Melbourne Dental School and Oral Health CRC, The University of Melbourne, Melbourne, VIC, Australia.
Oral Dis. 2018 Mar;24(1-2):224-227. doi: 10.1111/odi.12767.
The discovery of an oral glucocorticoid system has provided novel conceptual frameworks for understanding the effects of endogenous and exogenous corticosteroids in the oral cavity. For example, liquorice derivatives have long been used in the treatment of oral inflammatory conditions and it is now known that a chief constituent of liquorice root, glycyrrhetinic acid, inhibits 11β-hydroxysteroid dehydrogenase (11β-HSD) type 2 thus increasing local cortisol levels. Hence, targeting the local interconversion between inactive cortisone and active cortisol by 11β-HSD inhibitors/activators offers potentially advantageous strategies for the treatment of oral inflammatory and autoimmune conditions. The recent characterisation of a cancer-associated glucocorticoid system has further extended the implications of cortisol metabolism in oral disease. New evidence now questions the use of synthetic corticosteroids in patients with cancer and, possibly, in oral potentially malignant disorders. For example, cortisol production by cancer cells has been shown to inhibit tumour-specific CD8 T cells, to promote migration and invasion and to induce chemoresistance in vitro. This viewpoint briefly summarises the recent evidence for a role of the local steroid metabolism in oral oncology and immunology and its potential clinical implications.
口腔糖皮质激素系统的发现为理解内源性和外源性皮质激素在口腔中的作用提供了新的概念框架。例如，甘草衍生物长期以来一直被用于治疗口腔炎症性疾病，现在已知甘草根的主要成分甘草次酸抑制 11β-羟类固醇脱氢酶（11β-HSD）类型 2，从而增加局部皮质醇水平。因此，通过 11β-HSD 抑制剂/激活剂靶向局部之间无活性的可的松和活性皮质醇的相互转化，为治疗口腔炎症和自身免疫性疾病提供了潜在的有利策略。最近对癌症相关糖皮质激素系统的特征描述进一步扩展了皮质醇代谢在口腔疾病中的意义。新的证据现在质疑在癌症患者中使用合成皮质激素，并且可能在口腔潜在恶性疾病中使用。例如，癌细胞产生的皮质醇已被证明可抑制肿瘤特异性 CD8 T 细胞，促进迁移和侵袭，并在体外诱导化疗耐药性。这一观点简要总结了局部类固醇代谢在口腔肿瘤学和免疫学中的作用及其潜在的临床意义的最新证据。
