Influence of chronic severe periodontitis in the face of metabolic control, and of periodontal therapyin the immune response of diabetic type 2 individuals / Influencia da periodontite cronica severa frente ao controle metabolico bem como do tratamento periodontal na resposta imunologica de individuos diabeticos tipo 2

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

The purpose of this study was to evaluate the systemic influence of chronic severe periodontitis in relation to metabolic control and of periodontal therapy in the immune response of diabetic type 2 patients through the evaluation of cytokine protein and gene expression in human adherent peripheral blood mononuclear cells. Twenty patients were studied, distributed in 2 groups: test group - 10 type 2 diabetic patients with severe chronic periodontitis and inadequate metabolic control; control group - 10 type 2 diabetic patients without periodontitis and inadequate metabolic control. First, all participants were hospitalized for 8 to 10 days to obtain adequate metabolic control, without any periodontal condition alterations. Afterwards, the test group received one-stage non-surgical eriodontal therapy associated with Amoxicilin and Metronidazole. Blood samples were obtained on he first and last day of hospitalization, and 4 to 6 weeks after periodontal therapy for immunological analyses. For metabolic parameters analyses, like HbA1c, blood samples were obtained before and after hospitalization, and 3 to 6 weeks after periodontal therapy. Mononuclear cells were isolated by gradient density using Ficoll-Hypaque?. A total of 2.5 X 106 adherent cells/mL were cultivated during 24hs in the presence or absence of LPS. The cytokines TNF-a, IL-1ß, IL-8, IL-6 were quantified in cell culture supernatants using ELISA, while their gene expression was verified by Real Time PCR. It was demonstrated that metabolic control promoted a reduction of TNF- a (p=0,02), IL-1? (p=0,03), IL-8 (p=0,04) and IL-6 (p=0,02) levels in control group supernatants stimulated cells, while the test group showed increased levels of that cytokines compared to the control group after metabolic control (p<0,01 or p=0,01). The metabolic control as the presence of chronic severe periodontal infection, although did not affect the gene expression of that cytokines by stimulated cells from both groups, increased IL-8 gene expression 2 times (p=0,04) by test group unstimulated cells while it was verified a lower gene expression respectively of IL-1 ß, IL-8 and IL-6 (p<0,01 or p=0,01) by 4, 3, and 11 times related to the control group, before metabolic control. Moreover, periodontal therapy promoted a reduction of TNF- a (p=0,04) levels in test group supernatants stimulated cells, although did not affect the gene expression of the cytokines studied by these cells. There was observed combined effect of metabolic control and periodontal therapy on IL-1 ß and IL-6 (p<0,01) gene expression, that were increased by 6 and 5 times, respectively, by test group unstimulated cells. While metabolic control promoted reductions of 1% and 1,1% in HbA1c levels of control and test group respectively, periodontal therapy promoted an additional reduction of 1,6% in HbA1c levels of test group. Therefore, it was suggested that chronic severe periodontal infection can modulate the immunological response of type 2 diabetic patients, through the maintenance of the inflammatory reactive capacity of mononuclear cells even if in the presence of metabolic control, and that the local infection treatment can promote systemic effects, through decreasing the pro-inflammatory potential of mononuclear circulating cells, helping to restore insulin sensitivity, resulting in an improved glycemic control in those individuals

ASSUNTO(S)

inflammation diabetes mellitus monocytes citocinas cytokines monocitos teste imunoenzimatico pcr em tempo real diabetes elisa periodontite real-time pcr

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