Relationship of Subgingival and Salivary Microbiota to Gingival Overgrowth in Heart Transplant Patients Following Cyclosporin A Therapy

Abstract

Clinical parameters were not sufficient to determine which patients would develop GO. However, colonization by M. micros might play a role in the etiology of GO.

Gingival overgrowth in subjects under immunosuppressive regimens based on cyclosporine, tacrolimus, or sirolimus

“…Some periodontal variables were reported to exacerbate the occurrence of GO, independently of the immunosuppressive regimen (Seymour et al 2000). An association between poor plaque control and GO was suggested previously (Thomason et al 1993, Ellis et al 1999, Vescovi et al 2005), although contradictory reports were also published (Wondimu et al 1996, Romito et al 2004, Costa et al 2007). The lack of association between plaque scores and GO could be due to the low sensitivity of plaque measurements (Costa et al 2007).…”

“…An inflammatory response induced by an altered microflora was suggested as a potential mechanism for GO (Fischer et al 1996). The validity of plaque index as a tool for analysing the association between plaque and GO has been questioned (King et al 1993, Romito et al 2004), because the quality and not only the quantity of the microbiota can be related to the occurrence of GO. In fact, the microbiological profile of GO+ subjects has been poorly investigated.…”

“…Few studies investigated the oral microbiota of GO+ and GO− subjects and the results are varied (Romito et al 2004, Saraiva et al 2006, Spolidorio et al 2006, Gong et al 2008a, b). It was reported that the frequency of Streptococcus β ‐haemolytic was higher among GO− subjects (Saraiva et al 2006), and that the frequency of P. micra (formerly Micromomas micros ) was higher among GO+ subjects (Romito et al 2004). A higher frequency of P. gingivalis, T. denticola , and T. forsythia was also reported for GO+ subjects (Gong et al 2008a, b).…”

“…However, it is important to highlight that bacterial species can present different patterns of salivary occurrence, according to specific characteristics of the population under investigation (Könönen et al 2007). Besides, salivary samples are representative of subgingival samples in immunocompetent subjects, in a study evaluating a group of heart transplant recipients the occurrence of some periodontal pathogens differed between these two sites (Romito et al 2004). Studies comprising renal transplant recipients under diverse immunosuppressive regimens are essential to the evaluation of bacterial occurrence patterns in different oral sites.…”

Impact of environmental factors on alloimmunity and transplant fate

“…Studies in rats and liver transplant patients have associated administration of tacrolimus with increased intestinal permeability in the short term (128,129), which may correct itself at 2-3 years after transplantation (130). Gingival overgrowth is a common complication of treatment with the other calcineurin inhibitor cyclosporin A and may be due to salivary microbial overgrowth (131), perhaps because of reduced immune-imposed colonization restrictions. Long-term immunosuppression in transplant patients was associated with changes in the salivary bacteriome, increased bacterial richness, and outgrowth of potentially opportunistic pathogens (132).…”