Systemic Effects of Toxins of Periodontal Pathogenic Bacteria on Human Myocardium - a Possible Route to Elucidating the Link between Periodontitis and Heart Dysfunction

Objective: Aim was to verify preliminary initial results in connection and relation of periodontal pathogens to myocardium, and whether their toxins bind to myocardial tissue and are causative for inflammatory reactions in myocardial cells.

Methods: In 30 patients (68 ± 9 years; f = 10, m = 20) biopsies were taken from atrium (A) and ventricle (V) during heart surgery. The dental examination covered the dental and periodontal status (e.g., papilla bleeding index PBI), and a sample of bacteria from the deepest periodontal pockets. The detection of 11 periodontal pathogens in the oral and heart samples (A/V) was performed with PCR. The heart samples were prepared for detecting LPS-binding protein (Western Blot), sections of tissue for inflammation scoring (0–3), and for determining immunohistochemical (IHC) parameters (score 0–3): macrophages/CD68, LPS-binding protein/big42 and LPS-binding protein-receptor/CD14.

Results: All patients showed moderate (n = 7) to marked (n = 23) periodontitis. The periodontal pathogens in the oral samples of all patients revealed a similar distribution. To a lesser extent, and with a different distribution, these bacteria were also detected in A and V. A significant difference of LPS-binding protein occurrence was detected on A versus V (0.2 ± 0.16 versus 0.11 ± 0.13). Additionally, there was a significant difference of inflammation and IHC parameters between A and V, and there was a marked significant higher CD68 level in patients with higher PBI (p < 0.05).

Conclusion: In this follow up study we can show a high occurrence level of oral bacteria on the myocardium with higher incidence on atrial site. Higher CD68 levels in patients with higher PBI may indicate direct relationship to periodontal disease. Further studies are warranted to correlate these findings with clinical courses.