Non-invasive Assessment of Inflammatory Markers MIP-1 Alpha and IL-6 in Saliva of Post Myocardial Infarction and Stage 4 Periodontitis Patients
Condition: Myocardial Infarction; Periodontal Diseases
MeSH terms: Periodontitis; Periodontal Diseases; Myocardial Infarction; Infarction
Study type: Observational

Summary: 
      Periodontitis is an immunoinflammatory disease caused by microorganisms leading to sequential
      loss of the supporting structures of periodontium, resulting in periodontal pocket formation,
      gingival recession eventually leading to tooth loss.[1] A bacterial plaque is formed during
      the destructive changes of the periodontium which initiates a host of inflammatory and immune
      responses.[2] These inflammatory responses may also cause an increase in inflammatory
      activities in atherosclerotic lesions in the coronary arteries resulting in the increased
      risk of cardiovascular events like myocardial infarction.[3] Myocardial infarction (MI) is a
      cardiovascular condition that occurs when there is deprivation of oxygen in the heart muscle
      is due to the sudden interruption of the blood supply resulting from the coronary artery
      blockage by a plaque causing myocardial ischemia and cell death. Inflammation is pivotal in
      the initiation and progression of atherosclerosis. Various cytokines and chemokines are
      released during inflammation.[4] These inflammatory markers may have diagnostic potential for
      the detection of various inflammatory diseases.[5] Macrophages secrete macrophage
      inflammatory protein-1 alpha (MIP-1 alpha) which recruits inflammatory cells, inhibits stem
      cells, and activates bone resorption cells.[6] Interleukin-6 (IL-6) is produced in response
      to tissue injury and infection and contributes to the differentiation of B cells, the
      proliferation of T cells, and bone resorption.[7] The levels of these inflammatory markers
      are seen to be increased in inflammatory conditions, which include myocardial infarction and
      stage 4 periodontitis. Therefore, this study aims to assess the levels of these inflammatory
      markers in patients with myocardial infarction and periodontitis.
    

Detailed description: 
      This was a cross-sectional study involving the patients of the department of periodontics and
      department of cardiology.

      Patients included in the study were categorized into four groups: (1) group 1-healthy
      subjects, (2) group 2-stage 4 periodontitis patients, (3) group 3- post-MI patients with
      stage 4 periodontitis, (4) group 4- post-MI patients without periodontitis.

      The severity of the periodontitis was assessed by a periodontist. The diagnosis of acute MI
      was made by the cardiologists. Oral health assessment in acute MI patients was done at the
      subjects' bedside after stabilization of the patient, so as not to interfere with the ongoing
      medical treatment. Subjects' identification was kept confidential.

      All samples were collected from patients admitted within 48 hours of their cardiac event.
      Patients were diagnosed as acute ST-elevation myocardial infarction (STEMI) based on the
      elevation of ST segments on the electrocardiogram(ECG) by 0.1mV in contiguous leads in
      patients with signs and symptoms of myocardial ischemia and/ or development of new left
      bundle branch block, along with increased cardiac biomarkers. Non-ST-elevation myocardial
      infarction (NSTEMI) was diagnosed in patients with signs and symptoms of myocardial ischemia
      and depression in ST-segment on the ECG or new Q wave pathology along with elevation of
      cardiac biomarkers.[8] Stage four periodontitis was diagnosed using the World Workshop 2017
      classification.[9] Subjects who had undergone oral prophylaxis or periodontal surgery in the
      past 6 months were not included in the study. Smokers, pregnant women, lactating mothers, and
      those on medication (anti-microbial, non-steroidal anti-inflammatory drugs) in the past 3
      months as well as those with other chronic systemic diseases were excluded from the study.
      These were all excluded as each would affect the levels of biomarkers.
    

Intervention name(s): salivary test; salivary test
Intervention type(s): Diagnostic Test; Diagnostic Test
Intervention description(s): saliva was assessed for MIP-1 alpha; saliva was assessed for IL-6
Observational model: Case-Only
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Patients included in the study were categorized into four groups: (1) group 1-healthy
        subjects, (2) group 2-stage 4 periodontitis patients, (3) group 3- post-MI patients with
        stage 4 periodontitis, (4) group 4- post-MI patients without periodontitis.
      
Keywords: MIP-1 Alpha; IL-6; Myocardial infarction; Periodontal disease