The Evaluation of Salivary and Serum PTX-3 and CRP Levels in Periodontal Diseases of Different Severity

Öz

Objective: The aim of this study is to evaluate the salivary and serum levels of Pentraxin (PTX)-3 and C-reactive protein (CRP) of individuals who are periodontally healthy or have periodontal diseases with different severity (gingivitis, periodontitis – Stage I and Stage III).
Material-Method: Salivary and serum CRP and PTX-3 levels of 80 non-smoker systemically healthy individuals (periodontally healthy (Group 1), gingivitis (Group 2), Stage I periodontitis (Group 3) and Stage III periodontitis (Group 4) were determined by ELISA, compared among the groups and their correlations were analyzed.
Results: While the highest serum CRP level was determined in Group 4, Group 1 showed significantly lower serum CRP levels from all groups (p<0.05). Group 2 and 3 had similar serum CRP levels (p>0.05), but statistically significantly higher serum CRP levels were found in both groups than Group 1 and lower than Group 4 (p<0.05). Serum PTX-3 was ranked increasing from the healthy group to the groups with severe periodontitis; however, Group 2 presented significantly higher serum PTX-3 level than Group 3 (p<0.05).While salivary CRP and PTX-3 levels were significantly lower in Group 1 than the other groups, and significantly higher in Groups 3 and 4 than the other groups (p<0.05); Group 2 and Group 3 presented similar levels (p>0.05). When the correlations between periodontal parameters and serum and saliva parameters were examined, both CRP and PTX-3 showed strong correlations with all periodontal parameters (p<0.001).
Conclusion: The significant differences between the salivary and serum parameters’ levels among the study groups and the correlations between the parameters provided important data to clarify the periodontal disease-systemic disease relationship.

Anahtar Kelimeler

• gingivitis
• periodontitis
• inflammation
• CRP
• PTX3

Farklı Şiddetteki Periodontal Hastalıklarda Salya ve Serumdaki PTX-3 ve CRP Düzeylerinin Değerlendirilmesi

Öz

Amaç: Bu çalışmanın amacı periodontal açıdan sağlıklı ve farklı şiddetlerde periodontal hastalığı olan (gingivitis, periodontitis –Evre I ve Evre III) bireylerin salya ve serum örneklerinde Pentraksin (PTX)-3 ve C-reaktif protein (CRP) düzeylerinin belirlenmesidir.
Materyal-metot: Sağlıklı (Grup 1, n=20), gingivitis (Grup 2, n=20), Evre I periodontitisli (Grup 3) ve Evre III periodontitisli (Grup 4, n=20) olmak üzere 80 sigara içmeyen sistemik sağlıklı bireyin salya ve serum CRP ve PTX-3 düzeyleri ELISA yöntemiyle belirlenerek gruplar arasında karşılaştırıldı ve klinik parametrelerle korelasyonları incelendi.
Bulgular: En yüksek serum CRP düzeyi Grup 4’te belirlenirken, Grup 1 tüm gruplardan anlamlı düzeyde düşük serum CRP düzeyi sergiledi (p<0,05). Serum CRP düzeylerinin Grup 2 ve Grup 3’te istatistiksel olarak birbirine benzer (p>0,05); ancak Grup 1’den anlamlı yüksek (p<0,05) ve Grup 4’ten anlamlı düşük düzeyde (p<0,05)olduğu belirlendi. Serum PTX-3 sağlıklı gruptan şiddetli periodontitisli gruplarına doğru artan bir düzeyde sıralanmaktaydı; ancak bu sıralamada Grup 2 Grup 3’ten daha yüksek serum PTX-3 düzeyi sergiledi (p<0,05).
Salya CRP ve PTX-3 düzeyleri Grup 1’de diğer gruplardan anlamlı düşük, Grup 3 ve 4’te diğer gruplardan anlamlı yüksek düzeyde iken (p<0,05); Grup 2 ve Grup 3 birbirine benzer düzeyler sergiledi (p>0,05). Periodontal parametreler ve serum ve salya parametreleri arasındaki korelasyonlar incelendiğinde, hem CRP hem de PTX-3’ün tüm periodontal parametreler ile güçlü korelasyonlar sergilediği belirlendi (p<0,001).
Sonuç: İncelenen salya ve serum parametreleri (CRP ve PTX-3) ve çalışma grupları arasında belirlenen düzeysel farklılık ve parametreler arasındaki korelasyonlar periodontal hastalık-sistemik hastalık ilişkisini açıklamak için önemli veriler sunmuştur. 

Anahtar Kelimeler

• Gingivitis
• periodontitis
• enflamasyon
• CRP
• PTX-3

Kaynakça

1. [1] Hegde, R., Awan, K.H. 2019. Effects of periodontal disease on systemic health. Disease A Month, 65(6),185-92.
2. [2] Otomo-Corgel, J., Pucher, J.J., Rethman, M.P., Reynolds, M.A. 2012. State of the science: chronic periodontitis and systemic health. Journal of Evidence Based Dental Practice, 12(3), 20-8.
3. [3] Schenkein, H.A., Loos, B.G. 2013. Inflammatory mechanisms linking periodontal diseases to cardiovascular diseases. Journal of Periodontology, 84(4 Suppl) S51–S69.
4. [4] Sanz, M., Marco Del Castillo, A., Jepsen, S., Gonzalez-Juanatey, J.R., D'Aiuto, F., Bouchard, P., et al. Periodontitis and cardiovascular diseases: Consensus report. 2020. Journal of Clinical Periodontology, 47(3), 268-88.
5. [5] Nehring, S.M., Goyal, A., Bansal, P., Patel, B.C. 2021. C Reactive Protein. StatPearls. 2021; PMID: 28722873
6. [6] PolePalle, T.S., Moogala, S., Pu, S.B., PeSala, S., Palagi, F.B. 2015. Acute phase proteins and their role in periodontitis: a review. Journal of Clinical Diagnostic Research, 9(11), ZE01-ZE05.
7. [7] Ebersole, J.L., Cappelli, D. 2000. Acute-phase reactants in infections and inflammatory diseases. Periodontology 2000, 23(1):19–49.
8. [8] Demmer, R.T., Trinquart, L., Zuk, A., Fu, B.C., Blomkvist, J., Michalowicz, B.S., et al. 2013. The influence of anti-infective periodontal treatment on C-reactive protein: a systematic review and meta-analysis of randomized controlled trials. PLoS One, 148(10), e77441.

9. [9] Garlanda, C., Bottazzi, B., Bastone, A., Mantovani, A. 2005. Pentraxins at the crossroads between innate immunity, inflammation, matrix deposition, and female fertility. Annual Review of Immunology, 23, 337-66.
10. [10] Fujita, Y., Ito, H., Sekino, S., Numabe, Y. 2012. Correlations between pentraxin 3 or cytokine levels in gingival crevicular fluid and clinical parameters of chronic periodontitis. Odontology, 100(2), 215–21.
11. [11] Fazzini, F., Peri, G., Doni, A., Dell’Antonio, G., Dal Cin, E., Bozzolo, E, et al. 2001. PTX-3 in small-vessel vasculitides: An independent indicator of disease activity produced at sites of inflammation. Arthritis and Rheumatism, 44(12), 2841-50.
12. [12] Pradeep, A., Kathariya, R., Raghavendra, N., Sharma, A. 2011. Levels of pentraxin‐ 3 in gingival crevicular fluid and plasma in periodontal health and disease. Journal of Periodontology, 82(5), 734-41.
13. [13] Gümüş, P., Nizam, N., Nalbantsoy, A., Özçaka, Ö., Buduneli, N. 2014. Saliva and serum levels of pentraxin‐ 3 and interleukin‐ 1β in generalized aggressive or chronic periodontitis. Journal of Periodontology, 85(3), e40-e6.
14. [14] Çalapkorur, M.U., Alkan, B.A., Tasdemir, Z., Akcali, Y., Saatçi, E. 2017. Association of peripheral arterial disease with periodontal disease: analysis of inflammatory cytokines and an acute phase pro-tein in gingival crevicular fluid and serum. Journal of Periodontal Research, 52(3), 532-9.
15. [15] Folwaczny, M., Karnesi, E., Berger, T., Paschos, E. 2017. Clinical association between chronic periodontitis and the leukocyte extravasation inhibitors developmental endothelial locus-1 and pentraxin-3. European Journal of Oral Science, 125(4), 258–64.
16. [16] Papapanou, P.N., Sanz, M., Buduneli, N., Dietrich, T., Feres, M., Fine, D.H., et al. 2018. Periodontitis: consensus report of workgroup 2 of the 2017 World Workshop on the classification of periodontal and peri-implant diseases and conditions. Journal of Periodontology, 89 (Suppl 1), S173-82. [17] Chapple, I.L.C., Mealey, B., Van Dyke, T.E., Bartold, P.M., Dommisch, H., Eickholz, P., et al. 2018. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Journal of Periodontology, 89 (Suppl 1), S74-S84.
17. [18] Armitage, G.C. 2004. Periodontal diagnoses and classification of periodontal diseases. Periodontology 2000, 34(1), 9-21. [19] Löe, H. 1967. The gingival index, the plaque index and the retention index systems. Journal of Periodontology, 38(6 Suppl), 610-6.
18. [20] Löe, H., Silness, J. 1963. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontologica Scandnavica, 21(6), 533-51.
19. [21] Lobene, R.R., Weatherford, T., Ross, N.M., Lamm, R.A., Menaker, L. 1986. A modified gingival index for use in clinical trials. Clinical Preventive Dentistry, 8(1), 3-6.
20. [22] Nesse, W., Abbas, F., van der Ploeg, I., Spijkervet, F.K., Dijkstra, P.U., Vissink, A. 2008. Periodontal inflamed surface area: quantifying inflammatory burden. Journal of Clinical Periodontology, 35(8), 668-73.
21. [23] Hujoel, P., White, B., Garcia, R., Listgarten, M. 2001. The dentogingival epithelial surface area revisited. Journal of Periodontal Research, 36(1), 48-55.
22. [24] Leira, Y., Martín-Lancharro, P., Blanco, J. 2018. Periodontal inflamed surface area and periodontal case definition classification. Acta Odontologica Scandnavica, 2018,76(3), 195-8.
23. [25] Navazesh, M., Kumar, S.K.S. 2008. Measuring salivary flow challenges and opportunities. Journal of American Dental Association, 139 (Suppl), 35S-40S.
24. [26] Keles, G.C., Cetinkaya, B.O., Simsek, S.B., Koprulu, D., Kahraman, H. 2007. The role of periodontal disease on acute phase proteins in patients with coronary heart disease and diabetes. Turkish Journal of Medical Sciences, 37(1), 39-44.
25. [27] Loos, B.G. 2005. Systemic markers of inflammation in periodontitis. Journal of Periodontology, 76(11 Suppl), 2106-15.
26. [28] Fitzsimmons, T.R., Sanders, A.E., Bartold, P.M., Slade, G.D. 2010. Local and systemic biomarkers in gingival crevicular fluid increase odds of periodontitis. Journal of Clinical Periodontology, 37(1), 30-6. [29] Megson, E., Fitzsimmons, T., Dharmapatni, K., Bartold, P.M. 2010. C-reactive protein in gingival crevicular fluid may be indicative of systemic inflammation. Journal of Clinical Periodontology, 37(9), 797–804.
27. [30] Lakshmanan, R., Jayakumar, N., Sankari, M., Padmalatha, O., Varghese, S. 2014. Estimation of Pentraxin‐ 3 levels in the gingival tissues of chronic and aggressive periodontitis participants: an in vivo study. Journal of Periodontology, 85(2), 290-7.
28. [31] Varghese, M., Varghese, S., Jayakumar, D.M. 2015. Evaluation of pentraxins 3 in chronic periodontitis patients before and after the treatment. International Journal of Medical and Exercise Science, 1(1), 9-15.
29. [32] Koenig, W. 2013. High-sensitivity C-reactive protein and atherosclerotic disease: from improved risk prediction to risk-guided therapy. International Journal of Cardiology, 168(6), 5126-34.
30. [33] Nerkiz, P., Doganer, Y.C., Aydogan, U., Akbulut, H., Parlak, A., Aydogdu, A., et al. 2015. Serum pentraxin-3 level in patients who underwent coronary angiography and relationship with coronary atherosclerosis. Medical Principals and Practice, 24(4), 369-75.
31. [34] Temelli, B., Yetkin Ay, Z., Savaş, H.B., Aksoy, F., Kumbul Doğuç, D., Uskun, E., et al. 2018. Circulation levels of acute phase proteins pentraxin 3 and serum amyloid A in atherosclerosis have correlations with periodontal inflamed surface area. Journal of Applied Oral Science, 26, e20170322.
32. [35] Arboleda, S., Vargas, M., Losada,, S, Pinto, A. 2019. Review of obesity and periodontitis: an epidemiological view. British Dental Journal, 227(3), 235-9.
33. [36] Buduneli, N., Özçaka, Ö., Nalbantsoy, A. 2011. Salivary and plasma levels of toll-like receptor 2 and toll-like receptor 4 in chronic periodontitis. Journal of Periodontology, 82(6), 878-84.
34. [37] Tan, A., Gürbüz, N., Özbalci, F.İ., Koşkan, Ö., Yetkin Ay, Z. 2020. Increase in serum and salivary neutrophil gelatinase-associated lipocalin levels with increased periodontal inflammation. Journal of Applied Oral Science, 28, e20200276.