Expression of Toll-like receptors 2 and 4 in the saliva of patients with systemic lupus erythematosus and chronic periodontitis



The aim of this study was to investigate the expression of salivary Toll-like receptors (TRL) 2 and 4 in patients with systemic lupus erythematosus (SLE) and chronic periodontitis (CP).


A case-control study was conducted with 77 participants (42 SLE and 35 non-SLE) stratified according to CP diagnosis criteria. Periodontal parameters consisted of clinical attachment level (CAL), probing depth (PD), the visible plaque index (VPI), and the gingival bleeding index (GBI). Salivary TRL 2 and 4 expressions were determined by quantitative real-time polymerase chain reaction (RT-PCR). Statistical analysis included Mann-Whitney U test, Kruskal-Wallis test, Spearman’s correlation rank, and multiple linear regression.


Patients with isolated SLE or CP had higher TLR 2 and TLR 4 expression in their saliva samples (P < 0.05). The group with both SLE and CP had lower TLR 2 and 4 expressions (P < 0.05). TLR 2 and TLR 4 showed significant negative correlations with PD, CAL, and GBI in SLE patients, and a significant positive correlation with periodontal parameters in non-SLE patients. CP was independently associated with reduction of TLR2 and TLR4 expression, even after adjusting for clinical data and current drug use.


Reduced TRL 2 and 4 expression in saliva was associated with the presence of CP in SLE patients.

Key Points
• Patients affected by isolated CP or SLE had higher TLR2 and TLR4 expression.
• TLR under-expression may be associated with a worse periodontal status in SLE.
• Abnormalities in TLRs expression may increase the susceptibility to periodontitis.

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This work was supported by the Research Support Foundation of Maranhão State (FAPEMA) [grant number 009699/2015] and the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) [Finance Code 001].

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Correspondence to Vandilson P. Rodrigues.

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The study was approved by the Research Ethics Committee of the University Hospital of the Federal University of Maranhão (CAAE: 22437713.6.0000.5086).

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Marques, C.P.C., Rodrigues, V.P., de Carvalho, L.C. et al. Expression of Toll-like receptors 2 and 4 in the saliva of patients with systemic lupus erythematosus and chronic periodontitis. Clin Rheumatol (2021).

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  • Innate immunity
  • Periodontitis
  • Systemic lupus erythematosus
  • Toll-like receptor