Proanthocyanidins and Flavan-3-ols in the Prevention and Treatment of Periodontitis - Immunomodulatory Effects, Animal and Clinical Studies

Abstract

This paper continues the review study on antimicrobial properties relevant to the periodontal diseases. Inflammation as a major response of the periodontal tissues attacked by pathogenic microbes can significantly exacerbate the condition. However, the bidirectional activity of phytochemicals that simultaneously inhibit bacterial proliferation and proinflammatory signaling can provide a substantial alleviation of both cause and symptoms. The modulatory effects on various aspects of inflammatory and overall immune response has been covered, including confirmed and postulated mechanisms of action, structure activity relationships and molecular targets. Further, the clinical relevance of flavan-3-ols and available outcomes from clinical studies has been analyzed and discussed. Among the numerous natural sources of flavan-3-ols and proanthocyanidins the most promising are, similarly to antibacterial properties, constituents of various foods, such as fruits of Vaccinium species, tea leaves, grape seeds, and tannin-rich medicinal herbs. Despite a vast amount of in vitro and cell-based evidence of immunomodulatory there is still much less studies using animal models and only a few clinical studies. Most of the studies, regardless of the used model indicated efficiency of these phytochemicals from cranberries and other Vaccinium species and tea extracts (green or black). Other sources such as grape seeds and traditional medicinal plants, were seldom. In conclusion, the potential of flavan-3-ols and their derivatives in prevention and alleviation of periodontitis is remarkable but clinical evidence is urgently needed for issuing credible dietary recommendation and complementary treatments.

Proanthocyanidins and Flavan-3-Ols in the Prevention and Treatment of Periodontitis—Antibacterial Effects

“…In some references ( n = 16), the in vitro antibacterial tests were performed concurrently with investigations into the immunomodulatory effects in host cells or in animal models. The results of these studies pertaining to the inflammatory processes are reviewed in our other paper, separately [ 18 ].…”

“… Flowchart of the article search strategy, exclusion criteria, study selection, and data management process. Of all 65 considered references, thirty-one are reviewed in this paper and 50 in [ 18 ], of which 16 references are included in both reviews. …”

“…Due to the wide scope of the topic, the present paper focuses on the direct effects of procyanidins on periopathogens. The immunomodulatory, including animal and clinical, evidence will be covered in the second part of this review series [ 18 ].…”

A ação adjuvante do resveratrol na terapia periodontal: revisão de literatura / Adjuvant action of resveratrol in periodontal therapy: literature review

“…Adicionalmente, determinados medicamentos naturais podem ser aliados nesse tratamento, uma vez que fármacos naturais são passíveis de apresentam diversos efeitos antipatogênicos, como antimicrobianos, anti-inflamatórios e imunomoduladores (LAZAR; SAVIUC; CHIFIRIUC, 2016). Assim sendo, a utilização de produtos naturais não tóxicos e efetivos, por meio das referidas atividades biológicas, pode corroborar na redução dos sintomas e na prevenção da periodontite, ajudando no controle da destruição periodontal observada nesta doença e redução de sequelas irreversíveis (NAWROT-HADZIK et al, 2021).…”