Department of Pathophysiology, School of Dental Medicine, University of Belgrade, Belgrade, Serbia.
Central Library, School of Dental Medicine, University of Belgrade, Belgrade, Serbia.
Int Endod J. 2022 Jul;55(7):700-713. doi: 10.1111/iej.13756. Epub 2022 May 8.
The interaction between heredity and different environmental factors in the modification of apical periodontitis (AP) susceptibility and prediction of its progression remain poorly elucidated.
This umbrella review aimed to (i) analyse the available relevant systematic reviews in an attempt to determine the association between genotype and allelic distribution of different single-nucleotide polymorphisms (SNPs) and the development of AP, (ii) report deficiencies and gaps in knowledge in this area and (iii) present recommendations to conduct future clinical studies and systematic reviews.
A literature search was conducted using Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Database of Systematic Reviews, from inception to October 2021, with no language restrictions, including a grey literature search. Systematic reviews with/without meta-analysis evaluating genotype and allelic distribution of different SNPs between adult patients with/ without AP were included. All other type of studies were excluded. The methodological quality was assessed using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2 tool. Two independent reviewers were involved in study selection, data extraction and appraising the included reviews; disagreements were resolved by a third reviewer.
The current study includes five systematic reviews. Three reviews performed meta-analysis. Three reviews were graded by AMSTAR 2 as 'critically low' quality, whereas the other two were graded as 'low' and 'moderate' quality. Two reviews indicated that carriers of specific genotypes and alleles of tumour necrosis factor-alpha (TNF-α) -308 G > A and interleukin 1-beta (IL-1β) + 3954 C/T gene polymorphisms are more susceptible to an acute and persistent form of AP. However, high heterogeneity was observed.
The statistical heterogeneity within included systematic reviews was a consequence of clinical and methodological diversity amongst primary studies. Although some of the included reviews suggested that carriers of specific genotype and/or allele of TNF-α -308 G > A and IL-1β + 3954 C/T SNPs are more susceptible to AP, their conclusions should be interpreted with caution.
No candidate genes could be identified as a definitive genetic risk or protective factor for the development and progression of AP, and further high-quality genome-wide association studies are warranted.
遗传因素与不同环境因素在根尖周炎（AP）易感性的修饰和进展预测中的相互作用仍未得到充分阐明。
本伞式综述旨在：（i）分析现有相关系统综述，以确定不同单核苷酸多态性（SNP）的基因型和等位基因分布与 AP 发展之间的关联；（ii）报告该领域知识的不足和差距；（iii）提出建议，以开展未来的临床研究和系统综述。
从 2021 年 10 月开始，使用 Clarivate Analytics 的 Web of Science、Scopus、PubMed 和 Cochrane 系统评价数据库，对包括灰色文献在内的无语言限制的文献进行了检索，纳入了评估成人 AP 患者/无 AP 患者中不同 SNP 基因型和等位基因分布的系统综述，无论是否进行了荟萃分析。排除了所有其他类型的研究。使用评估系统评价的测量工具（AMSTAR-2）工具评估方法学质量。两名独立的审查员参与了研究选择、数据提取和纳入综述的评估；有分歧的地方由第三名审查员解决。
本研究共纳入 5 项系统综述。其中 3 项进行了荟萃分析。3 项综述被 AMSTAR-2 评为“严重低”质量，而另外 2 项则评为“低”和“中”质量。有 2 项综述表明，肿瘤坏死因子-α（TNF-α）-308G＞A 和白细胞介素 1-β（IL-1β）+3954C/T 基因多态性的特定基因型和等位基因携带者更容易发生急性和持续性 AP。然而，观察到高度异质性。
纳入的系统综述中的统计异质性是由于初级研究之间的临床和方法学多样性所致。尽管一些纳入的综述表明，TNF-α-308G＞A 和 IL-1β+3954C/T SNP 的特定基因型和/或等位基因携带者更容易发生 AP，但应谨慎解释其结论。
没有候选基因可以被确定为 AP 发展和进展的明确遗传风险或保护因素，需要进一步进行高质量的全基因组关联研究。
