Anti-Porphyromonas Gingivalis Antibody Levels in Patients With Stroke and Atrial Fibrillation: A Systematic Review and Meta-Analysis

Overview

Journal Clin Exp Dent Res

Publisher Wiley

Specialty Dentistry

Date 2024 Nov 13

PMID 39535348

Authors

Alessandro Cannavo

Nastaran Babajani

Behrad Saeedian

Elina Ghondaghsaz

Sandro Rengo

Amirmohammad Khalaji

Amir Hossein Behnoush

Affiliations

Soon will be listed here.

Abstract

Objectives: Atrial fibrillation (AF) and stroke are two highly related conditions, with periodontitis and periodontal pathogens, such as Porphyromonas gingivalis (Pg), appearing to be the most prominent common risk factors. In this study, we evaluated studies assessing Pg infection via serum/plasma anti-Pg antibodies in patients with AF and/or stroke.

Material And Methods: Online databases (PubMed, Scopus, Embase, and the Web of Science) were screened for studies showing the association between anti-Pg antibodies with stroke and/or AF. Relevant data were extracted, and a subsequent random-effects meta-analysis was performed to calculate the pooled odds ratio (OR) or standardized mean difference (SMD) and 95% confidence intervals (CIs) for Pg seropositivity or anti-Pg antibody levels in stroke patients compared to controls.

Results: Sixteen studies were included in the systematic review. Based on the meta-analysis performed, there was no significant difference in Pg IgA and IgG levels between patients with stroke and controls (IgA: SMD 0.11, 95% CI -0.02 to 0.25, p = 0.1; IgG: SMD -0.12, 95% CI -1.24 to 0.99, p = 0.83). Similarly, no difference was observed between these groups in terms of Pg IgA and IgG seropositivity (IgA: OR 1.63, 95% CI 1.06-2.50, p = 0.026; IgG: OR 2.30, 95% CI 1.39-3.78, p < 0.001). Subsequently, we reviewed the results of six articles investigating serum or plasma IgG antibodies against Pg in patients with AF. Our results revealed a strict association between Pg infection and AF, with AF patients exhibiting either higher anti-Pg antibody levels or a higher prevalence of positive serum Pg antibodies.

Conclusions: Our study supports the clinical utility of Pg infection assessment in patients with periodontitis and those with AF and solicits more focused studies to corroborate its use in clinical settings to enhance overall outcomes, reduce the risk of complications like stroke, and help fine-tune personalized therapies.

References

Radaic A, Kapila Y . The oralome and its dysbiosis: New insights into oral microbiome-host interactions. Comput Struct Biotechnol J. 2021; 19:1335-1360. PMC: 7960681. DOI: 10.1016/j.csbj.2021.02.010. View

Sfyroeras G, Roussas N, Saleptsis V, Argyriou C, Giannoukas A . Association between periodontal disease and stroke. J Vasc Surg. 2012; 55(4):1178-84. DOI: 10.1016/j.jvs.2011.10.008. View

Luo D, Wan X, Liu J, Tong T . Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res. 2016; 27(6):1785-1805. DOI: 10.1177/0962280216669183. View

Krishnamurthi R, Ikeda T, Feigin V . Global, Regional and Country-Specific Burden of Ischaemic Stroke, Intracerebral Haemorrhage and Subarachnoid Haemorrhage: A Systematic Analysis of the Global Burden of Disease Study 2017. Neuroepidemiology. 2020; 54(2):171-179. DOI: 10.1159/000506396. View

Park J, Lee H, Kim J, Song T . Association between periodontal disease status and risk of atrial fibrillation: a nationwide population-based cohort study. BMC Oral Health. 2023; 23(1):461. PMC: 10329345. DOI: 10.1186/s12903-023-03165-x. View

Kassebaum N, Smith A, Bernabe E, Fleming T, Reynolds A, Vos T . Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990-2015: A Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors. J Dent Res. 2017; 96(4):380-387. PMC: 5912207. DOI: 10.1177/0022034517693566. View

Zhang X, Xue J, Yang W, Xu X, Sun H, Hu L . Inflammatory markers as independent predictors for stroke outcomes. Brain Behav. 2020; 11(1):e01922. PMC: 7821567. DOI: 10.1002/brb3.1922. View

Wolf P, Abbott R, Kannel W . Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991; 22(8):983-8. DOI: 10.1161/01.str.22.8.983. View

Palm F, Pussinen P, Aigner A, Becher H, Buggle F, Bauer M . Association between infectious burden, socioeconomic status, and ischemic stroke. Atherosclerosis. 2016; 254:117-123. DOI: 10.1016/j.atherosclerosis.2016.10.008. View

10.

Lafon A, Pereira B, Dufour T, Rigouby V, Giroud M, Bejot Y . Periodontal disease and stroke: a meta-analysis of cohort studies. Eur J Neurol. 2014; 21(9):1155-61, e66-7. DOI: 10.1111/ene.12415. View

11.

Leira Y, Seoane J, Blanco M, Rodriguez-Yanez M, Takkouche B, Blanco J . Association between periodontitis and ischemic stroke: a systematic review and meta-analysis. Eur J Epidemiol. 2016; 32(1):43-53. DOI: 10.1007/s10654-016-0170-6. View

12.

Plomp R, de Haan N, Bondt A, Murli J, Dotz V, Wuhrer M . Comparative Glycomics of Immunoglobulin A and G From Saliva and Plasma Reveals Biomarker Potential. Front Immunol. 2018; 9:2436. PMC: 6206042. DOI: 10.3389/fimmu.2018.02436. View

13.

Kia Y, Cannavo A, Bahiraie P, Alilou S, Saeedian B, Babajani N . Insights into the Role of Galectin-3 as a Diagnostic and Prognostic Biomarker of Atrial Fibrillation. Dis Markers. 2023; 2023:2097012. PMC: 10578984. DOI: 10.1155/2023/2097012. View

14.

Sen S, Redd K, Trivedi T, Moss K, Alonso A, Soliman E . Periodontal Disease, Atrial Fibrillation and Stroke. Am Heart J. 2021; 235:36-43. PMC: 8084947. DOI: 10.1016/j.ahj.2021.01.009. View

15.

Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S . Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol. 2014; 6:213-20. PMC: 4064952. DOI: 10.2147/CLEP.S47385. View

16.

Liccardo D, Marzano F, Carraturo F, Guida M, Femminella G, Bencivenga L . Potential Bidirectional Relationship Between Periodontitis and Alzheimer's Disease. Front Physiol. 2020; 11:683. PMC: 7348667. DOI: 10.3389/fphys.2020.00683. View

17.

Park D, Woo B, Lee B, Yoon S, Cho Y, Kim Y . Serum Levels of Interleukin-6 and Titers of Antibodies Against Could Be Potential Biomarkers for the Diagnosis of Oral Squamous Cell Carcinoma. Int J Mol Sci. 2019; 20(11). PMC: 6600294. DOI: 10.3390/ijms20112749. View

18.

Aoyama N, Kure K, Minabe M, Izumi Y . Increased Heart Failure Prevalence in Patients with a High Antibody Level Against Periodontal Pathogen. Int Heart J. 2019; 60(5):1142-1146. DOI: 10.1536/ihj.19-010. View

19.

Nishi H, Hosomi N, Ohta K, Aoki S, Nakamori M, Nezu T . Serum immunoglobulin G antibody titer to Fusobacterium nucleatum is associated with unfavorable outcome after stroke. Clin Exp Immunol. 2020; 200(3):302-309. PMC: 7232001. DOI: 10.1111/cei.13430. View

20.

Leskela J, Pietiainen M, Safer A, Lehto M, Metso J, Malle E . Serum lipopolysaccharide neutralizing capacity in ischemic stroke. PLoS One. 2020; 15(2):e0228806. PMC: 7034831. DOI: 10.1371/journal.pone.0228806. View