Protease inhibitor levels in periodontal health and disease.

BACKGROUND AND OBJECTIVE: Our previous study showed that protease inhibitors were attenuated by the periodontal pathogen Porphyromonas gingivalis in cultured gingival epithelial cells. We hypothesize that fewer protease inhibitors would be present in more advanced periodontal disease sites, where the level of P. gingivalis may be high. The goal of this study was to investigate the relationship between the protease inhibitor [secretory leukocyte protease inhibitor (SLPI), elastase-specific inhibitor (ELAFIN) and squamous cell carcinoma antigen (SCCA)] levels in gingival crevicular fluid and the number of P. gingivalis micro-organisms in subgingival plaque. MATERIAL AND METHODS: Plaque samples from subjects without (n = 18) and with moderate to advanced periodontitis (n = 41) were used to quantify P. gingivalis using real-time PCR. Protease inhibitor levels in the gingival crevicular fluid of all the subjects were determined by ELISA. RESULTS: P. gingivalis was detected in 68.3% of patients with periodontitis, while 16.7% of subjects without periodontitis had a detectable level of P. gingivalis. Patients with periodontitis and P. gingivalis in their plaque exhibited lower SLPI and ELAFIN levels (p < 0.001) compared with control subjects without periodontitis. Secretory leukocyte protease inhibitor was also reduced (p < 0.05) in gingival crevicular fluid of periodontitis patients without a detectable level of P. gingivalis. Periodontitis patients with high vs. low levels of P. gingivalis exhibited reciprocal mean levels of SLPI and ELAFIN concentrations. CONCLUSION: The reduced concentrations of SLPI and ELAFIN may contribute to the loss of host protective capacity and increase susceptibility to breakdown from chronic infection. The work of this investigation may aid in finding diagnostic and prognostic markers in periodontal health and disease and may also help in finding pharmacological targets directed against periodontal inflammation.

[Amenorrhea rate after switch from sequential hormone replacement therapy to continuous combined administration of low dose estradiol and norethisterone acetate]. / Blutungsfreiheit nach der Umstellung von einer sequenziellen Hormonersatztherapie auf die kontinuierlich kombinierte Gabe von niedrig dosiertem Estradiol und Norethisteronacetat.

OBJECTIVE: Patient's wishes for a hormone replacement therapy (HRT) without withdrawal bleedings are decisive for a good compliance. Systematic experience concerning the bleeding profile when switching from a sequential hormone replacement therapy (s.c.HRT) to a continuous combined hormone replacement therapy (c.c.HRT) is sparse. This non-interfering study is designed to investigate the bleeding profile after such a switch. MATERIAL AND METHODS: 1 018 gynaecological centres recruited 3 917 patients pretreated with a s.c.HRT for this study. The switch from the s.c.HRT to the c.c.HRT was performed with a low-dose combination of 1 mg estradiol plus 0.5 mg norethisterone acetate (NETA). The bleeding profile was evaluated after 6 to 9 months of treatment according to the patient's diaries. RESULTS: Amenorrhoea was reached in 74.4 % of the enrolled patients after 3 months, in 90.6 % after 6 months, and in 92.1 % after 9 months of treatment. At the time of the switch to the c.c.HRT, already 32.4 % of the women were free of withdrawal bleedings. Parameters like age of the patients, body mass index (BMI), dosage of the estrogen during pretreatment did not influence the results considerably. 92.7 % of the physicians and 92.5 % of the women rated the combined treatment of 1 mg estradiol and 0.5 mg NETA (Activelle) as satisfactory. CONCLUSION: The switch from a s.c.HRT to a continuous combined treatment with 1 mg estradiol plus 0.5 mg NETA can be performed without problems, resulting in a high rate of amenorrhoea and a high acceptance of physicians as well as patients.