Understanding the role of endotoxin tolerance in chronic inflammatory conditions and periodontal disease

Lena Larsson, Carlos Garaicoa-Pazmino, Farah Asa'ad, Rogerio Moraes Castilho

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations


Objective: This review aims to present the current understanding of endotoxin tolerance (ET) in chronic inflammatory diseases and explores the potential connection with periodontitis. Summary: Subsequent exposure to lipopolysaccharides (LPS) triggers ET, a phenomenon regulated by different mechanisms and pathways, including toll-like receptors (TLRs), nuclear factor kappa-light-chain enhancer of activated B-cells (NFκB), apoptosis of immune cells, epigenetics, and microRNAs (miRNAs). These mechanisms interconnect ET with chronic inflammatory diseases including periodontitis. While the direct correlation between ET and periodontal destruction has not been fully elucidated, emerging reports point towards the potential tolerization of human periodontal ligament cells (hPDLCs) and gingival tissues with a significant reduction of TLR levels. Conclusions: There is a potential link between ET and periodontal diseases. Future studies should explore the crucial role of ET in the pathogenesis of periodontal diseases, as evidence of a tolerized oral mucosa may represent an intrinsic mechanism capable of regulating the oral immune response. A clear understanding of this host immune regulatory mechanism might lead to effective and more predictable therapeutic strategies to treat chronic inflammatory diseases and periodontitis.

Original languageEnglish (US)
Pages (from-to)270-279
Number of pages10
JournalJournal of Clinical Periodontology
Issue number3
StatePublished - Mar 2022
Externally publishedYes


  • endotoxin shock
  • endotoxins
  • inflammation
  • periodontal disease
  • sepsis

ASJC Scopus subject areas

  • Periodontics


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