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Matrix Metalloproteinases Gene Variants and Dental Caries in Czech

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Matrix Metalloproteinases Gene Variants and Dental Caries in Czech Borilova Linhartova et al. BMC Oral Health (2020) 20:138 https://doi.org/10.1186/s12903-020-01130-6 RESEARCH ARTICLE Open Access Matrix metalloproteinases gene variants and dental caries in Czech children Petra Borilova Linhartova1,2, Tereza Deissova2, Martina Kukletova1 and Lydie Izakovicova Holla1* Abstract Background: Matrix metalloproteinases (MMPs) play an important role in tooth formation and the mineralization of dental tissue. The aim of the study was to analyse Czech children with primary/permanent dentition polymorphisms in those genes encoding MMP2, MMP3, MMP9, MMP13, MMP16, and MMP20, which had been previously associated with dental caries in other populations. Methods: In total, 782 Czech children were included in this case-control study. DNA samples were taken from 474 subjects with dental caries (with decayed/missing/filled teeth, DMFT ≥ 1) and 155 caries free children (DMFT = 0) aged 13–15 years, as well as 101 preschool children with early childhood caries (ECC, dmft ≥ 1) and 52 caries free children (dmft = 0), were analyzed for nine MMPs single nucleotide polymorphisms (SNPs) using real time polymerase chain reaction TaqMan assays. Results: There were no significant differences in the allele and/or genotype frequencies of all the studied MMPs SNPs among children with dental caries in primary/permanent dentition and the healthy controls (P > 0.05). In addition, similar allele or genotype frequencies of the studied MMPs SNPs were found in children with severe dental caries in their permanent teeth (children with DMFT ≥ 6) and the healthy controls (DMFT = 0, P >0.05). Conclusions: This study demonstrated the lack of association between the selected SNPs in candidate genes of MMPs and the susceptibility to or severity of dental caries in both primary and permanent dentitions in Czech children. Keywords: Polymorphism, Association study, Caries, Oral disease, Genetic predisposition, ELSPAC Background enzymes. However, the proteases produced by the cariogenic Dental caries is a multifactorial disease affecting the hard tis- bacteria have been found to be highly pH sensitive, and they sues of teeth in both primary and permanent dentitions. In are not able to resist the acidic pH fall (pH 4.3) during the thepresenceofsomecarbohydrates, the dental biofilm is demineralization phase [2]. Therefore, the potential role of dominated by mainly gram-positive carbohydrate-fermenting the host derived proteases, and in particular matrix metallo- bacteria causing a pH decrease [1]. In the long-term, fre- proteinases (MMPs) in dentine matrix degradation, has been quent exposure to a pH lower than 5.5 causes irreversible considered [3]. A new concept in caries research termed as demineralization of the tooth enamel with a progression to “Dentin Degradonomics” has been introduced. This genomic dentin damage. The demineralization is caused by microbial and proteomic approach is applied to the identification of acids, and the degradation of the dentin organic matrix was proteases and their substrates in both physiological and thought to have been carried out by microbial proteolytic pathological conditions [4]. Host MMPs, which are the enzymes responsible for * Correspondence: [email protected] the degradation of intercellular substrates, play an im- 1 Clinic of Stomatology, Institution Shared with St. Anne’s University Hospital, portant role in physiological processes during early tooth Faculty of Medicine, Masaryk University, Pekarska 53, 656 91 Brno, Czech – MMP16 Republic development [5 7], for example, the gene may Full list of author information is available at the end of the article regulate ameloblast maturation and enamel formation © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Borilova Linhartova et al. BMC Oral Health (2020) 20:138 Page 2 of 8 [8]. Several different types of MMPs have been discov- Characteristics of participants and sampling ered, among them MMP2 and MMP9 (gelatinase A and Two groups of children from the South Moravia region B), MMP3 (stromelysin 1), MMP13 (collagenase 3), of the Czech Republic were selected according to their MMP16 (membrane-type MMP), and MMP20 (enamely- dentition - group 1: preschool children with primary sin). MMPs are initially synthesized as inactive zymo- dentition, and group 2: children with permanent denti- gens, and can be activated extracellularly by several tion, all of whom were recruited from the European mechanisms, e.g. low pH [9]. However, host MMPs are Longitudinal Study of Pregnancy and Childhood functional only in neutral pH. This is maintained by the (ELSPAC) [31]. salivary buffer systems which allow the pH-activated The inclusion criteria for group 1 were: at least 16 pri- MMPs to degrade the dentin matrix which has been pre- mary teeth, general good health, and the willingness of the viously demineralized by bacterial acids [10]. The host- parents to enter their children in the study. The exclusion derived proteases, and in particular MMPs, may be in- criteria for group 1 were: the presence of one or more per- volved in the destruction of the collagenous dentin manent teeth, a familial relationship between children, matrix and, therefore, in the control or progression of and ethnicity other than Caucasian Czech. The inclusion the carious process [3, 11]. MMPs are located through- criteria for group 2 were: age 13–15 years, general good out the dentine, along the enamel–dentine junction, and health, and the willingness of the parents to enter their in the predentine [12]. Increased MMP presence along children in the study [32]. The exclusion criteria for group the dentine–enamel junction may contribute to the 2 were: previous or concomitant therapy with orthodontic widening of caries along this junction, as it progresses appliances, a familial relationship between children, and into the dentine [13]. There are various possible ethnicity other than Caucasian Czech. sources of MMPs, in carious lesions they are released The children included in group 1 were recruited from into the saliva by the salivary glands, into the crevicu- the out-patients’ department of Paediatric Dentistry, lar fluid by the cells in the gingival crevices and into University Hospital Brno, and the Paediatric Department the dentinal fluids by pulpal odontoblast cells [3]. In- of the Clinic of Stomatology, St. Anne’s Faculty Hospital hibition of salivary or dentin endogenous collagenoly- in Brno, where they were sent for a preventive examin- tic enzymes may provide a preventive means against ation (healthy children) or complex treatment under the progression of caries [4, 14, 15]. general anaesthesia (children who were unable to Members of MMPs family are encoded by multiple undergo standard dental treatment due to their unco- genes and their variability has been widely studied in the operativeness and the need for multiple restorations and context of many diseases including oral diseases (such as extractions) in the period 2016–2018. Oral examinations oral cancer [16], periodontitis [17], periapical lesions were performed by two mutually calibrated experienced [18], and dental caries [19–30]). paediatric dentists under standard conditions (using a Based on the literature review, the aim of the study was dental probe and mirror after drying, and in a good to select the SNPs in the genes encoding MMP2, MMP3, light) in a professional dental unit. The dmft index was MMP9, MMP13, MMP16, and MMP20, which had been calculated using dental caries (D3 level) as a cut-off point previously associated with dental caries in other popula- for the detection of decay [32, 33]. tions [19–22, 26–29], and to determine the genotypes of Children selected from the ELSPAC study (group 2) these SNPs in Czech children with primary/permanent underwent dental examinations at the Clinic of Sto- dentitions. The null hypothesis is that there is no associ- matology, St. Anne’s University Hospital, in the ation between the selected SNPs and dental caries devel- period 2005–2007. To determine the DMFT index for opment in both dentitions in our population. each child the teeth were first dried and then exam- ined in a good light, all present teeth were examined in the dentist’s chair using a mirror and a dental Methods probe. The data was entered into a standard medical Design of study record. A radiograph examination was not performed This case-control genetic association study was con- as it was not part of the routine dental care for these ducted in the period from 2005 to 2018. adolescents and would therefore be deemed unethical. All of the procedures performed in the studies involv- The clinical assessment was carried out by one inves- ing human participants were in accordance with the eth- tigator using the cavitation of the lesion as the detec- ical standards of the institutional and/or national tion threshold of caries according to the criteria given research committee and with the 1964 Helsinki declar- in the WHO Oral Health Surveys as described previ- ation and its later amendments or comparable ethical ously [34].
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