Growth Differentiation Factor-15 As Predictor of Periodontal Treatment Effects in Patients with Periodontitis: a Randomized-Controlled Clinical Trial

Background: It has been shown that periodontal treatment could potentially decrease the risk of developing cardiovascular disease (CVD) and that growth differentiation factor 15 (GDF-15) is a valuable biomarker of early CVD risk. This study evaluated the efficacy of periodontal treatment on growth differentiation factor 15 (GDF-15) and related circulating systemic risk biomarkers such as glutathione peroxidase 1 (GPx-1), c-reactive protein (hs-CRP), and surfactant protein D (SP-D) and explored whether patients with high GDF-15 at baseline showed increased clinical benefits with two non-surgical treatments protocols at 6-months follow-up. Methods: Patients with periodontitis were randomized to receive quadrant (Q-SRP, n=23) or full-mouth disinfection (FMD, n=23) protocols. Clinical and periodontal parameters were recorded in all enrolled patients. Serum concentrations of GDF-15, GPx-1, hs-CRP, and SP-D concentrations were assessed at baseline and 30, 90, and 180-days follow-up through enzyme-linked immunosorbent assay (ELISA) and nephelometric assay techniques. Results: Q-SRP was more effective than FMD in lowering periodontal parameters, and the mean proportions of GDF-15 (p=0.005), GPx-1 (p=0.025), hs-CRP (p<0.001), and SP-D (p=0.042) after 6 months of treatment. Periodontal parameters were significantly associated with concentrations of GDF-15, GPx-1, hs-CRP, and SP-D at 6-months follow-up. Furthermore, the ANOVA analysis revealed that Q-SRP significantly influenced the upregulation of GPx-1 and on downregulation of GDF-15, and SP-D and substantially impacted the effectiveness of periodontal therapy at 6 months follow-up. Conclusion: The results evidenced that, in comparison with FMD, Q-SRP was more effective at reducing periodontal variables and positively impacting GDF-15, GPx-1, hs-CRP, and SP-D concentrations, although patients who exhibited higher GDF-15 and SP-D and lowered GPx-1 at baseline, more benefited the effects of periodontal treatment at 6-month follow-up.