Potential Treponema denticola-based periodontal vaccine to resolve a global public health challenge: a narrative literature review

ABSTRACTIntroduction Periodontitis is a diseased condition of the gum which imposes considerable costs on healthcare systems. It progresses further beyond the inflammation of supportive tissues of the teeth, and the collateral damages are closely associated with Alzheimer's disease, cardiovascular disease, and diabetes mellitus.Areas covered A comprehensive literature review was performed to summarize published studies in English during the period of 1990–2021 to discuss the rationales for developing periodontal vaccine, cost-effectiveness analyses on the prevention of periodontitis, Treponema denticola-based vaccine candidates, as well as immunological mechanisms in animal models.Expert opinion Preventive strategies against periodontitis may halt the onset of gum inflammation and the consequent chronic diseases. Considering the multi-microbial condition of periodontitis, an ideal periodontal vaccine should target multiple pathological pathways. Preventive approaches compared to surgical treatments evidently have significant impact on the healthcare budget and long-term health of the individuals in different communities. Despite many advances in periodontal vaccine research, there are still significant hurdles to overcome in developing a vaccine. Investment in research and development activities on key periodontal pathogens including Treponema denticola and Porphyromonas gingivalis in the foreseeable future is a worthy and cost-effective approach for the policymakers to prevent deleterious impacts of periodontitis.KEYWORDS: Periodontitisperiodontal vaccineTreponema denticolaPorphyromonas gingivaliscost-effectiveness AcknowledgmentsThe authors would like to dedicate this review to Professor Richard Ellen and Professor Christopher Fenno for their significant contributions and insights in the field of periodontitis.Article highlights Periodontitis progresses further beyond the inflammation of supportive tissues of the teeth, and the collateral damages may include other chronic diseases.Some researchers attempted to limit the extent of periodontitis in periodontal models using Treponema denticola and Porphyromonas gingivalis antigens.Successful preventive approaches against periodontitis should intervene the diseased condition prior to ramping up the bacterial biofilm formation in the sub-gingival tissue.Studies on immune responses to antigenic determinants of Treponema denticola have shown that PerioVax3 and FhbB antigens may potentially be used in a periodontal vaccine formulation.Considering the deleterious consequences of periodontitis, it would be conceivable and cost-beneficial to devise a multivalent vaccine formulation including Treponema denticola and Porphyromonas gingivalis antigens.Declaration of interestThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.