# Evaluation of saliva and serum heme oxygenase, arylesterase and nuclear factor erythroid 2-related factor 2 levels in patients with stage III periodontitis: a cross sectional study

## TL;DR

This study found that people with severe periodontitis have lower levels of certain antioxidants in their saliva and blood, which may contribute to tissue damage and could help in early diagnosis.

## Contribution

The study identifies HO-1 and NRF-2 as potential biomarkers for oxidative stress in periodontitis, offering new insights into disease mechanisms and diagnosis.

## Key findings

- Periodontitis patients had significantly lower salivary and serum antioxidant levels, including HO-1 and NRF-2.
- Decreased antioxidant capacity may contribute to oxidative stress and tissue damage in periodontitis.
- These biomarkers could aid in early diagnosis and targeted treatment of periodontal disease.

## Abstract

This study aimed to evaluate total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), arylesterase (ARE), heme oxygenase-1 (HO-1), and nuclear factor erythroid 2–related factor 2 (NRF-2) levels in saliva and serum samples of individuals with Stage III Grade B periodontitis, and to assess their relationship with disease activity and diagnostic potential in the pathogenesis of periodontitis.

Thirty-seven periodontally healthy individuals and thirty-seven patients with Stage III Grade B periodontitis were included in the study. After clinical measurements and sample collection ELISA method was used for analyses of TOS, TAS, OSI, ARE, HO-1, NRF-2 levels.

Salivary TAS, serum TAS, serum ARE, serum NRF-2, salivary HO-1 levels were significantly lower in periodontitis patients compared to the healthy control group (p = 0.015, p = < 0.001, p = 0.031, p = 0.041, p = 0.001). No significant difference was found in salivary and serum TOS, salivary and serum OSI, salivary ARE, salivary NRF-2, serum HO-1 levels (p = 0.685, p = 0.256, p = 0.146, p = 0.738, p = 0.513, p = 0.910, p = 0.256).

Within the limitations of this study, the results suggest that decreased antioxidant capacity, particularly involving HO-1 and NRF-2, may contribute to oxidative stress–related tissue damage in periodontitis.

Understanding the roles of HO-1 and NRF-2 in the antioxidant defense system provides novel insights into the biological mechanisms underlying periodontal tissue destruction. These biomarkers may help clinicians identify individuals with heightened oxidative stress and increased susceptibility to disease progression, enabling earlier diagnosis and more personalized, targeted therapeutic interventions to improve periodontal health outcomes.