J Periodontol • August 2014
Salivary Visfatin Concentrations in Patients With Chronic Periodontitis Zahra Alizadeh Tabari,* Abbas Azadmehr,† Ali Nohekhan,‡ Nima Naddafpour,* and Fatemeh Baharak Ghaedi*
Background: Visfatin, also known as pre-B-cell colonyenhancing factor, is secreted from a variety of cells and is thought to have some proinflammatory and immunomodulating effects. It is indicated that serum/plasma levels of visfatin increase in a number of inflammatory disorders. The present study aims to evaluate salivary concentrations of visfatin in patients with chronic periodontitis (CP). Methods: Twenty patients with CP and 20 periodontally healthy individuals were enrolled in this study. For each patient, the values of clinical parameters, such as bleeding index, plaque index, probing depth, and clinical attachment level (CAL), were recorded. Whole saliva samples were collected, and concentrations of visfatin were evaluated using standard enzyme-linked immunosorbent assay. Statistical analysis was performed using statistical software. Results: Visfatin was detectable in all samples. Salivary visfatin concentrations were significantly higher in the periodontitis group. In addition, there was a positive significant relationship between salivary visfatin concentrations and CAL in the periodontitis group. However, no significant association was observed between salivary visfatin levels and other periodontal parameters or body mass index. Conclusion: These results indicate that there is a relationship between salivary visfatin and CP; however, further studies are needed to confirm this finding. J Periodontol 2014; 85:1081-1085. KEY WORDS Adipokines; chronic periodontitis; nicotinamide phosphoribosyltransferase; saliva. * Periodontics Department, Dental School, Qazvin University of Medical Sciences, Qazvin, Iran. † Immunology Department, Qazvin University of Medical Sciences. ‡ Private practice, Tehran, Iran.
P
eriodontitis is a multifactorial inflammatory disease that is affected by both periodontal pathogens and the host inflammatory responses.1 The imbalance between these two factors results in loss of connective tissue attachment and alveolar bone breakdown.2 In periodontics, biomarkers have the ability to give additional information beyond standard clinical and radiographic findings.3 Saliva contains locally and systemically derived biomarkers of periodontal disease. This oral fluid can be easily collected in a non-invasive way. Therefore, it can be used as a diagnostic test for the evaluation of periodontal disease.4 Adipose tissue synthesizes many inflammatory factors, including adiponectin, resistin, leptin, and visfatin, as well as cytokines such as tumor necrosis factor (TNF)-a and interleukin (IL)-6.5 Visfatin, also known as pre-B-cell colonyenhancing factor and nicotinamide phosphoribosyltransferase, was originally cloned by Samal et al.6 In addition to adipose tissue, this protein is synthesized by a variety of cell types and tissues, including lymphocytes, bone marrow, liver cells, skeletal muscles, trophoblasts, and fetal membranes.7 This pleiotropic mediator acts as a growth factor, cytokine, and enzyme; in addition, it has several proinflammatory functions. It has been suggested that during infection and inflammation, the production of IL-1b, TNF-a, and IL-6 can doi: 10.1902/jop.2013.130388
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Salivary Visfatin and Chronic Periodontitis
be induced by visfatin.8 Several studies have indicated that serum/plasma levels of visfatin increase in a number of inflammatory disorders.9-11 There is some controversy regarding the relationship of visfatin with both age and body mass index (BMI).12 Few studies have evaluated gingival crevicular fluid (GCF) and serum levels of visfatin in periodontal disease and health. It has been demonstrated that visfatin levels increase progressively in both GCF and serum as periodontal disease progresses.13,14 It was indicated that visfatin is identifiable and measurable in saliva.15 To the authors’ knowledge, there have been no studies that investigated salivary concentrations of visfatin in periodontitis. The aim of this study is to evaluate salivary visfatin concentrations in patients with periodontitis and healthy controls. MATERIALS AND METHODS This case-control, cross-sectional study was performed from March 2012 to April 2013 at the Periodontology Department of Qazvin University of Medical Sciences. Patients were selected and enrolled in the study from among 200 individuals who visited the periodontology department. A total of 40 participants (13 males and 27 females) were enrolled, 20 healthy individuals (seven males and 13 females, aged 24 to 50 years) and 20 patients with chronic periodontitis (CP) (six males and 14 females, aged 32 to 62 years). Participants completed personal, medical, and dental history questionnaires, and written consent was obtained. The study was approved by the ethics committee of Qazvin University of Medical Sciences, Qazvin, Iran. Inclusion criteria of the study were: 1) aged >18 years, 2) good general health, 3) a minimum of 18 teeth, and 4) BMI range 18.5 to 25.16 Exclusion criteria included: 1) history of periodontal therapy during the past 2 years; 2) history of alcoholism and smoking; 3) liver, kidney, or salivary gland dysfunction; 4) infectious diseases; 5) inflammatory bowel disease; 6) rheumatoid arthritis; 7) granulomatous diseases; 8) hypertension; 9) diabetes; 10) organ transplantation; and 11) cancer therapy. In addition, patients using glucocorticoids, cyclooxygenase inhibitors, bisphosphonates, antibiotics, or immunosuppressant medication during the past 6 months; pregnant or lactating; needing antibiotics for infective endocarditis prophylaxis during dental procedures; having acute illness symptoms (i.e., fever, sore throat, body aches, or diarrhea); using orthodontic appliances; or having an oral mucosal inflammatory condition (e.g. aphthous, lichen planus, leukoplakia, or oral cancer) were excluded from the study. BMI was measured based on World Health Organization guidelines and recorded in charts.16 1082
Volume 85 • Number 8
Clinical Evaluation Clinical measurements were performed at four points per tooth using a probe§ and recorded in a chart by a periodontist (ZAT). Patients in the test group had a diagnosis of generalized moderate to severe CP, based on the criteria defined by the American Academy of Periodontology.17 This diagnosis was established from clinical parameters, including plaque index (PI),18 probing depth (PD), clinical attachment level (CAL), and bleeding index (BI).19 Individuals with periodontal disease had to have a minimum of two teeth with at least five sites with CAL ‡3 mm and PD ‡5 mm in at least two quadrants.20 Patients with aggressive periodontitis were excluded from the study based on the inconsistency among the amount of microbial deposits and periodontal disease severity, the familial aggregation, and the pattern of periodontal breakdown.17 The control group consisted of individuals with no history of periodontitis or clinical attachment loss (AL). In addition, they had BI
Salivary Visfatin Concentrations in Patients With Chronic Periodontitis Zahra Alizadeh Tabari,* Abbas Azadmehr,† Ali Nohekhan,‡ Nima Naddafpour,* and Fatemeh Baharak Ghaedi*
Background: Visfatin, also known as pre-B-cell colonyenhancing factor, is secreted from a variety of cells and is thought to have some proinflammatory and immunomodulating effects. It is indicated that serum/plasma levels of visfatin increase in a number of inflammatory disorders. The present study aims to evaluate salivary concentrations of visfatin in patients with chronic periodontitis (CP). Methods: Twenty patients with CP and 20 periodontally healthy individuals were enrolled in this study. For each patient, the values of clinical parameters, such as bleeding index, plaque index, probing depth, and clinical attachment level (CAL), were recorded. Whole saliva samples were collected, and concentrations of visfatin were evaluated using standard enzyme-linked immunosorbent assay. Statistical analysis was performed using statistical software. Results: Visfatin was detectable in all samples. Salivary visfatin concentrations were significantly higher in the periodontitis group. In addition, there was a positive significant relationship between salivary visfatin concentrations and CAL in the periodontitis group. However, no significant association was observed between salivary visfatin levels and other periodontal parameters or body mass index. Conclusion: These results indicate that there is a relationship between salivary visfatin and CP; however, further studies are needed to confirm this finding. J Periodontol 2014; 85:1081-1085. KEY WORDS Adipokines; chronic periodontitis; nicotinamide phosphoribosyltransferase; saliva. * Periodontics Department, Dental School, Qazvin University of Medical Sciences, Qazvin, Iran. † Immunology Department, Qazvin University of Medical Sciences. ‡ Private practice, Tehran, Iran.
P
eriodontitis is a multifactorial inflammatory disease that is affected by both periodontal pathogens and the host inflammatory responses.1 The imbalance between these two factors results in loss of connective tissue attachment and alveolar bone breakdown.2 In periodontics, biomarkers have the ability to give additional information beyond standard clinical and radiographic findings.3 Saliva contains locally and systemically derived biomarkers of periodontal disease. This oral fluid can be easily collected in a non-invasive way. Therefore, it can be used as a diagnostic test for the evaluation of periodontal disease.4 Adipose tissue synthesizes many inflammatory factors, including adiponectin, resistin, leptin, and visfatin, as well as cytokines such as tumor necrosis factor (TNF)-a and interleukin (IL)-6.5 Visfatin, also known as pre-B-cell colonyenhancing factor and nicotinamide phosphoribosyltransferase, was originally cloned by Samal et al.6 In addition to adipose tissue, this protein is synthesized by a variety of cell types and tissues, including lymphocytes, bone marrow, liver cells, skeletal muscles, trophoblasts, and fetal membranes.7 This pleiotropic mediator acts as a growth factor, cytokine, and enzyme; in addition, it has several proinflammatory functions. It has been suggested that during infection and inflammation, the production of IL-1b, TNF-a, and IL-6 can doi: 10.1902/jop.2013.130388
1081
Salivary Visfatin and Chronic Periodontitis
be induced by visfatin.8 Several studies have indicated that serum/plasma levels of visfatin increase in a number of inflammatory disorders.9-11 There is some controversy regarding the relationship of visfatin with both age and body mass index (BMI).12 Few studies have evaluated gingival crevicular fluid (GCF) and serum levels of visfatin in periodontal disease and health. It has been demonstrated that visfatin levels increase progressively in both GCF and serum as periodontal disease progresses.13,14 It was indicated that visfatin is identifiable and measurable in saliva.15 To the authors’ knowledge, there have been no studies that investigated salivary concentrations of visfatin in periodontitis. The aim of this study is to evaluate salivary visfatin concentrations in patients with periodontitis and healthy controls. MATERIALS AND METHODS This case-control, cross-sectional study was performed from March 2012 to April 2013 at the Periodontology Department of Qazvin University of Medical Sciences. Patients were selected and enrolled in the study from among 200 individuals who visited the periodontology department. A total of 40 participants (13 males and 27 females) were enrolled, 20 healthy individuals (seven males and 13 females, aged 24 to 50 years) and 20 patients with chronic periodontitis (CP) (six males and 14 females, aged 32 to 62 years). Participants completed personal, medical, and dental history questionnaires, and written consent was obtained. The study was approved by the ethics committee of Qazvin University of Medical Sciences, Qazvin, Iran. Inclusion criteria of the study were: 1) aged >18 years, 2) good general health, 3) a minimum of 18 teeth, and 4) BMI range 18.5 to 25.16 Exclusion criteria included: 1) history of periodontal therapy during the past 2 years; 2) history of alcoholism and smoking; 3) liver, kidney, or salivary gland dysfunction; 4) infectious diseases; 5) inflammatory bowel disease; 6) rheumatoid arthritis; 7) granulomatous diseases; 8) hypertension; 9) diabetes; 10) organ transplantation; and 11) cancer therapy. In addition, patients using glucocorticoids, cyclooxygenase inhibitors, bisphosphonates, antibiotics, or immunosuppressant medication during the past 6 months; pregnant or lactating; needing antibiotics for infective endocarditis prophylaxis during dental procedures; having acute illness symptoms (i.e., fever, sore throat, body aches, or diarrhea); using orthodontic appliances; or having an oral mucosal inflammatory condition (e.g. aphthous, lichen planus, leukoplakia, or oral cancer) were excluded from the study. BMI was measured based on World Health Organization guidelines and recorded in charts.16 1082
Volume 85 • Number 8
Clinical Evaluation Clinical measurements were performed at four points per tooth using a probe§ and recorded in a chart by a periodontist (ZAT). Patients in the test group had a diagnosis of generalized moderate to severe CP, based on the criteria defined by the American Academy of Periodontology.17 This diagnosis was established from clinical parameters, including plaque index (PI),18 probing depth (PD), clinical attachment level (CAL), and bleeding index (BI).19 Individuals with periodontal disease had to have a minimum of two teeth with at least five sites with CAL ‡3 mm and PD ‡5 mm in at least two quadrants.20 Patients with aggressive periodontitis were excluded from the study based on the inconsistency among the amount of microbial deposits and periodontal disease severity, the familial aggregation, and the pattern of periodontal breakdown.17 The control group consisted of individuals with no history of periodontitis or clinical attachment loss (AL). In addition, they had BI
