A literature review of bioactive substances for the treatment of periodontitis: In vitro, in vivo and clinical studies

Identification and Validation of Ferritinophagy-Related Biomarkers in Periodontitis

OBJECTIVE

While ferritinophagy is believed to play a significant role in the development of periodontitis, the exact mechanisms remain unclear. This study aimed to investigate the biomarkers associated with ferritinophagy in periodontitis using transcriptomic data.

METHODS

Two periodontitis-related datasets from Gene Expression Omnibus, GSE10334, and GSE16134, served as the training and validation cohorts, respectively. Additionally, 36 ferritinophagy-related genes (FRGs) were obtained from the GeneCards database. We compared the expression differences of FRGs between the periodontitis and control groups, identifying the different FRGs as candidates. Weighted gene coexpression network analysis (WGCNA) was applied to capture the key modules and modular genes related to periodontitis, utilizing the candidate FRG scores as trait. Then we intersected these with key module genes to identify differentially expressed FRGs. Hub genes were filtered using a protein-protein interaction network. Ultimately, biomarkers were acquired through machine learning, receiver operating characteristic curves, and expression levels. In addition, biomarker-associated immune cells and functional pathways were analysed to predict the upstream regulatory molecules.

RESULTS

In total, 18 candidate FRGs showed significant differences between the periodontitis and control groups, and from the protein-protein interaction network, eight hub genes were identified among the 175 differentially expressed FRGs by analysing 1096 differentially expressed genes and 4479 key modular genes. Eventually, ALDH2, diazepam binding inhibitor, HMGCR, OXCT1, and ACAT2 were identified as potential biomarkers through machine learning algorithms, receiver operating characteristic curve analysis, and gene expression assessments. In addition, resting dendritic cells, mast cells, and follicular helper T cells were positively correlated with the five biomarkers (Cor > 0.3 and P < .05). All five biomarkers are involved in the translation initiation pathway, including transcription factors like KLF5 and microRNAs such as hsa-miR-495-3p and hsa-miR-27a-3p. Reverse transcription-quantitative polymerase chain reaction analysis showed that all biomarkers were expressed at low levels in the periodontitis group. However, the differences in expression levels for OXCT1 and ACAT2 between groups were not statistically significant.

CONCLUSIONS

A total of five ferritinophagy-related biomarkers - ALDH2, diazepam binding inhibitor, HMGCR, OXCT1, and ACAT2 - were screened to explore new treatment options for periodontitis.

Fibroblast derived C3 promotes the progression of experimental periodontitis through macrophage M1 polarization and osteoclast differentiation

Complement C3 plays a critical role in periodontitis. However, its source, role and underlying mechanisms remain unclear. In our study, by analyzing single-cell sequencing data from mouse model of periodontitis, we identified that C3 is primarily derived from periodontal fibroblasts. Subsequently, we demonstrated that C3a has a detrimental effect in ligature-induced periodontitis. C3ar-/- mice exhibited significantly less destruction of periodontal support tissues compared to wild-type mice, characterized by mild gingival tissue damage and reduced alveolar bone loss. This reduction was associated with decreased production of pro-inflammatory mediators and reduced osteoclast infiltration in the periodontal tissues. Mechanistic studies suggested that C3a could promote macrophage polarization and osteoclast differentiation. Finally, by analyzing single-cell sequencing data from the periodontal tissues of patients with periodontitis, we found that the results observed in mice were consistent with human data. Therefore, our findings clearly demonstrate the destructive role of fibroblast-derived C3 in ligature-induced periodontitis, driven by macrophage M1 polarization and osteoclast differentiation. These data strongly support the feasibility of C3a-targeted interventions for the treatment of human periodontitis.

Patients with periodontal disease demonstrates changes in purinergic and inflammatory markers in PBMCs, serum and saliva

Periodontal disease (PD) is characterized by the presence of a chronic inflammatory process, due to the accumulation of bacterial biofilm and the host's response to these pathogens, resulting in the destruction of the supporting tissues of dental structures. Studies have revealed that components of the purinergic system and inflammation are related to the development and progression of PD. The objective was to evaluate periodontal clinical parameters, modulation of the purinergic system and inflammation in patients with PD, compared to individuals without the disease. This is a cross-sectional study with 25 healthy individuals (CT group) and 57 individuals with PD, where blood and saliva collection and isolation of blood components were carried out. The results showed that there was a significant reduction in the hydrolysis of adenosine triphosphate (ATP; p < 0.0001), adenosine diphosphate (ADP; p < 0.05) and adenosine monophosphate (AMP; p < 0.01) in peripheral blood mononuclear cells (PBMCs) from individuals in the PD group compared to the CT group, indicating that individuals with PD showed reduced NTPDase 1 and Ecto-5'-nucleotidase activity. Adenosine deaminase activity in saliva (p < 0.0001) and serum p < 0.05) from individuals with PD were significantly higher compared to the CT group. Extracellular ATP and the serum concentration of C-Reactive Protein showed a statistically significant increase in the PD group ((p < 0.0001 and p < 0.001, respectively). Therefore, the enzymes of the purinergic system are present in the modulation of PD, leading individuals affected by the disease to a pro-inflammatory state, hindering the action of the immune system and increasing serum markers of inflammation.

Effectiveness of Herbal Medicines with Anti-Inflammatory, Antimicrobial, and Antioxidant Properties in Improving Oral Health and Treating Gingivitis and Periodontitis: A Systematic Review

OBJECTIVES

This systematic review investigates the effectiveness of natural extracts with anti-inflammatory properties for improving oral health, particularly in managing gingivitis and periodontal disease (PD). With PD being a major global health issue, exacerbated by microbial dysbiosis and oxidative stress, the integration of phytochemicals and herbal formulations into periodontal therapy offers a promising avenue for adjunctive treatments.

METHODS

A systematic review was conducted following PRISMA guidelines and registered under the International Prospective Register of Systematic Reviews (ID: 641944). Databases, including PubMed, Scopus, and Web of Science, were searched between 18-24 December 2024, using Boolean keywords combining terms such as "herbal medicine", "plant extracts", "anti-inflammatory", and "periodontal therapy". Studies involving animal models, in vitro data, or non-peer-reviewed articles were excluded.

RESULTS

Seventeen studies met inclusion criteria. Polyherbal formulations and single-component extracts (e.g., Camellia sinensis, Punica granatum, Zingiber officinale, and Rosmarinus officinalis) demonstrated comparable efficacy to conventional agents like chlorhexidine (CHX). Polyherbal rinses, camellia sinensis gels, and extracts like Punica granatum reduced inflammation, improved gingival health, and showed antimicrobial properties, offering effective natural alternatives.

CONCLUSIONS

Natural products, including single extracts and polyherbal formulations, provide effective and safe alternatives for managing gingivitis and PD. Their anti-inflammatory, antimicrobial, and antioxidant properties support their adjunctive role alongside with scaling and root planning therapy (SRP) in periodontal therapy. However, further large-scale, long-term studies are needed to standardize formulations and establish optimal protocols.

Thermo-Responsive Hydrogel Containing Microfluidic Chitosan Nanoparticles Loaded with Opuntia ficus-indica Extract for Periodontitis Treatment

Periodontitis is a chronic inflammatory disease resulting from the dysbiosis of periodontal bacteria and the host's immune response, leading to tissue degradation and sustained inflammation. Traditional treatments, such as mechanical debridement and antimicrobial agents, often fail to fully eradicate pathogenic bacteria, especially in deep periodontal pockets. Consequently, the need for novel therapeutic approaches has increased the interest in bioactive natural extracts, such as that of Opuntia ficus-indica, known for its anti-inflammatory, antioxidant, and antimicrobial properties. This study investigates the encapsulation of Opuntia ficus-indica extract in OFI-loaded chitosan nanoparticles (OFI-NPs) via ionotropic gelation using a microfluidic system, allowing precise control over nanoparticle characteristics and enhancing protection against enzymatic degradation. To achieve localized and sustained release in periodontal pockets, a thermo-responsive hydrogel comprising hyaluronic acid and Pluronic F127 (OFI@tgels) was developed. The transition of OFI@tgels from a solution at low temperatures to a solid at body temperature enables prolonged drug release at inflammation sites. The in vitro application of the optimized formulation eradicated biofilms of S. mutans, P. aeruginosa (PAO1), and P. gingivalis over 36 h and disrupted extracellular polymeric substance formation. Additionally, OFI@tgel modulated immune responses by inhibiting M1 macrophage polarization and promoting a shift to the M2 phenotype. These findings suggest that OFI@tgel is a promising alternative treatment for periodontitis, effectively reducing biofilm formation and modulating the immune response.

Association Between Periodontal Diseases and Hypothyroidism: A Case-Control Study

Objective

Periodontal diseases are chronic inflammatory disorders influenced by systemic health of the individual. This study aimed to investigate the association between hypothyroidism and periodontal disease in a cohort of adult Saudi population.

Methods

This case-control study included 201 adults with hypothyroidism on hormone replacement therapy and 188 healthy controls. The medical files of patients were reviewed to check thyroid stimulation hormone (TSH) and free thyroxine (FT4) levels. Participants completed a questionnaire on demographic and health information, followed by a comprehensive periodontal examination. Pearson chi-square and binary logistic regression analyses determined associations, with a significance set at p ≤0.05.

Results

Gingivitis was found in 20.9% of cases and 58% of controls. Periodontitis stages I, II, III and IV were in general higher in cases compared to controls (23.4%, 27.9%, 21.9%, 6% in cases versus 13.8%, 17%, 9.6%, 1.6% in controls, respectively). Mean PPD and CAL values were higher in cases (5.54 ± 2.5 and 3.88 ± 3.1) than in controls (4.03 ± 1.6 and 1.72 ± 2.4). Significant associations between periodontal status and hypothyroidism were found (p < 0.0001). The periodontal status in hypothyroid cases correlated significantly with hormone replacement therapy dose and duration (p < 0.0001).

Conclusion

The findings of the current study showed that, in a cohort of adult Saudi subjects, patients with hypothyroidism have higher prevalence and more severe periodontal disease symptoms compared to controls, suggesting significant association.

Determination of chemical components of the endemic species Allium turcicum L. plant extract by LC-MS/MS and evaluation of medicinal potentials

The Allium turcicum L. (Zuzubak) plant as a cultivated vegetable have various health benefits and consumed as a food. Due to the shortcoming evidence in literature and the importance of this plant in folk medicine, in the present study, for the first time, we evaluated the bioactive profile of components (using LC-MS/MS), cytotoxicity, anticancer, antioxidant, and antibacterial prospectives of Zuzubak methanol extract. Reported results show that the extract is rich in bioactive compounds and has anticancer activity with breast cancer cells (MCF-7), human prostate cancer cells (DU-145), and Human osteosarcoma cancer Cell lines of (IC50) in dose dependent manner in the concentration range of 31.25 μg/mL and 2000 μg/mL for 24 and 48 h. Western blotting results determined that the extract significantly suppressed the growth of U2OS, MCF-7, and DU-145 cancer cells by down expression of Ang-1 (angiogenic protein) and Beclin-1 (autophagy protein) and overexpression of Bax (a proapoptotic protein). The oxidative stress indices showed a reduction in RPE-1 and MCF-7 cells and an upsurge in U2OS and DU-145 cells. Additionally, the antimicrobial assay showed suppression of the growth of various pathogenic microorganisms in 4.00-8.00 μg/concentrations of Zuzubak extract using the microdilution method. The phytochemicals identified showed promising anticancer, antioxidant effects, and antimicrobial properties, representing a valuable herbal source for drug development studies.