Tracing Salivary NET-Derived CitH3 as a Diagnostic Biomarker in Periodontal Disease: A Case Control Study

Abstract

Periodontal diseases encompass a continuum of inflammatory conditions, as a result of altered host-microbe interactions. Among the immune cells involved, neutrophils are pivotal through their ability to generate web-like structures released by neutrophils called (NETs) and histone H3 proteins modified through citrullination (CitH3). Thus, the study aim was based on the evaluation of diagnostic potential of salivary CitH3 in patients with periodontal disease. Ninety participants aged from 25 to 55 years involved in the study. Divided equally into three groups, healthy controls, patients with gingivitis, and patients with severe periodontitis/stage III. The periodontal parameters were recorded and salivary samples collected for (CitH3) evaluation using ELISA. Kruskal-Wallis, Spearman's correlation, and ROC curves were used for statistical analysis. CitH3 showed significantly higher levels in gingivitis and periodontitis groups (P < 0.001), with a positive significant relationship regarding gingival index. The receiver operating characteristic (ROC) analysis demonstrated that CitH3 exhibited a high level of discriminative power between gingivitis and control subjects (AUC = 0.90) and a decent diagnostic ability in differentiating periodontitis from health (AUC = 0.86). Salivary CitH3 seems to be a useful biomarker for periodontal inflammation because it shows how NETosis plays a role in the disease getting worse. The observed increase in patient groups substantiates its diagnostic significance, while its association with gingival inflammation suggests a potential function as a prognostic marker for periodontal disease activity.