Efeitos dos processos imunológicos associados à periodontite na patogênese da aterosclerose: uma revisão sistemática

Abstract

Periodontitis is an oral disease that affects the supporting tissues of the teeth and is inflammatory and progressive, affecting the host's immune system. In this sense, considering oral and systemic health as directly interdependent conditions, the influence of chronic periodontitis is highlighted as a risk factor for systemic diseases related to a dysregulation of the immune response. From this perspective, atherosclerosis stands out, a disease also characterized by its inflammatory nature, caused by the deposition of lipids in the intima layer of the vascular endothelium, which can culminate in narrowing of the lumen of the vessels and their obstruction. Therefore, the present study aimed to understand, through a systematic review of the literature, how the immunological mechanisms involved in periodontitis can affect the development and progression of the vascular disease atherosclerosis. The searches were performed in the PubMed, Medline Ovid, Scopus and Web of Science databases, seeking results until December 2023, using descriptors from Medical Subject Headings (MeSH) and Descritores em Ciências da Saúde (DeCS), combining the keywords "Periodontal Diseases", "Periodontitis", "Imune System Phenomena", "Imune Response", "Arteriosclerosis" and "Atherosclerosis" with the Boolean operators "AND", "OR" and "NOT". This review was structured according to the Preferred Reporting Framework for Systematic Reviews and Meta-Analyses (PRISMA) and a protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024520380). Initially, 309 studies were found. After exclusion of duplicates, titles, abstracts and full reading, 7 articles were selected for the review and 1 study was selected by reading the references of the selected articles, totaling 8 articles included for this systematic review. Then, the data were extracted and tabulated. The risk of bias assessment was performed using the Cochrane RoB 2 Risk of Bias 2, 2019 (RoB 2) tool for randomized trials. The selected articles mostly presented a low risk of bias. The main mechanisms observed regarding the immune response with influence on periodontitis and atherosclerosis conditions were endotoxemia, epitope cross-reactivity through molecular mimicry, monocyte reprogramming and elevated C-reactive protein (CRP) levels. In most cases, the analyses showed that the periodontal status relates to the level of the resulting inflammatory response. However, more specific studies are needed to fully elucidate these mechanisms, given the multifactorial nature of both target conditions of interest.