Effects of periodontal therapy on serum C-reactive protein, sE-selectin, and tumor necrosis factor-alpha secretion by peripheral blood-derived macrophages in diabetes. A pilot study.
OBJECTIVE
Diabetes is associated with an increased risk for vascular disease and periodontitis. The aim of this study was to assess the effects of periodontal treatment in diabetes with respect to alterations in the pro-inflammatory potential of peripheral blood mononuclear cells.


METHODS
Ten patients with diabetes and moderate to severe periodontitis received full-mouth subgingival debridement. Blood samples for serum/plasma and mononuclear cell isolation were collected prior to and 4 wk after therapy. Mononuclear cells were analyzed by flow cytometry and stimulated with lipopolysaccharide or ionomycin/phorbol ester to determine the pro-inflammatory capacity of macrophages and lymphocytes, respectively.


RESULTS
Following periodontal treatment, all patients demonstrated a significant improvement in clinical periodontal status (p < 0.05), despite only modest reduction in subgingival bacterial load or homologous serum immunoglobulin G titers. CD14(+) blood monocytes decreased by 47% (p < 0.05), and the percentage of macrophages spontaneously releasing tumor necrosis factor-alpha decreased by 78% (p < 0.05). There were no significant changes in the capacity of lymphocytes to secrete interferon-gamma. Among a number of serum inflammatory markers tested, high-sensitivity-C-reactive protein significantly decreased by 37% (p < 0.01) and soluble E-selectin decreased by 16.6% (p < 0.05).


CONCLUSIONS
These data suggest a reduced tendency for monocyte/macrophage-driven inflammation with periodontal therapy and a potential impact on atherosclerosis-related complications in diabetic individuals.
Lalla
E
E
Division of Periodontics, College of Dental Medicine, Columbia University, New York, NY 10032, USA. EL94@columbia.edu
Kaplan
S
S
Yang
J
J
Roth
G A
GA
Papapanou
P N
PN
Greenberg
S
S
D000328:Adult; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D018925:Chemokines / Q000097:blood; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016207:Cytokines / Q000097:blood; D018500:Diabetes Insipidus, Nephrogenic / Q000150:complications; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D019040:E-Selectin / Q000097:blood*; D005260:Female; D006801:Humans; D008264:Macrophages / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes / Q000627:therapeutic use; D010510:Periodontal Diseases / Q000382:microbiology / Q000628:therapy*; D010865:Pilot Projects; D018709:Statistics, Nonparametric; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
D015415:Biomarkers; D018925:Chemokines; D016207:Cytokines; D019040:E-Selectin; D009067:Mouthwashes; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; C010882:chlorhexidine gluconate; D002710:Chlorhexidine