Oral fluid cytokine balance characteristics in patients with iron deficiency anemia and inflammatory periodontal diseases

Relevance. Iron deficiency anemia (IDA) has various clinical manifestations, including those in the oral cavity, connected with depressed humoral and cell-mediated immunity. However, there is no clear understanding of the character of the cytokine storm in the oral cavity of these patients. Hence, the study aimed to investigate the amount of pro- and anti-inflammatory cytokines in the oral cavity of patients with iron-deficiency anemia before and after iron therapy.

Material and Methods. The study included 168 females aged 29.6±1.65 years old, who formed three groups: the main group comprised the patients with IDA, the comparison group included patients with inflammatory periodontal diseases without systemic diseases, and the control group contained the patients without oral inflammatory and systemic diseases. We examined all the patients, determined DMF index, OHI-S (Greene-Vermillion), PBI (Muhlemann-Saxer), gingival inflammation by the РМА index modified by Рarma and determined the level of IL-1β, IL-6, IL-4 and INF-γ in the oral cavity by enzyme immunoassay.

Results. The study determined the clinical signs of periodontal inflammation in all patients with IDA before treatment. Inflammatory periodontal diseases and IDA combination caused a significant decrease of pro-inflammatory cytokines IL-1β and IL-6 (9.67 pcg/ml and 20.52 pcg/ml, respectively) in the oral fluid of all the examined compared to the periodontal patients without systemic diseases. Patients with IDA demonstrated an increase of IL-1β (40.58 pcg/ml) and a decrease of IL-4 (25.18 pcg/ml) and INF-γ (46.93 pcg/ml) in the oral fluid after the completion of the iron therapy course.

Conclusion. A decrease in pro-inflammatory cytokine IL-1β and IL-6 levels in patients with IDA and oral inflammation evidenced the changes in the immune response compared to the group of periodontal patients without systemic diseases, which may lead to an unfavourable prognosis. After the iron therapy course, the oral cytokine concentration in patients with IDA corresponded to the oral fluid cytokine profile of comparison group patients, which indicated the compensation of secondary immune deficiency.

1. Chernysh NYu, Zenina NYu. Laboratory criteria for the diagnosis of anemic syndrome in elderly. Laboratory service. 2018;7(2):44-48 (In Russ.). doi: 10.17116/labs20187244-48

2. Archer NM, Brugnara C. Diagnosis of iron-deficient states. Critical reviews in clinical laboratory sciences. 2015;52(5):256-272. doi:10.3109/10408363.2015.1038744

3. Bogdanov AN, Mazurov VI. Iron deficiency anemia in the XXI centure. Herald of the Northwestern State Medical University named after I.I. Mechnikov. 2016;8(4):106-112 (In Russ.). Available from: https://www.elibrary.ru/item.asp?id=27673522

4. Zyubina LYu, Shpagina LA, Loseva MI, Ageeva TA, Ushakova GYu, Gerasimenko ON, et al. Clinical and functional state of the stomach and liver in conditions of chronic sideropenia. Bulletin SO RAMS. 2009;3(137):56-63 (In Russ.). Available from: https://cyberleninka.ru/article/n/kliniko-funktsionalnoe-sostoyanie-zheludka-i-pecheni-v-usloviyahhronicheskoy-sideropenii

5. Petrov RV, Khaitov RM, Chereshnev VA. Physiology of the immune system: cellular and molecular-biologocal mechanisms. Russian foundation for basic research journal. 2017;1:96-119 (In Russ.). Available from: https://www.elibrary.ru/item.asp?id=30715023

6. Zhavoronkov AA, Kudrin AV. Immunnje funkcii transferrina. Russian journal of hematology and transfusiology. 1999;44(2):40-43 (In Russ.). Available from: https://www.elibrary.ru/item.asp?id=38219802

7. Weston L. Convenient and reliable IL-2 bioassay using frozen CTLL-2 to improve the detection of helper T-lymphocyte precursors. Immunology and cell biology.1998;76(2):190-192. doi: 10.1046/j.1440-1711.1998.00733.x

8. Safuanova GSh, Nikulicheva VI, Bakirov AB. A comprehensive evaluation of the immune-system condition and of a variety of cytokines in patients with iron-deficient anemia. Clinical laboratory diagnostic. 2004;1:24-35 (In Russ.). Available from: https://www.elibrary.ru/item.asp?id=17039776

9. Khayatova ZB, Pekarev OG, Tsyrendorzhiev DD. Prognostic value of cytokines in combination of different forms of anemia and inflammatory diseases of internal genitalia of women reproductive age. Journal of Siberian Medical Sciences. 2011;4:21-24 (In Russ.). Available from: https://cyberleninka.ru/article/n/prognosticheskoeznachenie-tsitokinov-pri-sochetanii-raznyh-form-anemii-i-vospalitelnyh-zabolevaniy-vnutrennih-polovyhorganov-u

10. Smorkalova EV, Aznabaeva LF, Nikulicheva VI, Safuanova GSh, Chepurnaya AN. The characteristics of iron metabolism under iron-deficiency anemia and chronic disorders anemia. Russian Clinical Laboratory Diagnostics. 2011;7:30-32 (In Russ.). Available from: https://www.elibrary.ru/item.asp?id=16803776