Adrenomedullin, periodontitis, diabetes-unraveling the equivocal relationship: A clinicobiochemical cross-sectional study

A Suchetha, Akanksha Garg, P Lakshmi, Divya Bhat, N Sapna, S M Apoorva, A Suchetha, Akanksha Garg, P Lakshmi, Divya Bhat, N Sapna, S M Apoorva

Abstract

Context: Antimicrobial proteins and peptides constitute a diverse class of host-defense molecules that act early to combat invasion and infection with bacteria and other microorganisms. Among the various antimicrobial peptides in the oral cavity, adrenomedullin (ADM), a cationic peptide, is found in gingival crevicular fluids (GCFs) in amounts twice as high in periodontal disease sites as healthy sites. Studies have also shown that plasma levels of ADM increased in patients with type 2 diabetes mellitus as compared with controls.

Aims: This clinico-biochemical study was undertaken to try to decipher the probable link between ADM, diabetes and periodontitis.

Materials and methods: The study comprised of 90 patients who were divided into three groups based on community periodontal index scores and diabetes status. Probing pocket depth and clinical attachment level were measured in all subjects. GCF was collected from all the participants using micropipettes and blood samples were collected from subjects in Groups III, for analysis of glycated hemoglobin. ADM levels were measured in GCF samples by the enzyme-linked immunosorbent assay.

Statistical analysis used: The data obtained were subjected to analysis of variance, Bonferroni test and Pearson's correlation.

Results: An increase in GCF levels of ADM from periodontal health to disease and in periodontitis patients with type 2 diabetes was noted.

Conclusions: Increase in GCF levels of ADM from periodontal health to disease and in periodontitis patients with type 2 diabetes reinforces the perio-systemic interlink concept.

Keywords: Adrenomedullin; gingival crevicular fluid; periodontitis; type 2 diabetes.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Graph 1
Graph 1
Mean probing pocket depth
Graph 2
Graph 2
Mean clinical attachment level
Graph 3
Graph 3
Mean adrenomedullin levels

References

    1. Gorr SU. Antimicrobial peptides of the oral cavity. Periodontol 2000. 2009;51:152–80.
    1. Dale BA, Fredericks LP. Antimicrobial peptides in the oral environment: Expression and function in health and disease. Curr Issues Mol Biol. 2005;7:119–33.
    1. Lundy FT, O’Hare MM, McKibben BM, Fulton CR, Briggs JE, Linden GJ. Radioimmunoassay quantification of adrenomedullin in human gingival crevicular fluid. Arch Oral Biol. 2006;51:334–8.
    1. Kapas S, Pahal K, Cruchley AT, Hagi-Pavli E, Hinson JP. Expression of adrenomedullin and its receptors in human salivary tissue. J Dent Res. 2004;83:333–7.
    1. Kapas S, Bansal A, Bhargava V, Maher R, Malli D, Hagi-Pavli E, et al. Adrenomedullin expression in pathogen-challenged oral epithelial cells. Peptides. 2001;22:1485–9.
    1. Elsasser TH, Kahl S. Adrenomedullin has multiple roles in disease stress: Development and remission of the inflammatory response. Microsc Res Tech. 2002;57:120–9.
    1. Novak JM. Classification of diseases and conditions affecting the periodontium. In: Newman MG, Takei HH, Klokkevold PR, Caranza FA, editors. Carranza's Clinical Periodontology. 9th ed. Noida: Saunders Reed Elsevier India Private Limited; 1996. p. 67.
    1. Altman H, Steinberg D, Porat Y, Mor A, Fridman D, Friedman M, et al. In vitro assessment of antimicrobial peptides as potential agents against several oral bacteria. J Antimicrob Chemother. 2006;58:198–201.
    1. Allaker RP, Zihni C, Kapas S. An investigation into the antimicrobial effects of adrenomedullin on members of the skin, oral, respiratory tract and gut microflora. FEMS Immunol Med Microbiol. 1999;23:289–93.
    1. Lim SC, Morgenthaler NG, Subramaniam T, Wu YS, Goh SK, Sum CF. The relationship between adrenomedullin, metabolic factors, and vascular function in individuals with type 2 diabetes. Diabetes Care. 2007;30:1513–9.
    1. Iacopino AM. Periodontitis and diabetes interrelationships: Role of inflammation. Ann Periodontol. 2001;6:125–37.
    1. Bals R. Epithelial antimicrobial peptides in host defense against infection. Respir Res. 2000;1:141–50.
    1. Türkoðlu O, Emingil G, Kütükçüler N, Atilla G. Evaluation of gingival crevicular fluid adrenomedullin and human neutrophil peptide 1-3 levels of patients with different periodontal diseases. J Periodontol. 2010;81:284–91.
    1. Ruzicska E, Toth M, Tulassay Z, Somogyi A. Adrenomedullin and diabetes mellitus. Diabetes Metab Res Rev. 2001;17:321–9.
    1. García-Unzueta MT, Montalbán C, Pesquera C, Berrazueta JR, Amado JA. Plasma adrenomedullin levels in type 1 diabetes. Relationship with clinical parameters. Diabetes Care. 1998;21:999–1003.
    1. Turk HM, Buyukberber S, Sevinc A, Ak G, Ates M, Sari R, et al. Relationship between plasma adrenomedullin levels and metabolic control, risk factors, and diabetic microangiopathy in patients with type 2 diabetes. Diabetes Care. 2000;23:864–7.
    1. Mealey B. Diabetes mellitus. In: Rose LF, Genco RJ, Mealy BL, Cohen WD, editors. Periodontal Medicine. Hamilton, Ontario: B. C. Decker Inc.; 2000. pp. 121–51.
    1. Powers AC. Diabetes mellitus. In: Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's Principles of Internal Medicine. 16th ed. Vol. 2. New York: McGraw Hill Companies; 2005. pp. 2137–52.
    1. Kiran M, Arpak N, Unsal E, Erdoðan MF. The effect of improved periodontal health on metabolic control in type 2 diabetes mellitus. J Clin Periodontol. 2005;32:266–72.
    1. Faria-Almeida R, Navarro A, Bascones A. Clinical and metabolic changes after conventional treatment of type 2 diabetic patients with chronic periodontitis. J Periodontol. 2006;77:591–8.
    1. Nomura Y, Tamaki Y, Tanaka T, Arakawa H, Tsurumoto A, Kirimura K, et al. Screening of periodontitis with salivary enzyme tests. J Oral Sci. 2006;48:177–83.
    1. Okada H, Murakami S. Cytokine expression in periodontal health and disease. Crit Rev Oral Biol Med. 1998;9:248–66.
    1. Hosokawa I, Hosokawa Y, Ozaki K, Nakae H, Matsuo T. Adrenomedullin suppresses tumour necrosis factor alpha-induced CXC chemokine ligand 10 production by human gingival fibroblasts. Clin Exp Immunol. 2008;152:568–75.
    1. Allaker RP, Sheehan BE, McAnerney DC, McKay IJ. Interaction of adrenomedullin and calcitonin gene-related peptide with the periodontal pathogen Porphyromonas gingivalis. FEMS Immunol Med Microbiol. 2007;49:91–7.
    1. Martínez A, Weaver C, López J, Bhathena SJ, Elsasser TH, Miller MJ, et al. Regulation of insulin secretion and blood glucose metabolism by adrenomedullin. Endocrinology. 1996;137:2626–32.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する