Molecular Alterations of Parotid Saliva in Infantile Chronic Recurrent Parotitis

Abstract

Infantile chronic recurrent parotitis (ICRP) is an insidious disease whose etiopathogenesis remains an enigma. Alterations in the physical appearance of parotid saliva from ICRP patients have been frequently reported. However, sialochemical studies in regard to ICRP are very rare. The aim of this study was to determine whether saliva of ICRP patients presents major physicochemical and biochemical alterations compared with saliva from paired healthy controls. Parotid, whole, and submandibular/sublingual saliva was collected at an asymptomatic stage from 33 ICRP patients (5-16 y old, both sexes) and from 33 sex-and age-matched healthy controls. Saliva was analyzed for protein concentration, mode of protein diffusion on cellulose membranes, unidimensional sodium dodecylsulfate (SDS)-polyacrylamide gel electrophoresis protein profiles and zymographic profiles of metalloproteinase 2 (MMP-2) and metalloproteinase 9 (MMP-9). Parotid saliva of ICRP patients showed an increased protein concentration, altered mode of protein diffusion, a higher frequency of polypeptide bands of 43, 37,33,29,26,16, and 10 kD, higher asymmetry in the polypeptide profiles of both contralateral parotid saliva, and an increase in the frequency of MMP-2 and MMP-9. Parotid saliva of patients with ICRP is molecularly altered with respect to normal saliva. Some of the molecular differences could be related to the etiopathogenesis of the disease. ICRP is an inflammatory disease associated with nonobstructive glandular sialectasia. It is characterized by recurrent episodes of swelling of one or both parotid glands that alternate with remission intervals lasting for weeks or months in which glands are clinically asymptomatic (1,2). The onset of the disease usually occurs around age 3 y. Symptoms may diminish and disappear spontaneously after puberty. Sometimes the disease may persist until adulthood (1-3).Among the postulated etiological factors of ICRP are congenital ductal malformations, genetic factors, allergies, bacterial infections, local manifestations of autoimmune disease, and immunodeficiencies (1,2,4 -9). However, none of them has been demonstrated to play a causative role in the disease, and to date its etiopathogenesis remains an enigma.Likewise, consensus on the therapeutic management of ICRP has yet to be achieved. Different specialists have opted for different therapies. Among the therapeutic indications described in the specialized literature is a diversity of physical maneuvers to stimulate the salivary flux (1) and pharmacotherapy with nonsteroid anti-inflammatory agents (7) in combination with sialogogues and/or antibiotics (3,6,10). Recently, Nahlieli et al. (11) proposed an interventional approach using a sialendoscope. In cases in which irreversible damage has occurred, ligation of the excretory duct is indicated to produce glandular atrophy (1,2). In severe cases, partial or total parotidectomy is prescribed as a last resource (1,2,12).Studies on glandular tissue obtained from patients with ICRP have shown lymphocyt...

Parotiditis crónica recurrente infantil: una revisión actualizada de la literatura

“…El enfoque actual la considera una patología multifactorial y considera factores como enfermedades respiratorias, anomalías anatómicas, alteraciones inmuno-lógicas, factores genéticos, alteraciones oclusales y obstrucción del conducto parotídeo 1,2,4,5,7,8,10,11,[13][14][15][16][17]24,26,[30][31][32] ; la literatura publicada hasta la fecha ofrece estudios más contundentes de factores etiológicos a las enfermedades respiratorias y malformaciones anatómicas que se describen a continuación:…”

“…Al examen clínico del conducto parotídeo se observa un exudado descrito como: mucoso 14,15 , purulento 3,[12][13][14][15]25,26 , globoso 14 , mucopurulento 2,10 , blanquecino y granulado 15,19,21 (figura 1). Signos patognomónicos -perceptibles al examen con lupas-son la dilatación de la entrada del conducto, placas amarillentas en la saliva parotídea y una masa firme a la palpación en la glán-dula sintomática 1 .…”

“…Mediante espectofotometría evidenció niveles elevados de proteínas en comparación con pacientes control 15 .…”

“…Esto podría deberse a una producción aumentada, filtración desde el plasma o disminución en el contenido de agua 15,16 . Además, una fracción de las proteínas salivales se organizaba en complejos supramoleculares que podría explicar el enlentecimiento del flujo salival 15 .…”

“…Además, una fracción de las proteínas salivales se organizaba en complejos supramoleculares que podría explicar el enlentecimiento del flujo salival 15 .…”