The effects of non-surgical periodontal therapy on neutrophil elastase and elastase alpha-1 proteinase inhibitor levels in GCF in periodontitis patients with or without acute coronary syndrome

Objective Periodontitis may contribute to vascular damage, resulting in the destabilization of atherosclerotic plaque leading to acute coronary syndrome (ACS). In this study, we explored the effect of non-surgical periodontal treatment (NSPT) on cardiovascular blood biomarkers and gingival crevicular fluid (GCF) neutrophil elastase (NE) and α1-proteinase inhibitor (α-1PI) levels in periodontitis (P) participants with and without ACS. Materials and methods Medical and dental examinations were performed to diagnose ACS and periodontitis, respectively. Seventeen patients with diagnosis of ACS and periodontitis were included in this study, as a test group (group ACS). Twenty-six age and sex-matched control patients with periodontitis (group P) were otherwise systemically healthy. Both groups received NSPT. Plasma levels of cholesterol, triglyceride, high-density lipoprotein (HDL), low-density lipoprotein (LDL), C-reactive protein (CRP), GCF NE activity, GCF α 1 -PI levels, and GCF NE/α1-PI rates were measured at baseline, at1 st and 3 rd months after NSPT. Results GCF NE activity/time (μU/30s) decreased significantly at 3 rd month compared to baseline values in the Group P after NSPT. First and 3 rd months after NSPT, in the Group P GCF α 1 -PI activity/time (pg/30s) was significantly higher than the Group ACS. Moreover GCF NE/α 1 -PI rates decreased significantly compared to baseline values at 1 st and 3 rd months after NSPT in the group P. Conclusion NSPT yields decrease in NE/α 1 -PI rates. NE and its possible interactions with α 1 -PI may play a crucial role in both periodontitis and ACS. GCF α1PI activity/time (U/30s) can be a potential biomarker in management of periodontitis associated with ACS. Clinical relevance The GCF α1-PI reduction may alter the immune-inflammatory response in patients with periodontitis and thus increase the risk of ACS. Trial registration Thai Clinical Trials.gov (NCT04785235)