A clinical-experimental examination in patients with cardiac insufficiency

Aim of the present study was to investigate as part of a pilot project whether lipopolysaccharides (LPS) of periodontopathogenic microorganisms are able to ligate to the human myocardium initiating an inflammatory response in the myocardial cells. A quantitative determination of lipopolysaccharide binding protein (LBP) in atrium, ventricle and heart valve was performed and a potential association with the degree of periodontitis severity evaluated. 30 Patients (10 female, 20 male with an average age of 67.7 ±9.3 years) who underwent an aortic valve replacement due to aortic valve stenosis or aortic valve insufficiency were included in the study. After the patient was informed and signed the consent form, a medical history was taken including dental notation (DMFT und Papilla Bleeding Index (PBI)) and a periodontal chart. The degree of periodontitis severity was determined by the probing depth and the attachment level. During surgery, Thoracic and Cardiovascular Surgeons took heart tissue and blood samples. The average DMFT was 21.6 ±4.9. Concerning the PBI, eleven patients had Score 0, eleven patients had Score 1, six patients had Score 2, and two patients had Score 3. 23 patients had a severe periodontitis, five patients a moderate periodontitis, and two atients had no or a mild periodontitis. In the laboratory, the heart tissue samples were analyzed concerning the presence of LBP using protein purification and Western blot analysis. DNA was isolated from the blood samples and tested for IL-1 polymorphism. LBP was found in all patients´ heart tissue samples. The aortic valve displayed the highest big42-LBP expression; the lowest values were observed for the ventricle. eight patients had a genotype 1 (no increased risk for progressive development of periodontitis), eleven had a genotype 2 (increased risk for progressive development of periodontitis), three had a genotype 3 (high risk for progressive development of periodontitis), and eight had a genotype 4 (reduced inhibition of inflammatory reaction). Statistical evaluation showed that there were no significant influences of gender and smoking behavior on the degree of periodontitis severity or the PBI. The IL-1 genotype did also not have an impact on the degree of periodontitis severity (P=0.259) or on the PBI (P=0.167). The quantity of LBP was not associated with the PBI or the IL-1 genotype, but there was an association between LBP in the ventricle and the degree of periodontitis severity (P=0.018). For atrium (P=0.577) and heart valve (P=0.198), no association between LBP and the degree of periodontitis severity was observed. The present results confirm the working hypothesis that LPS of periodontopathogenic microorganisms can ligate to the myocardium and may contribute to heart tissue damage. Further studies are necessary to decipher the responsible mechanisms.2013-08-2