Journal of Prevention and Treatment for Stomatological Diseases ›› 2019, Vol. 27 ›› Issue (11): 681-688.DOI: 10.12016/j.issn.2096-1456.2019.11.001

• Expert Commentary • Previous Articles     Next Articles

Host modulation therapy in periodontitis

ZHOU Zheng1(),QI Xia1,2,YANG Dongru2   

  1. 1. Department of Periodontology, School of Dentistry, University of Detroit Mercy, Detroit 48201, USA
    2. Department of Periodontology, Hospital of Stomatology, School of Stomatology, Hebei Medical University, Hebei Key Laboratory of Stomatology, Shijiazhuang 050017, China
  • Received:2019-02-02 Revised:2019-05-10 Online:2019-11-20 Published:2019-12-03
  • Contact: Zheng ZHOU

牙周炎的宿主反应调节治疗

周征1(),齐霞1,2,杨冬茹2   

  1. 1. 美国底特律大学牙学院牙周系,密歇根州 底特律(48201)
    2. 河北医科大学口腔医院牙周科·河北医科大学口腔医学院·河北省口腔医学重点实验室,河北 石家庄(050017)
  • 通讯作者: 周征
  • 作者简介:周征,美国底特律大学牙学院牙周系教授,研究生课程主任,美国牙周病和种植专业委员会认证专科医师(Diplomate),国际牙医学院院士(美国分部)。美国牙周病学会会员,美国正畸学会会员,美国牙医协会会员。毕业于华西医科大学口腔医学院,获口腔医学学士,口腔正畸学博士学位;在美国佐治亚医学院完成牙周和种植住院医师培训。历任华西口腔医院正畸科副教授,研究生导师,英国利物浦大学牙学院客座教授,美国佐治亚医学院牙周系住院医师及临床指导教师,底特律大学牙学院牙周系副教授。主译《正畸驱动的骨皮质切开术》,参编、参译《中华口腔科学》,《口腔正畸学: 现代原理与技术》,《牙颌面畸形功能矫形》等专著多部。曾主持和参与国家自然科学基金、教育部留学回国基金等项目多项。
  • 基金资助:
    河北省政府资助临床医学优秀人才培养和基础课题研究项目(MX2B00049);河北省政府资助专科能力建设和专科带头人培养专科建设项目(361029)

Abstract:

Host modulation therapy (HMT), as a treatment concept for periodontitis, aims to modulate the host immune responses during the pathogenesis of periodontitis. Various drugs have been evaluated as HMT, including subdose doxycycline (SDD), nonsteroidal anti-inflammatory drugs (NSAIDs), bisphosphonates, and cytokine receptors, to modify or modulate inflammatory mediators and associated signaling pathways in the immune-inflammatory response, as well as connective tissue breakdown and bone resorption. SDD, a member of the tetracycline drug family, has been reported to improve periodontal treatment outcomes by inhibiting periodontal breakdown through inhibiting MMPs. NSAIDs may suppress periodontal inflammation by reducing cyclooxygenase-2(COX-2) activity. Combined application of SSD and NSAIDs may achieve a better clinical outcome. Recent studies of HMT treatment have focused on the prevention of excessive inflammation by regulating mediators using endogenous lipid mediators. Local administration of bisphosphonates and histone deacetylase inhibitors can inhibit osteoclast activity and regulate bone tissue remodeling. Currently, SSD is approved by the FDA for periodontal treatment. Other drugs, such as COX-2 selective inhibitor, nonsteroidal anti-inflammatory drugs, bisphosphonates, triclosan and iNOS inhibitors, have good application prospects in the prevention and treatment of periodontal disease, and the mechanism and side effects of these drugs remain to be further investigated.

Key words: host modulation therapy, periodontal disease, immune-inflammatory response, tetracyclines, non-steroidal anti-inflammatory drugs, bisphosphonates, cytokines

摘要:

宿主反应调节治疗(host modulation therapy,HMT)是针对牙周炎致病过程中宿主免疫炎症反应而提出,目前作为牙周病的一种治疗方法应用于临床。HMT应用多种不同生物学机制药物如:亚剂量强力霉素,非甾体类抗炎药,双膦酸盐,以及多种组织细胞受体、组蛋白去乙酰基酶抑制剂等对宿主免疫炎症反应、结缔组织破坏和骨组织吸收过程中相关介质及其信号传导通路进行调节,辅助治疗牙周炎。其中,亚剂量强力霉素属于四环素类药物,通过抑制基质金属蛋白酶来抑制牙周组织破坏,辅助牙周基础治疗可显著提高牙周病治疗效果。局部应用非甾体类抗炎药,可选择性抑制牙周病主要炎性介质环氧化酶-2来抑制牙周组织炎症反应。非甾体类抗炎药和四环素类药物联合应用具有更好的治疗效果。通过内源性脂质调控介质防止过度炎症成为近年HMT治疗牙周炎的重要研究方向。局部应用双膦酸盐、组蛋白去乙酰基酶抑制剂可抑制破骨细胞活性,调控骨组织重建。亚剂量强力霉素已通过美国FDA验证,并投入临床应用。其他诸如环氧化酶-2选择性抑制剂、非甾体类抗炎药、双膦酸盐、三氯生、iNOS抑制剂等对牙周病的防治具有良好的应用前景,但其作用机制和副作用等仍需进一步的研究探讨。

关键词: 宿主反应调节治疗, 牙周病, 免疫炎症反应, 四环素类药物, 非甾体抗炎药, 双膦酸盐, 细胞因子

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