Repurposing Metformin for periodontal disease management as a form of oral-systemic preventive medicine

• Published in: Journal of translational medicine Vol. 21; no. 1; pp. 1 - 655
• Main Authors: Neves, Vitor C. M, Satie Okajima, Luciana, Elbahtety, Eyad, Joseph, Susan, Daly, James, Menon, Athul, Fan, Di, Volkyte, Ayste, Mainas, Giuseppe, Fung, Kathy, Dhami, Pawan, Pelegrine, Andre A, Sharpe, Paul, Nibali, Luigi, Ide, Mark
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 10.10.2023; BioMed Central; BMC
• Subjects: Age; Aging; Antidiabetics; Blood glucose; Blood sugar; Bone loss; Communicable diseases; Control; Development and progression; Diabetes mellitus; Diabetes therapy; Diabetics; Disease management; Dosage and administration; Drug therapy; Dysbacteriosis; Experiments; Glucose; Glucose metabolism; Gum disease; Health aspects; Identification and classification; Infection control; Insulin; Insulin-like growth factors; Metabolism; Metformin; Methods; Microbial mats; Osteoporosis; Patient outcomes; Periodontal disease; Periodontal diseases; Physiological aspects; Placebos; Prevention; Risk factors; Czech Republic
• ISSN: 1479-5876; 1479-5876
• DOI: 10.1186/s12967-023-04456-1

Abstract Background Despite the improvements in treatment over the last decades, periodontal disease (PD) affects millions of people around the world and the only treatment available is based on controlling microbial load. Diabetes is known to increase the risk of PD establishment and progression, and recently, glucose metabolism modulation by pharmaceutical or dietarian means has been emphasised as a significant modulator of non-communicable disease development. Methods The impact of pharmaceutically controlling glucose metabolism in non-diabetic animals and humans (REBEC, UTN code: U1111-1276-1942) was investigated by repurposing Metformin, as a mean to manage periodontal disease and its associated systemic risk factors. Results We found that glucose metabolism control via use of Metformin aimed at PD management resulted in significant prevention of bone loss during induced periodontal disease and age-related bone loss in vivo. Metformin also influenced the bacterial species present in the oral environment and impacted the metabolic epithelial and stromal responses to bacterial dysbiosis at a single cell level. Systemically, Metformin controlled blood glucose levels and age-related weight gain when used long-term. Translationally, our pilot randomized control trial indicated that systemic Metformin was safe to use in non-diabetic patients and affected the periodontal tissues. During the medication window, patients showed stable levels of systemic blood glucose, lower circulating hsCRP and lower insulin levels after periodontal treatment when compared to placebo. Finally, patients treated with Metformin had improved periodontal parameters when compared to placebo treated patients. Conclusion This is the first study to demonstrate that systemic interventions using Metformin in non-diabetic individuals aimed at PD prevention have oral-systemic effects constituting a possible novel form of preventive medicine for oral-systemic disease management.