Periodontal treatment increases circulating EPC counts in patients with T2DM

Abstract

Objectives: It is evident that a decreased level of circulating endothelial progenitor cells (EPCs) reflects a poor glycemic control and increased risk of cardiovascular disease (CVD). Our recent study shows that chronic periodontitis is significantly associated with the reduction of EPCs in patients with type 2 diabetes (T2DM). This study extended to investigate the effects of periodontal treatment on EPC counts in subjects with T2DM. Methods: A single-blind randomized controlled trial was conducted in 44 Chinese adults with both T2DM and moderate to severe chronic periodontitis. They were randomly assigned into the Treatment group (n=22) with immediate periodontal treatment including oral hygiene instruction, scaling and root debridement, and the Control group (n=22) with a postponement of the same treatment after 6-month follow-up. Four subsets of circulating EPCs, namely CD34+, CD133+, CD34+/KDR+ and CD133+/KDR+ cells in peripheral blood were quantified by flow cytometry analysis at baseline and 6-month recall. Results: The overall periodontal condition in the Treatment group was greatly improved following the treatment. Meanwhile, there was a notable increase in the levels of CD133+ and CD133+/KDR+ cells (log transformed: 2.00±1.18 vs. 3.16±1.50, p< 0.01; 0.78±0.76 vs. 1.69±1.10, p<0.05), whereas, no significant change was found in the Control group. Furthermore, the increase in CD133+/KDR+ cell counts was reversely correlated with the reduction in sites% with probing depth ≥ 4mm (R2=0.105, p=0.04). No significant therapeutic effect was observed in the levels of CD34+ and CD34+/KDR+ cells. Conclusions: This study provides the first evidence that periodontal treatment may account for the increase of circulating CD133+ and CD133+/KDR+ cell counts in subjects with T2DM, implying that effective control of periodontal infection/inflammation could be beneficial for diabetes care and reduction of CVD risks.