Investigating Local Delivery of Mesenchymal Stromal Cell Extracellular Vesicles for Treatment-resistant Periodontitis: A Hypothesis

One of the main reasons for tooth loss and functional incompatibility of dentition is periodontitis which is a multi-factorial disease. Among the main reasons for periodontitis is inflammation.

Hypothesis:

 Some keystone bacteria, such as Prophyromonas gingivalis with a notable number of virulence factors could activate and modify inflammatory pathways in gingiva. A well-established therapy for this disease is topical antibiotics; however, these treatments have side effects and could promote antibiotic-resistant infections as well. Such antibiotic-resistant infections are a group of periodontitis with a severely complicated treatment approach that could fail. Thus, new strategies need to be developed for treatment-resistant (antibiotic-resistant) periodontitis. In the past decades, many randomized controlled clinical trials have shown that mesenchymal stromal cells (MSCs) could treat inflammatory-dependent diseases or disorders. In addition to MSCs, the anti-inflammatory effects of their extracellular vesicles (EVs) have also been studied in the clinic. 

Considering the anti-inflammatory potential of MSCs-derived EVs, it could be hypothesized that local delivery of these EVs could be an effective method for periodontal treatment due to the accessible location of the periodontium.

This study suggests further in vivo studies and randomized clinical trials on the potential effects of MSCs-derived EVs on periodontal disease treatment.