COBRE Phase III Year 5 Pilot: Does Periapical Infection Enable Cardiovascular Inflammation?

Atherosclerotic cardiovascular disease is the number one cause of death and top health economic expense in the US. Development of this disease involves complex biological and inflammatory events that contribute to atheromatous plaque development, erosion and rupture. Of note, evidence suggests that distant infections that produce pro-inflammatory and pro-coagulant events are contributing significantly to this process, however how this happens remains not well understood. Studies that advance our understanding of these processes are likely to create great public benefit. Here, we propose to study the bio-inflammatory response to periapical infection and its elimination in a pilot grant that enrolls 20 participants, with the larger goal of obtaining R21 funding to study 80 adults who have single-tooth periapical disease. An interventional observational study of cardiovascular inflammatory and tissue damage biomarkers (i.e., serum: apolipropotein B, C-reactive protein, interluekin1-b, interleukin-6, myeloperoxidase, lipoprotein-associated phospholipase A2, high sensitivity troponin, and saliva and serum lipopolysaccharides) at baseline and six weeks after tooth extraction is planned. Changes in biomarker concentrations adjusted for the severity of cardiovascular disease and oral disease will provide critical insight into the role of periapical infection and the production and circulation of biomolecules associated with cardiovascular inflammation. This project leverages the high prevalence of periapical disease and atherosclerotic cardiovascular disease in our population, and will provide critical insight into systemic inflammation after elimination of targeted oral disease. The findings are expected to contribute to the growing body of evidence that demonstrates the importance of oral health for the maintenance of optimal cardiovascular health.