The Pros1/Tyro3 axis protects against periodontitis by modulating STAT/SOCS signalling

Periodontitis, an oral inflammatory disease caused by periodontal pathogen infection, is the most prevalent chronic inflammatory disease and a major burden on healthcare. The TAM receptor tyrosine kinases (Tyro3, Axl and Mertk) and their ligands (Gas6 and Pros1) play a pivotal role in the resolution of inflammation and have been associated with chronic inflammatory and autoimmune diseases. In this study, we evaluated the effects of exogenous Pros1 in in vitro and in vivo models of periodontitis. We detected higher Pros1 but lower Tyro3 levels in inflamed gingival specimens of periodontitis patients compared with healthy controls. Moreover, Pros1 was mostly localized in the gingival epithelium of all specimens. In cultured human gingival epithelial cells (hGECs), Porphyromonas gingivalis LPS (p.g‐LPS) stimulation down‐regulated Pros1 and Tyro3. Exogenous Pros1 inhibited p.g‐LPS–induced production of TNF‐α, IL‐6, IL‐1β, MMP9/2 and RANKL in a Tyro3‐dependent manner as revealed by PCR, Western blot analysis, ELISA and gelatin zymography. Pros1 also restored Tyro3 expression down‐regulated by p.g‐LPS in hGECs. In rats treated with ligature and p.g‐LPS, administration of Pros1 attenuated periodontitis‐associated gingival inflammation and alveolar bone loss. Our mechanistic studies implicated SOCS1/3 and STAT1/3 as mediators of the in vitro and in vivo anti‐inflammatory effects of Pros1. Collectively, the findings from this work supported Pros1 as a novel anti‐inflammatory therapy for periodontitis.     

Interleukin‐6 (G‐174C) and tumour necrosis factor‐alpha (G‐308A) gene polymorphisms in geriatric patients with chronic periodontitis

doi:10.1111/j.1741‐2358.2009.00291.x
Interleukin‐6 (G‐174C) and tumour necrosis factor‐alpha (G‐308A) gene polymorphisms in geriatric patients with chronic periodontitis Background and objective: Periodontitis is a chronic inflammatory disease, and genetic factors may have an important role in its severity. Polymorphisms in the promoter regions of the interleukin‐6 (IL‐6) and tumour necrosis factor‐α (TNF‐α) genes have been reported to cause changes in the production of these cytokines. The aim of this study was to evaluate the possible role of IL‐6 (G?174C) and tumour necrosis factor (G?308A) polymorphisms, in the severity of chronic periodontitis in an elderly population. Materials and methods: In this study, a group of 65 elderly women, comprising 17 patients with moderate chronic periodontitis, 21 with severe chronic periodontitis and 27 healthy patients were selected. DNA was isolated from all subjects, and polymerase chain reaction was used to study the IL‐6 and TNF‐α gene polymorphisms. Results: The results of this study showed a significant difference in the allele and genotype frequencies of IL‐6 gene polymorphism between patients with periodontal disease and controls. Subjects carrying the G/G genotype of IL‐6 were most severely affected by periodontitis. The TNF‐α gene polymorphism showed no association with chronic periodontitis between patients and controls. Conclusion: The results suggest that the IL‐6 gene polymorphism may be associated with chronic periodontitis, and that TNF‐α gene polymorphism may not be involved in the progression of chronic periodontitis in the population of elderly Brazilian women.     

Inflammations mediators and circulating levels of matrix metalloproteinases: Biomarkers of diabetes in Tunisians metabolic syndrome patients

AimsThis study investigates the relationships between matrix metalloproteinases, inflammations mediators and type 2 diabetes mellitus in Tunisians metabolic syndrome (Mets) patients.MethodsThe study has included 239 MetS patients and 247 controls. Mets was defined according to the NCEP–ATPIII report. Mets patients were also divided into two categories: 29 MetS non-diabetics and 210 MetS diabetics. Dysglycemia markers, matrix metalloproteinase-9 (MMP-9), Tissue inhibitors of metalloproteinases (TIMP-1 and TIMP-2), tumor necrosis factor α (TNF-α), C-reactive protein (CRP) levels and White Blood Cells (WBC) counts were determined in patients and controls.ResultsIn our study, the level of inflammatory markers WBC, TNF-α and matrix metalloproteinases (MMP-8 and MMP-9) were significantly higher in diabetic patients with MetS, as compared with non-diabetic MetS patients. Inflammation mediators and MMP-9 were significantly associated with many clinical characteristics of MetS. The use of ROC “Receiver Operating Characteristic” analysis revealed the impact of TNF alpha on diabetes patients with MetS. In fact TNF alpha was found as a sensitive parameter in these patients with a sensitivity of 85%.ConclusionInflammation, matrix metalloproteinases and dysglycemia markers are not expressed in isolation but rather concurrently and are continuously interacting with each other, in MetS and diabetics patients. These markers fit with an early stage of cardiovascular disease (CVD); and measuring them could improve the risk evaluation, an early diagnosis, and the prognosis of CVD.     

Effects of smoking severity and moderate and severe periodontitis on serum C-reactive protein levels: an age- and gender-matched retrospective cohort study

Abstract

Background and purpose: C-reactive protein (CRP) which might affect cardiovascular events can be affected by chronic diseases and smoking. Since the effects of smoking dosage as well as the mutual effect of smoking and periodontitis on CRP levels have not been evaluated, we aimed to assess these.

Materials and methods: This retrospective age- and gender-matched study was performed on 120 dental patients. Clinical attachment loss, pocket probing depth (PPD), bleeding on probing (BoP), O’Leary plaque index and serum CRP were recorded. Patients were divided into one control and five cohort groups (n?=?20 each) according to smoking severity [pack years (PY) below or above 30] and periodontal condition (healthy periodontium and moderate/severe periodontitis). The effects of clinical measurements, age, gender, smoking and periodontitis on CRP were assessed using one- and two-way analyses of variance, Tukey and Bonferroni post hoc tests, and multiple linear regression (α?=?0.05).

Results: CRP concentrations were 0.07255?±?0.009539, 0.09645?±?0.010625, 0.122235?±?0.018442, 0.3758?±?0.187369, 0.81595?±?0.0410299 and 1.8717?±?0.652728?mg/l, respectively, in the control (PY?≤?30 with healthy periodontium), cohort 1 (PY?>?30 with healthy periodontium), cohort 2 (PY?≤?30 with moderate periodontitis), cohort 3 (PY?>?30 with moderate periodontitis), cohort 4 (PY?≤?30 with severe periodontitis) and cohort 5 (PY?>?30 with severe periodontitis). The positive effects of age, smoking severity, periodontitis and PPD, on CRP increase were significant (Regression p?<?0.02). BoP had a negative effect (p?=?0.015).

Conclusions: Clinicians should warn the patients, especially the older ones, about the effects of their gingival health and smoking on their cardiovascular condition.     

Increased Eotaxin and MCP-1 Levels in Serum from Individuals with Periodontitis and in Human Gingival Fibroblasts Exposed to Pro-Inflammatory Cytokines

Periodontitis is a chronic inflammatory disease of tooth supporting tissues resulting in periodontal tissue destruction, which may ultimately lead to tooth loss. The disease is characterized by continuous leukocyte infiltration, likely mediated by local chemokine production but the pathogenic mechanisms are not fully elucidated. There are no reliable serologic biomarkers for the diagnosis of periodontitis, which is today based solely on the degree of local tissue destruction, and there is no available biological treatment tool. Prompted by the increasing interest in periodontitis and systemic inflammatory mediators we mapped serum cytokine and chemokine levels from periodontitis subjects and healthy controls. We used multivariate partial least squares (PLS) modeling and identified monocyte chemoattractant protein-1 (MCP-1) and eotaxin as clearly associated with periodontitis along with C-reactive protein (CRP), years of smoking and age, whereas the number of remaining teeth was associated with being healthy. Moreover, body mass index correlated significantly with serum MCP-1 and CRP, but not with eotaxin. We detected higher MCP-1 protein levels in inflamed gingival connective tissue compared to healthy but the eotaxin levels were undetectable. Primary human gingival fibroblasts displayed strongly increased expression of MCP-1 and eotaxin mRNA and protein when challenged with tumor necrosis factor-α (TNF-α and interleukin-1β (IL-1β), key mediators of periodontal inflammation. We also demonstrated that the upregulated chemokine expression was dependent on the NF-κΒ pathway. In summary, we identify higher levels of CRP, eotaxin and MCP-1 in serum of periodontitis patients. This, together with our finding that both CRP and MCP-1 correlates with BMI points towards an increased systemic inflammatory load in patients with periodontitis and high BMI. Targeting eotaxin and MCP-1 in periodontitis may result in reduced leukocyte infiltration and inflammation in periodontitis and maybe prevent tooth loss.     

Detection of Streptococcus anginosus from saliva by real-time polymerase chain reaction

AIMS: The purpose of the present investigation was to assess the salivary levels of Streptococcus anginosus in periodontitis patients. METHODS AND RESULTS: The salivary levels of Strep. anginosus were assessed using real-time polymerase chain reaction (PCR). Streptococcus anginosus was detected in 28 of 37 (75.6%) of periodontitis patients and in three of the 20 (15%) healthy subjects. The mean values for bleeding on probing and probing depth in positive patients were statistically higher than those in negative patients. A significant decrease in Strep. anginosus levels was observed after periodontal treatment. CONCLUSIONS: Although the levels of Strep. anginosus are extremely low, they may reflect the status of periodontal health. SIGNIFICANCE AND IMPACT OF THE STUDY: Real-time PCR is a useful method for obtaining the relative quantities of Strep. anginosus from saliva samples and for monitoring the effect of therapy.     

Proinflammatory factors in saliva as possible markers for periodontal disease

Studies have indicated that host inflammatory proteins, enzymes and indicators of bone metabolism present in saliva differ in different types of periodontal disease. However, the number of markers analyzed was limited and the effect of edentulousness was not examined. We measured the concentration of host inflammatory proteins: C-reactive protein (CRP), C3 and C4 complement components, alpha-2-macroglobulin (alpha-2M) and tumor-necrosis factor (TNF) in unstimulated saliva of 14 periodontally healthy (PH), 9 edentulous persons (EP), 10 patients with chronic periodontitis (CP) and 18 with aggressive periodontitis (AgP). TNF was below the level of detection in all samples except one. Edentulous persons and patients with CP had significantly reduced concentrations of CRP, C3 and alpha-2M. Edentulous persons and AgP patients had lower C4 concentrations. We can conclude that edentulous persons and CP patients have reduced salivary concentrations of host inflammatory proteins. These findings suggest that a reduction in host responsiveness might play a role in the pathogenesis of CP.     

Heterogeneity of serum gelatinases MMP‐2 and MMP‐9 isoforms and charge variants

The matrix metalloproteinases (MMPs) gelatinase A (MMP‐2) and gelatinase B (MMP‐9) are mediators of brain injury in multiple sclerosis (MS) and valuable biomarkers of disease activity. We applied bidimensional zymography (2‐DZ) as an extension of classic monodimensional zymography (1‐DZ) to analyse the complete pattern of isoforms and post‐translational modifications of both MMP‐9 and MMP‐2 present in the sera of MS patients. The enzymes were separated on the basis of their isoelectric points (pI) and apparent molecular weights (Mw) and identified both by comparison with standard enzyme preparations and by Western blot analysis. Two MMP‐2 isoforms, and at least three different isoforms and two different states of organization of MMP‐9 (the multimeric MMP‐9 and the N‐GAL‐MMP‐9 complex) were observed. In addition, 2‐DZ revealed for the first time that all MMP‐9 and MMP‐2 isoforms actually exist in the form of charge variants: four or five variants in the N‐GAL complex, more charge variants in the case of MMP‐9; and five to seven charge variants for MMP‐2. Charge variants were also observed in recombinant enzymes and, after concentration, also in sera from healthy individuals. Sialylation (MMP‐9) and phosphorylation (MMP‐2) contributed to molecular heterogeneity. The detection of charge variants of MMP‐9 and MMP‐2 in MS serum samples illustrates the power of 2‐DZ and demonstrates that in previous studies MMP mixtures, rather than single molecules, were analysed. These observations open perspectives for better diagnosis and prognosis of many diseases and need to be critically interpreted when applying other methods for MS and other diseases.     

Endogenous IGFBP‐3 is required for both growth factor‐stimulated cell proliferation and cytokine‐induced apoptosis in mammary epithelial cells

TNF‐α and IGF‐I exert opposing effects on mammary epithelial cell (MEC) growth and survival. However, both increase IGF binding protein‐3 (IGFBP‐3) expression, a multifunctional protein that plays both IGF‐dependent as well as independent roles in these processes. We have reported that IGF‐I utilizes the PI3‐K and MAPK pathways to induce IGFBP‐3 expression in bovine MEC. Here we show that TNF‐α requires the SAPK pathway p38, but not JNK, to induce IGFBP‐3 expression. Contrary to reports in cancer cell lines, TNF‐α retained its ability to decrease DNA synthesis in cells transfected with IGFBP‐3 siRNA. It also retained its ability to inhibit IGF‐I‐stimulated DNA synthesis in these cells. In contrast, the ability of IGF‐I to increase DNA synthesis was attenuated with IGFBP‐3 knockdown. IGFBP‐3 knockdown also decreased basal DNA synthesis, indicating that a certain level of IGFBP‐3 may be required for cell proliferation. While TNF‐α alone failed to induce apoptosis, it increased cell death when added with the JNK agonist anisomycin (ANS). TNF‐α and ANS were unable to induce apoptosis when either IGFBP‐3 or JNK‐2 was knocked‐down, suggesting that both JNK and IGFBP‐3 may interact with a downstream molecule central to apoptosis. There are reports that IGFBP‐3 promotes either cell proliferation or apoptosis in different cell systems. However, this is the first report that endogenous IGFBP‐3 is required for the action of both stimulatory and inhibitory factors within the same cell line. Therefore, the actions of IGFBP‐3 are not pre‐determined, but instead governed by cellular context such as JNK activation. J. Cell. Physiol. 220: 182–188, 2009. © 2009 Wiley‐Liss, Inc.     

Macrophage-induced expression and release of matrix metalloproteinase 1 and 3 by human preadipocytes is mediated by IL-1β via activation of MAPK signaling

Obesity is associated with a chronic low‐grade inflammation and increased macrophage infiltration in adipose tissue. Matrix metalloproteinases (MMPs) are involved in adipose tissue remodeling and inflammatory responses in obesity. This study investigated whether macrophage‐derived factors modulate expression and secretion of MMP1 and MMP3 in human preadipocytes. The potential mediators and signaling pathways were also explored. MMP1 and MMP3 were primarily expressed and secreted by preadipocytes and dramatically reduced post‐differentiation. Preadipocytes were incubated with RPMI 1640 medium (control) or THP‐1 macrophage‐conditioned (MC) medium (25% and 100%) for 24 h. MC medium markedly increased mRNA levels of MMP1 (up to 122‐fold) and MMP3 (up to 59‐fold), as well as protein release of MMP1 (up to 378‐fold) and MMP3 (up to 10‐fold) in a dose‐dependent manner. Treatment with IL‐1β or TNFα, the major products of macrophages, also induced MMP1 and MMP3 secretion by preadipocytes. Neutralizing IL‐1β abolished the induction of MMP1 and MMP3 in preadipocytes by MC medium while the effects of TNFα neutralization were modest. Furthermore, MC medium or IL‐1β led to the phosphorylation of p38, ERK and JNK MAPKs. Inhibition of p38, ERK and JNK reversed the stimulatory effects of MC or IL‐1β on MMP1 and MMP3 production. MC medium and IL‐1β also activated NF‐κB p65 whereas reduced IκBα protein expression in preadipocytes. These results suggest that macrophage accumulation in adipose tissue has a central role in stimulating MMP1 and MMP3 production by preadipocytes, and this is partially mediated by IL‐1β via activation of the MAPK and NF‐κB signaling pathways. J. Cell. Physiol. 226: 2869–2880, 2011. © 2011 Wiley‐Liss, Inc.     

Concomitant elevations of MMP‐9, NGAL,proMMP‐9/NGAL and neutrophil elastase in serum of smokers with chronic obstructive pulmonary disease

A growing body of evidence points towards smoking‐related phenotypic differences in chronic obstructive pulmonary disease (COPD). As COPD is associated with systemic inflammation, we determined whether smoking status is related to serum levels of matrix metalloproteinase‐9 (pro‐ and active MMP‐9), neutrophil gelatinase‐associated lipocalin (NGAL) and the proMMP‐9/NGAL complex in patients with COPD. Serum samples were collected in 100 stable‐phase COPD patients (82 smokers, 18 never‐smokers) and 28 healthy adults (21 smokers, 7 never‐smokers). Serum levels of studied factors were measured in ELISA. Our data provide the first evidence of simultaneously elevated serum levels of MMP‐9, NGAL and proMMP‐9/NGAL in COPD smokers. While the triad discriminated between smokers and non‐smokers in the COPD group, MMP‐9 and proMMP‐9/NGAL (but not NGAL) discriminated between smokers with and without COPD. Adjustment for age and smoking pack‐years did not alter the findings. Serum MMP‐9, NGAL and proMMP‐9/NGAL levels were not correlated with the GOLD stage or FEV1 decline. Furthermore, serum levels of neutrophil elastase (NE) and MMP‐3 (but not of IL‐6 and MMP‐12) were also higher in COPD smokers than in healthy smokers before and after adjustment for age and pack‐years. Among COPD smokers, levels of MMP‐9, NGAL and proMMP‐9/NGAL were positively correlated with NE (P < 0.0001) but not with the remaining factors. Gelatin zymography detected proMMP‐9 in serum samples of healthy and COPD smoking groups. Our results suggest that associated serum levels of proMMP‐9, NGAL, proMMP‐9/NGAL and NE may reflect the state of systemic inflammation in COPD related to cigarette smoking.     

Tumor Necrosis Factor‐α Stimulates Cell Proliferation in Adipose Tissue‐Derived Stromal‐Vascular Cell Culture: Promotion of Adipose Tissue Expansion by Paracrine Growth Factors

Objective: Elevated levels of tumor necrosis factor‐α (TNF‐α) protein and mRNA have been reported in adipose tissue from obese humans and rodents. However, TNF‐α has catabolic and antiadipogenic effects on adipocytes. Addressing this paradox, we tested the hypothesis that paracrine levels of TNF‐α, alone or together with insulin‐like growth factor‐I (IGF‐I), support preadipocyte development. Research Methods and Procedures: Cultured stromal‐vascular cells from rat inguinal fat depots were exposed to serum‐free media containing insulin and 0.2 nM TNF‐α, 2.0 nM TNF‐α, or 0.2 nM TNF‐α + 1.0 nM IGF‐I at different times during 7 days of culture. Results: TNF‐α inhibited adipocyte differentiation as indicated by a reduction in both immunocytochemical reactivity for the preadipocyte‐specific antigen (AD3; early differentiation marker) and glycerol‐3‐phosphate dehydrogenase activity (late differentiation marker). Early exposure (Days 1 through 3 of culture) to 0.2 nM TNF‐α did not have a long term effect on inhibiting differentiation. Continuous exposure to 0.2 nM TNF‐α from Days 1 through 7 of culture resulted in a 75% increase in cell number from control. There was a synergistic effect of 0.2 nM TNF‐α + 1 nM IGF‐I on increasing cell number by Day 7 of culture to levels greater than those observed with either treatment applied alone. Discussion: These data suggest that paracrine levels (0.2 nM) of TNF‐α alone or in combination with IGF‐I may support adipose tissue development by increasing the total number of stromal‐vascular and/or uncommitted cells within the tissue. These cells may then be recruited to become preadipocytes or may alternatively serve as infrastructure to support adipose tissue growth.     

牙龈卟啉单胞菌、嵴链球菌、口腔链球菌属在口腔内不同解剖部位的分布

目的探讨牙龈卟啉单胞菌(Porphyromonas gingivalis)、嵴链球菌(Streptococcus cristatus)、口腔链球菌属(Streptococci oralis)在慢性牙周炎患者及牙周健康者不同口腔解剖部位生物膜的分布情况。方法选取慢性牙周炎患者25例,牙周健康者24例,分别作为慢性牙周炎组及健康对照组。测量临床指标(探诊深度、附着丧失和探诊出血),取受试者龈下菌斑、舌背、颊黏膜和唾液样品。Real-time PCR分析受试者不同受检部位S.cristatus、P.gingivalis、Streptococci oralis相对数量。结果慢性牙周炎组四个受检部位中P.gingivalis数量均大于健康对照组;慢性牙周炎组龈下菌斑中P.gingivalis数量大于其余受检部位;而慢性牙周炎组龈下菌斑、舌背、颊黏膜三个受检部位S.cristatus、Streptococci oralis数量小于健康对照者。结论与牙周健康者比较,慢性牙周炎患者口腔内不同解剖位置P.gingivalis数量增多,S.cristatus、Streptococci oralis数量减少;P.gingivalis检出数量增加提示牙周炎患病风险增加,而S.cristatus、Streptococci oralis检出数量降低提示牙周炎患病风险降低。     

Augmented LPS responsiveness in type 1 diabetes‐derived osteoclasts

Bone abnormalities are frequent co‐morbidities of type 1 diabetes (T1D) and are principally mediated by osteoblasts and osteoclasts which in turn are regulated by immunologic mediators. While decreased skeletal health in T1D involves alterations in osteoblast maturation and function, the effect of altered immune function on osteoclasts in T1D‐associated bone and joint pathologies is less understood. Here T1D‐associated osteoclast‐specific differentiation and function in the presence and absence of inflammatory mediators was characterized utilizing bone marrow‐derived osteoclasts (BM‐OCs) isolated from non‐obese diabetic (NOD) mice, a model for spontaneous autoimmune diabetes with pathology similar to individuals with T1D. Differentiation and osteoclast‐mediated bone resorption were evaluated along with cathepsin K, MMP‐9, and immune soluble mediator expression. The effect of lipopolysaccharide (LPS), a pro‐inflammatory cytokine cocktail, and NOD‐derived conditioned supernatants on BM‐OC function was also determined. Although NOD BM‐OCs cultures contained smaller osteoclasts, they resorbed more bone concomitant with increased cathepsin K, MMP‐9, and pro‐osteoclastogenic mediator expression. NOD BM‐OCs also displayed an inhibition of LPS‐induced deactivation that was not a result of soluble mediators produced by NOD BM‐OCs, although a pro‐inflammatory milieu did enhance NOD BM‐OCs bone resorption. Together these data indicate that osteoclasts from a T1D mouse model hyper‐respond to RANK‐L resulting in excessive bone degradation via enhanced cathepsin K and MMP‐9 secretion concomitant with an increased expression of pro‐osteoclastic soluble mediators. Our data also suggest that inhibition of LPS‐induced deactivation in NOD‐derived BM‐OC cultures is most likely due to NOD osteoclast responsiveness rather than LPS‐induced expression of soluble mediators. J. Cell. Physiol. 228: 349–361, 2013. © 2012 Wiley Periodicals, Inc.     

Nutritional status and oral status of the elderly with dementia: a 2-year study

doi: 10.1111/j.1741‐2358.2011.00555.x Nutritional status and oral status of the elderly with dementia: a 2‐year study Objectives: To determine the relationship between denture wearing and nutritional status in the elderly with dementia. Background: There could be a correlation between nutrition, oral health, dietary habits, patients’ satisfaction, and their socio‐economic status in the elderly, and the relationship between compromised oral status and nutritional status in the elderly with dementia. Subjects and methods: A 2‐year follow‐up study of 63 elderly Japanese women with and without dentures from a nursing home was undertaken to investigate their oral, physical and mental, and nutritional status. Results: Each item for 2006 and 2008 in this study showed no significant difference between 2006 and 2008, except the calories/day. The elderly with dementia without complete dentures during the 2 years of the study only significantly decreased the mean of the calories/day. Conclusion: The calories/day of the elderly with dementia without dentures decreased after 2 years. Denture wearing for the elderly with dementia could be necessary to maintain a satisfactory intake of calories.     

Oral and general health status in patients treated in a dental consultation clinic of a geriatric ward in Bern, Switzerland

doi: 10.1111/j.1741‐2358.2011.00529.x Oral and general health status in patients treated in a dental consultation clinic of a geriatric ward in Bern, Switzerland Introduction: This audit reports on the oral and general health of patients who were treated in a dental consultation clinic of a geriatric hospital. Material and Methods: Dental and medical records were obtained from 112 female and 80 male patients (mean age, 83.7 ± 8.2 years) who attended a dental consultation. Data analysis included the general health [American Society of Anesthesiologists (ASA) classification, number of diagnoses, cognitive function] and dental state in the age strata 60–69, 70–79, 80–89 and 90–99 years. Results: Seventy‐four per cent of patients were aged over 80 years. The prevalence of ASA‐P4 and P3 varied between age groups. Most patients (>86%) had more than three chronic diseases. Cognitive impairment was present in almost half of both older age cohorts (43 and 50%). Half of the patients (52%) were edentulous. In dentate patients, the average number of teeth was 12 ± 6 and differed in the maxilla significantly between age groups (p = 0.005). There was no significant association between dental state, ASA classification and systemic conditions. Conclusions: The profile of this cohort reflects a poor oral and general health status. The results underline the importance of an interdisciplinary consultation in a geriatric ward where oral health care is an integral part.     

Identification of a metabolic signature for multidimensional impairment and mortality risk in hospitalized older patients

A combination of several metabolic and hormonal adaptations has been proposed to control aging. Little is known regarding the effects of multiple deregulations of these metabolic and hormonal systems in modulating frailty and mortality in hospitalized elderly patients. We measured 17 biological serum parameters from different metabolic/hormonal pathways in 594 hospitalized elderly patients followed up to 1 year who were stratified into three groups according to their multidimensional impairment, evaluated by a Comprehensive Geriatric Assessment (CGA)‐based Multidimensional Prognostic Index (MPI). The mortality incidence rates were 7% at 1 month and 21% at 1 year. Our data show that frailty and mortality rate were positively associated with chronic inflammation and with a down‐regulation of multiple endocrine factors. Of the 17 biomarkers examined, blood levels of IGF‐1, triiodothyronine, C‐reactive protein, erythrocyte sedimentation rate, white blood cell and lymphocyte counts, iron, albumin, total cholesterol, and LDL‐c were significantly associated with both MPI severity grade and mortality. In multivariate Cox proportional hazard model, the following biomarkers most strongly predicted the risk of mortality (adjusted hazard ratio (HR) per 1 quintile increment in predictor distribution): IGF‐1 HR = 0.71 (95% CI: 0.63–0.80), CRP HR = 1.48 (95% CI: 1.32–1.65), hemoglobin HR = 0.82 (95% CI: 0.73–0.92), and glucose HR = 1.17 (95% CI: 1.04–1.30). Multidimensional impairment assessed by MPI is associated with a distinctive metabolic ‘signature’. The concomitant elevation of markers of inflammation, associated with a simultaneous reduction in multiple metabolic and hormonal factors, predicts mortality in hospitalized elderly patients.