Assessment of Serum Ferritin Levels and Periodontal Indices in Patients with Chronic Periodontitis Post/Pre Radiation Treatment of Head and Neck Cancer
DOI:
https://doi.org/10.15517/kvtbk628Keywords:
Head and neck cancer; Periodontal disease; Ferritin; Radiotherapy.Abstract
Acute phase protein (APP) positivity is exhibited by ferritin in the presence of inflammation and chronic infections, such as periodontal disease. This study aims to investigate serum ferritin levels compared between post- and pre-radiation of periodontal disease with head and neck cancer PD+HNC. A total of 100 individuals in the present study were enrolled, comprising 50 patient’s periodontal disease (PD) with head and neck cancer who underwent radiotherapy post-six months (post-RT HNC) and 50 PD patients (pre-RT HNC). Probing pocket depth (PPD), clinical attachment level (CAL), gingival bleeding index (GBI), plaque index (PI), oral pH, and hyposalivation were noted. Serum ferritin levels were measured using an electrochemiluminescence immunoassay (eCLIA). A significantly higher percentage of ferritin levels was found in patients post-RT PD+HNC (301.90 ng/ml) contrasted to pre-RT PD+HNC (82.71 ng/ml) subjects. Serum ferritin levels were shown to be significantly positively correlated with CAL, PPD, PI, and GBI in subjects with chronic periodontitis. Receiver operating characteristic results of ferritin (area under the curve (AUC) =0.806 for post-RT PD+HNC, AUC=0.454 for pre-RT PD+HNC). It may be suggested that elevated serum ferritin levels in patients with post-RT PD+HNC have the potential to be evaluated as biomarkers for inflammation during periodontal tissue breakdown via radiation treatment.
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Statistics, E.G.C., GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2020. 70 (4): p.313. DOI: https://doi.org/10.3322/caac.21609
Siegel, R.L., et al., Cancer statistics, 2023. CA: a cancer journal for clinicians, 2023. 73 (1): p.17-48. DOI: https://doi.org/10.3322/caac.21763
Saliem, S.S., et al., Pathogenesis of periodontitis-A potential role for epithelial-mesenchymal transition. Japanese Dental Science Review, 2022. 58: p.268-278. DOI: https://doi.org/10.1016/j.jdsr.2022.09.001
Bertolini, M. and D. Clark, Periodontal disease as a model to study chronic inflammation in aging. Geroscience, 2024. 46 (4): p.3695-3709. DOI: https://doi.org/10.1007/s11357-023-00835-0
Albukhalefah, A.K.M. and H.A.N. Nayyef, Association between biochemical lepetin and some biochemical markers in Iraqi patients with obesity and periodontal. Romanian Journal of Diabetes, Nutrition and Metabolic Diseases, 2024. 31 (1): p.569-586.
Kwon, T., I.B. Lamster, and L. Levin, Current concepts in the management of periodontitis. International dental journal, 2021. 71 (6): p.462-476. DOI: https://doi.org/10.1111/idj.12630
Gajjar, S., et al., Effect of serum ferritin levels in gingivitis and periodontitis patients before and after nonsurgical periodontal therapeutic intervention. Journal of Applied Pharmaceutical Science, 2023. 13 (11): p.152-160. DOI: https://doi.org/10.7324/JAPS.2023.147406
Karam, S.D. and D. Raben, Radioimmunotherapy for the treatment of head and neck cancer. The Lancet Oncology, 2019. 20 (8): p.e404-e416. DOI: https://doi.org/10.1016/S1470-2045(19)30306-7
Kutuk, T., et al., Interdisciplinary Collaboration in Head and Neck Cancer Care: Optimizing Oral Health Management for Patients Undergoing Radiation Therapy. Current Oncology, 2024. 31 (4): p.2092-2108. DOI: https://doi.org/10.3390/curroncol31040155
Moshtaha, W., Oral Complications of Dental Prosthetic for Patients after Chemotherapy and Radiotherapy Treatment. Dental Hypotheses, 2021. 12 (2): p.67-72. DOI: https://doi.org/10.4103/denthyp.denthyp_57_20
Costa, A.A., et al., The association between periodontitis and the impact of oral health on the quality of life of individuals with psoriasis and psoriatic arthritis. PloS one, 2024. 19 (6): p.e0301158. DOI: https://doi.org/10.1371/journal.pone.0301158
Irie, M.-S., et al., Periodontal therapy for patients before and after radiotherapy: A review of the literature and topics of interest for clinicians. Medicina oral, patologia oral y cirugia bucal, 2018. 23 (5): p.e524. DOI: https://doi.org/10.4317/medoral.22474
Pal, P.P., et al., New natural pro-inflammatory cytokines (TNF-α, IL-6 and IL-1β) and iNOS inhibitors identified from Penicillium polonicum through in vitro and in vivo studies. International Immunopharmacology, 2023. 117: p.109940. DOI: https://doi.org/10.1016/j.intimp.2023.109940
Zia, A., et al., Oral biomarkers in the diagnosis and progression of periodontal diseases. Biology and Medicine, 2011. 3 (2): p.45-52.
Powanda, M.C. and E.D. Moyer, A brief, highly selective history of acute phase proteins as indicators of infection, inflammation and injury. Inflammopharmacology, 2021. 29 (3): p.897-901. DOI: https://doi.org/10.1007/s10787-021-00820-z
Uppal, S.S., et al., Ten years of clinical experience with adult onset Still’s disease: is the outcome improving? Clinical rheumatology, 2007. 26: p.1055-1060. DOI: https://doi.org/10.1007/s10067-006-0440-x
Sudarev, V.V., et al., Ferritin self-assembly, structure, function, and biotechnological applications. International journal of biological macromolecules, 2023. 224: p.319-343. DOI: https://doi.org/10.1016/j.ijbiomac.2022.10.126
Chow, J.K., et al., Increased serum iron levels and infectious complications after liver transplantation. Clinical Infectious Diseases, 2010. 51 (3): p.e16-e23. DOI: https://doi.org/10.1086/654802
Sandnes, M., et al., Hyperferritinemia-a clinical overview. Journal of Clinical Medicine, 2021. 10 (9): p.2008. DOI: https://doi.org/10.3390/jcm10092008
Caudell, J.J., et al., Head and neck cancers, version 1.2022 featured updates to the NCCN guidelines. JNCCN Journal of the National Comprehensive Cancer Network, 2022. 20 (3): p.225-234.
Mohd Noh, N.Z. and E. Noor, Gingival recession at a glance. BDJ Student, 2024. 31 (2): p.64-65. DOI: https://doi.org/10.1038/s41406-024-1380-0
Barnes, C.M., et al., Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis, and supragingival plaque. Journal of Clinical Dentistry, 2005. 16 (3): p.71.
Gil-Montoya, J.A., et al., Oral and general health conditions involved in periodontal status during pregnancy: A prospective cohort study. Archives of Gynecology and Obstetrics, 2023. 308 (6): p.1765-1773. DOI: https://doi.org/10.1007/s00404-022-06843-3
Tonetti, M.S., H. Greenwell, and K.S. Kornman, Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. Journal of periodontology, 2018. 89: p.S159-S172. DOI: https://doi.org/10.1002/JPER.18-0006
Ahmad Akhoundi, M., et al., Urokinase-plasminogen activator protects periodontal ligament fibroblast from oxidative induced-apoptosis and DNA damage. Journal of Periodontal Research, 2018. 53 (5): p.861-869. DOI: https://doi.org/10.1111/jre.12576
Al-Kubaisi, A.A., et al., Soluble urokinase plasminogen activator receptor (suPAR) is a potential biomarker of stage III-IV, grade C periodontitis through the impact of post-radiotherapy on head and neck cancer patients. BMC Oral Health, 2024. 24 (1): p.1144. DOI: https://doi.org/10.1186/s12903-024-04801-w
Al-Kubaisi, A.A., et al., Changes and Roles of IL-6, hsCRP, and proCT in Patients with Chronic Periodontitis in Head and Neck Cancer Pre/Post Radiotherapy. Al-Rafidain Journal of Medical Sciences (ISSN 2789-3219), 2024. 7 (1): p.248-254. DOI: https://doi.org/10.54133/ajms.v7i1.1248
Huang, W., et al., Up-regulated ferritin in periodontitis promotes inflammatory cytokine expression in human periodontal ligament cells through transferrin receptor via ERK/P38 MAPK pathways. Clinical Science, 2019. 133 (1): p.135-148. DOI: https://doi.org/10.1042/CS20180679
Huang, W., et al., Ferritin expression in the periodontal tissues of primates. European Journal of Histochemistry: EJH, 2019. 63 (3). DOI: https://doi.org/10.4081/ejh.2019.3046
Faramarzi, M., et al., The effect of adjunctive use of melatonin as a supplement on serum ferritin level in periodontal patients: A randomized, controlled trial. Dental Research Journal, 2021. 18 (1): p.39. DOI: https://doi.org/10.4103/1735-3327.316656
Tiwana, M., et al., Whole saliva physico-biochemical changes and quality of life in head and neck cancer patients following conventional radiation therapy: a prospective longitudinal study. Indian journal of cancer, 2011. 48 (3): p.289-295. DOI: https://doi.org/10.4103/0019-509X.84918
Pontes, C.d.B., A.C.M. Polizello, and A.C.C. Spadaro, Clinical and biochemical evaluation of the saliva of patients with xerostomia induced by radiotherapy. Brazilian oral research, 2004. 18: p.69-74. DOI: https://doi.org/10.1590/S1806-83242004000100013
Sroussi, H.Y., et al., Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis. Cancer medicine, 2017. 6 (12): p.2918-2931. DOI: https://doi.org/10.1002/cam4.1221
Hommez, G.M., et al., Effect of radiation dose on the prevalence of apical periodontitis-a dosimetric analysis. Clinical oral investigations, 2012. 16: p.1543-1547. DOI: https://doi.org/10.1007/s00784-011-0665-1
Laheij, A.M. and J.J. de Soet, Can the oral microflora affect oral ulcerative mucositis? Current opinion in supportive and palliative care, 2014. 8 (2): p.180-187. DOI: https://doi.org/10.1097/SPC.0000000000000053
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