Lactobacillus reuteri for chronic periodontitis: focus on underlying mechanisms and future perspectives

ABSTRACTABSTRACTChronic periodontitis is a common oral disorder caused by pathogenic bacteria. Despite the wide use of antibiotics as the conventional adjunctive treatment, the challenges of increased antibiotic resistance and limited therapeutic effect receive considerable attention and the developments of alternative treatments gain increasing consideration. Growing evidence showed that Lactobacillus reuteri (LR) may represent a promising alternative adjunct for chronic periodontitis. It can attenuate inflammation and reduce tissue disruption. LR-assisted treatment has been shown to be effective and relatively safe in multiple clinical trials, and accumulating evidence suggests its significant biological roles. In the current review, we focus on capturing the underlying mechanisms of LR involved in chronic periodontitis, thereby representing a scientific foundation for LR-assisted therapy. Furthermore, we point out the challenges and future directions for further clinical trials to improve the clinical applicability for LR.KEYWORDS: Lactobacillus reuterichronic periodontitisprobioticsimmunoregulation AcknowledgementsThe authors acknowledge support for this work by the Scientific Research Talent Cultivation Project of the Stomatological Hospital, Southern Medical University (RC202102).11. The Acknowledge should be: Acknowledgments We thank Dr. Yan Jie at Guangzhou Medical University for helpful discussions in LR-mediated modulation of immunity and inflammation. And we are grateful to Dr. Duan Xuefeng at University of the Chinese Academy of Sciences for his kind suggestions.Disclosure statementNo potential conflict of interest was reported by the author(s).Abbreviations ERKextracellular regulated kinaseFoxp3forkhead box protein 3IFN-γinterferon-gammaILinterleukinJNKc-Jun NH2-terminal kinaseLPSlipopolysaccharidesLRLactobacillus reuteriMAPKmitogen-activated protein kinaseNF-κBnuclear factor-kappaBPgPorphyromonas gingivalisPI3Kphosphatidylinositol-3-kinaseSmadsmall mothers against decapentaplegicSTATsignal transducer and activator of transcriptionTGF-βtransforming growth factor-betaThT helperTLR4toll-like receptor 4TNFtumor necrosis factorTregsregulatory T cells.Data availability statementNo data was used for the research described in the article.CRediT authorship contribution statementKZ collected the data and drafted the original manuscript. JF reviewed the manuscript for its content, originality and usage of English language. KZ, JX, YS, and JF drafted the manuscript in consultation with all authors.Additional informationFundingThe work was supported by the Scientific Research Talent Cultivation Project of the Stomatological Hospital, Southern Medical University [RC202102].Notes on contributorsKeyi ZhouKeyi Zhou is a postgraduate studying at the School of Stomatology for pediatric dentistry at Southern Medical University.Jiaman XieJiaman Xie is a postgraduate studying at the School of Stomatology for pediatric dentistry at Southern Medical University.Yuan SuDr. Yuan Su is Associate Professor in Department of Periodontology at the School of Stomatology at the Southern Medical University. She has been engaged in clinical research and teaching of periodontal disease and oral implant repair. She is currently a member of the periodontal Professional Committee of Guangdong Stomatological Association.Jingxian FangDr. Jingxian Fang is Associate Professor at the Department of Pediatric dentistry at the school of Stomatology, Southern Medical University, and she's the vice director of the department. She is currently a member of pedodontic Professional Committee of Guangdong Stomatological Association.