Effect of adjuvant probiotic therapy (Lactobacillus reuteri) in the treatment of periodontitis associated with diabetes mellitus: clinical, controlled, and randomized study.

OBJECTIVES: Subgingival instrumentation (SI) with probiotics may be a proposal for the treatment of periodontitis (P), for patients with type 2 diabetes mellitus (T2DM). The Lactobacillus reuteri probiotic as an adjunctive therapy in the treatment of P associated with T2DM was evaluated. MATERIALS AND METHODS: Forty diabetic participants diagnosed with P (stage III and IV, grade B) were randomized into SI + Placebo (n = 20): subgingival instrumentation plus placebo lozenges and SI + Probi (n = 20): subgingival instrumentation plus probiotics. Probing depth (PD), gingival recession (GR), clinical attachment level (CAL), plaque index (PI), bleeding on probing (BoP), and PISA index were performed at baseline and 30, 90, and 180 days. Cytokine concentration in the gingival crevicular fluid, subgingival biofilm sample, and LDL and HDL subfractions were evaluated. RESULTS: In the deep pockets, PD in SI + Probi showed increased values (p = 0.02) compared to SI + Placebo at 90 days. For CAL, SI + Probi showed increased values compared to SI + Placebo, with a significant difference at 30 days (p = 0.03), 90 days (p = 0.02), and 180 days (p = 0.04). At #PD ≥ 7 mm, SI + Probi had a more frequent number of sites (p = 0.03) compared to SI + Placebo only at baseline. For the PISA, SI + Probi showed a significant difference (p = 0.04) compared to SI + Placebo at 90 days. For cytokines, SI + Probi showed higher quantification than SI + Placebo for IL-10 (p < 0.001) at 90 days, IL-12 (p = 0.010) at 90 days, IL-1ß (p = 0.035) at 90 days, and IL-8 (p = 0.003) at baseline. SI + Placebo showed higher quantification of IL-1ß (p = 0.041) compared to SI + Probi only at 30 days. There was a reduction in all microbial complexes. SI + Probi improved LDL size (246.7 nm vs 260.4 nm; p < 0.001), while large HDL subfractions were reduced aft 180 days of treatment (24.0% vs 20.3%; p = 0.022) when compared with SI + Placebo; this response was dependent of probiotics (1.0 mg/dL vs - 6.2 mg/dL; p = 0.002). CONCLUSION: Subgingival instrumentation improved the clinical periodontal parameters in patients with T2DM. The use of L. reuteri probiotics had no additional effects compared with the placebo; however, there was a positive effect on the lipoprotein subfraction. CLINICAL RELEVANCE: Scientific rationale for study: subgingival instrumentation with probiotics may be a proposal for the treatment of periodontitis (P), especially for patients with type 2 diabetes mellitus (T2DM). PRINCIPAL FINDINGS: the use of L. reuteri probiotics had no additional effects compared with the placebo; however, there was a positive effect on the lipoprotein subfraction.  Practical implications: L. reuteri as an adjunct to subgingival instrumentation may have significant therapeutic implications in dyslipidemia.

Eficácia dos flavonóides na dislipidemia / Efficacy of Flavonoids in Dyslipidemias

Os flavonóides têm se tornado cada vez mais evidentes devido aos efeitos benéficos à saúde, sendo destacada a sua função nas dislipidemias. São oxidantes polifenólicos encontrados nos alimentos, principalmente nas verduras, frutas, grãos, sementes como o cacau, castanhas, condimentos e ervas e também em bebidas como vinho e chá. Inibem a oxidação do LDL, diminuindo a aterogenicidade e conseqüentemente, o risco de doença coronariana, além de sua ação antioxidante. Este trabalho, elaborado a partir de uma revisão bibliográfica, visa avaliar a eficácia dos flavonóides nas dislipidemias, verificando se é possível diminuir os níveis de concentrações lipídicas plasmáticas e atuar como antioxidante evitando assim a aterogenicidade, aterosclerose. O consumo de flavonóides demonstrou uma diminuição dos triglicerídeos no plasma, da concentração do colesterol total, dos níveis de LDL e aumento ou inalteração do HDL. O mecanismo de ação pode ser explicado por meio da regulação dos receptores de LDL, do aumento do turnover da apolipoproteína B do LDL e da estabilização da membrana tecidual, uma vez que houve uma diminuição da fluidez lipídica dessa membrana. Estudos recentes demonstraram que os flavonóides inibem a atividade da enzima squalene epoxidase, essencial na síntese do colesterol. Concluiu-se que os flavonóides presentes da dieta podem estar envolvidos na prevenção da aterosclerose, mas ainda existem algumas controvérsias, sendo necessários mais estudos para que todo o mecanismo de ação seja esclarecido e sua eficácia comprovada