Evaluation of Salivary and Serum BAFF and TWEAK Levels in Patients with Thalassemia Major and Gingival Inflammation: An Observational Case–Control Study

Abstract

Objective

Limited research has been conducted to evaluate the relationship between periodontal parameters, systemic biomarkers, and thalassemia major (TM) concerning gingival inflammation. This study aims to assess the potential association of B cell activating factor (BAFF) and tumor necrosis factor weak inducer of apoptosis (TWEAK) with periodontal parameters in patients diagnosed with TM and gingivitis, compared with their healthy counterparts.

Materials and Methods

The current study involved 101 participants aged 18 to 35 years; each subject completed a preliminary assessment to ascertain their eligibility for recruitment. Periodontal parameters were recorded, including the following indices: plaque index, bleeding on probing, and the Oral Hygiene Simplified Index (OHS-I-calculus index). The concentrations of BAFF and TWEAK in saliva and serum were evaluated using enzyme-linked immunosorbent assay.

Statistical Analysis

The Mann–Whitney and the Kruskal–Wallis tests were employed for comparisons, with the Dunn–Bonferroni post hoc method applied for pairwise multiple comparisons when applicable. Intraclass correlation coefficient and kappa tests were used to test the reliability of the examiner calibration. Spearman rank correlation was used to assess the relationship between the biomarkers under study and clinical periodontal data. Additionally, multiple linear regression analysis was utilized to investigate the association of biomarkers, TM, and gingivitis while controlling for potential confounding effect of age. p-Values below 0.05 were set to be statistically significant.

Results

Both biomarkers were detected in all subjects, with a significant difference in their levels between the groups. Additionally, significant correlations were found between the levels of TWEAK and BAFF and periodontal indices (p < 0.001). Multiple linear regressions demonstrated a significant association between the elevated levels of salivary and serum BAFF and TWEAK with TM and gingival health status (p < 0.05), as for age was not statistically significant.

Conclusion

The findings demonstrate a possible correlation between elevated salivary and serum levels of BAFF and TWEAK and the presence of TM and gingival inflammation, suggesting that these biomarkers may reflect systemic immune alterations in TM in the presence of gingival inflammation.

Keywords

thalassemia major - gingival inflammation - BAFF - TWEAK

Publikationsverlauf

Artikel online veröffentlicht:
18. August 2025

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