Biologic agents and oral diseases; therapeutic prospects and restrictions

Abstract: Biologic agents (BAs) are synthesized by the products of living organisms and are widely used in the treatment of inflammatory and neoplastic conditions with favorable results. The purpose of this review is to provide an update of the biologic agents reported to have been used in treatment of diseases that affect the oral mucosa, as off-label indications. Identification of cases studies referring to the use of biologic agents in patients with Sjögren syndrome (including patients with MALT-lymphomas), pemphigus (vulgaris, foliaceous, paraneoplastic), mucous membrane pemphigoid, oral lichen planus, Behcet’s disease, orofacial granulomatosis, and recurrent aphthous ulceration (RAU), was achieved using Pubmed –Medline database , performing both electronic search (with key words infliximab, etanercept, adalimumab, rituximab, efalizumab, epratuzumab and alefacept , oral diseases, oral manifestations, dermatologic diseases, immune mediated diseases, biologic agents , anti-TNF agents, monoclonal antibodies, anti-B cell agents, anti T-cell agents ) and hand search to identify articles that referred specifically to patients with oral involvement..  According to the literature so far the use of BAs in patients that suffered from refractory forms of the immune-related diseases of the oral mucosa seems in general a clinically encouraging therapeutic option, but not without side effects including secondary infections, and also with a questionable economic cost-effect. Indeed, more studies in larger groups and longer period of time are required in order to confirm their efficacy and safety.  </p

Reduced platelet hyper-reactivity and platelet-leukocyte aggregation after periodontal therapy

Background: Platelets from untreated periodontitis patients are hyper-reactive and form more platelet-leukocyte complexes compared to cells from individuals without periodontitis. It is not known whether the improvement of the periodontal condition achievable by therapy has beneficial effects on the platelet function. We aimed to assess the effects of periodontal therapy on platelet reactivity. Methods: Patients with periodontitis (n=25) but unaffected by any other medical condition or medication were included and donated blood before and after periodontal therapy. Reactivity to ADP or oral bacteria was assessed by flow cytometric analysis of membrane markers (binding of PAC-1, P-selectin, CD63) and platelet-leukocyte complex formation. Reactivity values were expressed as ratio between the stimulated and unstimulated sample. Plasma levels of soluble (s) P-selectin were determined by enzyme-linked immunosorbent assay (ELISA). Results: Binding of PAC-1, the expression of P-selectin and CD63 in response to the oral bacterium P. gingivalis were lower at recall (1.4±1.1, 1.5±1.2, and 1.0±0.1) than at baseline (2.7±4.1, P=0.026, 6.0±12.5, P=0.045, and 2.7±6.7, P=0.042, respectively). Formation of platelet-leukocyte complexes in response to P. gingivalis was also reduced at recall compared to baseline (1.2±0.7 vs. 11.4±50.5, P=0.045). sP-selectin levels were significantly increased post-therapy. Conclusions: In periodontitis patients, the improvement of the periodontal condition is paralleled by a reduction in platelet hyper-reactivity. We suggest that periodontal therapy, as an intervention for improved oral health, can facilitate the management of thrombotic risk, and on the long term can contribute to the prevention of cardiovascular events in patients at risk. Trial registration: Current Controlled Trials identifier ISRCTN36043780. Retrospectively registered 25 September 2013