Gingival and salivary endothelial growth factor in diabetes mellitus: significance in mechanical stress and oral homeostasis in immediate denture wearers

Abstract

Vascular endothelial growth factor (VEGF) is critical component in processes of angiogenesis, vasculogenesis and neurogeneis. Angiogenesis is important for wound healing and for restoring blood flow to tissues after injury or insult. When regulation of angiogenic growth factors, such as VEGF, fails, blood vessels are formed excessively or insufficiently. Important environmental effects on VEGF expression include: hypoxia, mechanical stress, nitric oxide, acid conditions, glycemia and hormones. VEGF is constitutively expressed in oral tissues such as gingiva, gingival cervical fluid, and saliva and is affected by various pathological processes. Diabetes mellitus type 2 (DM type 2) is associated with a range of basic complications such as, neuropathy, microvascular and macrovascular disease and altered wound healing. Also DM type 2 is linked with increased incidence of several oral conditions: periodontal disease, salivary gland dysfunction, burning mouth, delayed healing of wounds and mucosa ulcerations. There is a suggestion that these abnormalities, most likely are related to increased oxidative stress, compromised host defense, chronic systemic inflammation, vasculopathy and impaired salivary secretion. It is well documented that DM type 2 and associated complications significantly alter VEGF levels...

Faktor rasta vaskularnog endotela (Vascular endothelial growth factor, VEGF) ima značajnu ulogu u procesima angiogeneze, vaskulogeneze i neurogeneze. U fiziološkim uslovima, angiogeneza je značajna za zarastanje rana i obnovu krvotoka kroz tkiva posle povrede, dok u patološkim uslovima, kada se poremeti fiziološka regulacija angiogenih faktora rasta, uključujuci VEGF i njihovih inhibitora dolazi do prekomernog ili nedovoljnog stvaranja krvnih sudova. Na ekspresiju VEGF značajan efekat imaju lokalni faktori na mestu stvaranja ovog faktora rasta u koje se ubrajaju: hipoksija, mehanički stres, azot monoksid, ph, glikemija i hormoni. Stalno prisustvo VEGF je utvrdjeno u tkivima i tečnostima usne šupljine (gingiva, tečnost gingivalnog sulkusa, pljuvačka), kao i da se ono menja u toku patoloških procesa. Diabetes mellitus tip 2 (DM tip 2) je oboljenje u kome su najčešće sistemske komplikacije nefropatija, retinopatija i otežano zarastanje rana, direktno posledice mikro i makrovaskulopatija i neuropatija. Dobro dokumentovane kliničke studije pokazuju da je DM tip 2 povezan sa povećanom incidencom oralnih poremećaja kao što su: parodontopatija, hipofunkcija pljuvačnih žlezda, različiti oblici stomatitisa, kao i usporeno zarastanje rana. Više faktora koji leže u osnovi DM tip 2 utiče na incidencu ovih oralnih poremećaja: povećan oksidativni stres, smanjene odbrambene snage, hronična inflamacija, vaskulopatije i poremećena sekrecija pljuvačke...