Brain, Behavior, and Immunity 26 (2012) 541542

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Brain, Behavior, and Immunity

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Brief Commentary

Human saliva as a tool to investigate intimate partner violence

Chamindie Punyadeera
Saliva Research Group, Tissue Engineering and Microuidics Laboratory, Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Old Cooper Road, St. Lucia, 4072 Queensland, Australia The School of Chemical Engineering, Faculty of Engineering and Architecture and IT, Australia

Human saliva mirrors bodys health and well-being and many of the biomolecules present in blood or urine can also be found in salivary secretions. However, biomolecular concentrations in saliva are usually one tenth to one thousandth of the levels in blood (Pfaffe et al., 2011). Sensitive detection technology platforms are therefore required to detect biomolecules in saliva. Another road block to the advancement of salivary diagnostics is the lack of information related to healthy state saliva vs. a diseased saliva, baseline levels and reference ranges and diurnal variations. Saliva has numerous advantages over blood or urine as a diagnostic uid: (a) the non-invasive nature of sample collection and the simple, safe, painless and cost-effective methods to collect it; (b) unskilled personnel can collect saliva samples at multiple time points; and (c) the total protein concentration is approximately a quarter of that is present in plasma, which makes it easier to investigate low abundance proteins (Pfaffe et al., 2011). Currently, saliva assays are routinely used to determine, diseases such as HIV, drugs and substances of abuse to provide information on exposure and give qualitative information on the type of illicit drug used (Kintz et al., 2009), cortisol levels for diagnosing Cushings syndrome (Doi et al., 2008), and use for biomonitoring of exposure to chemicals (Caporossi et al., 2010) to measure hormones (Grschl, 2009). There is a growing interest in clinical and translational research for the discovery and development of biomarkers that are indicative of disease status and progression. Biomarkers of clinical relevance are predominantly proteins. A recent study by Bandhakavi et al. identied 2340 proteins in human saliva and approximately 20% of these proteins are also found in plasma (Bandhakavi et al., 2009). This highlights the signicance and potential of saliva as a biological uid and warrants more comprehensive evaluation as a diagnostic medium. Circulating levels of C-reactive protein (CRP) (acute phase inammatory marker produced by hepatocytes) has shown to be an independent predictor of cardiovascular (CVD) events (Ridker et al., 2008; Punyadeera et al., 2011) as well as an inammatory marker. In addition, the inammatory process is also activated during childhood maltreatment and intimate partner violence (IPV). Frequent and multiple injuries resulting from the physical violence may contribute to higher levels of systemic inammation, but also the negative health behaviors and stress Tel.: +61 (0) 7 334 63891; fax: +61 (0) 7 334 63973.
E-mail address: c.punyadeera@uq.edu.au URL: http://espace.library.uq 0889-1591/$ - see front matter 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.bbi.2012.02.006

related mental health symptoms. Previous studies suggest that inammation is a key mechanism through which harsh life events affect development of physical health problems. The paper by Stephanie Woods and coworkers (2012) in this issue of Brain, Behavior, and Immunity evaluated individual differences in salivary CRP levels in a prospective, cross-sectional study in relation to systemic inammation and risk for CVD. The authors examined the associations between salivary and plasma CRP, as well as the capacity of salivary CRP to predict high vs. low levels of plasma CRP using a clinically relevant cut off level of 3 mg/mL. They also measured both plasma and salivary CRP levels multiple times a day within an ethnically diverse group of women seeking help from domestic violence crisis agencies (N = 107; mean age at start of study = 34 years). Plasma and saliva CRP levels were moderately associated cross-sectionally and over 2 years. This study is an excellent example for demonstrating the usefulness of evaluating salivary CRP levels to determine the risk of developing CVD in IPV women. This study also documented that the average salivary CRP levels were higher in the morning than evening and that the saliva and plasma CRP levels were also associated with a high body mass index. In contrast, research from our group demonstrated no signicant changes in salivary CRP levels during the day (8). Furthermore, intervention studies have shown that weight loss and exercise are associated with decreases in serum CRP levels. Human saliva provides diagnostic alphabets to a large number of clinical applications. Saliva has been used as a biological uid for the diagnosis and prognosis of oral cancers (Nagler, 2009), diabetes (Rao et al., 2009), and autoimmune disorders. In addition, scientists have identied biomarkers in saliva for the detection of early-stage pancreatic cancer (Farrell et al., 2011). Streckfus et al. (2008) measured soluble c-erbB-2Her2/neu levels in saliva collected from breast cancer patients and concluded that c-erbB may have potential use in the initial detection and/or follow-up screening to determine the recurrence of breast cancer. Further research is undoubtedly needed to test the hypothesis that saliva has broad clinical utility as an analytical matrix alternative to blood-based assays. It is also important to standardize saliva collection methods and validate procedures. Increased understanding of the components of saliva proteome, their modications and dynamics in health and disease might well allow saliva to enter the clinical laboratory as an alternative biological uid compared blood based assays.

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C. Punyadeera / Brain, Behavior, and Immunity 26 (2012) 541542 Out, D., Hall, R.J., Granger, D.A., Page, G.G., Woods, S.J., 2012. Assessing salivary Creactive protein: longitudinal associations with systemic inammation and cardiovascular disease risk in women exposed to intimate partner violence. Brain Behav. Immun. 26 (4), 543551. Pfaffe, T., Cooper-White, J., Beyerlein, P., Kostner, K., Punyadeera, C., 2011. Diagnostic potential of saliva: current state and future applications. Clin. Chem. 57 (5), 675687. Punyadeera, C., Dimeski, G., Kostner, K., Beyerlein, P., Cooper-White, J., 2011. Onestep homogeneous C-reactive protein assay for saliva. J. Immunol. Methods 373, 1925. Rao, P.V. et al., 2009. Proteomic identication of salivary biomarkers of type-2 diabetes. J. Proteome Res. 8 (1), 239245, Translated from English. Ridker, P.M., Danielson, E., Fonseca, F.A., Genest, J., Gotto Jr., A.M., Kastelein, J.J., Koenig, W., Libby, P., Lorenzatti, A.J., MacFadyen, J.G., Nordestgaard, B.G., Shepherd, J., Willerson, J.T., Glynn, R.J., 2008. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N. Engl. J. Med. 359, 21952207. Streckfus, C.F. et al., 2008. Breast cancer related proteins are present in saliva and are modulated secondary to ductal carcinoma in situ of the breast. Cancer Invest. 26 (2), 159167.

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