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The Potential Role of P.Gingivalis in Gastrointestinal Cancer

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The Potential Role of P.Gingivalis in Gastrointestinal Cancer Liu et al. Infectious Agents and Cancer (2019) 14:23 https://doi.org/10.1186/s13027-019-0239-4 REVIEW Open Access The potential role of P.gingivalis in gastrointestinal cancer: a mini review Xiao-bo Liu1, Zi-ye Gao2, Chuan-tao Sun1, Hui Wen1, Bo Gao3, Sheng-bao Li1* and Qiang Tong1* Abstract Bacterial infection may be involved in the entire process of tissue carcinogenesis by directly or indirectly affecting the occurrence and development of tumors. Porphyromonas gingivalis (P.gingivalis) is an important pathogen causing periodontitis. Periodontitis may promote the occurrence of various tumors. Gastrointestinal tumors are common malignant tumors with high morbidity, high mortality, and low early diagnosis rate. With the rapid development of molecularbiotechnology, the role of P.gingivalis in digestive tract tumors has been increasingly explored. This article reviews the correlation between P.gingivalis and gastrointestinal cancer and the pathogenesis of the latter. The relationship among P.gingivalis, periodontal disease, and digestive tract tumors must be clarifiedthrough a multi-center, prospective, large-scale study. Keywords: Porphyromonasgingivalis, Periodontitis, Gastrointestinal cancer;esophageal cancer, Pancreatic cancer Introduction The morbidity rate of periodontitis is approximately Pathogen infection is one of the main causes of chronic 10.0~17.6%, and it is often accompanied with increasing inflammation, and the most common types are bacterial levels of inflammatory factors [8]. The definition and viral infections [1]. With the development of clinical “chronic periodontitis” has been replaced in the new medicine, a fundamental has shift occurred in the link be- periodontal diseases classification [9], the forms of the tween bacteria and cancer [2]. Tumorigenesis may be as- disease previously recognized as “chronic” or “aggres- sociated with inflammation. Bacterial infection may sive”, now grouped under a single category, “periodon- participate in the entire process of carcinogenesis by dir- titis”. In this study we have made changes according to ectly or indirectly affecting the occurrence and develop- the latest standards. Pathogenic bacteria can spread to ment of the disease. [1] Chronic infection may be involved the blood and even to the brain [10], and they are asso- in 17~28% of the morbidity and death of patients with ciated with various of systemic diseases and cancers [11, cancer in countries such as China and South Korea [3]. 12]. Periodontitis can cause tooth loss, and meta- The human flora plays an important role in normal analyses [13] suggest that tooth loss and alimentary physiological activities [4], and carcinogenesis [5]. More canal cancer are remarkbaly correlated and exhibit a than 700 kinds of bacteria exist in the normal oral cavity, dose–effect relationship, that is, the overall risk of cancer and these include at least 11 mycobacteria and 70 genera increases by 9% for every 10 teeth lost, and esophageal [6], among which red complex is an important pathogenic cancer (+ 14%), gastric cancer (+ 9%), head and neck bacterium for periodontal disease [7]. Red complex con- cancer (+ 31%), colorectal cancer (+ 4%) and pancreatic sists of P.gingivalis, Treponema denticola (T. denticola) cancer (+ 7%) [13]. and Tannerellaforsythia [7]. All three are Gram-negative P.gingivalis is an important pathogenic bacterium that anaerobic bacteria, which can express virulence factors to mediates the local inflammatory response of periodon- interfere in the defense system,and invade and destroy titis [14], adhere to and invade gingival epithelial cells, periodontal tissue and host immune function [7]. interfere with normal physiological metabolism, and in- hibit apoptosis [15], which is a potential risk factor for * Correspondence: [email protected]; [email protected] cancer [16]. Gastrointestinal cancer involves common 1Department of Gastroenterology, Taihe Hospital, Hubei University of Medicine, 32 south renmin road, Shiyan, Hubei 442000, People’s Republic of malignant tumors with high morbidity and mortality, China low diagnostic rate in the early stage, huge consumption Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Liu et al. Infectious Agents and Cancer (2019) 14:23 Page 2 of 7 of medical resources [17], high treatment cost for pa- periodontitis generally increases with the increase in P.gin- tients at the late stage, and poor effects. Furthermore, givalis IgG level [33]. However, the study in Taiwan [34] the early diagnosis rate of digestive tract tumors is low found that after adjusting the known risk factors, patients [18, 19], and advanced treatment costs are high and have with severe periodontitis do not show an increased overall poor effects, therefore tumors have become the main risk of gastrointestinal tumor (HR: 0.99, 95% CI: 0.84– healthcare burden of Chinese residents [20]. Domestic 1.16) nor the risk of a single tumor such as esophageal and foreign researches have shown a correlation between cancer, gastric cancer, small intestinal tumor, colorectal P. gingivalis and digestive tract tumor [21, 22]. This art- cancer and pancreatic cancer. The reasons for the differ- icle systematically evaluates the results of recent studies ent findings may be related to differences in disease sever- to provide clinical assistance. ity, race and sample size, and differences in risk factors between the two studies. With regard to P. gingivalis P. gingivalis is a gram-negative obligate anaerobic bacil- P. gingivalis and oral squamous cell carcinoma (OSCC) lus [12], which can express a variety of virulence factors, Oral cancer is the sixth most common cancer in the including trichoderma, gingipains, tetratricopeptide re- world and one of the most common cancers in develop- peat (TPR) sequence protein, extracellular polysaccha- ing countries [35]. OSCC is the most common type of rides, hemoglobin uptake system, lipopolysaccharides oral cancer with high incidence and recurrence rates and (LPS), etc. [23]. Gingipains and LPS co-activate could poor prognosis [36, 37]. Patients often experience logo- affect periodontal tissue immune defense function, and pathy and swallowing dysfunction, which seriously affect cause inflammation, leading to periodontal tissue de- facial appearance and social interactions [38]. The spe- struction and alveolar bone absorption [24]. cific risk factors of OSCC include dietary habits, poor Gingipains can degrade foreign protein and polypep- living habits, such as smoking, alcohol abuse, betel nut tide, which provide nutrition to P. gingivalis and main- chewing, DNA carcinogenic virus and genetic factors tain its growth [12]. P. gingivaliscan produce virulence [39–41],; however, OSCC in approximately 15% of pa- factors, such as Outer membrane vesicles (OMVs), E- tients still cannot be explained by these factors [42]. cadherin, toxin and proteolytic enzyme [25]. P. gingivalis Studies have shown that oral flora plays a role in oral OMVs show enriched selectivity in C-terminal domain cancer [43]. Oral bacterial infection can cause chronic (CTD)-family proteins, support bacterial cohesion, pro- periodontal inflammation, and serum P.gingivalis IgG mote the development of the biological membrane, and levels are significantly increased in patients with peri- function as intermdiates for transporting nonmotile bac- odontitis compared with normal subjects [31–33]. teria [26]. Pathogenic bacteria such as P. gingivalis have been de- As an intracellular pathogenic bacterium, P. gingivalis tected in OSCC [44], indicating that periodontitis is can invade a variety of eukaryotic cells,such as human probably related to OSCC. After long-term and repeated aortic endothelial cells, human coronary artery endothe- exposure to P. gingivalis, the invasiveness of OSCC cells lial cells (HCAEC) [27], human umbilical vein endothe- increases either by IL-8 and MMPs upregulation of [45] lial cells [28], gingival epithelial cells [15], coronary or by obtaining stem cell characteristics [46]. artery smooth muscle cells (CASMC) [29], epithelial After continuous exposure to P. gingivalis, human im- buccal KB cells [30]. After invasion, P. gingivalis changes mortalized oral epithelial cells show improved prolifera- its expressionto avoid the immune defenses of the host tion invasiveness and tumorigenicity improve [47]. The and then serves as a reservoir for future reinfection [26, possibility of carcinogenesis increases after the primary 28]. In addition, it can interact with the host and cell of a human being is infected by P. gingivalis [48]. In colonize periodontal tissue [26]. addition, continuous infection with P. gingivalis causes On the basis of different antibody levels of P. gingi- paclitaxel resistance in OSCC cells, and improved meta- valis IgG in vivo, periodontitis is divided into none or static ability [49]. The relationship of OSCC with P. gin- light(<69EU(Enzyme-linked immunosorbent
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