Serum Matrix Metalloproteinase-2: A Possible Link between COVID-19 and Periodontitis

Background: Coronavirus disease-19 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).  It is a severe infection primarily targeting the respiratory system. However, many other extrapulmonary body organs are also affected with a varying degree of severity. Some evidence indicated the development of periodontist in patients, although the pathogenesis is not well-defined. Aims: This study aimed to investigate the association of COVID-19 severity and role of matrix metalloproteinase 2 in development of periodontitis. Patients and Methods: This is a cross sectional study which included a total of 160 patients with COVID-19. Patients were categorized into severe and mild-moderated according to World Health Organization criteria. Periodontitis was diagnosed in those patients according to clinical criteria. Serum level of matrix metalloproteinase 2 was estimated in all patients using enzyme linked immunosorbent assay (ELISA). Demographic and laboratory data were obtained from the patients’ records. Results: Forty-two patients (26.25%) had severe COVID-19. Demographically, older ages and the presence of comorbidities were significantly associated with COVID-19 severity. Besides the inflammatory markers, the median serum level of MMP-2 was higher in severe than mild-moderate COVID-19 cases (208.12 ng/ml vs. 196.33 ng/ml) with a significant difference. The PO rate in severe and mild-moderate COVID-19 was 23.81% and 10.17%, respectively, with a significant difference. The median serum MMP-2 in patients with PO was 228.5 ng/ml which was significantly higher than those without PO 193.81 ng/ml. Conclusions: These data indicate the significant association between COVID-19 severity and development of PO. Matrix metalloproteinase-2 could be the possible link between severe COVID-19 and PO.