Department of Oral Medicine and Diagnostic Sciences, University of Illinois Chicago, Chicago, Illinois, USA.
Department of Periodontics, University of Illinois Chicago, Chicago, Illinois, USA.
Rev Med Virol. 2024 May;34(3):e2543. doi: 10.1002/rmv.2543.
COVID-19 as a pan-epidemic is waning but there it is imperative to understand virus interaction with oral tissues and oral inflammatory diseases. We review periodontal disease (PD), a common inflammatory oral disease, as a driver of COVID-19 and oral post-acute-sequelae conditions (PASC). Oral PASC identifies with PD, loss of teeth, dysgeusia, xerostomia, sialolitis-sialolith, and mucositis. We contend that PD-associated oral microbial dysbiosis involving higher burden of periodontopathic bacteria provide an optimal microenvironment for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. These pathogens interact with oral epithelial cells activate molecular or biochemical pathways that promote viral adherence, entry, and persistence in the oral cavity. A repertoire of diverse molecules identifies this relationship including lipids, carbohydrates and enzymes. The S protein of SARS-CoV-2 binds to the ACE2 receptor and is activated by protease activity of host furin or TRMPSS2 that cleave S protein subunits to promote viral entry. However, PD pathogens provide additional enzymatic assistance mimicking furin and augment SARS-CoV-2 adherence by inducing viral entry receptors ACE2/TRMPSS, which are poorly expressed on oral epithelial cells. We discuss the mechanisms involving periodontopathogens and host factors that facilitate SARS-CoV-2 infection and immune resistance resulting in incomplete clearance and risk for 'long-haul' oral health issues characterising PASC. Finally, we suggest potential diagnostic markers and treatment avenues to mitigate oral PASC.
COVID-19 作为一种泛流行病正在消退,但了解病毒与口腔组织和口腔炎症性疾病的相互作用至关重要。我们回顾了牙周病(PD),一种常见的炎症性口腔疾病,它是 COVID-19 和口腔急性后遗症(PASC)的驱动因素。口腔 PASC 与 PD、牙齿缺失、味觉障碍、口干、唾液腺炎-唾液石、黏膜炎有关。我们认为,与 PD 相关的口腔微生物失调涉及更高负担的牙周病细菌,为严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)感染提供了最佳的微环境。这些病原体与口腔上皮细胞相互作用,激活分子或生化途径,促进病毒在口腔中的粘附、进入和持续存在。一系列不同的分子识别这种关系,包括脂质、碳水化合物和酶。SARS-CoV-2 的 S 蛋白与 ACE2 受体结合,并被宿主弗林或 TRMPSS2 的蛋白酶活性激活,弗林或 TRMPSS2 切割 S 蛋白亚单位以促进病毒进入。然而,PD 病原体通过诱导 ACE2/TRMPSS 等病毒进入受体提供额外的酶辅助作用,这些受体在口腔上皮细胞上表达水平较低,从而增强 SARS-CoV-2 的粘附,这增加了病毒进入的风险。我们讨论了涉及牙周病原体和宿主因素的机制,这些机制促进了 SARS-CoV-2 感染和免疫抵抗,导致不完全清除,并增加了“长途”口腔健康问题的风险,这些问题是 PASC 的特征。最后,我们提出了潜在的诊断标志物和治疗途径,以减轻口腔 PASC。
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