The link between chronic periodontitis and COPD: a common role for the neutrophil?

Abstract

BackgroundThe possible relationship between chronic inflammatory diseases and their co-morbidities has become an increasing focus of research. Both chronic periodontitis and chronic obstructive pulmonary disease are neutrophilic, inflammatory conditions characterized by the loss of local connective tissue. Evidence suggests an association and perhaps a causal link between the two diseases. However, the nature of any relationship between them is unclear, but if pathophysiologically established may have wide-reaching implications for targeted treatments to improve outcomes and prognosis.DiscussionThere have been a number of epidemiological studies undertaken demonstrating an independent association between chronic periodontitis and chronic obstructive pulmonary disease. However, many of them have significant limitations, and drawing firm conclusions regarding causality may be premature. Although the pathology of both these diseases is complex and involves many cell types, such as CD8 positive cells and macrophages, both conditions are predominantly characterized by neutrophilic inflammation. Increasingly, there is evidence that the two conditions are underpinned by similar pathophysiological processes, especially centered on the functions of the neutrophil. These include a disturbance in protease/anti-protease and redox state balance. The association demonstrated by epidemiological studies, as well as emerging similarities in pathogenesis at the level of the neutrophil, suggest a basis for testing the effects of treatment for one condition upon the severity of the other.SummaryAlthough the evidence of an independent association between chronic periodontitis and chronic obstructive pulmonary disease grows stronger, there remains a lack of definitive studies designed to establish causality and treatment effects. There is a need for future research to be focused on answering these questions.

Respiratory viral infection: a potential “missing link” in the pathogenesis of COPD

“…The neutrophil is a key effector cell that accumulates within the airway mucosa in COPD [31,32]. Sustained activation of the innate immune response leads to increased episodic neutrophilic inflammation [32,33]. Dysregulation of adaptive immune mechanisms are also implicated in the chronic inflammation and irreversible "airway remodelling" seen in COPD [13,34,35].…”

Periodontitis and airflow limitation in older Swedish individuals

“…Proposed mechanisms linking periodontitis and COPD include the following: aspiration of potentially pathogenic bacteria from the oral cavity (Scannapieco, 1999); systemic inflammatory mechanisms (Cardoso, Reis, & Manzanares‐Cespedes, 2018); or a common role of neutrophil dysfunction including disturbances in protease/anti‐protease and redox state balance that predispose to inflammation and tissue destruction in both lung and periodontal tissues (Usher & Stockley, 2013). The potential implication of periodontitis causally contributing to COPD pathogenesis is important as it provides a rationale to consider periodontal prevention and treatment as therapeutic options in the management of COPD (Kucukcoskun, Baser, Oztekin, Kiyan, & Yalcin, 2013; Shen et al, 2016; Zhou et al, 2014).…”

Effects of doxycycline on local and systemic inflammation in stable COPD patients, a randomized clinical trial

“…Although these anti-inflammatory effects of doxycycline never has been described in respiratory diseases, these effects where described in other chronic diseases such as abdominal aneurysm (AA) [17,18] and periodontitis [28]. Several parallels exist between AA, periodontitis and COPD [29,30]. Both with regard to risk factors as well as to the underlying pathophysiology in which persistent inflammation and excess matrix turnover play a pivotal role [29].…”

“…Several parallels exist between AA, periodontitis and COPD [29,30]. Both with regard to risk factors as well as to the underlying pathophysiology in which persistent inflammation and excess matrix turnover play a pivotal role [29]. It was therefore thought that doxycycline might reduce chronic inflammation in COPD.…”