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

Vitor Neves*, Luciana Satie Okajima, Eyad Elbahtety, Susan Joseph, James Daly, Athul Menon, Di Fan, Ayste Volkyte, Giuseppe Mainas, Kathy Fung, Rawan Dhami, Andre A Pelegrine, Paul Sharpe, Luigi Nibali, Mark Ide

*Corresponding author for this work

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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.
Original languageEnglish
Article number655
Number of pages18
JournalJournal Of Translational Medicine
Issue number1
Publication statusPublished - 10 Oct 2023


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