Impact of N‐terminal pro‐B‐type natriuretic peptide and related inflammatory biomarkers on periodontal treatment outcomes in patients with periodontitis: An explorative human randomized‐controlled clinical trial

Abstract

BackgroundN‐terminal portion of the B‐type natriuretic propeptide (NT‐proBNP) has potentially been shown to play an important role in the development of periodontitis and cardiovascular disease (CVD). This study evaluated the efficacy of periodontal treatment on NT‐proBNP and related CVD biomarkers and explored whether subjects harboring high NT‐proBNP at baseline showed increased clinical benefits with the non‐surgical periodontal treatment performed with full‐mouth scaling and root planing (FM‐SRP) at 6‐month follow‐up.MethodsForty‐eight patients with stage III periodontitis were randomized to receive minimal standard oral care (SOC) (n = 24) or FM‐SRP (n = 24) protocol. Clinical periodontal parameters (probing depth, clinical attachment loss, bleeding on probing), serum NT‐proBNP, α1‐antitrypsin, C‐reactive protein (hs‐CRP), endothelial cell‐specific molecule‐1 (ECM‐1), and neutrophil gelatinase‐associated lipocalin (NGAL) concentrations were assessed at baseline and at 1‐, 3‐, and 6‐ month follow‐up.ResultsAt 6 months, FM‐SRP was more effective than SOC in reducing periodontal parameters and mean proportions of NT‐proBNP (p = 0.004), hs‐CRP (p = 0.003), α1‐antitrypsin (p = 0.012), ECM‐1 (p = 0.014), and NGAL (p = 0.045). At 6‐month follow‐up, the reduced NT‐proBNP, α1‐antitrypsin, hs‐CRP, ECM‐1, and NGAL levels were significantly correlated with the extent of periodontitis (p < 0.05). Furthermore, the analysis of variance analysis evidenced that, at 6‐month follow‐up, FM‐SRP significantly impacted the reduction of NT‐proBNP, hs‐CRP, ECM‐1, and NGAL. Moreover, high levels of NT‐proBNP, hs‐CRP, ECM‐1, and NGAL at baseline significantly influenced the efficacy of periodontal treatment positively.ConclusionIn this study, FM‐SRP was more effective than SOC in reducing clinical variables and NT‐proBNP levels, although subjects who harbored high NT‐proBNP concentrations at baseline showed greater clinical benefits of periodontal treatment at 6‐month follow‐up.

Potential role of epithelial–mesenchymal transition induced by periodontal pathogens in oral cancer

“…So far, periodontal pathogens cannot be considered as a direct aetiology of oral cancer, but there is no doubt that periodontal pathogens have a strong link with oral cancer. Elevated levels of some oral miRNAs in patients with periodontitis, as well as the release of some systemic inflammatory markers, like NT‐proBNP, have been shown to affect endothelial function and may also drive the progression of oral cancer 73,109 . EMT mediated by periodontal pathogens is widely recognized for promoting the malignant metastasis of tumour cells and the formation of secondary tumours.…”

“…Elevated levels of some oral miRNAs in patients with periodontitis, as well as the release of some systemic inflammatory markers, like NT‐proBNP, have been shown to affect endothelial function and may also drive the progression of oral cancer. 73 , 109 EMT mediated by periodontal pathogens is widely recognized for promoting the malignant metastasis of tumour cells and the formation of secondary tumours. This review introduced a wealth of evidence for EMT caused by P. gingivalis and F. nucleatum in oral cancer progression (Figure 2 ), but our current appreciation of the involvement of oral bacteria in cancer through EMT may be just the tip of the iceberg.…”

The Role of Caspase-11 and Pyroptosis in the Regulation of Inflammation in Peri-Implantitis

“…Reduction of NT-proBNP was influenced by the periodontal treatment and positively influenced the efficacy of periodontal treatment. 62 …”

“…Reduction of NT-proBNP was influenced by the periodontal treatment and positively influenced the efficacy of periodontal treatment. 62 Since higher levels of caspase-11 could induce the pyroptosis and inflammation of cells, we suggested that caspase-11 could promote and suppress the inflammation during the development of peri-implantitis. But the fact is the role of Caspase-11 in oral peri-implantitis, the role of LPS in the activation of Caspase-11 in P. gingivalis, the regulation of the subsequent pyroptosis, early diagnostic markers and development of peri-implant inflammation have not been clearly revealed.…”

Impact of local drug delivery and natural agents as new target strategies against periodontitis: new challenges for personalized therapeutic approach

“…Chlorhexidine, triclosan, desiccant agents, vitamins, and probiotic compounds, cetylpyridinium chloride, and others have been analyzed to understand their propriety and the possibility to be used in periodontal disease. 8 – 13 Herbals medicine have different properties such as anti-inflammatory, antimicrobial and antioxidant.…”