Correlation between Leptin Levels and CD4 Count in HIV Patients Receiving Highly Active Antiretroviral Therapy (HAART)

Background: HIV/AIDS is an immunodeficiency disease with CD4 T lymphocytes as the main target. Although antiretroviral therapy has increased life expectancy of HIV patients, its adverse effect, lipodystrophy, causes a decrease in leptin production by adipose tissue and reduce leptin effect on T lymphocytes’ stimulation. Previous studies had examined the correlation between leptin levels and CD4 count, although the results were inconclusive. This study aims to assess the association between leptin levels and CD4 count in HIV patients receiving HAART. Methods: This is a cross sectional study conducted at the outpatient clinic of Tropical and Infectious Disease Haji Adam Malik General Hospital Medan between April and July 2020. Correlation between variables were assessed through Pearson’s or Spearman’s correlations. Data were analyzed using the SPPS program where p <0.05 was considered significant. Results: A total of 40 HIV patients were analyzed. The mean age of the subjects were 33.62 ± 7.61 years. The mean leptin levels were 1198.97 ± 832.47 ng/mL and the mean CD4 count was 330.55 ± 163.98 cells/mm3. There were no significant differences in leptin levels between HIV stage III and IV (1067.71 ± 902.39 vs. 1090.80 ± 1185.74, p = 0.961). No significant differences were found between CD4 count and HIV clinical stage (392.34 ± 164.70 vs. 339.0 ± 177.46, p = 0.904). There was a significant association between leptin levels and CD4 count in HIV patients receiving HAART (r = 0.351, p = 0.026). Conclusion: Leptin levels were significantly correlated with CD4 count in HIV patients receiving HAART. Keywords: Leptin, CD4 lymphocyte count, HIV, highly active antiretroviral therapy.

Leptin and systemic lupus erythematosus: A comprehensive review

Leptin, a cytokine-like hormone produced by adipocytes, modulates innate and adaptive responses of the immune system. Several reports have indicated that leptin exerts pro-inflammatory effects which significantly trigger autoimmune responses in chronic inflammatory diseases e.g. systemic lupus erythematosus (SLE), an inflammatory, multi-system disease characterized by the presence of autoantibodies. Irrespective of contradictory results, many studies have indicated that leptin concentrations are increased in SLE patients. This might reflect genetic association, or a mechanism underlying the pathogenesis of SLE. To shed light on this possibility, recent studies investigated several polymorphism genes related to leptin in SLE patients from different ancestral groups. This review focuses on current understanding of the role of leptin in the pathogenesis of SLE and its immunomodulatory effects. This is expected to provide new leptin-based therapeutic interventions as modern approaches which are safer than the currently used ones for the treatment of SLE. Keywords: Leptin, Systemic Lupus Erythematosus, Polymorphism, Gene expression

CLINICAL SIGNIFICANCE OF THE LEVELS OF THE GINGIVAL CREVICULAR FLUID VOLUME AND LEPTIN DURING ORTHODONTIC TOOTH MOVEMENT

It is assumed that leptin has a role in protecting gingival tissues, leptin stimulates the immune system and enhances bone formation by acting directly on osteoblasts. As periodontal disease progresses, the protective role of leptin on the gingiva is lost owing to a decrease in the leptin level. During orthodontic tooth movement, the early response of periodontal tissues to mechanical stress is an acute infammatory reaction. Study of leptin therefore is a useful guide to determine its relationship with tooth movement in both tension and pressure sites and the role of this cytokine in controlling the local infammation around the tooth. Detection of the leptin level in GCF at sites under orthodontic movement had been tested and it was found that the concentration of leptin in GCF is decreased by orthodontic tooth movement. The present study was planned in Department of Periodontology, Manipal College of Dental Sciences Manipal. Total 20 cases were evaluated in the present study. The 10 cases were enrolled in Group A as study cases and 10 cases were enrolled in control cases. The selected 10 patients were bonded with fixed appliance 0.022" PEA bracket slot, MBT prescription. The maxillary right canines (control tooth, CT) were not bonded with the bracket. The initial wire will be 0.016" NiTi wire. The distalisation force were applied on the left canine (test tooth, TT) using 0.010 SS lace backs. Significantly decreased levels of leptin concentration might result from the presence of inflammation adjacent to the teeth undergoing movement. It has been shown previously that orthodontic tooth movement may therefore show local traits of a damage/ repair process with inflammation-like reactions: high vascular activity, many leukocytes and macrophages, and involvement of the immune system. Keywords: Leptin levels, periodontal disease activity, orthodontic tooth movement, ininflammatory markers

ASSESSMENT OF LEPTIN CONCENTRATION IN GINGIVAL CREVICULAR FLUID (GCF) DURING ORTHODONTIC TOOTH MOVEMENT

The numbers of patients undergoing orthodontic treatment have increased spectacularly from past several decades. During orthodontic tooth movement the early response of periodontal tissues to mechanical stress is an acute inflammatory reaction. Mechanical stress from orthodontic appliances is believed to induce cells in the periodontal ligament (PDL) to form biologically active substances, such as enzymes and cytokines, responsible for connective tissue remodeling. Biochemical analysis of the gingival crevicular fluid (GCF) has provided a non-invasive model for investigating the cellular response of the underlying PDL during orthodontic tooth movement in vivo. In GCF, several substances such as interleukin, tumor necrosis factor, leptin, osteoprotegerin and alkaline phosphatase have been found to be significantly elevated in teeth under orthodontic forces compared with untreated control teeth. [14] Hence due to the above relevance the present study was planned for Assessment of Leptin Concentration in Gingival Crevicular Fluid (GCF) during Orthodontic Tooth Movement. The present study was planned in Department of Private Practioner, Swastik Dental Clinic and Orthodontic Centre Gaya. Total 10 cases of orthodontic of age 13 – 15 years were evaluated in the present study. For each subject, a maxillary cuspid undergoing distal orthodontic tooth movement was used as an experimental tooth, and the contralateral cuspids served as control tooth. Orthodontic brackets were placed on the canines. Experimental canines were moved in the distal direction through an archwire by use of an elastic chain exerting an initial force of 250 g. The amount of tooth movement for each tooth was measured with digimaticcalipers. At the distal aspect of experimental and control teeth, GCF was collected for subsequent analysis and the following examinations of the periodontium were conducted: Probing depth, presence or absence of plaque, and bleeding on probing. The collection and examinations were conducted immediately before activation and at 1 hr, 1 day, and 7days after the initiation of tooth movement. The data generated from the present study concludes that concentration of leptin in the GCF is decreased by orthodontic tooth movement. Leptin may be one of the mediators associated with orthodontic tooth movement. Orthodontic tooth movement can be carried out without any significant destructive changes in investing tissues of the teeth provided oral hygiene is properly maintained. Keywords: Leptin Gingival crevicular fluid, GCF, orthodontic, etc.