Effect of scaling and root planing on gingival crevicular fluid levels of adrenomedullin in chronic periodontitis patients with and without diabetes mellitus type 2: A clinico-biochemical study

Abstract

Background: Increased plasma adrenomedullin levels are usually observed in certain conditions such as diabetes mellitus (DM). Aims and Objectives: To gauge adrenomedullin values in the gingival crevicular fluid (GCF) of healthy individuals, chronic periodontitis (CP) patients with and without DM, and diabetics without any periodontal involvement, prior and after periodontal therapy. Materials and Methods: A total of 120 subjects were segregated into four categories of 30 each: Group 1 (healthy subjects), Group 2 (CP without DM), Group 3 (patients with CP and DM), and Group 4 (diabetics without any periodontal involvement). GCF was collected from all the patients. Nonsurgical periodontal therapy was done in Group 2 and Group 3 patients, followed up for 6 weeks, and GCF was obtained again from the same site. Enzyme-linked immunosorbent assay was used to evaluate the samples. Results: Adrenomedullin level in the GCF was high in diabetics without any periodontal involvement than in healthy individuals and significantly elevated in those with CP and DM. Reduced adrenomedullin was noted 6 weeks postperiodontal therapy. Conclusion: Adrenomedullin levels being higher in diabetics without any periodontal involvement than healthy controls suggest a link between DM and adrenomedullin. Furthermore, infection plays a noteworthy role in the elevation of adrenomedullin, indicating its role in periodontal disease progression.

Host Defence Peptides in Diabetes Mellitus Type 2 Patients with Periodontal Disease. A Systematic Review

“…From a total of 12 studies, 10 were observational studies (6 cross-sectional [ 30 , 31 , 32 , 33 , 34 , 35 ] and four case-control [ 36 , 37 , 38 , 39 ]), 1 was an animal study [ 40 ], and 1 was an in vitro study [ 41 ]. Different fluids/tissues were used for the HDPs’ analysis, including GCF [ 30 , 31 , 34 , 36 , 37 , 38 ], saliva [ 33 , 35 , 39 ], GT [ 32 ], and human oral epithelial cells [ 41 ]. However, one study [ 40 ] used both blood and GT for the analysis.…”

“…However, one study [ 40 ] used both blood and GT for the analysis. Three studies investigated adrenomedullin [ 30 , 36 , 38 ], two studies investigated HBD 1 [ 33 , 34 ], and study each investigated hBD 1 and hBD 3 [ 31 ], hBD 2, hBD 3 and hCAP18/LL-37 [ 32 ], hBD 2 [ 35 ], hCAP18/LL-37 [ 37 ], hBD 1, hBD 2, hBD 3 and hCAP18/LL-37 [ 39 ], and hBD 3 [ 40 ] and lipocalin 2 [ 41 ].…”

“…However, for the one animal study [ 40 ], total of eight monkeys were utilized. From the 12 studies, 9 showed greater levels of HDP in the DM2 group with PD [ 30 , 31 , 32 , 33 , 35 , 36 , 38 , 40 , 41 ]. In one study, the healthy control group showed more increased levels of HDP than the DM2 group with PD [ 34 , 37 ].…”

“…All the studies [ 36 , 37 , 38 , 39 ] evaluated by NOS for cross-sectional studies scored more than 7, suggesting high quality of the studies ( Figure 2 ). For studies assessed by the NOS modified for cross-sectional studies, 1 study [ 30 ] scored 9 points (very good study), 4 studies [ 31 , 32 , 33 , 34 ] scored 8 points (good studies), and 1 study [ 35 ] scored 6 points (satisfactory study) ( Figure 3 ).…”

“…The hBD 3 expression in GCF [ 31 ] and GT [ 32 , 40 ] have revealed similar outcomes, signifying that DM2 may upregulate hBD 3 levels in individuals with PD. Likewise, hCAP18/LL-37 [ 32 , 39 ], lipocalin 2 [ 41 ], and adrenomedullin [ 30 , 36 , 38 ], a multifunctional vasopeptide, have been overexpressed in individuals with DM2 with PD. However, a paucity of experimental substantiation of the DM effects on the molecular mechanisms behind expression of HDP in GT still exist.…”