Impact of scaling and root planing on salivary and serum plasminogen activator inhibitor‐1 expression in patients with periodontitis with and without type 2 diabetes mellitus

Abstract

Background: Plasminogen activator inhibitor-1 (PAI-1) is significantly enhanced in insulin resistance and inflammation and ascribed as a proinflammatory marker. This study aimed to compare and correlate salivary and serum PAI-1 and alpha 2-macroglobulin (α2MG) in patients with periodontitis with and without type 2 diabetes mellitus (T2DM) and also appraise the consequence of periodontal treatment on these biomarkers. Methods: Sixty subjects enlisted were split into two groups; Group 1 consisted of 30 systemically healthy subjects with Stage II and III, generalized, Grade B, C periodontitis while Group 2 consisted of 30 patients with periodontitis and well-controlled T2DM (PDM). Salivary and serum PAI-1 and α2MG levels were estimated by enzyme-linked immunosorbent assay and allied with clinical parameters before and 3 months post non-surgical periodontal therapy (NSPT).Data were statistically analyzed using student t-test and Spearman correlation. Results: Analogous improvements in clinical periodontal markers were experienced in both groups after initial periodontal treatment. Estimates of salivary and serum PAI-1 and α2MG were higher among the PDM group compared with periodontitis alone at baseline. Significant diminution in estimates of biomarkers was noted 3 months after NSPT. In the PDM group, there was also an improvement in glycemic control.Conclusions: NSPT positively impacted both groups. Noteworthy expression of salivary and serum PAI-1 in patients with periodontitis and diabetes insinuates a possible role of the adipokine in periodontal inflammation and glucose level regulation. Salivary PAI-1 could thus be used as a diagnostic biomarker to detect disease activity and to track periodontal therapy response.

Biomarker panel discriminates diabetics with and without periodontitis pre‐ and post‐therapy

“…Consistent with this and other studies, 33,54–57 we found that several salivary biomolecules are differentially expressed in DWoP and DWP compared with periodontally healthier patients, and persistent elevations of salivary IL‐1β, MMP‐8, and resistin were associated with incomplete resolution of periodontal disease in diabetics at the patient level. Thus, our findings suggest that this salivary biomarker panel could be helpful in determining whether periodontal disease processes are unresolved after treatment 31,32 …”

“…Thus, our findings suggest that this salivary biomarker panel could be helpful in determining whether periodontal disease processes are unresolved after treatment. 31,32 In Figures 3 and 4, we analyzed the biomarker profiles based on each participant's clinical parameters of disease severity, independent of their diabetes status. We used two periodontal classification schemes in this analysis to (1) align with the fact that our study was initiated prior to the release of the 2017 World Workshop on Classification of Periodontal and Peri-Implant…”

“…[19][20][21][22][23][24] However, despite pro-inflammatory (i.e., interleukin [IL]-1b, and IL-6) and collagen degradation (i.e., matrix metalloprotease [MMP]-8) biomarker levels being detected in saliva of periodontitis patients without T2DM, 13,15,16,20,25 their presence in patients with T2DM, and their relationship with resistin, which is linked to obesity and diabetes, have not been fully explored with respect to severity of periodontitis or response to therapy. [26][27][28][29][30][31][32][33] Thus, advances in this field require pre-and post-treatment studies in diverse populations that include diabetic patients and a profile of biomarkers that have important regulatory roles in inflammation, tissue destruction, and insulin resistance.…”

Diabetes mellitus promotes susceptibility to periodontitis—novel insight into the molecular mechanisms

“…Another interventional comparative study showed that there were significant differences in the levels of omentin-1 in the saliva and serum of chronic periodontitis patients with or without T2DM ( 109 ). In addition, compared to periodontitis alone, periodontitis patients with T2DM have higher levels of plasminogen activator inhibitor-1 (PAI-1) in saliva and serum, suggesting a possible role of adipokines in the regulation of glycemic levels and periodontal inflammation ( 110 ).…”

“…A recent study found that progranulin in the saliva of diabetes patients with periodontitis was significantly reduced after nonsurgical periodontal treatment, considering that progranulin might be a target inflammatory marker for diabetesrelated periodontitis (108). Another interventional comparative study showed that there were significant differences in the levels of omentin-1 in the saliva and serum of chronic periodontitis patients with or without T2DM (109). In addition, compared to periodontitis alone, periodontitis patients with T2DM have higher levels of plasminogen activator inhibitor-1 (PAI-1) in saliva and serum, suggesting a possible role of adipokines in the regulation of glycemic levels and periodontal inflammation (110).…”