Analysis of Soluble TREM (Triggering Receptor Expressed on Myeloid Cells)-1 and -2 in Crevicular Fluid and Associated Bacterial Flora in Patients Affected by Periodontitis

Study Overview
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Brief Summary
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Etiopathology of periodontitis is complex and various risk factors are known : Bacterial factors: major risk factor. Although the presence of periodontopathogen bacteria is necessary for the onset of periodontitis, these microorganisms are not sufficient for progression of all periodontal disease. Immune factor: host immune response modulates the disease evolution to destruction or recovery. The most studied cytokine in periodontology is IL-1 that induces various immune reactions and bone resorption directly or indirectly through the stimulation of prostaglandin E2 (PGE2) release. PGE2 activates the matrix metalloproteinases that are responsible of the degradation of bone extracellular matrix. Cytokine production, especially TNFα, IL-1β, IL-6 and IL-8, by some immune cells is modulated by new identified molecules such as Triggering Receptor Expressed on Myeloid cells (TREM) whose role in periodontitis is unknown. The purpose of this study is to compare concentrations of soluble TREM-1 and TREM-2 markers in infected sites and in healthy sites in patients affected by periodontitis. Other purposes are Comparison of soluble TREM-1 and TREM-2 concentrations in healthy sites in patients affected by periodontitis and in healthy patients Comparison of soluble TREM-1 and TREM-2 concentrations before and after etiologic periodontitis treatment Estimation of the correlation between soluble TREM-1 and TREM-2 concentrations and clinical signs of periodontitis Description of soluble TREM-1/TREM-2 ratio before and after etiologic treatment Description of presence of some bacteria in sites analyzed for soluble TREM-1 and TREM-2 Search for the most observed bacteria in presence of high concentrations of soluble TREM-1 and TREM-2 before and after etiologic treatment Evaluation of the impact of psychological stress measured through salivary cortisol level in saliva on TREM-1 and -2 expression Evaluation of the impact of psychological stress through stress and anxiety auto-questionnaires (Spielberger and Cohen) on soluble TREM-1 and TREM-2 concentrations in crevicular fluid of healthy and pathologic teeth.

Official Title
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Analysis of Soluble TREM (Triggering Receptor Expressed on Myeloid Cells)-1 and -2 in Crevicular Fluid and Associated Bacterial Flora in Patients Affected by Periodontitis

Conditions
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Periodontitis

Intervention / Treatment
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* Biological: Crevicular samples (1-10µl)
* Biological: Saliva samples (1ml)
* Other: Etiologic treatment
* Other: Psychometric tests


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All: Affiliation to social security plan Absence of refusal of patient Group 1. Periodontal patients: Affected by moderate to severe chronic periodontitis At least 2 distinct infected sites with periodontal pocket depth ≥ 5mm Having not received any root planing during last 6 months before visit Group 2. Control: No periodontitis Consulting for dental checkup and eventually scaling Exclusion Criteria: All: Pregnant women (change in bacterial flora) and breast-feeding Administration of systemic antibiotherapy or any treatment influencing periodontal environment (anti-inflammatory, anti-epileptic, immune-suppressor, calcium inhibitor) during 6 months before sample collection Patients having a pathology needing a prophylactic antibiotherapy (possibly influencing the treatment) Teeth with periapical inflammatory lesions of endodontic origin Person under guardianship Group 1. Periodontal patients: - Root planing during last 6 months before visit Group 2. Control: - Periodontitis

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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Design Details

Primary Purpose: Basic Science
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: 1. Periodontitis patients<br>30 patients consulting at Odontology department for periodontal treatment | Biological: Crevicular samples (1-10µl)<br>* In periodontitis patients: from 2 sites affected by periodontitis and 1 healthy site, 2 samples/site, before and after treatment In non-periodontitis individuals: 2 samples from 1 site<br>Biological: Saliva samples (1ml)<br> <br> Other: Etiologic treatment<br>* education on oral hygiene, scaling and root planing<br>Other: Psychometric tests<br>* Spielberger State-Trait Anxiety Inventory and Cohen Perceived Stress Scale<br>|
| Other: 2. Control<br>10 patients not affected by periodontitis consulting at Odontology department for checkup of teeth state and/or scaling | Biological: Crevicular samples (1-10µl)<br>* In periodontitis patients: from 2 sites affected by periodontitis and 1 healthy site, 2 samples/site, before and after treatment In non-periodontitis individuals: 2 samples from 1 site<br>Biological: Saliva samples (1ml)<br> <br> Other: Psychometric tests<br>* Spielberger State-Trait Anxiety Inventory and Cohen Perceived Stress Scale<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Average concentration (quantified with ELISA assay) of soluble TREM-1 and TREM-2 in crevicular fluid from 2 distant sites affected by periodontitis and 1 healthy site of each periodontitis patients at first consultation |  | day 0 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Average concentration (quantified with ELISA assay) of soluble TREM-1 and TREM-2 in crevicular fluid from healthy sites of periodontitis patients and non-periodontitis patients at first consultation | Crevicular fluid from 3 sites (2 distant affected by periodontitis and 1 healthy) of periodontitis patients and from 1 healthy site of non-periodontitis patients | day 0 | 
| Average concentration (quantified with ELISA assay) of soluble TREM-1 and TREM-2 in crevicular fluid of periodontitis patients before and after etiologic treatment of periodontitis | Crevicular fluid from 3 sites (2 distant affected by periodontitis and 1 healthy) of periodontitis patients | day 0 and after 13 to 15 weeks (after etiologic treatment of periodontitis patients) | 
| Identification of periodontal bacterial flora | The kit microIDent®plus11 (Hain, Lifesciences) allows the identification by PCR of the most pathogen periodontal bacteria. | day 0 and after 13 to 15 weeks (after etiologic treatment of periodontitis patients) | 
| Psychological stress score with Cohen Perceived Stress Scale |  | day 0 | 
| Psychological stress score with Spielberger State-Trait Anxiety Inventory |  | day 0 | 
| Quantification of salivary cortisol by ELISA to measure psychological stress |  | day 0 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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immunology factors, TREM, stress