance-Global Health Consequences. Dent J (Basel) 2019; 7:dj7010022. [PMID: 30823670 PMCID: PMC6473604 DOI: 10.3390/dj7010022] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/03/2019] [Accepted: 02/20/2019] [Indexed: 12/15/2022] Open
Abstract
Antibiotics are widely used in dental caries and another dental related issues, both for therapeutic and prophylactic reasons. Unfortunately, in recent years the use of antibiotics has been accompanied by the rapid emergence antimicrobial resistance. Dental caries and periodontal diseases are historically known as the top oral health burden in both developing and developed nations affecting around 20⁻50% of the population of this planet and the uppermost reason for tooth loss. Dental surgeons and family practitioners frequently prescribed antimicrobials for their patients as outpatient care. Several studies reported that antibiotics are often irrationally- and overprescribed in dental diseases which is the basis of antimicrobial resistance. The aim of this review is to evaluate the use of antibiotics in dental diseases. Almost certainly the promotion of primary oral health care (POHC) in primary health care program especially among the least and middle-income countries (LMIC) may be the answer to ensure and promote rational dental care.
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Affiliation(s)
- Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Sungai Besi, 57000 Kuala Lumpur, Malaysia.
| | - Massimo Sartelli
- Department of Surgery, Macerata Hospital, via Santa Lucia 2, 62100 Macerata, Italy.
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Abstract
Ischaemic stroke is a treatable medical emergency. In an era of time-dependent reperfusion techniques, it is crucial that an accurate and prompt diagnosis is made. Approximately 30% of patients admitted to hyperacute stroke units are subsequently found not to have a final diagnosis of acute stroke although some of these patients do have incidental or previously symptomatic cerebrovascular disease. These patients do not benefit from thrombolysis and may require the input of other specialists or treatments. Meanwhile, a proportion of patients with acute stroke have unusual presentations and are sometimes initially admitted to general medical admissions units prior to accessing stroke unit care. It is important that atypical presentations of stroke are recognised so that patients are not denied the benefits of stroke unit care and secondary prevention. This article describes some characteristics of common stroke mimics and chameleons, considers how to avoid diagnostic mistakes and discusses the contributory role of imaging.
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Krishnan K, Chen T, Paster BJ. A practical guide to the oral microbiome and its relation to health and disease. Oral Dis 2016; 23:276-286. [PMID: 27219464 DOI: 10.1111/odi.12509] [Citation(s) in RCA: 205] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 12/14/2022]
Abstract
The oral microbiome is incredibly complex with the average adult harboring about 50-100 billion bacteria in the oral cavity, which represent about 200 predominant bacterial species. Collectively, there are approximately 700 predominant taxa of which less than one-third still have not yet been grown in vitro. Compared to other body sites, the oral microbiome is unique and readily accessible. There is extensive literature available describing the oral microbiome and discussing the roles that bacteria may play in oral health and disease. However, the purpose of this review is not to rehash these detailed studies but rather to educate the reader with understanding the essence of the oral microbiome, namely that there are abundant bacteria in numbers and types, that there are molecular methods to rapidly determine bacterial associations, that there is site specificity for colonization of the host, that there are specific associations with oral health and disease, that oral bacteria may serve as biomarkers for non-oral diseases, and that oral microbial profiles may have potential use to assess disease risk.
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Affiliation(s)
- K Krishnan
- Department of Microbiology, The Forsyth Institute, Cambridge, MA, USA.,New England BioLabs, Ipswich, MA, USA
| | - T Chen
- Department of Microbiology, The Forsyth Institute, Cambridge, MA, USA
| | - B J Paster
- Department of Microbiology, The Forsyth Institute, Cambridge, MA, USA.,Department of Oral Medicine, Infection & Immunity, Harvard School of Dental Medicine, Boston, MA, USA
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Onwuamaegbu ME, Belcher RA, Soare C. Cell Wall-Deficient Bacteria as a Cause of Infections: A Review of the Clinical Significance. J Int Med Res 2016; 33:1-20. [PMID: 15651712 DOI: 10.1177/147323000503300101] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cell wall-deficient bacteria (CWDB) are pleomorphic bacterial forms. These atypical organisms may occur naturally or they can be induced in the laboratory. Their presence has been known about for over a century, but a definite link to clinical disease outcomes has not been demonstrated. A number of case reports and laboratory studies suggest some disease associations, however. Considerable controversy surrounds the true relevance of CWDB to disease; there is a widespread belief that they may represent a response by the walled organism to adverse extracellular conditions like antibiotic pressure. This review looks at studies published between 1934 and 2003, which were identified by Dialog DataStar using the key words ‘cell wall deficient bacteria and clinical significance and infections’ and by further scanning the reference list at the end of the papers retrieved. We conclude that the evidence for the clinical significance of CWDB in disease is not compelling.
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Affiliation(s)
- M E Onwuamaegbu
- Department of Clinical Cardiology, Royal Brompton Hospital, London, UK.
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8
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Centurión OA. Serum biomarkers and source of inflammation in acute coronary syndromes and percutaneous coronary interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:119-28. [DOI: 10.1016/j.carrev.2016.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 01/05/2016] [Accepted: 01/13/2016] [Indexed: 11/17/2022]
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Monocyte Activation in Immunopathology: Cellular Test for Development of Diagnostics and Therapy. J Immunol Res 2016; 2016:4789279. [PMID: 26885534 PMCID: PMC4739459 DOI: 10.1155/2016/4789279] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/20/2015] [Accepted: 12/21/2015] [Indexed: 12/14/2022] Open
Abstract
Several highly prevalent human diseases are associated with immunopathology. Alterations in the immune system are found in such life-threatening disorders as cancer and atherosclerosis. Monocyte activation followed by macrophage polarization is an important step in normal immune response to pathogens and other relevant stimuli. Depending on the nature of the activation signal, macrophages can acquire pro- or anti-inflammatory phenotypes that are characterized by the expression of distinct patterns of secreted cytokines and surface antigens. This process is disturbed in immunopathologies resulting in abnormal monocyte activation and/or bias of macrophage polarization towards one or the other phenotype. Such alterations could be used as important diagnostic markers and also as possible targets for the development of immunomodulating therapy. Recently developed cellular tests are designed to analyze the phenotype and activity of living cells circulating in patient's bloodstream. Monocyte/macrophage activation test is a successful example of cellular test relevant for atherosclerosis and oncopathology. This test demonstrated changes in macrophage activation in subclinical atherosclerosis and breast cancer and could also be used for screening a panel of natural agents with immunomodulatory activity. Further development of cellular tests will allow broadening the scope of their clinical implication. Such tests may become useful tools for drug research and therapy optimization.
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Schicho R, Marsche G, Storr M. Cardiovascular complications in inflammatory bowel disease. Curr Drug Targets 2016. [PMID: 25642719 DOI: 10.2174/138945011666650202161500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Over the past years, a growing number of studies have indicated that patients suffering from inflammatory bowel disease (IBD) have an increased risk of developing cardiovascular disease. Both are chronic inflammatory diseases and share certain pathophysiological mechanisms that may influence each other. High levels of cytokines, C-reactive protein (CRP), and homocysteine in IBD patients may lead to endothelial dysfunction, an early sign of atherosclerosis. IBD patients, in general, do not show the typical risk factors for cardiovascular disease but changes in lipid profiles similar to the ones seen in cardiovascular events have been reported recently. Higher levels of coagulation factors frequently occur in IBD which may predispose to arterial thromboembolic events. Finally, the gut itself may have an impact on atherogenesis during IBD through its microbiota. Microbial products are released from the inflamed mucosa into the circulation through a leaky barrier. The induced rise in proinflammatory cytokines could contribute to endothelial damage, artherosclerosis and cardiovascular events. Although large retrospective studies favor a link between IBD and cardiovascular diseases, the mechanisms behind still remain to be determined.
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Affiliation(s)
| | | | - Martin Storr
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Austria.
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11
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Schicho R, Marsche G, Storr M. Cardiovascular complications in inflammatory bowel disease. Curr Drug Targets 2016; 16:181-8. [PMID: 25642719 DOI: 10.2174/1389450116666150202161500] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 01/08/2015] [Accepted: 01/16/2015] [Indexed: 02/07/2023]
Abstract
Over the past years, a growing number of studies have indicated that patients suffering from inflammatory bowel disease (IBD) have an increased risk of developing cardiovascular disease. Both are chronic inflammatory diseases and share certain pathophysiological mechanisms that may influence each other. High levels of cytokines, C-reactive protein (CRP), and homocysteine in IBD patients may lead to endothelial dysfunction, an early sign of atherosclerosis. IBD patients, in general, do not show the typical risk factors for cardiovascular disease but changes in lipid profiles similar to the ones seen in cardiovascular events have been reported recently. Higher levels of coagulation factors frequently occur in IBD which may predispose to arterial thromboembolic events. Finally, the gut itself may have an impact on atherogenesis during IBD through its microbiota. Microbial products are released from the inflamed mucosa into the circulation through a leaky barrier. The induced rise in proinflammatory cytokines could contribute to endothelial damage, artherosclerosis and cardiovascular events. Although large retrospective studies favor a link between IBD and cardiovascular diseases, the mechanisms behind still remain to be determined.
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Affiliation(s)
| | | | - Martin Storr
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Austria.
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12
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Orekhov AN, Sobenin IA, Gavrilin MA, Gratchev A, Kotyashova SY, Nikiforov NG, Kzhyshkowska J. Macrophages in immunopathology of atherosclerosis: a target for diagnostics and therapy. Curr Pharm Des 2015; 21:1172-9. [PMID: 25312739 PMCID: PMC4428062 DOI: 10.2174/1381612820666141013120459] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 10/01/2014] [Indexed: 01/22/2023]
Abstract
Immunopathology plays important roles in the development of different life-threatening diseases, such as atherosclerosis and its consequences (acute myocardial infarction and stroke), cancer, chronic inflammatory diseases. Effective modulation of the immune system may significantly increase the efficacy of prevention and therapy efforts. Currently there are no marketed drugs capable of normalizing immune system function in an intrinsic and comprehensive way. Here, we describe a test system designed for complex analysis of monocyte activity in individuals to diagnose immunopathology and monitor treatment efficacy. This cell-based test system may also be useful for screening compounds with an immune-correcting effects. Both diagnostic and screening systems are based on primary culture of human monocytes and/or monocyte-derived macrophages. This is the first step in creating a method for assessment of macrophage activity, which is required for further development of immune-correcting drugs. The existing preliminary data provide the basis for realization of this idea.
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Affiliation(s)
| | | | | | | | | | | | - Julia Kzhyshkowska
- Laboratory of Angiopathology, Institute of General Pathology and Pathophysiology, Russian Academy of Medical Sciences, 8 Baltiyskaya Street, 125315 Moscow, Russia.
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Golpasand Hagh L, Zakavi F, Hajizadeh F, Saleki M. The association between hyperlipidemia and periodontal infection. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e6577. [PMID: 25763249 PMCID: PMC4341345 DOI: 10.5812/ircmj.6577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 02/01/2014] [Accepted: 10/25/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Periodontitis is a local chronic inflammatory condition of the supporting structures of the teeth resulting from a dental plaque biofilm attached to teeth surfaces. Recent studies have indicated that this oral disease may have effects on systemic health. OBJECTIVES The aim of the present study was to evaluate the association between periodontitis and hyperlipidemia. PATIENTS AND METHODS This case-control study was conducted in Iran during March 2011. In this case-control study, levels of serum lipids in 45 subjects with periodontitis were measured and compared with 45 age, gender and body mass index (BMI) matched controls. Data were analyzed using student t-test and chi-square test with P < 0.05 as the limit of significance. RESULTS Mean values of total cholesterol (CHL) (periodontitis group = 218.11 ± 29.77, control group = 162.31 ± 48.24) and triglycerides (TG) (periodontitis group = 209.77 ± 44.30, control group = 125.60 ± 44.16) were significantly higher in the periodontitis group (P < 0.001). High-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol levels were higher in the case group, but this difference was not statistically significant. Frequency of pathological values of CHL and TG were significantly higher in cases compared with the controls (P = 0.002 and P = 0.015, respectively). CONCLUSIONS This study indicates that hyperlipidemia may be associated with periodontal disease in healthy individuals; yet whether periodontitis causes an increase in levels of plasma lipids or whether hyperlipidemia is a risk factor for periodontal infection and cardiovascular disease, it needs further investigations.
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Affiliation(s)
- Leila Golpasand Hagh
- Department of Periodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Faramarz Zakavi
- Department of Operative Dentistry, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Fatemeh Hajizadeh
- Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Corresponding Author: Fatemeh Hajizadeh, Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Golestan St., Ahvaz, IR Iran. Tel: +98-9166317753, Fax: +98-6133730142, E-mail:
| | - Morteza Saleki
- Department of Pediatric Dentistry, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Arvand Branch, Ahvaz, IR Iran
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Association of TLR and TREM-1 gene polymorphisms with risk of coronary artery disease in a Russian population. Gene 2014; 550:101-9. [PMID: 25128583 DOI: 10.1016/j.gene.2014.08.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/29/2014] [Accepted: 08/13/2014] [Indexed: 12/22/2022]
Abstract
Atherosclerosis, manifesting itself as acute coronary syndrome, stroke, and peripheral arterial diseases, is a chronic progressive inflammatory disease which is driven by responses of both innate and adaptive immunity. Toll-like receptors (TLRs) and Triggering Receptor Expressed on Myeloid Cells-1 (TREM-1) are important effectors of the innate immune system, and polymorphisms within genes encoding them may increase risk of occurrence of various pathologies including cardiovascular disorders. Thus, we carried out a genetic association study on the sample of 702 consecutive Caucasian (Russian) patients with coronary artery disease (CAD) and 300 age-, sex-, and ethnicity-matched healthy controls. We revealed that the C/C genotype of the TLR1 rs5743551 polymorphism was significantly associated with a reduced risk of CAD according to the recessive model (OR=0.41, 95% CI=0.20-0.84, P=0.017, adjusted by age and gender). Concerning TREM-1 gene polymorphisms, we found that A/A genotype of the rs2234237 polymorphism, the G/G genotype of the rs6910730 polymorphism, the C/C genotype of the rs9471535 polymorphism, and the T/T genotype of the rs4711668 polymorphism were significantly associated with elevated CAD risk according to the recessive model (OR=5.52, 95% CI=1.17-25.98, P=0.011; OR=4.28, 95% CI=1.09-16.81, P=0.021; OR=5.55, 95% CI=1.18-26.09, P=0.011, and OR=1.66, 95% CI=1.10-2.52, P=0.014, respectively, adjusted by age and gender). Conversely, the G allele of the rs1817537 polymorphism, the T allele of the rs2234246 polymorphism, and the T allele of the rs3804277 polymorphism significantly correlated with similarly decreased risk of CAD according to the dominant model (OR=0.57, 95% CI=0.40-0.81, P=0.0013; OR=0.59, 95% CI=0.42-0.84, P=0.003, and OR=0.58, 95% CI=0.41-0.81, P=0.0014, respectively, adjusted by age and gender). We conclude that certain TLR and TREM-1 gene polymorphisms may be associated with CAD in Russian population; however, their significance as predictive and pathogenic markers of CAD should be interpreted with caution in other populations.
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The association of chronic apical periodontitis and endodontic therapy with atherosclerosis. Clin Oral Investig 2013; 18:1813-23. [PMID: 24338091 PMCID: PMC4145204 DOI: 10.1007/s00784-013-1156-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 11/25/2013] [Indexed: 01/08/2023]
Abstract
Objectives Chronic apical periodontitis (CAP) appears to be a risk factor for coronary heart disease. The aims of the study were to estimate the significance of AP for the atherosclerotic burden and to examine the potential effect of endodontic treatment. Materials and methods The whole-body computed tomography (CT) examinations of 531 patients with a mean age of 50 ± 15.7 years were evaluated retrospectively. The atherosclerotic burden of the abdominal aorta was quantified using a calcium scoring method. The parameters of periodontitis were measured using the CT scan. Results The patients had a total of 11,191 teeth. The volume of the aortic atherosclerotic burden for patients with at least one CAP lesion was 0.32 ± 0.92 ml, higher than for patients with no CAP (0.17 ± 0.51 ml; p < 0.05). The atherosclerotic burden increased with age and number of CAP lesions without root canal treatment, but not with number of CAP lesions with endodontic treatments (p < 0.05 each). In logistic regression models, age (Wald 90.8), CAP without endodontic treatment (Wald 39.9), male gender (Wald 9.8), and caries per tooth (Wald 9.0) correlated positively and the number of fillings (Wald 11) correlated negatively with the atherosclerotic burden (p < 0.05 each). Apical radiolucencies in teeth with endodontic treatment were irrelevant with respect to atherosclerosis. Conclusions CAP correlated positively with the aortic atherosclerotic burden. In regression models, CAP without endodontic treatment was found to be an important factor, not however apical radiolucencies in teeth with endodontic treatment. Clinical relevance Further research is needed to clarify the possible clinical significance of these associations.
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Ramezani A, Raj DS. The gut microbiome, kidney disease, and targeted interventions. J Am Soc Nephrol 2013; 25:657-70. [PMID: 24231662 DOI: 10.1681/asn.2013080905] [Citation(s) in RCA: 485] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The human gut harbors >100 trillion microbial cells, which influence the nutrition, metabolism, physiology, and immune function of the host. Here, we review the quantitative and qualitative changes in gut microbiota of patients with CKD that lead to disturbance of this symbiotic relationship, how this may contribute to the progression of CKD, and targeted interventions to re-establish symbiosis. Endotoxin derived from gut bacteria incites a powerful inflammatory response in the host organism. Furthermore, protein fermentation by gut microbiota generates myriad toxic metabolites, including p-cresol and indoxyl sulfate. Disruption of gut barrier function in CKD allows translocation of endotoxin and bacterial metabolites to the systemic circulation, which contributes to uremic toxicity, inflammation, progression of CKD, and associated cardiovascular disease. Several targeted interventions that aim to re-establish intestinal symbiosis, neutralize bacterial endotoxins, or adsorb gut-derived uremic toxins have been developed. Indeed, animal and human studies suggest that prebiotics and probiotics may have therapeutic roles in maintaining a metabolically-balanced gut microbiota and reducing progression of CKD and uremia-associated complications. We propose that further research should focus on using this highly efficient metabolic machinery to alleviate uremic symptoms.
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Affiliation(s)
- Ali Ramezani
- Division of Renal Diseases and Hypertension, The George Washington University, Washington DC
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Sediri Y, Hammami S, Kallel A, Mourali MS, Feki M, Elasmi M, Haj-Taieb S, Omar S, Sanhaji H, Mechmeche R, Jemaa R, Kaabachi N. C(-260)T polymorphism in the promoter of CD 14 gene is not associated with myocardial infarction in the Tunisian population. Exp Mol Pathol 2011; 90:276-9. [PMID: 21333644 DOI: 10.1016/j.yexmp.2011.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 02/09/2011] [Accepted: 02/09/2011] [Indexed: 11/25/2022]
Abstract
Recent findings suggest that inflammation plays a role in atherosclerosis and its acute complications. Several known mechanisms may play at least a partial role in this process. One of the most likely mechanisms involves lipopolysaccharide (LPS) and its receptor, CD14. The C(-260)T single nucleotide polymorphism (rs2569190) in the promoter region of the CD14 receptor gene has been reported to be associated with a higher risk of MI. Others studies, however, have not corroborated these findings. Considering the contradictory results, the aim of the present study was to investigate the possible association between the CD14 C(-260)T polymorphism and the risk of MI in the Tunisian population. A total of 321 Tunisian patients with MI and 344 healthy controls were included in the study. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. The frequency of TT homozygous genotype for the CD14 C(-260)T polymorphism was 26.2% in MI patients and 27.0% in the control group. However, the genotype distribution and allele frequencies were not significantly different between MI and controls subjects. Moreover, the odds ratio for MI associated with the TT genotype failed to reach statistical significance (OR=1.22; 95% CI: 0.85-1.77; p=0.272). These results do not support the hypothesis that the C-260T polymorphism of CD14 gene contributes to the genetic susceptibility to MI in the Tunisian population studied.
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Affiliation(s)
- Yousra Sediri
- Research Laboratory LR99ES11, Department of Biochemistry, Tunisia
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19
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Pathways to further boost treatment rates and clinical outcomes in hospitalized stroke patients. Crit Pathw Cardiol 2010; 9:8-13. [PMID: 20215904 DOI: 10.1097/hpc.0b013e3181cd5c84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Inpatient quality improvement initiatives have been associated with impressive improvements in evidence-based discharge treatment rates in hospitalized stroke patients. However, these programs have generally focused only on optimizing recurrent stroke prevention strategies among ischemic stroke patients. Many patients hospitalized with recent symptomatic cerebral ischemia are also at risk for future ischemic episodes emanating from other vascular beds, and the inpatient setting could represent an opportunity to screen and appropriately manage such patients who harbor cross-vascular risk. The stroke hospitalization may also be ideal for identifying stroke patients susceptible to a highly preventable yet common trigger of vascular events and poor clinical outcomes like influenza infection. Finally, several hospital-based prevention measures are underutilized in patients hospitalized with intracerebral hemorrhage (ICH) compared with those with ischemic stroke or transient ischemic attack, and so protocols geared at enhancing prevention of ICH recurrence, are certainly warranted. This article presents pathways (algorithms, pocket cards, preprinted orders) developed from expert consensus prevention guidelines and implemented within a broader stroke inpatient quality improvement program, which target patients highly vulnerable to future coronary events, poor clinical outcomes following influenza infection, and recurrent ICH.
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Griffiths R, Barbour S. Lipoproteins and lipoprotein metabolism in periodontal disease. CLINICAL LIPIDOLOGY 2010; 5:397-411. [PMID: 20835400 PMCID: PMC2933935 DOI: 10.2217/clp.10.27] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A growing body of evidence indicates that the incidence of atherosclerosis is increased in subjects with periodontitis - a chronic infection of the oral cavity. This article summarizes the evidence that suggests periodontitis shifts the lipoprotein profile to be more proatherogenic. LDL-C is elevated in periodontitis and most studies indicate that triglyceride levels are also increased. By contrast, antiatherogenic HDL tends to be low in periodontitis. Periodontal therapy tends to shift lipoprotein levels to a healthier profile and also reduces subclinical indices of atherosclerosis. In summary, periodontal disease alters lipoprotein metabolism in ways that could promote atherosclerosis and cardiovascular disease.
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Affiliation(s)
- Rachel Griffiths
- Department of Biochemistry & Molecular Biology, Virginia Commonwealth University School of Medicine, Box 980614, Richmond, VA 23298-0614, USA
| | - Suzanne Barbour
- Department of Biochemistry & Molecular Biology, Virginia Commonwealth University School of Medicine, Box 980614, Richmond, VA 23298-0614, USA
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21
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Watts A, Crimmins EM, Gatz M. Inflammation as a potential mediator for the association between periodontal disease and Alzheimer's disease. Neuropsychiatr Dis Treat 2008; 4:865-76. [PMID: 19183779 PMCID: PMC2626915 DOI: 10.2147/ndt.s3610] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Periodontal disease (PDD) is associated with increased risk of cardiovascular disease, cerebrovascular disease, and mortality in many studies, while other studies have begun to suggest an association of PDD with Alzheimer's disease (AD). This paper discusses how infectious pathogens and systemic infection may play a role in AD. The roles of infection and inflammation are addressed specifically with regard to known AD pathologic lesions including senile plaques, neuron death, neurofibrillary tangles, and cerebrovascular changes. A testable model of proposed pathways between periodontal infection and AD is presented including three possible mechanisms: a) direct effects of infectious pathogens, b) inflammatory response to pathogens, and c) the effects on vascular integrity. The role of gene polymorphisms is discussed, including apolipoprotein (APOE) varepsilon4 as a pro-inflammatory and pro-infection genotype.
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Affiliation(s)
- Amber Watts
- Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA.
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Abdalla Abbas M, Guenther A, Galantucci S, Fawi G, Comi G, Kwan J, Corea F. Microbial risk factors of cardiovascular and cerebrovascular diseases: potential therapeutical options. Open Neurol J 2008; 2:20-4. [PMID: 19018303 PMCID: PMC2577933 DOI: 10.2174/1874205x00802010020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 02/27/2008] [Accepted: 04/04/2008] [Indexed: 01/23/2023] Open
Abstract
Infection and inflammation may have a crucial role in the pathogenesis of atherosclerosis. This hypothesis is supported by an increasing number of reports on the interaction between chronic infection, inflammation, and atherogenesis. Assessment of serological and inflammatory markers of infection may be useful adjuncts in identifying those patients who are at a higher risk of developing vascular events, and in whom more aggressive treatments might be warranted.
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Affiliation(s)
- Mohammed Abdalla Abbas
- Neurology Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
- Istituto di Neurologia Sperimentale (INSPE), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Milano, Neurologia, Dimer, Via Olgettina, 48, 20132, Milano, Italy
| | - Albrecht Guenther
- Department of Neurology, Friedrich-Schiller-University, Jena, Erlanger Allee 101, 07747 Jena, Germany
| | | | - Gharib Fawi
- Neurology Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Giancarlo Comi
- Istituto di Neurologia Sperimentale (INSPE), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Milano, Neurologia, Dimer, Via Olgettina, 48, 20132, Milano, Italy
| | - Joseph Kwan
- Department of Medicine for the Elderly, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, UK
| | - Francesco Corea
- Istituto di Neurologia Sperimentale (INSPE), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, Milano, Neurologia, Dimer, Via Olgettina, 48, 20132, Milano, Italy
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Harskamp RE, van Ginkel MW. Acute respiratory tract infections: a potential trigger for the acute coronary syndrome. Ann Med 2008; 40:121-8. [PMID: 18293142 DOI: 10.1080/07853890701753672] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Clinical studies suggest that acute respiratory tract infection (ARTI) may be a risk factor for the acute coronary syndrome (ACS). ARTI is associated with an increased risk for ACS up to 2 weeks prior to a cardiac event. The mechanism that may underlie this association is unclear. Infections are thought to play a role in the progression and instability of atherosclerotic plaques, resulting in plaque rupture, sudden constriction, and/or blockage of coronary arteries. Inflammation, endothelial dysfunction and thrombotic activation seem to play an important role in this. Influenza vaccination may reduce the risk of ACS in patients with coronary artery disease. Future studies will provide more information about the underlying mechanisms of infection-related ACS.
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Affiliation(s)
- Ralf E Harskamp
- University of Texas Health Science Center at San Antonio, Division of Cardiothoracic Surgery, San Antonio, Texas 78229-3900, USA.
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24
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Oz SG, Fentoglu O, Kilicarslan A, Guven GS, Tanrtover MD, Aykac Y, Sozen T. Beneficial Effects of Periodontal Treatment on Metabolic Control of Hypercholesterolemia. South Med J 2007; 100:686-91. [PMID: 17639748 DOI: 10.1097/smj.0b013e31802fa327] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The authors aimed to evaluate whether local periodontal therapy may influence plasma lipid levels in patients with periodontitis. METHODS Fifty patients (31 females and 19 males, age 36-66 yr) were randomly assigned to the treatment and control groups. Lipid profile and dental variables were measured at baseline and at the end of the study in both groups. RESULTS In the third month, there was a significant decrease in total and low density lipoprotein (LDL) cholesterol levels of the treatment group compared with baseline values. Also, the reduction in bleeding on probing, pocket depth, attachment loss, plaque index and gingival index were statistically significant in the treatment group. CONCLUSIONS The present study indicates that periodontitis causes changes in total and LDL cholesterol levels and local periodontal treatment resulted in a significant decrease in these markers. These results suggest a potential effect of periodontitis-driven systemic inflammation on lipid metabolism.
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Affiliation(s)
- S Gul Oz
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey.
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25
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Sonoki K, Nakashima S, Takata Y, Naito T, Fujisawa K, Ootsubo T, Wakisaka M, Iwase M, Iida M, Yokota M. Decreased lipid peroxidation following periodontal therapy in type 2 diabetic patients. J Periodontol 2007; 77:1907-13. [PMID: 17076618 DOI: 10.1902/jop.2006.060088] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although diabetes mellitus and periodontal disease promote atherosclerosis, the relation of oxidative stress with these diseases remains unclear. To investigate the influence of periodontal disease on oxidative stress, we assessed the effects of initial periodontal therapy on lipid peroxide (LPO), an oxidative stress index, in type 2 diabetic and non-diabetic patients. METHODS Seventeen subjects with or without type 2 diabetes were enrolled in this intervention study. No patient had a history of cardiovascular or peripheral vascular disease. Five type 2 diabetic and six non-diabetic patients, all with moderate to severe periodontal disease, received and completed the initial periodontal therapy and examination. Before and after the therapy, patients underwent medical examinations and blood determinations, including LPO. RESULTS Before the therapy, the periodontal probing depth and bleeding on probing (BOP) were similar between groups. LPO, triglyceride, and white blood cell counts were significantly higher in diabetic than non-diabetic patients. Therapy improved the periodontal parameters in both groups and significantly decreased LPO in diabetic patients. Anti-malondialdehyde-modified low-density lipoprotein (MDA-LDL) antibody, a marker of oxidized LDL, significantly decreased with treatment in both groups. Overall, Spearman rank correlation showed no significance between periodontal parameters and LPO or anti-MDA-LDL antibody, but BOP tended to correlate with LPO in diabetic patients (r = 0.585; P = 0.0791). CONCLUSION Although this is a small and preliminary study, and the changes of LPO and anti-MDA-LDL antibody were within the normal range, the initial periodontal therapy significantly decreased LPO, an oxidative stress index, in type 2 diabetic patients with periodontal disease.
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Affiliation(s)
- Kazuo Sonoki
- Division of General Internal Medicine, Department of Health Promotion, Science of Health Improvement, Kyushu Dental College, Kitakyushu, Japan.
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26
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Mullooly JP, Bridges CB, Thompson WW, Chen J, Weintraub E, Jackson LA, Black S, Shay DK. Influenza- and RSV-associated hospitalizations among adults. Vaccine 2007; 25:846-55. [PMID: 17074423 DOI: 10.1016/j.vaccine.2006.09.041] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Revised: 08/17/2006] [Accepted: 09/07/2006] [Indexed: 11/27/2022]
Abstract
We estimated influenza- and respiratory syncytial virus (RSV)-associated hospitalizations by age, high-risk status and outcome, during the 1996/1997-1999/2000 respiratory seasons among adults who did not receive influenza vaccine. Using three health maintenance organization (HMO) databases and local viral surveillance data, we identified weeks when influenza and RSV were circulating and estimated influenza- and RSV-associated hospitalizations. Persons aged > or = 65 years with and without high-risk conditions had significantly increased rates of influenza-associated hospitalizations for pneumonia and influenza, and circulatory and respiratory diseases. Persons aged > or = 65 years with high-risk conditions also had significantly increased rates of influenza-associated hospitalizations for cardiac conditions (16.9 per 10,000 person periods). Relative to the influenza estimates for high-risk persons > or = 65 years, we found lower rates of RSV-associated hospitalizations for pneumonia and influenza diseases (23.4 per 10,000 person periods), cardiac diseases (4.3 per 10,000 person periods) and circulatory and respiratory diseases (44.0 per 10,000 person periods). Among low-risk persons aged 50-64 years, we did not identify significantly elevated rates of influenza- or RSV-associated hospitalizations. Excess hospitalization estimates among adults aged > or = 65 years and high-risk 50-64 year olds during the influenza season suggest that these groups should have priority for influenza vaccine during vaccine shortages.
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Affiliation(s)
- John P Mullooly
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR 97227, United States.
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27
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Signorelli SS, Stivala A, Di Pino L, Salmeri M, Tempera G, Toscano MA, Nicoletti G. Chronic peripheral arteriopathy is associated with seropositivity to Chlamydia pneumoniae. J Chemother 2006; 18:103-6. [PMID: 16572901 DOI: 10.1179/joc.2006.18.1.103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The study was carried out to clarify the correlation between Chlamydia pneumoniae infection and peripheral arterial disease (PAD). The level of specific antibodies of the 133 consecutive patients suffering from PAD at 2nd stage of Leriche's classification were compared with 60 healthy controls by using a commercial Micro-IF Test. A higher incidence of serological evidence of C. pneumoniae infection was found in the patients (106/133) than in controls (6/60). These results are in agreement with other findings that measured the infection in atheromasic plaques. A strong cause-effect relationship between bacterial infection and peripheral arterial disease was not found, but the raised seropositivity level could be considered as a target for medical therapy of PAD.
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Affiliation(s)
- S S Signorelli
- Department of Internal Medicine and Systemic Disease, Medical Angiology Care Unit, University of Catania, Italy
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28
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Wong CM, Yang L, Chan KP, Leung GM, Chan KH, Guan Y, Lam TH, Hedley AJ, Peiris JSM. Influenza-associated hospitalization in a subtropical city. PLoS Med 2006; 3:e121. [PMID: 16515368 PMCID: PMC1391978 DOI: 10.1371/journal.pmed.0030121] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Accepted: 12/21/2005] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The impact of influenza on morbidity and hospitalization in the tropics and subtropics is poorly quantified. Uniquely, the Hong Kong Special Administrative Region has computerized hospital discharge diagnoses on 95% of total bed days, allowing disease burden for a well-defined population to be accurately assessed. METHODS AND FINDINGS Influenza-associated morbidity and hospitalization was assessed by Poisson regression models for weekly counts of hospitalizations in Hong Kong during 1996 to 2000, using proportions of positive influenza types A (H1N1 and H3N2) and B isolations in specimens sent for laboratory diagnosis as measures of influenza virus circulation. We adjusted for annual trend, seasonality, temperature, and relative humidity, as well as respiratory syncytial virus circulation. We found that influenza was significantly associated with hospitalization for acute respiratory disease (International Classification of Diseases version 9 codes [ICD9] 460-466 and 480-487) and its subcategory pneumonia and influenza (ICD9 480-487) for all age groups. The annual rates of excess hospitalization per 100,000 population for acute respiratory diseases for the age groups 0-14, 15-39, 40-64, 65-74, and 75+ were 163.3 (95% confidence interval [CI], 135-190), 6.0 (95% CI, 2.7-8.9), 14.9 (95% CI, 10.7-18.8), 83.8 (95% CI, 61.2-104.2), and 266 (95% CI, 198.7-330.2), respectively. Influenza was also associated with hospitalization for cerebrovascular disease (ICD9 430-438) for those aged over 75 y (55.4; 95% CI, 23.1-87.8); ischemic heart disease (ICD9 410-414) for the age group 40-64 y (5.3; 95% CI, 0.5-9.5) and over 75 y (56.4; 95% CI, 21.1-93.4); and diabetes mellitus (ICD9 250) for all age groups older than 40 y. CONCLUSIONS Influenza has a major impact on hospitalization due to cardio-respiratory diseases as well as on cerebrovascular disease, ischemic heart disease, and diabetes mellitus in the tropics and subtropics. Better utilization of influenza vaccine during annual epidemics in the tropics will enhance global vaccine production capacity and allow for better preparedness to meet the surge in demand that is inevitable in confronting a pandemic.
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Affiliation(s)
- Chit Ming Wong
- 1University of Hong Kong, Department of Community Medicine, Hong Kong, Hong Kong Special Administrative Region, China
| | - Lin Yang
- 1University of Hong Kong, Department of Community Medicine, Hong Kong, Hong Kong Special Administrative Region, China
| | - King Pan Chan
- 1University of Hong Kong, Department of Community Medicine, Hong Kong, Hong Kong Special Administrative Region, China
| | - Gabriel M Leung
- 1University of Hong Kong, Department of Community Medicine, Hong Kong, Hong Kong Special Administrative Region, China
| | - Kwok H Chan
- 2University of Hong Kong, Department of Microbiology, Queen Mary Hospital, Hong Kong, Hong Kong Special Administrative Region, China
| | - Yi Guan
- 2University of Hong Kong, Department of Microbiology, Queen Mary Hospital, Hong Kong, Hong Kong Special Administrative Region, China
| | - Tai Hing Lam
- 1University of Hong Kong, Department of Community Medicine, Hong Kong, Hong Kong Special Administrative Region, China
| | - Anthony Johnson Hedley
- 1University of Hong Kong, Department of Community Medicine, Hong Kong, Hong Kong Special Administrative Region, China
| | - Joseph S. M Peiris
- 2University of Hong Kong, Department of Microbiology, Queen Mary Hospital, Hong Kong, Hong Kong Special Administrative Region, China
- * To whom correspondence should be addressed. E-mail:
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Menschikowski M, Hagelgans A, Siegert G. Secretory phospholipase A2 of group IIA: Is it an offensive or a defensive player during atherosclerosis and other inflammatory diseases? Prostaglandins Other Lipid Mediat 2006; 79:1-33. [PMID: 16516807 DOI: 10.1016/j.prostaglandins.2005.10.005] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Revised: 10/29/2005] [Accepted: 10/31/2005] [Indexed: 02/07/2023]
Abstract
Since its discovery in the serum of patients with severe inflammation and in rheumatoid arthritic fluids, the secretory phospholipase A2 of group IIA (sPLA2-IIA) has been chiefly considered as a proinflammatory enzyme, the result of which has been very intense interest in selective inhibitors of sPLA2-IIA in the hope of developing new and efficient therapies for inflammatory diseases. The recent discovery of the antibacterial properties of sPLA2-IIA, however, has raised the question of whether the upregulation of sPLA2-IIA during inflammation is to be considered uniformly negative and the hindrance of sPLA2-IIA in every instance beneficial. The aim of this review is for this reason, along with the results of various investigations which argue for the proinflammatory and proatherogenic effects of an upregulation of sPLA2-IIA, also to array data alongside which point to a protective function of sPLA2-IIA during inflammation. Thus, it could be shown that sPLA2-IIA, apart from the bactericidal effects, possesses also antithrombotic properties and indeed plays a possible role in the resolution of inflammation and the accelerated clearance of oxidatively modified lipoproteins during inflammation via the liver and adrenals. Based on these multipotent properties the knowledge of the function of sPLA2-IIA during inflammation is a fundamental prerequisite for the development and establishment of new therapeutic strategies to prevent and treat severe inflammatory diseases up to and including sepsis.
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Affiliation(s)
- Mario Menschikowski
- Technische Universität Dresden, Medizinische Fakultät Carl Gustav Carus, Institut für Klinische Chemie and Laboratoriumsmedizin, Fetscherstrasse 74, D-01307 Dresden, Germany.
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Hejase de Trad C. Soluble CD40L versus myocyte enhancer factor: predicting a prominent marker for cardiovascular disease. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2006; 2006:1698-1701. [PMID: 17945659 DOI: 10.1109/iembs.2006.260240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Atherosclerosis (ACS) has set off the innovation of molecular markers measured in plasma or serum, and used for the identification of individuals at high risk of Coronary Heart Disease (CHD). In an attempt to improve cardiovascular risk prediction, considerable interest is focused on inflammatory biomarkers including Interleukin (IL)-6, Phospholamban (PLB), Myocyte enhancer factor 2A (MEF2A), and Soluble CD40 ligand. In this paper, signal-processing techniques predicted the characteristic frequencies of the above-mentioned proteins, and common binding sites. The CD40L characteristic frequency, 0.3555+/-0.0001, is correlated with Protease inhibitors and the second peak, 0.4531+/-0.0009, is closely related to Fgfs. This study also revealed that for MEF2A, the characteristic frequency, 0.0488+/-0.0001, is specific for enhancers DNA regulating sequences. The remaining frequencies, 0.3672 +/-0.0001 and 0.4648+/-0.0002, are characteristic of the Myocyte Protease inhibiting activity and SOS operator function. Furthermore, clinical data suggested that the increased levels of CD40L reliably identify the subgroup of patients with ACS who are at highest risk for cardiac events. It is suggested that CD40L is a most prominent candidate for early detection of cardiac disease.
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Krack A, Sharma R, Figulla HR, Anker SD. The importance of the gastrointestinal system in the pathogenesis of heart failure. Eur Heart J 2005; 26:2368-74. [PMID: 15980032 DOI: 10.1093/eurheartj/ehi389] [Citation(s) in RCA: 193] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Chronic heart failure (CHF) is a multi-organ disease with increasing evidence for the involvement of the gastrointestinal (GI) system in this syndrome. In recent research, the gut has received very little attention from cardiologists as its role in the pathogenesis of cardiovascular disease is poorly understood. Intestinal ischaemia may play an important role in bacterial translocation by increasing bowel permeability. Decreased cardiac function can reduce bowel perfusion and so clearly impairs the function of the intestinal barrier. There is an increasing evidence to suggest that a 'leaky' bowel wall may lead to translocation of bacteria and/or endotoxin, which may be an important stimulus for inflammatory cytokine activation in CHF. Impaired functioning of the GI system may also contribute to malnutrition and cachexia in CHF. It is hoped that by improving our understanding of the role of the gut in cardiac disease will lead to the development of novel therapeutic strategies in the future.
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Affiliation(s)
- Andreas Krack
- Clinical Cardiology, NHLI, Imperial College School of Medicine, London, UK.
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Yap FHY, Ho PL, Lam KF, Chan PKS, Cheng YH, Peiris JSM. Excess hospital admissions for pneumonia, chronic obstructive pulmonary disease, and heart failure during influenza seasons in Hong Kong. J Med Virol 2004; 73:617-23. [PMID: 15221909 DOI: 10.1002/jmv.20135] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is widely held that Southern China is a hypothetical influenza epicentre for the emergence of pandemic influenza viruses. However, influenza is perceived as a relatively unimportant infection in this part of the world compared with western countries. Hong Kong is situated within the hypothetical epicentre and serves as a sentinel post for the region. In a retrospective study, the influenza-associated excess hospitalisations in a regional hospital for pneumonia, chronic obstructive pulmonary disease (COPD), heart failure, and asthma in persons aged > or = 65 years from 1998 to 2001 were each estimated by a model taking into consideration the confounding effect of other respiratory viral infections, seasonal factors, time trends, and weather and pollution indices. In the regression models, influenza activity is an independent significant factor affecting admission rates for pneumonia, COPD, and heart failure but not that for asthma. The variations in hospital admissions for pneumonia, COPD, and heart failure explained by influenza activity were 38.9, 7.5, and 45.6%, respectively. The adjusted rates of excess influenza-associated hospital admissions for the three diagnoses combined amounted to 58.5, 20.0, 29.2, and 13.4 per 10,000 populations aged > or = 65 years in 1998, 1999, 2000, and 2001, respectively. In conclusion, influenza activity is associated significant excess hospital admissions among elderly aged 65 or above in Hong Kong, comparable to the data reported in Western countries. The findings support a wider application of annual influenza vaccination in this region.
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Affiliation(s)
- Florence H Y Yap
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
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Higgins JP, Higgins JA, Higgins PM, Ahuja S, Higgins DL. Chlamydia pneumoniae and coronary artery disease: legitimized linkages? Expert Rev Cardiovasc Ther 2003; 1:367-84. [PMID: 15030265 DOI: 10.1586/14779072.1.3.367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chlamydia pneumoniae (Cp) infection in early life may accelerate atherosclerosis over ensuing decades, leading to cardiovascular complications. Cp promotes endothelial dysfunction and may modulate inflammation underlying atherosclerosis. It represents a biologically plausible candidate for the causation of atherosclerosis. Other infections simultaneously occurring with Cp may result in a synergistic effect to promote atherosclerosis. Studies on the treatment of Cp with antibiotics indicates decreased rates of infection, modulation of inflammation and in some settings, fewer cardiovascular complications.
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Affiliation(s)
- John P Higgins
- Harvard Medical School, Brigham and Women's Hospital, Cardiology Section, 4C108, VA Boston Healthcare System, 1400 VFW Parkway, Boston, MA 02132, USA.
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Hämäläinen P, Meurman JH, Keskinen M, Heikkinen E. Relationship between dental health and 10-year mortality in a cohort of community-dwelling elderly people. Eur J Oral Sci 2003; 111:291-6. [PMID: 12887393 DOI: 10.1034/j.1600-0722.2003.00055.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Dental examinations were carried out as part of the Evergreen project, which focuses on functional capacity and health among the elderly residents of the city of Jyväskylä, central Finland. Dental status was examined in 1990 for the whole population born in 1910 (n = 226). Mortality data were collected over 10 yr. The aim of the study was to assess the possible role of dental health as a predictor of mortality. The Kaplan-Meier method was used to analyse survival curves and Cox regression models, with the number of chronic conditions and self-rated health used as covariates in analysing the risks of death. The results showed that the more teeth or filled teeth a subject had, the smaller was their risk for death. The effect of missing teeth was significant after adjusting for the general health variables. Thus, our results support the hypothesis that poor dental health is linked to increased mortality among elderly people.
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Affiliation(s)
- Piia Hämäläinen
- Institute of Dentistry, University of Helsinki, and Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland.
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Nichol KL, Nordin J, Mullooly J, Lask R, Fillbrandt K, Iwane M. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med 2003; 348:1322-32. [PMID: 12672859 DOI: 10.1056/nejmoa025028] [Citation(s) in RCA: 546] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Upper respiratory tract illnesses have been associated with an increased risk of ischemic heart disease and stroke. During two influenza seasons, we assessed the influence of vaccination against influenza on the risk of hospitalization for heart disease and stroke, hospitalization for pneumonia and influenza, and death from all causes. METHODS Cohorts of community-dwelling members of three large managed-care organizations who were at least 65 years old were studied during the 1998-1999 and 1999-2000 influenza seasons. Administrative and clinical data were used to evaluate outcomes, with multivariable logistic regression to control for base-line demographic and health characteristics of the subjects. RESULTS There were 140,055 subjects in the 1998-1999 cohort and 146,328 in the 1999-2000 cohort, of which 55.5 percent and 59.7 percent, respectively, were immunized. At base line, vaccinated subjects were on average sicker, having higher rates of most coexisting conditions, outpatient care, and prior hospitalization for pneumonia than unvaccinated subjects. Unvaccinated subjects, however, were more likely to have been given a prior diagnosis of dementia or stroke. Vaccination against influenza was associated with a reduction in the risk of hospitalization for cardiac disease (reduction of 19 percent during both seasons [P<0.001]), cerebrovascular disease (reduction of 16 percent during the 1998-1999 season [P<0.018] and 23 percent during the 1999-2000 season [P<0.001]), and pneumonia or influenza (reduction of 32 percent during the 1998-1999 season [P<0.001] and 29 percent during the 1999-2000 season [P<0.001]) and a reduction in the risk of death from all causes (reduction of 48 percent during the 1998-1999 season [P<0.001] and 50 percent during the 1999-2000 season [P<0.001]). In analyses according to age, the presence or absence of major medical conditions at base line, and study site, the findings were consistent across all subgroups. CONCLUSIONS In the elderly, vaccination against influenza is associated with reductions in the risk of hospitalization for heart disease, cerebrovascular disease, and pneumonia or influenza as well as the risk of death from all causes during influenza seasons. These findings highlight the benefits of vaccination and support efforts to increase the rates of vaccination among the elderly.
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Affiliation(s)
- Kristin L Nichol
- Veterans Affairs Medical Center and the University of Minnesota, Minneapolis 55417, USA.
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Abstract
Parallel with the mounting evidence that atherosclerosis has a major inflammatory component, provoking agents that may initiate and drive this process have been sought. Infectious agents such as Chlamydia pneumoniae have been alleged to be activators of inflammation that may contribute to atherosclerosis and thus coronary artery disease (CAD) and its associated complications. A logical pneumoniae extension of this theory whether treating C pneumoniae infection with antibiotics and/or modulating inflammatory processes can affect CAD and its sequelae. This article discusses the potential role of C pneumoniae in atherosclerosis, its detection, and the rationale for antibiotics. Additionally, it summarizes the current randomized clinical trials of antichlamydial antibiotics in patients with CAD and draws conclusions based on the results.
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Affiliation(s)
- John P Higgins
- Department of Medicine, University of Oklahoma, Tulsa, USA.
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Persson RE, Hollender LG, Powell VL, MacEntee M, Wyatt CCL, Kiyak HA, Persson GR. Assessment of periodontal conditions and systemic disease in older subjects. II. Focus on cardiovascular diseases. J Clin Periodontol 2002; 29:803-10. [PMID: 12423292 DOI: 10.1034/j.1600-051x.2002.290903.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Panoramic radiographs (PMX)s may provide information about systemic health conditions. AIMS i). To study clinical periodontal conditions and collect self-reported health status in a cohort of 1084 older subjects; ii). to study signs of alveolar bone loss and carotid calcification from panoramic radiographs obtained from these subjects; and iii). to study associations between study parameters. MATERIAL AND METHODS PMXs from 1064 adults aged 60-75 (mean age 67.6, SD +/- 4.7) were studied. Signs of alveolar bone loss, vertical defects, and molar furcation radiolucencies defined periodontal status. Medical health histories were obtained via self-reports. Signs of carotid calcification were identified from panoramic radiographs. RESULTS The PMX allowed assessment of 53% of the films (Seattle 64.5% and Vancouver 48.4%). A self-reported history of a stroke was reported by 8.1% of men in Seattle and 2.9% of men in Vancouver (P < 0.01). Heart attacks were reported by 12% of men in Seattle and 7.2% in Vancouver (N.S.). PMX evidence of periodontitis was found in 48.5% of the subjects, with carotid calcification in 18.6%. The intraclass correlation score for PMX findings of carotid calcification and stroke was 0.24 (95% CI: 0.10-0.35, P < 0.001). The odds ratio for PMX carotid calcification and periodontitis was 2.1 (95% CI: 1.3-3.2, P < 0.001), and for PMX carotid calcification and stroke 4.2 (95% CI: 1.9-9.1, P < 0.001). The associations disappeared when smoking was accounted for. A history of a heart attack was associated with stroke, gender, age, and PMX scores of alveolar bone loss. CONCLUSIONS PMXs may provide valuable information about both oral conditions and signs of carotid calcification, data that are consistent with self-reported health conditions. Alveolar bone loss as assessed from PMXs is associated with cardiovascular diseases.
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Affiliation(s)
- R E Persson
- Department of Oral Medicine, University of Washington, Seattle, WA, USA.
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Dugan JP, Feuge RR, Burgess DS. Review of evidence for a connection between Chlamydia pneumoniae and atherosclerotic disease. Clin Ther 2002; 24:719-35. [PMID: 12075941 DOI: 10.1016/s0149-2918(02)85147-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Established risk factors account for no more than 50% of coronary artery disease cases; therefore, the search continues for other modifiable risk factors. In recent years, there has been renewed interest in the infectious theory of atherosclerosis. Chlamydia pneumoniae has been implicated as a potential cause of atherosclerotic disease. OBJECTIVE This review discusses possible mechanisms of C pneumoniae involvement in atherosclerosis, summarizes the case-control studies and antibiotic trials completed, and identifies remaining questions about future therapy. METHODS Published data were identified by a MEDLINE search of the English-language literature from 1966 through 2001 using the terms Chlamydia, atherosclerosis, and coronary artery disease. Relevant conference presentations and book chapters were also included. RESULTS C pneumoniae antibodies are found in approximately 50% of middle-aged adults world-wide. These antibodies have been detected in atherosclerotic tissue by various methods, including microimmunofluorescence, and several studies have linked high antibody titers with increased risk of cardiovascular events. A few possible mechanisms for this perceived increase in risk have been proposed, such as induction of atheroma through damage to the endothelium, expression of procoagulant factor leading to thrombus formation, and production of cytokines resulting in increased inflammatory response. Results of animal studies suggest that early antibiotic treatment may reduce cardiovascular risk, but the first human studies have not produced conclusive results. CONCLUSIONS Although a connection has been suggested, the precise mechanism by which C pneumoniae affects atherosclerosis has not yet been identified. Large-scale trials are needed to determine whether eradication of C pneumoniae reduces the incidence of cardiovascular events in humans.
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Babaei S, Stewart DJ, Picard P, Monge JC. Effects of VasoCare therapy on the initiation and progression of atherosclerosis. Atherosclerosis 2002; 162:45-53. [PMID: 11947896 DOI: 10.1016/s0021-9150(01)00680-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
VasoCare therapy, which involves the administration of autologous blood following the ex vivo exposure to physico-chemical stressors, has been shown to modulate immune responses. Since immune mechanisms have been recognized to be pivotal in the pathogenesis of atherosclerosis, we hypothesized that VasoCare treatment would inhibit atherosclerosis in LDL-R (-/-) mice. Three groups of LDL-R (-/-) mice were studied: a control group that was fed normal chow (Group I) and no other treatment; a control group that received a high cholesterol (HC) diet for 8 weeks (group II) with sham saline injections; and a third group (III) that received HC diet for 8 weeks and VasoCare treatment initiated after four weeks of HC feeding. Atherosclerotic area (AA), relative to total aortic area (TA), was assessed after 8 weeks of HC feeding by oil red O staining, and cross sectional plaque area at the level of the aortic valve leaflets was determined by quantitative morphometry. HC mice exhibited substantial aortic lipid deposition which was profoundly reduced in the VasoCare treated animals (AA/TA ratios in group II: 0.32+/-0.15 vs. group III: 0.17+/-0.06; P<0.05). This was associated with a significant decrease in cross sectional area of plaque in the aortic sinuses. VasoCare therapy also reduced the xanthoma formation and limb swelling characteristic of this animal model. However, cholesterol levels, measured by an enzymatic assay, showed similar marked increases in total serum cholesterol (CHO) in the animals receiving HC diet alone and those receiving the HC diet and VasoCare treatment [group I: 5.4+/-0.8 mM, group II: 46.7+/-3.6 mM, and group III: 44.7+/-2.8 mM (P<0.01 vs. group I)]. We conclude that VasoCare treatment inhibits progression of atherosclerotic lesions in a murine model of human familial hypercholesterolemia by a mechanism independent of cholesterol lowering.
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Affiliation(s)
- Saeid Babaei
- Terrence Donnelly Vascular Biology Laboratory, Terrence Donnelly Heart Center, Division of Cardiology, St. Michael's Hospital, 30 Bond Street, Toronto Ont., Canada M5B 1W8
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Hughes ES, Shaw KM, Ashley RH. Mutagenesis and functional reconstitution of chlamydial major outer membrane proteins: VS4 domains are not required for pore formation but modify channel function. Infect Immun 2001; 69:1671-8. [PMID: 11179342 PMCID: PMC98071 DOI: 10.1128/iai.69.3.1671-1678.2001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chlamidial organisms are obligate intracellular pathogens containing highly antigenic porin-like major outer membrane proteins (MOMPs). MOMP epitopes are of substantial medical interest, and they cluster within four relatively short variable (VS) domains. If MOMPs adopt a beta-barrel fold, like bacterial porins, the VS domains may form extramembranous loops and the conserved regions of the protein may correspond to predicted membrane-located beta-strands. However, molecular studies on native MOMPs have been hampered by the need to culture chlamydiae in eukaryotic host cells and purification and reconstitution remain problematic. In addition, the organisms are difficult to manipulate genetically, and it has also been difficult to functionally reconstitute recombinant MOMPs. To help overcome these problems and improve our understanding of MOMP structure and function, we cloned and expressed C. trachomatis and C. psittaci MOMPs and functionally reconstituted them at the single-channel level. We measured significant functional differences between the two proteins, and by removing and exchanging VS4, we tested the hypothesis that the largest variable domain forms an extramembranous loop that contributes to these differences. Proteins in which VS4 was deleted continued to form functional ion channels, consistent with the idea that the domain forms an extramembranous protein loop and incompatible with models in which it contributes to predicted membrane-located beta-strands. Additionally, the properties of the chimeric proteins strongly suggested that the VS4 domain interacts closely with other regions of the protein to form the channel entrance or vestibule. Our approach can be used to probe structure-function relationships in chlamydial MOMPs and may have implications for the generation of effective antichlamydial vaccines.
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Affiliation(s)
- E S Hughes
- Department of Biomedical Sciences, University of Edinburgh, Edinburgh EH8 9XD, United Kingdom
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Okuda K, Ishihara K, Nakagawa T, Hirayama A, Inayama Y, Okuda K. Detection of Treponema denticola in atherosclerotic lesions. J Clin Microbiol 2001; 39:1114-7. [PMID: 11230436 PMCID: PMC87882 DOI: 10.1128/jcm.39.3.1114-1117.2001] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We examined 26 atherosclerotic lesions and 14 nondiseased aorta specimens to detect the periodontopathogenic part of the bacterial 16S rRNA locus by PCR. Treponema denticola sequence of the 16S rRNA locus was found in 6 out of 26 DNA samples (23.1%) from the formalin-fixed, paraffin-embeded atherosclerotic lesions obtained during surgery but not in any of the 14 nondiseased aorta samples from deceased persons. Utilizing immunofluorescence microscopy, we observed aggregated antigenic particles reacting with rabbit antiserum against T. denticola in thin sections of the PCR-positive samples, but we could not detect any reacting particles in the PCR-negative thin sections.
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Affiliation(s)
- K Okuda
- Oral Health Science Center, Tokyo Dental College, 1-2-2, Masago, Mihama-ku, Chiba, Japan.
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42
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Abstract
Recently, it has been recognized that oral infection, especially periodontitis, may affect the course and pathogenesis of a number of systemic diseases, such as cardiovascular disease, bacterial pneumonia, diabetes mellitus, and low birth weight. The purpose of this review is to evaluate the current status of oral infections, especially periodontitis, as a causal factor for systemic diseases. Three mechanisms or pathways linking oral infections to secondary systemic effects have been proposed: (i) metastatic spread of infection from the oral cavity as a result of transient bacteremia, (ii) metastatic injury from the effects of circulating oral microbial toxins, and (iii) metastatic inflammation caused by immunological injury induced by oral microorganisms. Periodontitis as a major oral infection may affect the host's susceptibility to systemic disease in three ways: by shared risk factors; subgingival biofilms acting as reservoirs of gram-negative bacteria; and the periodontium acting as a reservoir of inflammatory mediators. Proposed evidence and mechanisms of the above odontogenic systemic diseases are given.
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Ito D, Murata M, Tanahashi N, Sato H, Sonoda A, Saito I, Watanabe K, Fukuuchi Y. Polymorphism in the promoter of lipopolysaccharide receptor CD14 and ischemic cerebrovascular disease. Stroke 2000; 31:2661-4. [PMID: 11062291 DOI: 10.1161/01.str.31.11.2661] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE A growing amount of evidence suggests that infectious and inflammatory processes may be involved in the initiation of arteriosclerosis, but the mechanisms are conceivably multifactorial and complex. Two European groups have recently demonstrated that a C(-260)-->T polymorphism in the promoter of the CD14 lipopolysaccharide receptor may be a risk factor for coronary artery disease (CAD). The T allele of this polymorphism reportedly increases the expression of CD14 and may be involved in atherogenesis. In the present study we investigated a possible association between the C(-260)-->T polymorphism in the CD14 promoter and the occurrence of symptomatic ischemic cerebrovascular disease (CVD). METHODS Genotype frequencies of the C(-260)-->T polymorphism in the CD14 promoter were determined in 235 patients with CVD, as confirmed by brain CT and/or MRI, and 309 age- and sex-matched control subjects. RESULTS The distribution of genotypes was as follows: CVD patients, T:/T: 24.3%, C:/T: 53.2%, and C:/C: 22. 6%; controls, T:/T: 26.9%, C:/T: 50.2%, and C:/C: 23.0%. There was no significant difference between the CD14 promoter genotypes of the CVD patients and the controls (chi(2)=0.601, P:=0.741). We also measured the concentration of serum soluble CD14 and the density of membranous CD14 on monocytes in the CVD patients, but the polymorphism was not associated with either the concentration of soluble CD14 or the density of membranous CD14 (P:=0.358, P:=0.238, respectively). CONCLUSIONS Our results indicate that the C(-260)-->T polymorphism in the CD14 promoter is not associated with an increased risk for CVD.
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Affiliation(s)
- D Ito
- Department of Neurology, School of Medicine, Keio University, Tokyo, Japan
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Haraszthy VI, Zambon JJ, Trevisan M, Zeid M, Genco RJ. Identification of periodontal pathogens in atheromatous plaques. J Periodontol 2000; 71:1554-60. [PMID: 11063387 DOI: 10.1902/jop.2000.71.10.1554] [Citation(s) in RCA: 697] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Recent studies suggest that chronic infections including those associated with periodontitis increase the risk for coronary vascular disease (CVD) and stroke. We hypothesize that oral microorganisms including periodontal bacterial pathogens enter the blood stream during transient bacteremias where they may play a role in the development and progression of atherosclerosis leading to CVD. METHODS To test this hypothesis, 50 human specimens obtained during carotid endarterectomy were examined for the presence of Chlamydia pneumoniae, human cytomegalovirus, and bacterial 16S ribosomal RNA using specific oligonucleotide primers in polymerase chain reaction (PCR) assays. Approximately 100 ng of chromosomal DNA was extracted from each specimen and then amplified using standard conditions (30 cycles of 30 seconds at 95 degrees C, 30 seconds at 55 degrees C, and 30 seconds at 72 degrees C). Bacterial 16S rDNA was amplified using 2 synthetic oligonucleotide primers specific for eubacteria. The PCR product generated with the eubacterial primers was transferred to a charged nylon membrane and probed with digoxigenin-labeled synthetic oligonucleotides specific for Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Porphyromonas gingivalis, and Prevotella intermedia. RESULTS Eighty percent of the 50 endarterectomy specimens were positive in 1 or more of the PCR assays. Thirty-eight percent were positive for HCMV and 18% percent were positive for C. pneumoniae. PCR assays for bacterial 16S rDNA also indicated the presence of bacteria in 72% of the surgical specimens. Subsequent hybridization of the bacterial 16S rDNA positive specimens with species-specific oligonucleotide probes revealed that 44% of the 50 atheromas were positive for at least one of the target periodontal pathogens. Thirty percent of the surgical specimens were positive for B. forsythus, 26% were positive for P. gingivalis, 18% were positive for A. actinomycetemcomitans, and 14% were positive for P. intermedia. In the surgical specimens positive for periodontal pathogens, more than 1 species was most often detected. Thirteen (59%) of the 22 periodontal pathogen-positive surgical specimens were positive for 2 or more of the target species. CONCLUSIONS Periodontal pathogens are present in atherosclerotic plaques where, like other infectious microorganisms such as C. pneumoniae, they may play a role in the development and progression of atherosclerosis leading to coronary vascular disease and other clinical sequelae.
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Affiliation(s)
- V I Haraszthy
- Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, USA
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Li X, Kolltveit KM, Tronstad L, Olsen I. Systemic diseases caused by oral infection. Clin Microbiol Rev 2000; 13:547-58. [PMID: 11023956 PMCID: PMC88948 DOI: 10.1128/cmr.13.4.547] [Citation(s) in RCA: 471] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Recently, it has been recognized that oral infection, especially periodontitis, may affect the course and pathogenesis of a number of systemic diseases, such as cardiovascular disease, bacterial pneumonia, diabetes mellitus, and low birth weight. The purpose of this review is to evaluate the current status of oral infections, especially periodontitis, as a causal factor for systemic diseases. Three mechanisms or pathways linking oral infections to secondary systemic effects have been proposed: (i) metastatic spread of infection from the oral cavity as a result of transient bacteremia, (ii) metastatic injury from the effects of circulating oral microbial toxins, and (iii) metastatic inflammation caused by immunological injury induced by oral microorganisms. Periodontitis as a major oral infection may affect the host's susceptibility to systemic disease in three ways: by shared risk factors; subgingival biofilms acting as reservoirs of gram-negative bacteria; and the periodontium acting as a reservoir of inflammatory mediators. Proposed evidence and mechanisms of the above odontogenic systemic diseases are given.
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Affiliation(s)
- X Li
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway.
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46
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Loesche WJ. The antimicrobial treatment of periodontal disease: changing the treatment paradigm. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 2000; 10:245-75. [PMID: 10759408 DOI: 10.1177/10454411990100030101] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the last 100 years, methods of surgical periodontal treatment have enjoyed a history of success in improving oral health. The paradigm of care is based on the "non-specific plaque hypothesis"--that is, the overgrowth of bacterial plaques cause periodontal disease, and the suppression of this overgrowth reduces disease risk. The central feature of this approach to care is the removal of inflamed gingival tissue around the teeth to reduce periodontal pocket depth, thereby facilitating plaque removal by the dentist and by the patient at home. Over the last 30 years, with the recognition that periodontal disease(s) is caused by specific bacteria and that specific antimicrobial agents can reduce or eliminate the infection, a second paradigm has developed. This new paradigm, the "specific plaque hypothesis", focuses on reducing the specific bacteria that cause periodontal attachment loss. The contrast between the two paradigms can be succinctly stated as follows: The antimicrobial therapy reduces the cause, while the surgical therapy reduces the result of the periodontal infection. The specific plaque hypothesis has two important implications. First, with the increasing attention to evidence-based models for prevention, treatment, outcome assessment, and reimbursement of care, increasing attention and financial effort will be channeled into effective preventive and treatment methods. Second, the recent observations that periodontal infections increase the risk of specific systemic health problems, such as cardiovascular disease, argue for the prevention and elimination of these periodontal infections. This review highlights some of the evidence for the specific plaque hypothesis, and the questions that should be addressed if antimicrobial agents are to be used responsively and effectively.
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Affiliation(s)
- W J Loesche
- University of Michigan School of Dentistry, Ann Arbor 48109, USA
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47
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Costa DL. Understanding the twentieth-century decline in chronic conditions among older men. Demography 2000. [DOI: 10.2307/2648096] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
I argue that the shift from manual to white-collar jobs and reduced exposure to infectious disease were important determinants of declines in chronic disease rates among older men from the early 1900s to the 1970s and 1980s. The average decline in chronic respiratory problems, valvular heart disease, arteriosclerosis, and joint and back problems was about 66%. Occupational shifts accounted for 29% of the decline; the decreased prevalence of infectious disease accounted for 18%; the remainder are unexplained. The duration of chronic conditions has remained unchanged since the early 1900s, but when disability is measured by difficulty in walking, men with chronic conditions are less disabled now than they were in the past.
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Affiliation(s)
- Dora L. Costa
- Massachusetts Institute of Technology, Department of Economics, E52-274C, 50 Memorial Drive, Cambridge, MA 02142
- National Bureau of Economic Research, USA
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48
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Abstract
A growing amount of epidemiologic, experimental, and clinical evidence has linked infection as a risk factor to variousatherosclerotic diseases including acute myocardial infarction and cerebral infarction. Bacteremic infections with and without endocarditis carry a high risk for both stroke and acute myocardial infarction. During the last decade, chronic bacterial infections such as Chlamydia pneumoniae and dental infections have been associated as risk factors for various atherosclerotic diseases. These chronic bacterial infections are risk factors for acute cardiovascular events, but they may also have some role in the etiopathogenesis of atherosclerotic process itself. There are many known mechanisms that might explain the observed association of infection and atherosclerotic diseases, but it is probable that these mechanisms are complex and multifactorial and probably differ from infection to infection and from patient to patient. Infection theory is by no means against classic risk factor theory in the etiopathogenesis of atherosclerosis. Infection may also act as a synergistic risk factor together with classic risk factors in the development of various atherosclerotic diseases.
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Affiliation(s)
- V V Valtonen
- Division of Infectious Diseases, Department of Medicine, Helsinki, Finland
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49
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Dorn BR, Dunn WA, Progulske-Fox A. Invasion of human coronary artery cells by periodontal pathogens. Infect Immun 1999; 67:5792-8. [PMID: 10531230 PMCID: PMC96956 DOI: 10.1128/iai.67.11.5792-5798.1999] [Citation(s) in RCA: 227] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/1999] [Accepted: 07/30/1999] [Indexed: 12/20/2022] Open
Abstract
There is an emerging paradigm shift from coronary heart disease having a purely hereditary and nutritional causation to possibly having an infectious etiology. Recent epidemiological studies have shown a correlation between periodontal disease and coronary heart disease. However, to date, there is minimal information as to the possible disease mechanisms of this association. It is our hypothesis that invasion of the coronary artery cells by oral bacteria may start and/or exacerbate the inflammatory response in atherosclerosis. Since a few periodontal pathogens have been reported to invade oral epithelial tissues, we tested the ability of three putative periodontal pathogens-Eikenella corrodens, Porphyromonas gingivalis, and Prevotella intermedia-to invade human coronary artery endothelial cells and coronary artery smooth muscle cells. In this study we demonstrate by an antibiotic protection assay and electron microscopy that specific species and strains invade coronary artery cells at a significant level. Actin polymerization and eukaryotic protein synthesis in metabolically active cells were required since the corresponding inhibitors nearly abrogated invasion. Many intracellular P. gingivalis organisms were seen to be present in multimembranous vacuoles resembling autophagosomes by morphological analysis. This is the first report of oral microorganisms invading human primary cell cultures of the vasculature.
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Affiliation(s)
- B R Dorn
- Department of Oral Biology, College of Dentistry, College of Medicine, University of Florida, Gainesville, Florida 32610, USA
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Affiliation(s)
- B L Mealey
- Department of Periodontics, Eglin Air Force Base Hospital, Eglin Air Force Base, Florida, USA
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