Cytokines and Bone-Related Factors in Systemically Healthy Patients With Chronic Periodontitis and Patients With Type 2 Diabetes and Chronic Periodontitis

Background: This study compares the levels of cytokines and bone-related factors in the gingival crevicular fluid (GCF) of systemically healthy patients with chronic periodontitis (CP); and better-controlled, and poorly controlled patients with type 2 diabetes and CP. Methods: Thirty-seven patients with type 2 diabetes and CP and 20 systemically healthy patients with CP were enrolled in this study. The patients with diabetes mellitus were categorized as better-controlled (n = 17; HbA(1c) levels <= 8%) or poorly controlled (n = 20; glycated hemoglobin values >8%). Levels of tumor necrosis factor-alpha, interleukin (IL)-4, interferon (IFN)-gamma, IL-23, IL-17, soluble receptor activator of nuclear factor-kappa B ligand (sRANKL), and osteoprotegerin (OPG) in GCF of diseased sites were analyzed by enzyme-linked immunosorbent assay. Results: Type 2 diabetes mellitus, as a whole, upregulates the levels of OPG, sRANKL, IFN-gamma, IL-17, and IL-23 and downregulates the production of IL-4 in sites with CP (P<0.05). Better-controlled individuals exhibited the highest levels of IFN-gamma, whereas poorly controlled patients presented the highest levels of IL-17 (P <0.05). There were no differences in the levels of tumor necrosis factor-a, OPG, and IL-23 among systemically healthy, better-controlled, and poorly controlled patients with diabetes (P>0.05). Conclusions: Increased levels of proinflammatory cytokines and RANKL were observed in the GCF of patients with type 2 diabetes with CP, compared to patients without diabetes. In addition, poor or good glycemic status seems to modulate osteo-immunoinflammatory mediators in a different manner. J Periodontol 2011;82:1187-1196.