Estimation of proinflammatory cytokines and biochemical parameters in patients chronic periodontitis with post-radiotherapy head and neck cancer

Head and neck cancer (HNC) patients have many problems post-radiotherapy (e.g. periodontitis, oral complications, hyposalivation, and oral pH change). The present study aimed to investigate the influence of Interleukin 1 Beta (IL-1β), Macrophage Inflammatory Proteins 1 Alpha (MIPs-1α), Osteoprotegerin (OPG), and Urokinase- Type Plasminogen Activator (uPA) in sera of chronic periodontitis with HNC post-RT, chronic periodontitis without HNC, and periodontally healthy (control). The study also included vitamin D3, vitamin B12, calcium, uric acid, alkaline phosphatase, ferritin, and folate as biochemical tests, and Interleukin-6 (IL-6), high sensitive C reactive protein (HS-CRP), procalcitonin (ProCT) as pro-inflammatory tests, for risk developing. IL-1β, MIPs-1α, OPG, and uPA were determined by using enzyme-linked immunosorbent assay (ELISA) kits, biochemical and pro-inflammatory parameters by using modern electrochemiluminescence immunoassay (eCLIA). A total of (N=150) participants in the current study, were included CP+HNC post-RT (n=50), CP without HNC (n=50), and periodontally healthy, as control (n=50), the participants were divided among males, (n=40, 80%), and female, (n=10, 20%) in each studied groups, respectively. The age differences were non-significant between the three groups (P>0.05). The results have shown significantly higher (P<0.05) levels of serum IL-1β, MIPs-1α, OPG, and uPA in patients (CP+HNC post-RT) and (CP without HNC) compared to control. Biochemical parameters significantly differed (P<0.05) in three groups. Furthermore, pro-inflammatory biomarkers IL-6, HS-CRP, and ProCT biomarkers were significant (P<0.05) in three groups. The results have shown high significant (P<0.05) levels of periodontal indices CAL, PPD, GBI, and PI in patients (CP+HNC post-RT) compared to (CP without HNC) and control. The levels of IL-1β, MIPs-1α, OPG, and uPA showed a positive correlation with changes in periodontal parameters such as CAL, PPD, GBI, and PI gain. The correlations were negatively correlated in IL-1β, MIPs-1α, OPG, and uPA levels with oral pH and hyposalivation after six months following radiotherapy in HNC patients. The ROC analysis indicated IL-1β, MIPs-1α, uPA, and OPG excellent sensitivity as diagnostic markers for (CP+HNC post-RT). On the other hand, the results of ROC analysis indicated IL-1β and uPA showed good sensitivity as prognostic markers for (CP without HNC). Furthermore, MIPs-1α and OPG were shown poor and fair sensitivity as prognostic markers for (CP without HNC). In conclusion, the expression increases in periodontal indices, pro-inflammatory biomarkers, and biochemical parameters in patients with CP+HNC post-RT compared to CP without HNC and control. This may result from the inflammatory induction due to periodontium tissue damage as a result of side effects of radiation.