Correlative analysis of plasma and urine neopterin levels in the pre- and post-menopausal women with periodontitis, following nonsurgical periodontal therapy

Diagnostic Accuracy of Urinary Biomarkers in Periodontitis: A Systematic Review and Meta-Analysis

Background

Biomarkers can be measured in various biological samples. Urine is among the most useful biofluids for routine testing, and several experimental and clinical studies support its role as a tool for the diagnosis and prevention of various diseases. The present systematic review aimed to examine periodontitis-specific urine biomarkers that could have a diagnostic relevance and to provide a qualitative assessment of the current literature.

Materials and Methods

Relevant studies identified from PubMed, Embase, Cochrane Library, and Scopus databases were examined to answer the following PECO question: "Could the concentration of specific metabolites in the urine be related to periodontal health and what is their diagnostic accuracy?". Quality of included studies was rated using ROBINS-I tool. Meta-analysis was conducted on available quantitative data.

Results

After the screening of 768 titles, five studies were included in qualitative synthesis. The studies included referred to the evaluation of 8-hydroxy-2'-deoxyguanosine (8-OHdG) and neopterin. Meta-analysis was conducted for neopterin concentration on data available in four studies involving 129 participants. Higher concentrations of neopterin were found in periodontitis-affected patients compared to controls and patients treated for periodontitis.

Conclusions

The literature appears controversial in attributing a role to neopterin and 8-OHdG as periodontal biomarkers, highlighting the need for further clinical studies on this topic. While some studies report variations in 8-OHdG and neopterin levels in periodontally affected patients versus either controls or periodontally treated patients, the level of evidence appears still limited to draw firm conclusions (PROSPERO CRD42020222681).

β 2-Microglobulin and Neutrophil Gelatinase-Associated Lipocalin, Potential Novel Urine Biomarkers in Periodontitis: A Cross-Sectional Study in Japanese

Objectives

Several serum biomarkers have been reported to increase in periodontitis patients as possible mediators linking periodontal inflammation to systemic diseases. However, the relationship between periodontitis and urine biomarkers is still unclear. The aim of this cross-sectional study was to investigate potential urine biomarkers of periodontitis in a Japanese population.

Materials and Methods

This study included 108 male subjects, and microbiological and clinical parameters were evaluated as a periodontitis marker. The correlation between nine urine biomarkers (typically used to diagnose kidney disease) and periodontal parameters was analyzed. Based on the findings, β₂-microglobulin (β₂-MG) and neutrophil gelatinase-associated lipocalin (NGAL) were selected for comparison and multivariate regression analysis, and the Kruskal–Wallis test followed by Bonferroni correction was used to identify differences in their concentrations between the three periodontitis groups (severe, moderate, and no/mild periodontitis).

Results

β₂-MG and NGAL exhibited a significant correlation with clinical parameters of periodontitis. The prevalence of clinical parameters such as bleeding on probing and number of sites with probing depth (PD) ≥ 6 mm were greater in the β₂-MG high group (≥300 μg/g creatinine) than in the normal group (P=0.017 and 0.019, respectively). Multivariate regression analysis indicated that the number of sites with PD ≥ 6 mm was independently associated with urine β₂-MG. Moreover, the number of sites with the clinical attachment level (CAL) ≥ 6 mm was greater in the NGAL high group (highest quartile) (P=0.041). Multivariate regression analysis showed that the number of sites with CAL ≥ 6 mm was associated independently with urine NGAL. Finally, β₂-MG was significantly higher in the severe periodontitis subjects compared to the no/mild periodontitis subjects.

Conclusion

The significant association between urine β₂-MG or NGAL and periodontitis was revealed. These biomarkers can potentially be used to screen for or diagnose periodontitis. This trial is registered with the UMIN Clinical Trials Registry UMIN000013485.