BANGALORE, KARNATAKA
M.D.S PERIODONTICS
Synopsis for Registration of Dissertation
M.R AMBEDKAR DENTAL COLLEGE AND HOSPITAL
#1/36,Cline Road, Cooke Town
Bangalore 560005
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE.
ANNEXURE II
SYNOPSIS FOR REGISTRATION OF DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / Dr. SOUBIYAD/O Asghar Noorulla
D/9, GM Infinite Silver Corner,
15 Atmanand Colony, Sultan Palya,
R.T. Nagar Post,
Bangalore 560032.
2 / NAME OF INSTITUTION / M. R. AMBEDKAR DENTAL COLLEGE & HOSPITAL
#1/36, Cline Road, Cooke Town
Bangalore 560005.
3 / COURSE OF STUDY AND SUBJECT / M.D.S PERIODONTICS
4 / DATE OF ADMISSION /
27 May, 2013
5 / TITLE OF THE TOPIC
AN ESTIMATION OF ADIPOCYTE FATTY ACID BINDING PROTEIN LEVELS IN GINGIVAL CREVICULAR FLUID IN PERIODONTAL HEALTH AND DISEASE
6. Brief resume of intended work:
6.1 Need for study:
Chronic periodontitis is defined as an inflammatory disease of the supporting tissues of the teeth caused by groups of specific microorganisms, resulting in progressive destruction of the periodontal ligament and alveolar bone with pocket formation, recession or both.1
Since 1989, a number of studies have been undertaken in the area of periodontal medicine to investigate relationship between periodontal disease and systemic diseases. Periodontitis shares many features with other inflammatory diseases including biomarkers.2
Adipocyte fatty acid binding protein (AFABP/aP2/FABP4) is a member of intercellular lipid protein and plays a role in evolutionary crossroads of inflammation, atherosclerosis and metabolic responses. It accounts for 6% of cytosolic protein and is also produced by macrophages and endothelial cells in significant amounts. It is emerging as an alternative biomarker of systemic inflammation and cardiovascular diseases.3
Results of an animal experiment suggest that AFABP gene deletion could prevent or reduce development of atherosclerosis in the atherosclerotic prone Apo lipoprotein(apoE)-deficient mice.3 First human study was published in 2007, which reported that circulating AFABP levels are elevated in subjects with atherosclerosis.4
Currently AFABP levels are also being investigated for its role in various facets of metabolic syndrome, vascular disease, diabetes and other inflammatory diseases including periodontitits5. A pilot study concluded that serum and plasma levels of AFABP decreased in patients with chronic periodontitis after nonsurgical periodontal therapy was performed6. However until date there has been no attempt to estimate the gingival crevicular fluid (GCF) levels of AFABP in periodontal health and disease.
Based on the current understanding of AFABP and its critical role in inflammation, this investigation is designed to study the association of GCF levels of AFABP in periodontal health and disease, and to explore the possibility of using AFABP as a biomarker of periodontal inflammation as it is understood that GCF has great potential in
early detection of periodontitis and healing of periodontal tissues after therapy.
6.2 Review of Literature:
1. Periodontitis is an infection with episodic nature of tissue destruction. A study with an aim to determine levels of chemokines, cytokines, MMP-13, periodontal pathogens and inflammatory cells in periodontitis was conducted. The study indicated higher levels of the above parameters in active sites of tissue destruction and partially explained the mechanism associated with it.1
2. A study was done to investigate the association between severe periodontitis and increase in inflammatory and metabolic risk factors for cardiovascular disease. Blood samples of subjects were collected and assessed to reveal a possible link between severe periodontitis, systemic inflammation and a dysmetabolic state in otherwise healthy individuals.2
3. An animal experiment conducted on Apo lipoprotein deficient mice (apoE), also deficient in AFABP. The study concluded that apoE mice showed protection from atherosclerosis indicating an independent role of AFABP in atherogenesis.3
4. A study on Chinese population was conducted for the first time in 2007 to co-relate serum AFABP levels and atherosclerosis. Serum AFABP levels positively correlated with carotid intima media thickness (IMT) in both men and women and presence of plaque. The study concluded that serum AFABP is an independent determinant of carotid atherosclerosis.4
5. An in vitro study was conducted to evaluate role of AFABP/aP2 in cellular metabolism using knockout mice. The study concluded that ligand-bound AFABP/aP2 binds to and attenuates JAK2 signaling and establishes a new role for AFABP/aP2 as a fatty acid sensor affecting cellular metabolism via protein-protein interactions.5
6. A pilot clinical trial was conducted on 24 Chinese subjects grouped into healthy and periodontitis group. Treatment was provided to the periodontitis group immediately and delayed for 3 months in control group. Serum levels of AFABP were measured using ELISA. The results showed significant decrease in serum AFABP levels in treatment group when compared to control group.6
6.3 Objectives of the study:
1. To estimate gingival crevicular fluid (GCF) levels of adipocyte fatty acid binding protein (AFABP) in
periodontal health and disease.
2. To evaluate association between GCF levels of AFABP and periodontal parameters.
3. To explore the possibility of using AFABP as a biomarker for periodontal disease.
7. Methodology
7.1 Source of data:
The study population will consist of subjects belonging to both the sexes. All the subjects will be selected from M.R. Ambedkar Dental College and Hospital, Bangalore, Karnataka, India. The nature and purpose of the study will be explained to the subjects and written informed consent will be taken.
7.2 Methods of collection of data:
60 subjects will be recruited and divided into 3 groups consisting of 20 subjects each according to the criteria shown below.
· Group 1: Subjects with healthy periodontium.
· Group2: Subjects with gingivitis.
· Group 3: Subjects with chronic periodontitis.
Selection Criteria
Inclusion Criteria
· Healthy subjects: Subjects who are systemically healthy with probing depth (PD) <3mm, absence of clinical attachment loss, bleeding on probing ≤5% of sites examined.
· Gingivitis subjects: subjects with inflammatory changes in gingival tissue with probing depth (PD)≤3mm, presence of bleeding on probing (BOP)≥50% of sites examined.
· Periodontitis Subjects: subjects with inflammatory changes in gingival tissue, probing pocket depth (PD) ≥5mm, clinical attachment loss (CAL) ≥ 3mm, presence of bleeding on probing (BOP).
Exclusion Criteria
· History of underlying systemic disease.
· History of Periodontal treatment in past 6 months.
· Under antibiotic treatment during past 6 months.
· History of Tobacco chewing.
· Current and former smoker.
· Pregnant females and lactating mothers .
· Patients on steroid therapy and oral contraceptives.
· Any medication affecting periodontal health.
Written informed consent will be taken from all subjects. Bleeding index (Ainamo and Bay), Plaque index (Silness and Loe), Probing depth and Attachment loss will be recorded in all subjects. 3µl of gingival crevicular fluid (GCF) will be collected by extracrevicular method using calibrated micro capillary pipettes.
The samples of the subjects will be stored frozen (preferably at -70 degree Celsius) for quantitative determination of adipocyte fatty acid binding protein. Each sample will be subjected to an enzyme linked immunosorbent assay using a Human AFABP ELISA Kit. Values obtained from the test will be recorded, computed and subjected to statistical analysis. Probable statistical analysis to be used is the one-way analysis of variance (ANOVA), Pearson correlation analysis, to compare the samples of the three groups.
Duration of study: The study will be carried out from March 2014 to August 2015.
7.3 Does the study require any investigations to be conducted on patients or other humans or animals?
Yes
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes
8. List of References:
1. Silva N, Dutzan N, Hernandez M, Dezerega A, Rivera O, Aguillon JC, Aravena O, Lastres P, Pozo P, Vernal R, Gamonal J. Characterization of progressive periodontal lesions in chronic periodontitis patients: levels of chemokines, cytokines, matrix metalloproteinase-13, periodontal pathogens and inflammatory cells. J Clin Periodontol 2008; 35: 206–214.
2. Nibali, L., D'Aiuto, F., Griffiths, G., Patel, K., Suvan, J. and Tonetti, MS. Severe periodontitis is associated with systemic inflammation and a dysmetabolic status: a case–control study. J Clin Periodontol 2007; 34:931–937.
3. Makowski, Jeffrey, Kazuhisa, Vladimir, Ulysal, Maureen, Parker, Suttles, Fazio Gokhan, Linton. Lack of macrophage fatty acid–binding protein aP2 protects mice deficient in apolipoprotein E against atherosclerosis. Nature medicine 2001;7: 699-705.
4. D.C.Y. Yeung, A. Xu, C.W.S. Cheung, N.M.S. Wat, M.H. Yau, C.H.Y.Fong, M.T. Chau and K.S Lam. Serum adipocyte fatty acid-binding protein levels were independently associated with carotid atherosclerosis. Arteriosclerosis, thrombosis and vascular biology 2007; 27: 1796-1802.
5. Brian R. Thompson, Anna M. Thompson, Mazurkiewicz-Muñoz, Jill Suttles, Christin, Carter-Su and David A. Bernlohr. Interaction of Adipocyte Fatty Acid- binding Protein (AFABP) and JAK2 AFABP/aP2 a regulator of JAK2 signaling. Journal of Biological Chemistry 2009; 284: 13473-13480.
6. Li X, Tse H, Yiu KH, Zhang C, Jin LJ. Periodontal therapy decreases serum levels of adipocyte fatty acid-binding protein in systemically healthy subjects: a pilot clinical trial. J Periodont Res 2013; 48: 308–314.
SIGNATURE OF THE CANDIDATE
REMARKS OF THE GUIDE
NAME AND DESIGNATION OF THE GUIDE / Dr. HEMALATA. M
PROFESSOR,
DEPARTMENT OF PERIODONTICS,
M.R.AMBEDKAR DENTAL COLLEGE,
BANGALORE-05
SIGNATURE OF THE GUIDE
CO- GUIDE / ------
SIGNATURE / ------
HEAD OF THE DEPARTMENT /
Dr. MOHAMED FAIZUDDIN
SIGNATURE
REMARKS OF THE PRINCIPAL
SIGNATURE
CONSENT FORM
I, ______, aged______yrs, son/daughter/wife /husband of
______hereby authorize Dr SOUBIYA, working at M.R AMBEDKAR DENTAL COLLEGE AND HOSPITAL, to perform any diagnostic examination and collection of gingival crevicular fluid.
The nature of the condition and any possible complications of the procedure have been explained to me in the language i understand by my doctor.
I also agree that if any untoward incident happens, which is beyond the doctor’s control, no responsibility will be attached to the doctor(s)/hospital/ staff.
I also agree and give my full consent to participate in the study conducted in Department of Periodontics, M.R Ambedkar Dental College and Hospital, the nature of the study have been explained to me by my doctor (s).
I declare that I am of sound mind and I am giving this consent with my own free will after having read and understood the contents of the consent form.
Name of the procedure:
Measurement of the clinical parameters and collection of gingival crevicular fluid.
Signature of the patient/person giving consent: Date:
WITNESS SIGNATURE
1.
2.