İdiopatik Rekürren Aftöz Stomatit Hastalarında Serum Zonulin Seviyesi ve Serum IL-8 Düzeyi ile Karşılaştırılması
Bozbek, Gülsün Hazan
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Although the etiopathogenesis of recurrent aphthous stomatitis (RAS) has not yet been clearly elucidated, it has been discussed over the years that autoimmunity may play a role. Genetic and environmental factors are known to have combined effects in the background of autoimmunity, but it has recently been emphasized that an impaired intestinal barrier system is also involved in the development of the disease. Zonulin is a protein that reversibly leads increasing in intestinal permeability and interleukin-8 (IL-8) is activation marker of RAS. This study aimed to evaluate the zonulin levels in recurrent aphthous stomatitis primarily, also compare to serum IL-8 level. In this prospective case-control study included patients aged 18 to 65 years old, who were diagnosed with recurrent aphthous stomatitis that was divided into two separate groups according to active ulcer status, and a healthy control group. Patients with systemic diseases, such as Behçet disease, inflammatory bowel disease, celiac disease and systemic lupus erythematosus were excluded. Other exclusion criteria were use of systemic medication to treat ulcers, active infection disease, immunosuppression, and use of antibiotics. We recorded demographics, smoking habits, disease history, medication, mode of delivery, breast milk intake time, type of aphthous ulcer, frequency of aphthous ulcer, levels of blood haemoglobin, serum ferritin, folate, and vitamin B12. Zonulin and IL-8 were studied using the enzyme- linked immunosorbent assay. A total of 78 individuals, 27 (21 females, 6 males) diagnosed with recurrent aphthous stomatitis and active aphthous ulcer, 25 (21 females, 4 males) diagnosed with recurrent aphthous stomatitis but no active aphthous ulcer and 26 (20 females, 6 males) healthy control were included in this study. The mean ages were 36 ± 11.7 and 36 ± 13.2 years for the case groups respectively, 33.4 ± 9.4 years for the control group. There was no difference between the three groups in terms of age and gender (p=0.798, p=0.792, respectively). In the patient groups, the serum zonulin levels were found to be significantly higher than control group (127.3 ± 61.5 ng/ml, 121 ± 62.9 ng/ml, 89.2 ± 49.5 ng/ml respectively; p<0.05). Except for 2 patients and 3 healthy controls, all the serum IL-8 levels were below the detection limit. This is the first study in the literature to demonstrate that the serum zonulin levels are increased in patients with recurrent aphthous stomatitis and leaky gut is likely an etiological factor in pathophysiology of recurrent aphthous stomatitis.