Periodontitis and Inflammation

Study Overview
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Brief Summary
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Today, to understand pathogenic mechanisms involved in periodontitis remains a challenge to identify biomarkers or therapeutic targets to improve prevention and screening, as well as the effectiveness of periodontitis treatments. The aim is to characterize, in vivo, specific molecular markers reflecting the activity of the pathology, which could lead to improve the knowledge of the pathogenesis of periodontitis; determine target molecules involved in tissue destruction; determine molecular profiles of patients at local and systemic risk; determine therapeutic targets For this purpose, biological samples will be collected (plaque, saliva, crevicular fluid) from patients with periodontitis stage 3 or 4 versus patients with a healthy periodontium. Biological samples will be collected before and all along the periodontal treatment. Gingiva explants collection will be sampling within the surgical procedures (if they are needed). The primary objective is to investigate tissue and cellular expression of molecular markers associated with periodontal destruction during periodontitis in relation to periodontal infection and systemic changes in host response. A characterization of the cytokines in gingival fluid and unstimulated saliva (Luminex® technique) of patients with periodontitis versus without periodontitis will be done. The secondary objective is to study the influence of periodontitis on systemic pathologies via serum analysis of molecules and bacteria involved in periodontal destruction. Immunofluorescence evaluation of protein expression and distribution (inflammatory mediators, inflammatory pathway signaling proteins) in gingival explants, characterization of proteases (MMP) present in gingival fluid and unstimulated saliva (Luminex® technique) and microbiological analysis of the subgingival biofilm (by quantitative PCR).

Detailed Description
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Today, to understand pathogenic mechanisms involved in periodontitis remains a challenge to identify biomarkers or therapeutic targets to improve prevention and screening, as well as the effectiveness of periodontitis treatments. The aim is to characterize, in vivo, specific molecular markers reflecting the activity of the pathology, which could lead to improve the knowledge of the pathogenesis of periodontitis; determine target molecules involved in tissue destruction; determine molecular profiles of patients at local and systemic risk; determine therapeutic targets The research focuses on the characterization of the immuno-inflammatory response involved in periodontitis. A characterization of the mediators or cells involved will be performed from biological samples (gingival fluid, unstimulated saliva, gingival explants). The gingival fluid is composed of serum inflammatory exudate and inflammatory mediators produced locally in the periodontal pocket. Unstimulated saliva is a biological fluid composed in part of the gingival fluid that drains into it. It has the advantage of being easier to collect (larger quantity, collection by any health professional). This is a non-interventional, cross-sectional, multicenter, prospective, open-label, non-randomized study to collect tissue, crevicular, salivary, and serum samples as part of the patient's routine care in oral medicine departments to form a biological collection. The samples and the clinical data of the patients (excel file with anonymized data and locked by a password) will be transferred to UR2496 for their analysis. Patients will be recruited in the oral medicine departments of AP-HP hospitals (Charles Foix (Ivry/seine) and Henri Mondor (Créteil)) by periodontists in two groups (cases = periodontitis and controls = healthy periodontium but patients requiring surgical care). The time-line of the research is consistent with the usual patient management in oral medicine departments. Inclusion period is 12 months. There is no specific follow-up due to the research. Gingival tissue sampling during surgery of patients will be performed after their inclusion.

Official Title
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Characterization of the Immuno-inflammatory Response Involved in Bone Destruction During Periodontitis: Study With Biological Collection

Conditions
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Periodontitis

Intervention / Treatment
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* Procedure: Periodontal treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Common criteria for all patient groups Patient > 18 years old Patient affiliated to a social security system, beneficiary or beneficiary of a right other than AME Patient who speaks and understands French well enough to be able to read and understand the study information note. Patient who does not object to his participation in the study Specific criteria: - Case: Patient with localized or generalized periodontitis, stage 3 or 4. The diagnosis of periodontitis is based on the elements found during the interview and clinical examination -Control group: Patient with gingival health on intact or reduced periodontium with no history of periodontitis and requiring surgical care such as dental avulsion and pre-prosthetic periodontal corrective/aesthetic surgeries (coronal elongation, neck alignment.) Exclusion Criteria: Patients who have received antibiotic prophylaxis, antibiotic therapy, or anti-inflammatory treatment within 3 months prior to inclusion Pregnant or breastfeeding women Patient included in another interventional research protocol or in a period of exclusion. Patients under guardianship, curatorship or legal protection. Patient having expressed his opposition to participate in the research

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Case (patients with stage 3 or 4 periodontitis)<br> | Procedure: Periodontal treatment<br>* For Cases : Inclusion; Periodontal bacteria, gingival fluid and unstimulated saliva collection; Teaching of oral hygiene techniques. Non-surgical periodontal treatment At 3 months = periodontal reevaluation; Periodontal bacteria, gingival fluid and unstimulated saliva collection If periodontal pockets greater than 5mm and bleeding persist: periodontal surgery and gingival explant sampling At 3 months post-surgery = periodontal re-evaluation; Periodontal bacteria, gingival fluid and unstimulated saliva collection Maintenance For Controls: Inclusion; Periodontal bacteria, gingival fluid and unstimulated saliva collection, teaching of oral hygiene techniques. Plastic or pre-prosthetic surgery = gingival explant sampling Healing control at 15 days<br>* Other names: pre-prosthetic periodontal surgery;|
| Control (healthy periodontium)<br>Patients with gingival health on intact or reduced periodontium without a history of periodontitis and requiring surgical care such as dental avulsion or pre-prosthetic periodontal surgeries or aesthetic surgeries | Procedure: Periodontal treatment<br>* For Cases : Inclusion; Periodontal bacteria, gingival fluid and unstimulated saliva collection; Teaching of oral hygiene techniques. Non-surgical periodontal treatment At 3 months = periodontal reevaluation; Periodontal bacteria, gingival fluid and unstimulated saliva collection If periodontal pockets greater than 5mm and bleeding persist: periodontal surgery and gingival explant sampling At 3 months post-surgery = periodontal re-evaluation; Periodontal bacteria, gingival fluid and unstimulated saliva collection Maintenance For Controls: Inclusion; Periodontal bacteria, gingival fluid and unstimulated saliva collection, teaching of oral hygiene techniques. Plastic or pre-prosthetic surgery = gingival explant sampling Healing control at 15 days<br>* Other names: pre-prosthetic periodontal surgery;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Characterization of a panel of cytokines in gingival fluid of patients with periodontitis versus without periodontitis | Analysis of gingival fluids and unstimulated saliva by the Luminex allows detection and quantification of 15 cytokines (IL- 1α, IL- 1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-13, IL-15, IL-17, IL-18, IFN γ, TNF) simultaneously | 1 month once the collection is completed | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cytokines expression in periodontal cells | Analysis of cytokines, inflammation pathways and inflammation cells by histological analysis (immunofluorescence) of surgical specimens. | 6 months once the collection is completed | 
| Cytokines expression in periodontal cells | Immunofluorescence evaluation of protein distribution (inflammatory mediators, inflammatory pathway signaling proteins) in gingival explants (confocal microscopy analysis). | 6 months once the collection is completed | 
| Microbiological analysis of the subgingival biofilm determination of the percentage of periodontopathogens. | assessment through RT-PCR | 3 months once the collection is completed | 
| Characterization of proteases (MMP) present in gingival fluid and unstimulated saliva | assessment through Luminex® | 1 month once the collection is completed | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Periodontitis, Inflammation, Cytokines, Diabetes Mellitus