Connecting the dots: NETosis and the periodontitis-rheumatoid arthritis nexus

Shahbaz, Maliha and Al-Maleki, Anis Rageh and Cheah, Chia Wei and Aziz, Jazli and Bartold, Peter Mark and Vaithilingam, Rathna Devi (2024) Connecting the dots: NETosis and the periodontitis-rheumatoid arthritis nexus. International Journal of Rheumatic Diseases, 27 (11). e15415. ISSN 1756-1841, DOI https://doi.org/10.1111/1756-185X.15415.

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Official URL: https://doi.org/10.1111/1756-185X.15415

Abstract

Periodontitis (PD) is characterized by the host's inflammatory responses to microbial dental biofilm dysbiosis, potentially resulting in tooth loss if left untreated. Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease leading to synovial inflammation and destruction of joint cartilage and bone. The suggested association between PD and RA is based on the potential of chronic inflammation present in periodontitis, which could induce alterations in proteins through post-translational modifications, leading to the formation of citrullinated and carbamylated protein antigens. Antibodies directed against these antigens can serve as biomarkers for the underlying immunological processes in RA. Recent studies have also focused on bacterial proteolytic enzymes released from PD-associated bacteria, such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, which are also sources of these antibodies. Chronic inflammation in PD causes increased levels of inflammatory cytokines (interferon-alpha, interleukins-6 and 8, tumor necrosis factor-alpha) and neutrophil extracellular traps (NETs). The oral microbiota in PD is also associated with the release of NETs (a process known as NETosis). Elevated NET levels are a source of citrullinated and carbamylated proteins which highlights their role in an individual's risk of developing RA (pre-RA individuals) and the progression of chronic RA. This narrative review describes periodontitis and the dysbiotic subgingival microbiota and its role in NETosis as risk factors for inducing early RA and the prospects of identifying pre-RA individuals and seronegative RA patients with these risk factors.

Item Type: Article
Funders: Ministry of Education, Malaysia (FP014-2021)
Uncontrolled Keywords: anti-carbamylated protein; anti-citrullinated protein; NETosis; neutrophil extracellular trap; oral microbiome; periodontitis; rheumatoid arthritis
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Dentistry > Department of Oral & Craniofacial Sciences
Faculty of Dentistry > Department of Restorative Dentistry
Faculty of Medicine > Medical Microbiology Department
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 19 Feb 2025 01:59
Last Modified: 19 Feb 2025 01:59
URI: http://eprints.um.edu.my/id/eprint/47377

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