Impact of 0.2% Hyaluronic Acid on TNF-α and TGF-β1 in Periodontitis Patients with Type 2 Diabetes Mellitus

Periodontitis is a chronic inflammatory disease that significantly impacts the health of patients with type 2 diabetes mellitus (T2DM) due to their impaired immune response and delayed healing capabilities. Hyaluronic acid (HA), known for its anti-inflammatory and regenerative properties, may influence cytokine activity crucial for periodontal tissue repair. Tumor Necrosis Factor-alpha (TNF-α) and Transforming Growth Factor-beta1 (TGF-β1) are inflammatory cytokines involved in the healing process.

This study aims to assess the effect of subgingival application of 0.2% HA gel on TNF-α and TGF-β1 levels during the healing process of periodontitis in patients with T2DM.

A randomized clinical trial was conducted involving T2DM patients with diagnosed periodontitis. Participants received HA treatment alongside standard periodontal therapy. Gingival crevicular fluid (GCF) samples were collected before scaling and root planing (SRP) and at the 4-week follow-up to measure TNF-α and TGF-β1 levels using enzyme-linked immunosorbent assay (ELISA). Participants were randomly assigned to receive either 0.2% HA gel or a placebo gel, with a 1:1 allocation ratio. Identical packaging was used to maintain blinding. Following SRP, the applicator tip was carefully inserted subgingivally into the periodontal pocket, ensuring the gradual delivery of the gel until the pocket was filled, with gel visible at the gingival margin, indicating adequate treatment coverage.

Biomolecular analysis revealed a substantial reduction in TNF-α levels (p<0.05) and an elevation in TGF-β1 levels (p<0.05) in both groups after 4 weeks of follow-up. Although the delta change analysis between initial assessment and follow-up at 4 weeks showed statistically insignificant results (p>0.05) for TNF-α and TGF-β1 levels in T2DM patients treated with 0.2% HA gel and placebo gel, a clear trend of TNF-α reduction and TGF-β1 elevation was observed.

The results demonstrated that HA has a profound impact on the inflammatory and regenerative pathways in periodontal tissues of T2DM patients. The reduction in TNF-α levels suggests that HA effectively suppresses the chronic inflammatory response, which is crucial for managing periodontitis in T2DM patients. Concurrently, the increase in TGF-β1 levels indicates enhanced tissue repair and regeneration. This dual modulation by HA supports its use as an adjunctive therapy, providing both anti-inflammatory and regenerative benefits.

This study highlights the therapeutic potential of HA in managing periodontitis in T2DM patients by modulating key cytokines involved in inflammation and tissue regeneration. Further research is warranted to optimize dosing and administration protocols and to evaluate long-term outcomes.