Obesity Is Associated with a Weakened Gingival Inflammatory Cytokine Response

Background and Objectives: An obesity-related elevated body mass index (BMI) across life is associated with chronic low-grade inflammation and increased levels of C-reactive protein (CRP) in blood. CRP is a marker and promoter of inflammation. The objectives of this study were to examine the effect of obesity on the relationship between peripheral and gingival CRP levels and to examine the effects of gingival CRP levels on gingival fluid inflammatory cytokines in periodontitis-resistant obese individuals. Materials and Methods: Thirty-nine participants in good periodontal health were recruited. Twenty patients were classified as lean and nineteen as obese based on their BMI levels. A thorough periodontal assessment was carried out. Gingival crevicular fluid (GCF) and blood samples were collected. Both GCF and blood samples were analyzed for interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), interleukin-17A (IL-17A), and CRP. Results: GCF CRP levels were significantly higher in the obese than in the lean individuals. No statistically significant differences were noted between the two groups in either GCF or blood in terms of any of the inflammatory cytokine levels. IL-17A was not detected in the GCF of most subjects in both groups. GCF CRP levels were positively associated with blood CRP levels, and the association tended to be stronger in the obese individuals. GCF CRP showed no associations with GCF IL-10 in both groups. Although GCF CRP levels were positively associated with multiple GCF inflammatory cytokines (e.g., IL-1β, IL-6, IL-8, and TNF-α) in all subjects, the associations tended to be weaker in the obese individuals (e.g., IL-1β, IL-6, and TNF-α). Furthermore, the levels of the GCF inflammatory cytokines IL-6 and TNF-α were decreased in the obese individuals. Conclusions: Obesity unfavorably influences the relationship between blood and GCF CRP levels and promotes increased CRP levels in GCF. Collectively, the findings suggest a weakened inflammatory cytokine response in the gingival tissues of obese individuals.

Non-Surgical Periodontal Therapy Could Improve the Periodontal Inflammatory Status in Patients with Periodontitis and Chronic Hepatitis C

Non-surgical periodontal therapy (NSPT) is the first essential step for the management of any periodontitis patient. This study aims to evaluate the impact of NSPT on pro-inflammatory mediators’ regulation and on clinical parameters in periodontitis patients who suffer from chronic hepatitis C. At baseline, selected patients were clinically evaluated for their periodontal status. A subsequent quantitative assessment of C-reactive protein and pentraxin-3 in samples of gingival fluid was performed by Enzyme-Linked Immunosorbent Assay (ELISA). Afterwards, NSPT was performed. Three months after NSPT, the clinical and ELISA assessments were repeated. The results show an improvement of the clinical parameters in periodontitis patients at the three-month recall. In chronic hepatitis C patients with periodontitis, the gingival fluid levels of pro-inflammatory markers reduced significantly. The targeted markers also expressed significant correlations with the clinical parameters used for the assessment of periodontitis’ severity. The results suggest that, while chronic hepatitis C patients exhibited a more negative periodontal status at baseline as compared to non-hepatitis ones, NSPT is effective in decreasing the local periodontal inflammatory reaction and in proving the periodontal status of this type of patients. Given the limitation of the study, periodontal screening and NSPT should be included in the integrated therapeutical approach of chronic hepatitis C patients, for its impact on the local inflammatory response.

COVID-19 diagnosis by RT-qPCR in alternative specimens

BACKGROUND

The high demand for adequate material for the gold standard reverse transcription real-time polymerase chain reaction (RT-qPCR)-based diagnosis imposed by the Coronavirus disease 2019 (COVID-19) pandemic, combined with the inherent contamination risks for healthcare workers during nasopharyngeal swab (NP) sample collection and the discomfort it causes patients, brought the need to identify alternative specimens suitable for the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

OBJECTIVES

The aim of this work was to compare saliva and gingival fluid swabs to NP swabs as specimens for RT-qPCR-based SARS-CoV-2 diagnosis.

METHODS

We compared gingival fluid swabs (n = 158) and saliva (n = 207) to the rayon-tipped NP swabs obtained from mild-symptomatic and asymptomatic subjects as specimens for RT-qPCR for SARS-CoV-2 detection.

FINDINGS

When compared to NP swabs, gingival fluid swabs had a concordance rate of 15.4% among positive samples, zero among inconclusive, and 100% among negative ones. For saliva samples, the concordance rate was 67.6% among positive samples, 42.9% among inconclusive, and 96.8% among negative ones. However, the concordance rate between saliva and NP swabs was higher (96.9%) within samples with lower cycle threshold (Ct) values (Ct > 10 ≤ 25).

MAIN CONCLUSIONS

Our data suggests that whereas gingival fluid swabs are not substitutes for NP swabs, saliva might be considered whenever NP swabs are not available or recommended.

[Diagnostic possibilities of laboratory assessment of cathepsin K activity in gingival and peri-implant fluid under normal conditions and periimplantitis]

OBJECTIVE

The aim of the work was to develop a non-invasive laboratory method for local control of the severity of osteo-destructive processes in the bone tissue of the jaws after dental implantation.

MATERIALS AND METHODS

The study comprised 75 individuals aged 18 to 65. The main group included 40 patients with a diagnosis of dental periimplantitis (ICD K 10.2). A comparison group (n=20) included patients after dental implantation without postoperative complications. The control group (n=25) consisted of individuals without dental pathology. Cathepsin K (CTSK) (Human) ELISA Kit (Cloud-Clone Corp., USA) was used to determine the concentration of cathepsin K by the enzyme immunoassay in the gingival or peri-implant fluid.

RESULTS

The concentration of cathepsin K in the gingival fluid in the patients of the control group was 1.7±0.3 pmol/l, in the comparison group the concentration of the studied biomarker corresponded to 2.3±0.4 pmol/l. In the main group, the concentration of cathepsin K in the exudate of peri-implantation pockets increased 2.8 times (p<0.05) and corresponded to 4.9±0.5 pmol/l. The concentration of cathepsin K in the gingival fluid normally did not depend on age and gender, which increased the independence of the osteomarker for characterizing the osteoresorbent process in the peri-implantation area. After dental implantation, an excess of cathepsin K concentration above the level of 2.7 pmol/l with a diagnostic sensitivity of 82.5% and a specificity of 83.7% suggests a high risk of developing peri-implantitis.

CONCLUSION

The concentration of cathepsin K may be seen as valuable marker for local inflammatory and destructive processes in the contents of the peri-implantation area.

Laboratory control of the osteoresorptive effects of glucorcorticoids in patients with purpose colitis

The aim of the work was to develop an informative method for laboratory monitoring of osteoresorbent action during systemic administration of glucocorticoids in patients with ulcerative colitis. The study included 54 patients with ulcerative colitis aged 18 to 44 years: 35 (64,8%) men and 19 (35,2%) women. In patients of the clinical group before and after the first, second, third courses of glucocorticosteroids, as well as during the formation of steroid dependence, the concentration of the osteoresorption marker cathepsin K was determined simultaneously in the blood serum and gingival fluid by enzyme immunoassay. The concentration of the osteomarker was compared with the parameters of the densitometric density of the lumbar vertebrae L1-L4 during X-ray examination. It was found that with the systemic use of glucocorticoids in patients with ulcerative colitis, the concentration of cathepsin K in the gingival fluid increased earlier than in the blood serum. It was found that with an increase in the concentration of cathepsin K in the gingival fluid of more than 2,6 pmol/l in conditions of systemic administration of glucocorticosteroids, the risk of osteoporosis increased with a diagnostic sensitivity of 81,8% and a specificity of 74,4% (p=0,0001).The diagnostic accuracy was 78,1%. With an increase in the concentration of cathepsin K in the gingival fluid above the differential separation level (2,6 pmol/l), the risk of developing osteoporosis increased 3,2 times (p= 0,0001). The study developed a methodological and informational algorithm has been developed for the non-invasive control of steroidal osteoporosis in patients with ulcerative colitis with systemic use of glucocorticoids by assessing the concentration of cathepsin K in the gingival fluid.

Comparison of nasopharyngeal and saliva swabs for the detection of RNA SARS-CoV-2 during mass screening (SALICOV study)

In the context of a second wave of SARS-CoV-2 transmission, the use of saliva sampling has become an issue of real importance. SARS-CoV-2 RNA screening was performed on nasopharyngeal and saliva swabs collected from 501 individuals from residential homes for the elderly. The saliva samples were collected at the same time as the nasopharyngeal samples. Nasopharyngeal samples yielded positive results for 26 individuals, only two of whom also tested positive with saliva swabs. In this context, saliva collected by swabbing the fluid is not an ideal sample.

[Spectroscopic studies of the molecular composition of the dentinal and gingival fluids and their diagnostic potential for preventive screening of dentin caries]

PURPOSE OF THE STUDY

The aim of the work is a spectroscopic investigation and comparison of the molecular composition of dentine and gingival fluids as well as of their diagnostic potential for the preventive screening of dentin caries.

MATERIAL AND METHODS

Applying infrared spectroscopy including synchrotron radiation the samples of biological fluids taken from the oral cavity (dentine fluid, fluid from the gingival sulcus and blood) were studied for the patients with the progressive dentine caries. The part of this research was undertaken with the infrared microspectroscopy beamline at the Australian Synchrotron.

RESULTS

Dentine and gingival fluids were shown to have no less complicated composition than the blood serum. Having all this in mind, in spite that these two fluids are derivatives of the blood serum, and a majority of the molecular groups observed in all of the three fluids can be detected in their IR-spectra, it follows that there is a number of signature modes that are in fact present in the IR spectra of only dentine and gingival fluids. This fact indicates at the molecular exchange between them under certain conditions. It means the high diagnostic potential in the study of the pathologic processes occurring in the oral fluid of a human. We have observed and fixed an increase of thiocyanates and esters in the samples of both dentine and gingival fluids under the development of dentin caries.

CONCLUSION

Utilization of the gingival fluid for screening taking into account that its sampling is not such a complicated challenge as dentine fluid sampling will promote a transition to the personalized medicine, the development of high-technology healthcare and technology of the health preservation as a whole.

[Hypoxia-dependent transcriptional control of activity of destructive inflammatory and malignant periodontium changes]

The aim of the study was to evaluate the diagnostic value of determining the level of hypoxia-inducible factor-1α (HIF-1α) in the gingival fluid in patients with chronic generalized periodontitis (CGP) and exacerbation of inflammatory periodontal diseases in patients with cancer of the oral mucosa (OM). A clinical study was carried out with the participation of 60 patients with CGP (group 1) and 22 patients with cancer of OM (group 2) of the T1-2N0M0 stage, as well as 15 healthy individuals with no revealed periodontal pathology. CGP patients, depending on the depth of periodontal pockets (PC), were divided into two subgroups - with a mild degree (PC depth up to 3.5 mm) and an average degree (PC depth from 4 to 6 mm). Group 2 patients were also divided into two subgroups - with exacerbation of CGP (n=12) and patients with no complications (n=10). The content of HIF-1α in the gingival fluid was determined by enzyme immunoassay. The results of the study made it possible to establish that in patients of group 1, the concentration of HIF-1α in inflammatory exudate increased by 2.4 times (p<0.001) compared with the control group. The concentration of HIF-1α in the contents of periodontal pockets in patients with CGP depended on the severity of the disease: with mild CGP, it did not differ from the control group, and with moderate CGP it was 3.15 times higher (p<0.001). In patients with cancer of OM, the concentration of HIF-1α in the gingival fluid did not depend on the presence of inflammatory periodontal lesions and was determined by a multiple increase in the biomarker level (7.5 times) due to the development of a malignant process in the oral cavity. Therefore, monitoring the concentration of HIF-1α in the gingival fluid is informative in patients with CGP in assessing the severity of periodontal conditions, as well as in differential diagnosis with malignant formations of the oral cavity.

[Influence of different type of toothbrushes on gingival fluid proteolytic potential during orthodontic treatment]

THE AIM

To study the effect of toothbrushes of various types on the accumulation of plaque and the proteolytic potential of gingival fluid as a pathogenic factors in long-term orthodontic treatment of patients with a distal permanent bite.

MATERIAL AND METHODS

We examined 63 patients of both sexes aged 11-18 years. Orthodontic treatment was carried out for the close position of the teeth with a distal permanent bite (K07.2) and cleft palate and lips (Q37.1). Patients were divided into three groups depending on the type of toothbrush used for individual oral hygiene: group 1 (n=21) - an orthodontic manual toothbrush (Professor Persin, «Spazzolificio Piave», Italy); Group 2 (n=22) - an ultrasonic toothbrush (Emmi-dent, EMAG AG, Germany) and group 3 (n=20) - an electric toothbrush ("Oral-B Pro-Expert, «Procter & Gamble», USA).

RESULTS

The amount of soft plaque was assessed by the Silness-Loe hygiene index in the subgingival region. The activity of proteolytic enzymes - elastase, collagenase, and a α-inhibitor of proteinases was determined by the enzymatic method using a XL 200 biochemical analyzer («Erba Lachema», Czech Republic). The accumulation of plaque in the gingival region on both jaws during the entire period of orthodontic treatment is most pronounced when using a manual brush compared to ultrasonic and electric brushes. An increase in proteolytic activity in the gingival fluid with a simultaneous decrease in antiprotease potential with long-term orthodontic treatment of patients was observed when using a manual orthodontic brush, which can be regarded as an increase in the activity of the pathogenic factors for the development of local inflammatory and destructive changes.

CONCLUSION

To prevent inflammatory and destructive changes during prolonged orthodontic treatment of patients, the use of ultrasonic and electric toothbrushes in daily oral hygiene is justified.

Interleukin-1α and -1β assessment in the gingival crevicular fluid of periodontal patients with chronic hepatitis C

The study assessed whether the increased production of interleukin-1α (IL-1α) and interleukin-1β (IL-1β), as a result of chronic hepatic inflammation, could be the expression of the negative impact on periodontal disease. The study included chronic periodontitis patients who were systemically healthy, chronic periodontitis patients suffering from chronic hepatitis C, as well as control patients, being systemically and periodontally healthy. After periodontal examination and the assessment of certain periodontal parameters, gingival crevicular fluid was collected from all participating patients. By using the enzyme-linked immunosorbent assay method, a quantitative assessment of IL-1α and IL-1β levels was possible. The immunologic results were correlated to the clinical periodontal data. The gingival fluid levels of cytokines were higher for periodontitis patients with chronic hepatitis C than for the systemically healthy periodontitis patients (1.8-fold higher for IL-1α and 2.1-fold higher for IL-1β). In addition, the gingival fluid cytokine levels were significantly higher for the periodontal patients (with/without chronic hepatitis C) than for the control group. Positive correlations were found between gingival fluid IL-1α and IL-1β levels and certain clinical periodontal parameters or the age of the viral hepatitis C diagnosis, in periodontitis patients with chronic hepatitis C. The chronic hepatic inflammation may have an important additional negative impact on the periodontal status, as both inflammatory reactions seem to be promoted by common pro-inflammatory cytokines.

[Diagnostic and prognostic significance of the hypoxia-dependent transcriptional mediator for the development of a carious lesion]

OBJECTIVE

To study diagnostic informational content of change of concentration a hypoxia-inducible factor (HIF-1α) in gingival liquid of patients for assessment of risk of development of carious process.

MATERIAL AND METHODS

75 patients with the diagnosis dentine caries entered the research: group 1 (n=30) involved patients with primary caries while group 2 (n=45) consisted of patients with caries recurrence in 12 months after treatment.

RESULTS

In all patients HIF-1α was determined in gingival liquid before treatment by the IFA method. Logistic regression and the ROC analysis were used for the statistical analysis. In group 2 the level of HIF-1α was two-fold higher than in group 1 (p<0.001) and 82% higher than in healthy individuals (p<0.001). The increased initial HIF-1α level of 98 pg/ml was associated with high risk of caries recurrence in 12 months after treatment with diagnostic sensitivity of 88.4% and diagnostic specificity of 78.1% with chances of development increased by 4 times (p<0.0001). The change of HIF-1α in gingival liquid from 80 pg/ml to 170 pg/ml increased the risk of caries recurrence 12 months from 13% up to 94%.

CONCLUSION

The initial content in gingival liquid a hypoxia-inducible factor-1α higher than 98 pg/ml allows triage of patients with high risk of caries recurrence requiring dental monitoring for personification of preventive measures.

[Hypoxia-dependent control of the activity of innate antimicrobial immunity in patients with dentin caries]

OBJECTIVE

To study interrelation of maintenance of α-defensins 1-3 and a hypoxia-inducible factor 1-alpha (HIF-1α) in gingival liquid of patients with caries.

MATERIAL AND METHODS

75 patients with the diagnosis dentine caries were enrolled in the study and divided into two groups: in group 1 (n=30) caries was diagnosed in earlier untreated tooth, the 2nd group (n=45) included patients with the recurrence of carious process (in earlier treated tooth). Controls involved 25 caries-free individuals. The level of α-defensins 1-3 was studied in gingival fluid by ELISA method.

RESULTS

The level of α-defensins 1-3 and antimicrobic peptide in gingival liquid in group 2 was 28 and 36% higher than in the 1st group, correspondingly (p<0.001). Concentration of HIF-1α in gingival liquid in the 2^nd group was almost twice higher (p<0.001) than in group 1 and 82% higher than in controls (p<0.001), while in group 1 it decreased by 11% when compared to controls (p<0.001). All controls showed a close correlation between the level of α-defensins 1-3 and HIF-1α in gingival fluid (R=0.78, p<0.001), not observed in group 1 (R=0.32, p>0.05) but statistically significant in group 2 (R=0.78, p<0.001). Thus, the recurrence of carious process in caries-associated tooth is associated with the hypoxia-dependent activation of a congenital antimicrobial immunity by means of accumulation of HIF-1α and pronounced increase of α-defensins 1-3 in gingival fluid.

[Diagnostic and prognostic significance of the hypoxia-dependent factor-1α for the development of a carious lesion]

The research objective was to study the diagnostic value of a hypoxia-dependent factor (HIF-1α) in gingival fluid for assessment of carious process risk. 75 patients with dentine caries entered were enrolled in the study: group 1 (n=30) - primary caries, group 2 (n=45) - secondary recurrent disease (12 months after treatment). HIF-1α was assessed in in gingival liquid of all patients before treatment by the IFA method. Statistical analysis included logistic regression and the ROC analysis. In the 2^nd group of patients HIF-1α value was two-fold higher than in group 1 (p<0.001) and by 82% in healthy controls (p<0.001). The ROC analysis revealed that the initial HIF-1α level higher than 98 pg/ml was associated with high risk of caries relapse in 12 months after treatment (with diagnostic sensitivity of 88.4% and specificity of 78.1%), and chances of disease development are increased by 4 times (p<0.0001). Logistic regressions created a mathematical model for calculation of caries relapse prognosis. Pearson's χ²=50.3 (p<0.0001) indicated the statistical importance of dependence between the risk and the size of a predictor. HIF-1α concentration change in gingival liquid from 80 pg/ml to 170 pg/ml correlates with the 12 months recurrent disease risk growth from 13 up to 94%. Thus, the initial gingival fluid content of HIF-1α higher than 98 pg/ml indicates high risk for caries relapse and demands personification of preventive measures of the disease progression.

The complexity of oral physiology and its impact on salivary diagnostics

OBJECTIVES

Saliva contains biomarkers for systemic as well as oral diseases. This study was undertaken to assess the variability in the sources of such biomarkers (plasma, cells) and attempted to identify saliva deterioration markers in order to improve saliva diagnostic outcomes.

MATERIALS AND METHODS

Inter- and intrasubject variations in salivary gingival crevicular fluid levels were determined by measuring salivary albumin and transferrin levels. The purity of collected glandular secretions was determined by bacterial culture, and the variability in epithelial cell numbers by cell counting and optical density measurement. Saliva sample deterioration markers were identified by RP-HPLC and LC-ESI-MS/MS.

RESULTS

Tenfold variations were observed in plasma-derived albumin and transferrin levels, emphasizing the need for biomarker normalization with respect to plasma contributions to saliva. Epithelial cell levels varied 50-fold in samples collected before and after a meal. Salivary fungal levels varied within subjects and among subjects from 0 to >1,000 colony-forming units per milliliter. In saliva samples incubated for various time intervals at 37°C, five peptides were identified that steadily increased in intensity over time and which could be explored as "deterioration markers."

CONCLUSION

Taking saliva characteristics appropriately into account will help realize the promise that this body fluid is suitable to be exploited for reliable healthcare monitoring and surveillance.