MONOCYTIC TNF-ALPHA SECRETION PATTERNS IN IDDM PATIENTS WITH PERIODONTAL-DISEASES

The aim of the present study was to identify whether monocytic TNF alp ha secretion patterns could serve as a potential phenotypic discrimina tor for periodontal disease susceptibility within insulin-dependent di abetes mellitus (IDDM) patients. In 32 IDDM individuals the lipopolysa ccharide (LPS) stimulated monocytic TNF alpha secretion dose-response characteristics were analyzed and related to two different periodontal status categories. Diabetics were divided into group A (gingivitis or mild periodontal disease) and group B (moderate to severe periodontal disease). In addition, 17 non-diabetic individuals with various degre es of periodontal disease served as control patients. Diabetics as a g roup had a significantly higher monocytic TNF alpha production in resp onse to increasing Porphyromonas gingivalis A 7436 lipopolysaccharide concentrations (0, 0.003, 0.03, 0.3 and 3.0 mu g/ml) as compared to no n-diabetic patients with gingivitis or adult periodontitis (p<0.05). A significant difference in the dose response was also noted in the lev el of TNF alpha secreted as a function of P. gingivitis LPS concentrat ions between group A and B diabetics, as determined by two-way repeate d measurements ANOVA (p<0.05). Furthermore, there was no significant d ifference in the mean HbA(1C) between the two diabetic groups, and the TNF alpha level was not significantly associated with the HbA(1C) lev el within diabetic patients. These data suggest that the diabetic stat e results in an upregulated monocytic TNF alpha secretion phenotype (4 .6-fold increase) which, in the presence of Gramnegative bacterial cha llenge, is associated with a more severe periodontal disease expressio n. In addition, approximately 40% (10 of 24) IDDM periodontitis patien ts in group B demonstrated a 62-fold elevation in TNF alpha secretion relative to non-diabetic gingivitis or periodontitis patients and a 13 .5-fold increase relative to IDDM group A (gingivitis or mild periodon titis) patients.