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Honored Professor Alpdogan Kantarci from The Forsyth Institute, Harvard School of Dental Medicine Affiliate, Cambridge, MA, United States, served as an opponent of DDS Laura Lahdentausta in her academic dissertation entitled “Serum and saliva biomarkers in cardiovascular diseases and periodontitis- Smoking as a confounding factor”. The dissertation was held in Biomedicum Helsinki 5th December 2018 and the PhD thesis was conducted in Department of Oral and Maxillofacial Diseases, University of Helsinki. Supervisors were adjunct Professor Pirkko Pussinen and Professor Timo Sorsa.

The PhD study consisted of three different study populations from which serum and saliva biomarker levels (MMP-8, MMP-9, TIMP-1, and MPO) were measured. Firstly, the Triangel data collected at Lund University Central Hospital in Sweden (n = 669) comprised ACS patients and healthy controls. Secondly, the case-control data collected from Ludwigshafen, Germany (n = 198), consisted of ischemic stroke patients and their controls whose oral status was estimated through a questionnaire and cumulative risk score (CRS) to assess their risk of having periodontitis determined from saliva molecules. Thirdly, the Parogene cohort (n = 508) consisted of patients with an indication of coronary angiography seen at Helsinki University Central Hospital in Finland. The clinical oral status was examined for patients in this cohort.

The data from this study indicate that saliva biomarkers distinguish periodontitis patients from controls, and cardiac status has a minor effect on the salivary periodontal diagnostics. Serum biomarkers designate the systemic state, and can be utilized in the diagnosis of CVD, including both ACS and ischemic stroke. This observation emerged from the Ludwigshafen study, where elevated serum biomarkers associated with ischemic stroke, while stroke-free healthy controls more frequently exhibited signs of current periodontitis reflected in elevated saliva biomarker levels. However, in the Parogene study periodontitis interfered in the diagnosis of ACS using serum MMP-9, indicating the systemic effect of periodontal disease. Finally, smoking complicates the use of saliva and serum biomarkers, whereby the smoking dimension (i.e., quantity, duration, and time since cessation) influences the biomarkers.

Overall, it was found that periodontitis and CVD associate with one another and the degradation of ECM remains crucial in both diseases. Thus, the same biomarkers can be utilized in the diagnosis of both diseases. However, the selection of sample material is crucial. Specifically, saliva is suitable for distinguishing periodontitis patients from controls, whereas serum biomarkers are suitable for CVD diagnostics. Smoking remains a factor that must be taken into account when using both serum and saliva biomarkers, such as MMP-8, MMP-9, TIMP-1, and MPO. To conclude, these biomarkers could be utilized by different healthcare professionals for screening, early diagnosis, and prevention aiming to improve patient quality of life.

Electronic link to thesis

On the picture from left to right: Ulvi K. Gürsoy (Un. of Turku), Mervi Gürsoy (Un. of Turku), Alpdogan Kantarci (Forsyth inst.), Laura Lahdentausta (Un. of Helsinki), Pirkko Pussinen (Un. of Helsinki), and Tulay Yucel-Lindberg (Karolinska inst.).