title: Role of smoking and type 2 diabetes in the immunobalance of advanced chronic periodontitis.
abstract: BACKGROUND
  This study evaluates the tissue levels of interleukin (IL)-17(+), IL-15(+), Foxp3(+) cells, fibrosis, and plasma B-cell infiltration in sites with chronic periodontitis in smokers and subjects with type 2 diabetes.
  
  
  METHODS
  Gingival biopsies were harvested from the following groups: systemically and periodontally healthy subjects (healthy group, n = 10); non-smokers and subjects with advanced periodontitis and without diabetes (non-risk factor/periodontitis group, n = 10); heavy smokers with advanced periodontitis and without diabetes (smoking/periodontitis group, ≥20 cigarettes per day for at least the past 5 years, n = 10); and non-smoking poorly controlled subjects with diabetes (glycated hemoglobin levels ≥9%) with advanced periodontitis (diabetes mellitus/periodontitis group [DMP], n = 10). The number of IL-17(+), IL-15(+), and Foxp3(+) cells was analyzed by immunohistochemistry, whereas the amount of fibrosis and plasma B-cell infiltration in gingival tissue was analyzed by histomorphometry.
  
  
  RESULTS
  The number of Foxp3(+) cells was significantly higher in the periodontitis groups compared to the healthy group (P <0.05). The DMP group presented higher levels of Foxp3(+) cells than other periodontitis groups (P <0.05). The levels of IL-15(+) and IL-17(+) cells and the amount of fibrosis were higher in the DMP group than in the other groups (P <0.05). There was a trend for a decreased B-cell infiltration in the DMP group (P >0.05). There was a slightly significant negative correlation between B-cell infiltration and the amount of fibrosis (P <0.05).
  
  
  CONCLUSIONS
  Upregulation of IL-17(+), IL-15(+), and Foxp3(+) cells and increased amounts of fibrosis were observed in chronic periodontitis sites in subjects with type 2 diabetes, suggesting that periodontitis development in these subjects may be influenced by the T helper 17/T regulatory axis.
authors: Department of Periodontics, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil.
authors: Poliana M
authors: PM
authors: Duarte
authors: Vanessa R
authors: VR
authors: Santos
authors: Fernanda A
authors: FA
authors: Dos Santos
authors: Sanivia A
authors: SA
authors: de Lima Pereira
authors: Denise B R
authors: DB
authors: Rodrigues
authors: Marcelo H
authors: MH
authors: Napimoga
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D055113:Chronic Periodontitis / Q000150:complications* / Q000276:immunology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000276:immunology; D005260:Female; D005351:Fibromatosis, Gingival / Q000209:etiology; D051858:Forkhead Transcription Factors / Q000032:analysis; D005881:Gingiva / Q000276:immunology; D006801:Humans; D019409:Interleukin-15 / Q000032:analysis; D020381:Interleukin-17 / Q000032:analysis; D008297:Male; D008875:Middle Aged; D020556:Neutrophil Infiltration; D010950:Plasma Cells / Q000276:immunology; D012907:Smoking / Q000276:immunology*; D018709:Statistics, Nonparametric; D015854:Up-Regulation
chemical_list: C418974:FOXP3 protein, human; D051858:Forkhead Transcription Factors; D019409:Interleukin-15; D020381:Interleukin-17