title: High incidence of Aggregatibacter actinomycetemcomitans infection in patients with cerebral infarction and diabetic renal failure: a cross-sectional study.
abstract: BACKGROUND
  Recent epidemiological studies suggest that periodontitis is a major risk factor for renal failure and cerebral infarction. The aim of this study was to evaluate the association among periodontitis, renal failure, and cerebral infarction, focusing on microbiological and immunological features.
  
  
  METHODS
  Twenty-one patients treated with hemodialysis (HD) were enrolled in this study. They were 8 with diabetic nephropathy and 13 with non-diabetic nephropathy. Blood examination, periodontal examination, brain magnetic resonance image (MRI), and dental radiography were performed on all patients. Subgingival plaque, saliva, and blood samples were analyzed for the periodontal pathogens, Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis (P. gingivalis), and Prevotella intermedia (P. intermedia) using quantitative real-time polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA).
  
  
  RESULTS
  We found that the patients with diabetic nephropathy had more A. actinomycetemcomitans compared with non-diabetic nephropathy (P = 0.038) in dental plaque. Furthermore, the patients with diabetic nephropathy showed a significantly higher incidence of cerebral infarction compared with those with non-diabetic nephropathy (P = 0.029). Clinical oral and radiographic scores tended to be higher among patients in the diabetic nephropathy group than in the non-diabetic nephropathy group.
  
  
  CONCLUSIONS
  Periodontal pathogens, particularly A. actinomycetemcomitans, may play a role, at least a part, in the development of cerebral infarction in Japanese HD patients with diabetic nephropathy.
authors.affiliation: Department of Advanced Clinical Science and Therapeutics, University of Tokyo, Tokyo, Japan. junichisuzuki-circ@umin.ac.jp.
authors.forename: Minoru
authors.initials: M
authors.lastname: Murakami
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Suzuki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamazaki
authors.forename: Masaya
authors.initials: M
authors.lastname: Ikezoe
authors.forename: Rintaro
authors.initials: R
authors.lastname: Matsushima
authors.forename: Norihiko
authors.initials: N
authors.lastname: Ashigaki
authors.forename: Norio
authors.initials: N
authors.lastname: Aoyama
authors.forename: Naho
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Kouji
authors.initials: K
authors.lastname: Wakayama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Akazawa
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Izumi
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D000368:Aged; D016976:Aggregatibacter actinomycetemcomitans / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D002544:Cerebral Infarction / Q000453:epidemiology / Q000382:microbiology*; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000382:microbiology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010326:Pasteurella Infections / Q000453:epidemiology / Q000382:microbiology*; D010518:Periodontitis / Q000453:epidemiology / Q000382:microbiology*; D051437:Renal Insufficiency / Q000453:epidemiology / Q000382:microbiology