DNA Methylation Underlies the Long-Term Association Between Periodontitis and Atherosclerotic Cardiovascular Disease.

Periodontitis, one of the most common inflammatory conditions, and the leading cause of adult tooth loss, has been identified as an independent risk factor for cardiovascular disease (CVD). Long-term studies in edentulous patients with a history of periodontitis showed persistence of increased CVD risk for years after edentulism, suggesting that clinical elimination of disease is not sufficient in decreasing periodontitis-induced CVD risk. This is similar to other CVD risk factors, such as smoking and diabetes. We hypothesized that periodontitis induces epigenetic changes in hematopoietic stem cells in the bone marrow (BM), and such changes persist after clinical elimination of the disease and underlie the induced-CVD risk. To simulate clinical elimination of periodontitis and persistence of the hypothesized epigenetic reprogramming, we used a BM transplant approach. Using the low density lipoprotein receptor (LDLR) KO atherosclerosis mouse model, BM donor mice were fed a high fat diet (HFD) to induce atherosclerosis, and orally inoculated with Porphyromonas gingivalis(Pg), a keystone periodontal pathogen, to induce periodontitis; a second group was sham inoculated. (We previously showed that HFD-fed, Pginoculated mice developed more atherosclerosis than sham-inoculated). Naïve LDLR KO mice were irradiated and transplanted with BM from one of the 2 donor groups. Recipients of BM from Pg-inoculated donors developed significantly more atherosclerosis, accompanied by more pro-inflammatory plasma and macrophage cytokine profiles. Using whole genome bisulfite sequencing, 375 differentially methylated regions (DMR), and a global hypomethylation in recipients of BM from Pg-inoculated donors, were identified. Some DMRs pointed to involvement of enzymes with major roles in methylation and demethylation. In recipients of BM from Pg-inoculated donors, methionine adenosyl transferase (MAT), which catalyzes the conversion of methionine to S-denosylmethionine (SAM), the universal methyl-donor, was hypermethylated. The gene for S-adenosylhomocysteine hydrolase, which catalyzes the reversible conversion of the potent methylation inhibitor, S-adenosylhomocysteine (SAH), to homocysteine and adenosine, was also hypermethylated. In contrast, the de-methylation enzyme, Ten-Eleven Translocase (TET) 2, was hypomethylated. In validation assays, we found a significant increase in activity of TET2 and a decrease in activity of DNA methyltransferases. Plasma SAH levels were significantly higher and the SAM to SAH ratio was decreased, both of which have been associated with CVD. Homocysteine, is at the intersection of the methionine cycle and the transsulphuration pathway, where it can either be re-methylated to methionine and go through the methionine cycle, or it can synthesize cysteine through the transsulphuration pathway. Glutathione, a critical antioxidant, is the end-product of the transsulphuration pathway. In conditions of oxidative stress, the transsulphuration pathway is favored over the methionine cycle. Periodontitis is associated with oxidative stress. These data suggest a paradigm shifting mechanism linking epigenetic changes in gene methylation with the long term association between periodontitis and atherosclerotic CVD.