Fellowship/Madsen: Inflammatory Mediator Levels in Patients with Advanced Periodontal Disease Before and After Full-Mouth Extractions

The levc1s of yarious ini1ammatory mediators are elcvated in patients at risk of cardiovascular e\"l_~nis.Selected mediators shown to be important in predicting the occurrence of such events such as myocardial infarction include C-reactive protein (CRP), interleukin-6 (lL-6). fibrinogen. and amyloid A. Elevated serum lewis ofCRP. amyloid A, and IL-6 incrcase patients' risk of coronary artery disease (CAD), myocardial int'lrction (MI), and stroke.[1-3] C-Reactive Protein (CRP) is an acute phase plasma protein, that is mostly synthesized in the liver. Plasma concentrations increase in response to innammatory stimuli. CRP has the ability to act as an opsonin during microbial cell infection and may also fix complement. During the early stages of carotid atherosclerosis. the CRP concentration is a Inarkcr of carotid atherosclerotic activity and is a predictor of the risk of death or 'v!L[3-7] It is belie,.ed that inf1ammation involving atherosclerotic pla4ues in the coronary arteries may predispose to thrombl1sis as well as CRP production. Research has shown that patients Vo.rith CAD ha\"e higher serum levels of CRP than control subjects.[S-l 0] CRP predicts the risk of future MI and stroke[I, 21 and is a marker of carotid athcn}sclerotic actlyity.[4J CRP is also a marker of increased I-year risk of ischemic strokc.[ll, 12] Interleukin-6 is a cytokine that mediates innate immul1lty. It i.s included with 11.-1. Tumor Necrosis Factor, and Interferon-a. The function of these cytokines is to promote leukocy1e recruitment and acute inflammatory responses. Fibrinogen is one of that last components of the clotting cascade. It is interrelated with plasma mediators that induce inflammation. Fibrin is also the precursor to tibrinopeptides, which have int1ammatory properties. They work in a similar manner to thrOtnbin to induce inflalnmation by acting on platelets, endothelium, and smooth muscle cells.