Lipid Peroxidation Levels and Total Oxidant/Antioxidant Status in Serum and Saliva From Patients With Chronic and Aggressive Periodontitis. Oxidative Stress Index: A New Biomarker for Periodontal Disease?

• Autores: Esra Balticioglu
• Localización: Journal of periodontology, ISSN 0022-3492, Nº. 10, 2014, págs. 1432-1441
• Idioma: inglés
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• Resumen

  • Background: In this study, levels of malondialdehyde (MDA), which is a significant product of lipid peroxidation (LPO), total oxidant status (TOS), total antioxidant capacity (TAOC), and the oxidative stress index (OSI), a novel value as a marker of periodontal disease activity, are investigated in serum and saliva from patients with chronic (CP) and generalized aggressive (GAgP) periodontitis.

    Methods: A total of 98 patients (33 with CP, 35 patients with GAgP, and 30 periodontally healthy controls) enrolled in the study. After clinical measurements and sample collection, the MDA level, TOS, and TAOC were measured by high-performance liquid chromatography and a novel automatic colorimetric method. The OSI was calculated as [(TOS/TAOC) × 100].

    Results: Although the salivary MDA levels and serum and salivary TOS and OSI values were significantly higher in the periodontitis groups than in the control group (P <0.05), the serum and salivary TAOC levels were significantly lower, and no significant difference in serum MDA levels was found (P >0.05). Furthermore, oxidative stress parameters were higher in the GAgP group than in the CP group (except the serum and salivary MDA levels and serum TAOC). Significant positive and negative correlations were observed between periodontal parameters and the MDA levels and TOS, TAOC, and OSI values (except serum MDA) (P <0.05).

    Conclusions: The present findings suggest that an increased TOS and decreased TAOC, rather than LPO, play important roles in the pathology of periodontitis and are closely associated with clinical periodontal status. Furthermore, the OSI may be a useful and practical parameter for evaluating periodontal disease activity.

    Periodontitis is an inflammatory disease characterized by the breakdown of tooth-supporting hard and soft tissues. It is initiated by specific bacteria within the plaque biofilm, and the progression of periodontal disease depends on complex interactions between periodontopathic bacteria and the host immune system.1-5 Numerous studies dealt with the pathogenesis of periodontitis.6 The production of reactive oxygen species (ROS) is known to be involved in the pathophysiologic progression of periodontal diseases.3,4 ROS are highly reactive, short-lived derivatives of oxygen metabolism produced in all biologic systems.3 Low levels of ROS are indispensable in several biochemical processes, including intracellular messaging, cellular differentiation, growth arrest, apoptosis, and immunity.7 However, ROS cause tissue damage via multiple mechanisms, including DNA damage, lipid peroxidation (LPO), protein damage, and enzyme oxidation.3,8-10 The removal of ROS by antioxidant defense systems is essential for maintaining health.3,7,10 Oxidative stress is a process in which the dynamic redox balance between oxidants and antioxidants is intensely shifted toward oxidative potentials.3,7,8,10 There is a large body of evidence showing the role of oxidative stress in >100 disorders and more recently in periodontitis.3,8,11-13 LPO is a major outcome of ROS-mediated tissue injury.14,15 When ROS interact with the polyunsaturated fatty acids in membranes or lipoproteins, LPO,8 shown to cause profound alterations in the structural integrity and function of cell membranes, begins.16 Because LPO is an outcome of oxidative stress, numerous markers have been used to monitor this process. Malondialdehyde (MDA) is the principal and one of the most studied products of polyunsaturated fatty acid peroxidation.14,15 Recently, attention has focused on the role of LPO products, ROS, antioxidant systems, and oxidative stress in the pathology of periodontitis.8 The effective role of increased oxidative stress and decreased antioxidant capacity in the pathogenesis of periodontal tissue breakdown has been shown in serum, saliva, and gingival crevicular fluid (GCF).3,8,9,11,17,18 Other studies also demonstrated an increase in LPO levels in periodontitis.8,19-23 Fewer studies examined the relationships among oxidative stress, inflammation, and periodontitis.3,13,24 In periodontal lesions, excessive ROS production appears as a result of inflammatory responses.3,13,25,26 During gingival inflammation, the flow of GCF increases, and components of the inflammatory response are detectable in saliva.27 Although specific biomarkers should be examined to clearly identify oxidative stress,3,4,8,11-13,17,18,24-29 logical approaches to the assessment of oxidative stress lie in evaluation of the total oxidant status (TOS) and total antioxidant capacity (TAOC).8,12,30,31 At the same time, a novel oxidative stress index (OSI) was developed to more clearly define oxidant/antioxidant imbalances, and it was asserted that this index may be a suitable parameter in the determination of oxidative stress.31 When the OSI is adapted to periodontology, it can be considered a practical approach to the determination of oxidative stress in periodontal disease.32 Although the differences and similarities between generalized aggressive (GAgP) and chronic (CP) periodontitis have not been clearly distinguished,33 a limited number of studies evaluated whether there is a difference in oxidative stress between the pathologic mechanisms of these two diseases.13,24,34 The main objective of this study is to examine whether the OSI can serve as a biomarker of periodontal disease activity. For this purpose, OSI values were detected and compared for two different types of periodontitis with different degrees and rates of periodontal breakdown,35 and then their relationships with clinical periodontal parameters were analyzed. To the best of the authors� knowledge, no previously published studies measured and compared the OSI values in CP and GAgP. In the current study, it is hypothesized that oxidative stress plays a role in the occurrence of more severe breakdown in GAgP compared to CP and that the OSI can be used as a diagnostic parameter to determine the severity and activity of periodontal disease. An additional objective of the present study is to investigate whether LPO or a TOS/TAOC imbalance is more important in periodontal diseases by means of measuring LPO levels and identifying the relationships between these parameters. Therefore, in the present study, the levels of MDA, an LPO product, and TOS, TAOC, and OSI values in serum and saliva samples from patients with CP and GAgP are investigated. The data obtained were compared to those from healthy controls, and the relationships between the clinical periodontal parameters and MDA levels and TOS, TAOC, and OSI values were analyzed.