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Periodontal clinical status, microbial profile, and expression of interleukin-1β in men under androgenic anabolic steroids abuse
Stephanie von Stein Cubas Warnavin & Henrique Meister Valenga & Thainá Biudes Conforto Costa & Joao Daniel Paganella Chaves & Luis Carlos Spolidorio & Denise Madalena Palomari Spolidorio & Magda Feres & Geisla Mary Silva Soares & Joao Paulo Steffens
Abstract
Objectives Androgenic anabolic steroids (AAS) abuse is a serious health problem associated with several systemic complications. Here, we evaluated the periodontal clinical status, microbial profile, and expression of total protein (TP) and interleukin (IL)-1β in men using AAS.
Materials and methods Men using AAS were recruited (case group) and matched for age with men who had never used AAS (control group) but also performed physical activities. Plaque index (PI), marginal bleeding (MB), probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BoP) were evaluated. Crevicular fluid and subgingival biofilm were collected from healthy and diseased sites (PD ≥ 4 mm with CAL ≥ 1 mm and BoP) and evaluated for TP, IL-1β, and proportions of 40 bacterial species.
Results Thirty patients were included (n = 15/group). AAS consumers had significantly higher mean PD and a higher percentage of diseased sites; sites with PD ≥ 4 mm or with CAL ≥ 1 mm than non-consumers. Also, AAS users showed a more dysbiotic biofilm containing lower proportions of host-compatible species and higher proportions of pathogens. IL-1β expression was statistically higher in diseased than in healthy sites only in the control group. A statistically positive correlation was detected between periodontal pathogens and IL-1β expression. The number of AAS cycles was positively associated with higher percentages of periodontal pathogens, but not with IL-1β or total protein concentrations.
Conclusions AAS intake can worsen clinical and immunological periodontal conditions and the biofilm composition in healthy sites.
Introduction
Testosterone is the main male sex hormone responsible for the development of primary and secondary adult sexual characteristics (e.g., muscle mass, facial hair, libido, and sperm production) and, to a lesser extent, water, and electrolyte balance [1, 2]. Synthetic steroids derived from testosterone, such as androgenic anabolic steroids (AAS) have been developed to treat men suffering from hypogonadism, late puberty, and some types of impotence [3, 4]. However, these products started to be widely used by professional or recreational athletes aiming to increase performance, gain lean muscle mass, and decrease body fat percentage [5]. The use of AAS in high doses by athletes and bodybuilders may lead to a variety of side effects, which include fluid retention, acne, hepatic intoxication, arterial hypertension, blood cell disorders, anemia, depression, infertility, and even heart-related conditions [6]. The adverse effects of inappropriate and abusive use of AAS vary according to the individual's age and sex, as well as the dose, duration, and type of steroid. The protocol of use of AAS (e.g., dose, duration, and the interval between courses) varies according to the aim of the treatment and is frequently called AAS cycle [3].
It has been suggested that steroid hormones may influence the physiology of oral and periodontal tissues due to the homeostasis of anabolic and catabolic functions in the connective tissue and bone matrix [7]. These hormones and their derivatives may play a role in the progression of periodontal disease, including alterations in the composition of the microbiota and the healing process [8–13]. The periodontal biofilm is a complex structure that may change according to the host immune competence and the environmental conditions [14]. Environmental changes can generate a shift in microbiological profile by increasing microorganisms associated with the onset and progression of periodontitis (red and orange microbial complexes) and decreasing those associated with periodontal health (purple, yellow, green, and Actinomyces complexes) [15–17].
In humans, the use of AAS has been associated with gingival enlargement [18], higher prevalence of severe periodontitis, greater gingival inflammation, and an increased odds ratio to be infected with Prevotella intermedia, Aggregatibacter actinomycetemcomitans, and Candida spp. than non-AAS users [13]. Similarly, high endogenous testosterone levels were correlated with higher prevalence and severity of periodontitis in men [19]. In animals, treatment with supraphysiological doses of testosterone has been shown to increase ligature-induced bone loss in orchiectomized male rats [20]. In vitro, it was demonstrated that high doses of testosterone increased osteoclasteogenesis directly from RAW264.7 cells, in addition to increasing RANKL/OPG ratio in murine osteoblast primary culture [20, 21]. However, to the best of our knowledge, a combined evaluation of the microbiological and immunological oral response to AAS has not been performed in humans. Among immunological features, interleukin (IL)-1β is one of the most common biomarkers that can be used as an indicator of periodontal disease progression [22].
Hence, the aim of this study was to evaluate if AAS influences periodontal clinical and microbiological parameters, as well as to assess the expression of total protein and interleukin (IL)-1β in the gingival crevicular fluid.
In conclusion, the results of this study indicate that AAS intake can negatively impact periodontal health, suggesting that dental care professionals should perform full-mouth periodontal screening and schedule regular follow-up appointments for patients under AAS use.
Stephanie von Stein Cubas Warnavin & Henrique Meister Valenga & Thainá Biudes Conforto Costa & Joao Daniel Paganella Chaves & Luis Carlos Spolidorio & Denise Madalena Palomari Spolidorio & Magda Feres & Geisla Mary Silva Soares & Joao Paulo Steffens
Abstract
Objectives Androgenic anabolic steroids (AAS) abuse is a serious health problem associated with several systemic complications. Here, we evaluated the periodontal clinical status, microbial profile, and expression of total protein (TP) and interleukin (IL)-1β in men using AAS.
Materials and methods Men using AAS were recruited (case group) and matched for age with men who had never used AAS (control group) but also performed physical activities. Plaque index (PI), marginal bleeding (MB), probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BoP) were evaluated. Crevicular fluid and subgingival biofilm were collected from healthy and diseased sites (PD ≥ 4 mm with CAL ≥ 1 mm and BoP) and evaluated for TP, IL-1β, and proportions of 40 bacterial species.
Results Thirty patients were included (n = 15/group). AAS consumers had significantly higher mean PD and a higher percentage of diseased sites; sites with PD ≥ 4 mm or with CAL ≥ 1 mm than non-consumers. Also, AAS users showed a more dysbiotic biofilm containing lower proportions of host-compatible species and higher proportions of pathogens. IL-1β expression was statistically higher in diseased than in healthy sites only in the control group. A statistically positive correlation was detected between periodontal pathogens and IL-1β expression. The number of AAS cycles was positively associated with higher percentages of periodontal pathogens, but not with IL-1β or total protein concentrations.
Conclusions AAS intake can worsen clinical and immunological periodontal conditions and the biofilm composition in healthy sites.
Introduction
Testosterone is the main male sex hormone responsible for the development of primary and secondary adult sexual characteristics (e.g., muscle mass, facial hair, libido, and sperm production) and, to a lesser extent, water, and electrolyte balance [1, 2]. Synthetic steroids derived from testosterone, such as androgenic anabolic steroids (AAS) have been developed to treat men suffering from hypogonadism, late puberty, and some types of impotence [3, 4]. However, these products started to be widely used by professional or recreational athletes aiming to increase performance, gain lean muscle mass, and decrease body fat percentage [5]. The use of AAS in high doses by athletes and bodybuilders may lead to a variety of side effects, which include fluid retention, acne, hepatic intoxication, arterial hypertension, blood cell disorders, anemia, depression, infertility, and even heart-related conditions [6]. The adverse effects of inappropriate and abusive use of AAS vary according to the individual's age and sex, as well as the dose, duration, and type of steroid. The protocol of use of AAS (e.g., dose, duration, and the interval between courses) varies according to the aim of the treatment and is frequently called AAS cycle [3].
It has been suggested that steroid hormones may influence the physiology of oral and periodontal tissues due to the homeostasis of anabolic and catabolic functions in the connective tissue and bone matrix [7]. These hormones and their derivatives may play a role in the progression of periodontal disease, including alterations in the composition of the microbiota and the healing process [8–13]. The periodontal biofilm is a complex structure that may change according to the host immune competence and the environmental conditions [14]. Environmental changes can generate a shift in microbiological profile by increasing microorganisms associated with the onset and progression of periodontitis (red and orange microbial complexes) and decreasing those associated with periodontal health (purple, yellow, green, and Actinomyces complexes) [15–17].
In humans, the use of AAS has been associated with gingival enlargement [18], higher prevalence of severe periodontitis, greater gingival inflammation, and an increased odds ratio to be infected with Prevotella intermedia, Aggregatibacter actinomycetemcomitans, and Candida spp. than non-AAS users [13]. Similarly, high endogenous testosterone levels were correlated with higher prevalence and severity of periodontitis in men [19]. In animals, treatment with supraphysiological doses of testosterone has been shown to increase ligature-induced bone loss in orchiectomized male rats [20]. In vitro, it was demonstrated that high doses of testosterone increased osteoclasteogenesis directly from RAW264.7 cells, in addition to increasing RANKL/OPG ratio in murine osteoblast primary culture [20, 21]. However, to the best of our knowledge, a combined evaluation of the microbiological and immunological oral response to AAS has not been performed in humans. Among immunological features, interleukin (IL)-1β is one of the most common biomarkers that can be used as an indicator of periodontal disease progression [22].
Hence, the aim of this study was to evaluate if AAS influences periodontal clinical and microbiological parameters, as well as to assess the expression of total protein and interleukin (IL)-1β in the gingival crevicular fluid.
In conclusion, the results of this study indicate that AAS intake can negatively impact periodontal health, suggesting that dental care professionals should perform full-mouth periodontal screening and schedule regular follow-up appointments for patients under AAS use.
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