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Year : 2020  |  Volume : 12  |  Issue : 5  |  Page : 37-42  

The association of matrix metalloproteinase gene polymorphisms and periodontitis: An overview

1 Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
2 Ministry of Health, Riyadh, Saudi Arabia
3 Prince Sultan Military Medical City, Riyadh, Saudi Arabia
4 Department of Preventive Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, Saudi Arabia
5 Department of Periodontics, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India

Date of Submission05-Feb-2020
Date of Decision08-Feb-2020
Date of Acceptance02-Mar-2020
Date of Web Publication28-Aug-2020

Correspondence Address:
Dalal H Alotaibi
Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, King Saud University, Riyadh 11451
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpbs.JPBS_136_20

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Periodontitis is a multifactorial inflammatory disease, pathogenic bacteria being the primary etiological agents. The host response and the severity of clinical manifestation are determined by genetic and environmental factors. There is some evidence that the individual response to environmental variations in the immune response in periodontitis is associated with genetic factors. Matrix metalloproteinases (MMPs) are a family of proteolytic enzymes located in the extracellular matrix. Their primary function is the breakdown of connective tissue components. Their role in the oral cavity is very vital. In this literature review, we summarized the contemporary knowledge on the function of MMPs in oral cavity and periodontal disease.

Keywords: Extracellular matrix, gene polymorphism, gingival crevicular fluid, matrix metalloproteinases, periodontitis

How to cite this article:
Alotaibi DH, Altalhi AM, Sambawa ZM, Koppolu P, Alsinaidi AA, Krishnan P. The association of matrix metalloproteinase gene polymorphisms and periodontitis: An overview. J Pharm Bioall Sci 2020;12, Suppl S1:37-42

How to cite this URL:
Alotaibi DH, Altalhi AM, Sambawa ZM, Koppolu P, Alsinaidi AA, Krishnan P. The association of matrix metalloproteinase gene polymorphisms and periodontitis: An overview. J Pharm Bioall Sci [serial online] 2020 [cited 2021 Apr 20];12, Suppl S1:37-42. Available from:

   Introduction Top

Periodontitis is a chronic inflammatory disease that caused in an irreversible damage to the periodontal attachment and the alveolar bone. As disease progresses, it may lead teeth loss.[1] Periodontitis can be divided into two forms: chronic periodontitis (CP) and aggressive periodontitis (AgP) based on several criteria as in American Academy of Periodontology (AAP) classification in 1999.[2] It is estimated that periodontitis prevalence (in both forms) can reach up to 72% of middle-aged US population[3] and at 89% of Indian population.[4] This difference in prevalence between the two populations can be explained by disease nature and other factors.[3],[4]

Host response considered as a modulating factor; only 8% of tea workers in Sri Lanka who never involved in oral hygiene program developed severe periodontitis and 81% of them had moderate periodontitis. The explanation of such difference in severity and how the human body reacts to is not fully understood.[1] Host response involves many contributing factors such as systemic condition, smoker status, genetic basis, and other factor directly or indirectly affecting the host. Genetic factors were evident in studies and they found 50% of periodontitis accounted for genetics factors that lead researchers to investigate the genetic polymorphism by either genome-wide associations (GWAS) or single-nucleotide polymorphisms (SNPs) to detect gene mutations and allelic variants leading to abnormal function of proteins.[4],[5]

Matrix metalloproteinase (MMP) enzymes are thought as host-derived proteinases. They play an essential part in the embryonic development, morphogenesis, tissue repair, and pathological behavior during connective tissue destruction and play dissimilar role in oral environments in periodontitis. They could be used as a biomarker in gingival crevicular fluid (GCF). MMPs are zinc-dependent zymogens. Their primary function is related to degradation, chemokine’s inactivation, cell proliferation, angiogenesis, and apoptosis.[3],[4],[5],[6]

Our aim in this literature review was to look into the genetic polymorphism in MMPs on periodontitis patient.

   Search Methodology Top

Using PubMed, Google Scholar, Embase, and MEDLINE databases for the key words “matrix metalloproteinases, polymorphism, periodontal disease, periodontitis, chronic periodontitis and aggressive periodontitis” we retrieved all clinical trials and systemic reviews. Only human studies that were written in English were included. Inappropriate articles by title and meta-analyses were omitted. Further exclusion by reading the abstract led to the most appropriate articles to our topic.

   Matrix Metalloproteinase Structure, Histology Classification, and Function Top

MMPs are family of 24 enzymes; they have similar structure in approximately 40% of time. They are zinc-dependent endopeptidase and usually secreted in an inactive form, except the membrane-associated MMPs (MT-MMPs). The primary structure of one MMP can be divided into three main segments: N-terminal peptide, the catalytic segment (lined with a hinge to the), and C-terminal domain.[6] In all secreted MMPs (except MMP-7 and MMP-26), the catalytic domain is followed by a C-terminal hemopexin-like domain contributing to substrate and tissue inhibitor of metalloproteinase (TIMP) binding, proteolytic activity, and membrane activation. In the MT-MMPs, the C-terminal domain attaches the molecule to the plasma membrane. A type 2 transmembrane MMPs (MMP-23) has cysteine array and immunoglobulin-like domains instead of the conserved hemopexin-like domain.[5]

According to their cleavage capability, they can be classified into six groups: collagenases, gelatinases, matrilysins, stromelysin membrane-associated MMPs, and MMPs with no group designation. Classification with numbers MMP-1 to MMP-28 is used for designation. MMPs can cleave the major and minor components of the extracellular matrix (ECM), with few exceptions such as MMP-11 and MMP-23. MMPs have the ability to lysis ECM components as well as acting as an activator for important biological molecules. The mode of action of dissimilar types of MMPs is greatly dependent on the group, which they belong to. For example, the Collagenases (MMP-1, MMP-8, and MMP-13) can degrade the interstitial collagen (types I, II, and III). The Gelatinases include MMP-2 and MMP-9, and have a broader function as they primarily cleave collagen type IV in basal membranes, but they can also denatured collagen types V, VII, X, XIV, elastin, fibronectin, and aggrecan.[5],[6]

On the contrary, Stromelysins can cleave the non-collagenous ECM such as fibronectin, proteoglycans, laminin, and glycoproteins. The collagen degradation of the cell membrane is chiefly the function of MT-MMPs. The macrophage elastase and other MMPs, mainly MMP-12, can cleave elastin, laminin, fibronectin, emalogenin, entactin, collagen, basal membrane, chondroitin sulfate, and others.[7]

   Matrix Metalloproteinase Role in Oral Environment Top

MMPs are fundamental in both physiological and pathological events in oral cavity. They have been isolated from specimens of GCF, enamel, saliva as well as periodontal tissues. MMPs are involved in various events like enamel formation, cell migration, tissue remodeling, wound healing, and organogenesis. Several studies showed that MMPs have a concrete role in the remodeling of the organic matrix of dentin and bone during oral tissue formation and repair.[8],[9]

MMPs have a variety of roles in physiological events like immune response, inflammation and ECM remodeling. Their production, activation, and inhibition are all tightly regulated in health; it is only when uncontrolled dysregulation of MMPs occurs, that destructive actions ensue.[7],[8],[9]

Role in enamel and dentine formation

In enamel, MMP-20 is a tooth-specific MMP and known as enamelysin, which is expressed by ameloblast and odontoblast. It plays a significant function in enamel and dentine formation. In the case of mutations of MMP-20, defective enamel will be formed as seen in amelogenesis imperfecta. Also, MMP-2, MMP-9, MMP-8, and MMP-14 produced by odontoblasts have a regulation role during dentine formation and after mineralization of the dentine, the inactive forms of MMPs will be trapped within the calcified dentine.[10]

Role in dental caries

Different hypotheses about how MMPs have a role in caries were proposed. One of which reported that excessive bacterial acids rise acidic pH, which in turn activates MMPs to digest the dentin matrix. It was also reported that the breakdown of the Small Integrin-binding Ligand N-linked Glycoproteins (SIBLINGs) by the caries may enhance the release of MMPs and their activation, which subsequently leads to caries. Therefore, MMP inhibition may provide treatment pathway to stop caries progression in dentin.[11]

Role in adhesive restorations

In adhesive restoration, the weakest layer is a hybrid layer located at interface between restoration and tooth structure and becomes weaker at dentin due to humid nature of dentine. As a result of acidity of caries and acid etching, both had ability to degradation of dental collagen that leads to an abundant release of MMP (MMP-2 and MMP-9) as protective measures, but in the case of adhesive restoration the released MMP will potentially degrade the exposed collagen fiber within hybrid layer and that will have affect a negative effect on strength of bond at hybrid layer and by applying MMPs inhibitors such as cholorhexidine digluconate the strength of bond at hybrid layer increases.[10],[11],[12]

Role in gingival crevicular fluid and saliva

GCF and saliva contain different types of MMPs. Most likely the cell origin of MMPs in GCF and saliva are the polymorphoneuclear (PMN) leucocytes. Many observations confirmed that PMN leukocytes are the chief contributors of MMP in GCF. For example, early research showed metabolites in GCF originated from plasma, and PMN leukocytes. Also, it was shown that GCF contains α-2M, albumin, and immunoglobulins that are present at high concentrations, produced by PMN leukocytes and carried to the GCF via different carriers (CL, Mr 92K GL, elastase, and myeloperoxidase.[13],[14]

Role in periodontal disease

It is known that periodontitis (chronic or aggressive) is one of the dental pathologies where genetic component and phenotypic alterations contribute to overall disease progression and severity. Periodontal disease is a long-lasting chronic inflammation and tissue destruction, which lead into pocket formation and bone loss. Destruction process is predominantly related to bacterial challenge that can lead to overexpression of defense mechanism such as MMPs and other mediators. They are formed by infiltrating neutrophils, macrophages, and resident cells of periodontium. Moreover, there is a significant bank of evidence implicating the pivotal role of MMPs in periodontal tissue destruction in disease. Several MMPs, such as MMP-1, MMP-2, MMP-3, MMP-7, MMP-8, and MMP-9, have been found in higher proportion on GCF and saliva samples obtained from periodontitis patients and evident for direct correlation with severity and progress of periodontal disease by high expression of MMP or imbalance of tissue inhibitor of MMPs. Among them, MMP-8 has shown in many laboratories and chair side studies to be elevated in disease and appears as a promising biomarker.[13],[14],[15]

Apart from MMP-8, MMP-13 and MMP-14, by virtue of pro-MMP-9 effects, have been observed to be involved periodontal tissue destruction by coordinated effects with other proteinases of the family. Activated MMPs are in turn able to stimulate production of other signaling molecules such as cytokines and chemokines further cementing its role in regulating periodontitis progression.[16] It was found that treatment of periodontitis with scaling and root planning (SRP) reduced level of different MMPs (MMP-1, MMP-2, MMP-3, MMP-8, MMP-9, MMP-12, and MMP-13).[16],[17]

It was also found that nonsurgical therapy with antibiotics as well reduced the levels of MMP-8. Phase 1 therapy, wherein elimination/control of etiological factors is carried out, has been found to reduce levels of MMPs and increased ratio of TIMPs. Interestingly, by detection MMP-8 and MMP-1 from GCF could be useful biomarkers to distinguish between different types of periodontitis also for mentoring of the disease during maintenance phase.[6],[17]

   Matrix Metalloproteinase and Polymorphism Top

Any genetic polymorphisms that influence MMP expression or their activity can also affect predisposition to periodontitis. Several polymorphisms have been detected in promoter regions of several MMPs. There are potential areas susceptible to polymorphism in the MMP structure, mainly MMP-2-753C/T, MMP-3-1171A5/A6, MMP-8-799C/T, MMP-9-1562C/T, and MMP-12- 357Asn/Ser.[5],[7],[8],[9]

In MMP-1, gene alteration occurs at the allele 1607 on chromosome; there have been four cohort studies: one with mixed races, one on China mainly for Asians, one on Turkish population, and one in Brazilian race. Two showed an association with CP, one showed probable link to CP or AgP, and one showed a limited role. In MMP-2, allele alteration occurs at 753C/T location. Relation with periodontal disease has been investigated in one Caucasian race, one Chinese, and one Turkish with a limited role in all of them. The Asian cohort showed an association with AgP found in TIMP-2- 418GC gene polymorphism from oral swabs.[16],[17],[18],[19],[20]

In MMP-3, change happens at 1171 A5/A6 most commonly. Four studies were carried out to study the effect on periodontal disease: two in Brazil, one in China, and one in Japan. All showed an association except the Japanese cohort. In MMP-8 gene, the polymorphism occurs at 17C/G (rs2155052) 799 C/T. We found four publications studied the effect on periodontitis development: three via peripheral blood samples and one by gingival fluid assessments. Three showed association with periodontal disease and one showed that both SNPs on −799C/T and +17C/G in the MMP-8 gene were not associated with periodontitis. MMP-9 gene alteration at 1562 C/T is one of the most investigated polymorphisms.[6],[14],[15],[16],[17]

We found 10 studies investigating MMP-9 alone or with other MMP effect on periodontal disease. Four on Caucasian race, two on mixed races, three on Asians, and one on India. Most of these were performed using the polymerase chain reaction analyzing DNA from either blood or oral samples. Six showed strong or probable association with periodontitis, and four showed no true association. Identifying different polymorphism leading to periodontitis may help to build new therapeutics or diagnostic tool. We summarized the most frequent polymorphism in the structure of different MMPs published as potential causes for periodontitis in [Table 1][Table 2][Table 3]].[18],[19],[20],[21],[22]
Table 1: Studies related to MMP-1-1607

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Table 2: Studies related to MMP-2-753C/T and MMP-3-1171A5/A6

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Table 3: Studies related to MMP-8-799C/T and MMP-9-1562C/T

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   Conclusion Top

We performed this literature review to better understand their mechanism of active and function within the oral cavity, as well, to identify the gap in literature. Genetic polymorphism studies have shown variances depending on geographical location, ethnicity of population, and type of periodontal disease. So while it may be difficult to draw a definitive conclusion, what we can observe is that MMPs are the primal gateways for irreversible periodontal tissue destruction and polymorphisms in specific promoter regions can influence the disease susceptibility. Further corroborative evidence can help in developing genetic therapeutic targets in future for better control or prevention of disease. Locally we were not able to find any published research from Saudi Arabia or including a Saudi population.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Löe H, Anerud A, Boysen H, Morrison E Natural history of periodontal disease in man. Rapid, moderate and no loss of attachment in Sri Lankan laborers 14 to 46 years of age. J Clin Periodontol 1986;13:431-45.  Back to cited text no. 1
Llano E, Pendás AM, Knäuper V, Sorsa T, Salo T, Salido E, et al. Identification and structural and functional characterization of human enamelysin (MMP-20). Biochemistry 1997;36:15101-8.  Back to cited text no. 2
Franco C, Patricia HR, Timo S, Claudia B, Marcela H Matrix metalloproteinases as regulators of periodontal inflammation. Int J Mol Sci 2017;18:440.  Back to cited text no. 3
Cao Z, Li C, Jin L, Corbet EF Association of matrix metalloproteinase-1 promoter polymorphism with generalized aggressive periodontitis in a Chinese population. J Periodontal Res 2005;40:427-31.  Back to cited text no. 4
Repeke CE, Trombone AP, Ferreira SB Jr, Cardoso CR, Silveira EM, Martins W Jr, et al. Strong and persistent microbial and inflammatory stimuli overcome the genetic predisposition to higher matrix metalloproteinase-1 (MMP-1) expression: a mechanistic explanation for the lack of association of MMP1-1607 single-nucleotide polymorphism genotypes with MMP-1 expression in chronic periodontitis lesions. J Clin Periodontol 2009;36:726-38.  Back to cited text no. 5
de Souza AP, Trevilatto PC, Scarel-Caminaga RM, de Brito RB Jr, Barros SP, Line SR Analysis of the MMP-9 (C-1562 T) and TIMP-2 (G-418C) gene promoter polymorphisms in patients with chronic periodontitis. J Clin Periodontol 2005;32:207-11.  Back to cited text no. 6
Pirhan D, Atilla G, Emingil G, Sorsa T, Tervahartiala T, Berdeli A Effect of MMP-1 promoter polymorphisms on GCF MMP-1 levels and outcome of periodontal therapy in patients with severe chronic periodontitis. J Clin Periodontol 2008;35:862-70.  Back to cited text no. 7
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Chen D, Wang Q, Ma ZW, Chen FM, Chen Y, Xie GY, et al. MMP-2, MMP-9 and TIMP-2 gene polymorphisms in Chinese patients with generalized aggressive periodontitis. J Clin Periodontol 2007;34:384-9.  Back to cited text no. 9
Itagaki M, Kubota T, Tai H, Shimada Y, Morozumi T, Yamazaki K Matrix metalloproteinase-1 and -3 gene promoter polymorphisms in Japanese patients with periodontitis. J Clin Periodontol 2004;31:764-9.  Back to cited text no. 10
Astolfi CM, Shinohara AL, da Silva RA, Santos MC, Line SR, de Souza AP Genetic polymorphisms in the MMP-1 and MMP-3 gene may contribute to chronic periodontitis in a Brazilian population. J Clin Periodontol 2006;33:699-703.  Back to cited text no. 11
Gürkan A, Emingil G, Saygan BH, Atilla G, Cinarcik S, Köse T, et al. Matrix metalloproteinase-2, -9, and -12 gene polymorphisms in generalized aggressive periodontitis. J Periodontol 2007;78:2338-47.  Back to cited text no. 12
Loo WT, Wang M, Jin LJ, Cheung MN, Li GR Association of matrix metalloproteinase (MMP-1, MMP-3 and MMP-9) and cyclooxygenase-2 gene polymorphisms and their proteins with chronic periodontitis. Arch Oral Biol 2011;56:1081-90.  Back to cited text no. 13
Letra A, Silva RM, Motta LG, Blanton SH, Hecht JT, Granjeirol JM, et al. Association of MMP3 and TIMP2 promoter polymorphisms with nonsyndromic oral clefts. Birth Defects Res A Clin Mol Teratol 2012;94:540-8.  Back to cited text no. 14
Chou YH, Ho YP, Lin YC, Hu KF, Yang YH, Ho KY, et al. MMP-8 -799 C>T genetic polymorphism is associated with the susceptibility to chronic and aggressive periodontitis in Taiwanese. J Clin Periodontol 2011;38:1078-84.  Back to cited text no. 15
Izakovicova Holla L, Hrdlickova B, Vokurka J, Fassmann A Matrix metalloproteinase 8 (MMP8) gene polymorphisms in chronic periodontitis. Arch Oral Biol 2012;57:188-96.  Back to cited text no. 16
Emingil G, Han B, Gürkan A, Berdeli A, Tervahartiala T, Salo T, et al. Matrix metalloproteinase (MMP)-8 and tissue inhibitor of MMP-1 (TIMP-1) gene polymorphisms in generalized aggressive periodontitis: gingival crevicular fluid MMP-8 and TIMP-1 levels and outcome of periodontal therapy. J Periodontol 2014;85:1070-80.  Back to cited text no. 17
Keles GC, Gunes S, Sumer AP, Sumer M, Kara N, Bagci H, et al. Association of matrix metalloproteinase-9 promoter gene polymorphism with chronic periodontitis. J Periodontol 2006;77:1510-4.  Back to cited text no. 18
Isaza-Guzmán DM, Arias-Osorio C, Martínez-Pabón MC, Tobón-Arroyave SI Salivary levels of matrix metalloproteinase (MMP)-9 and tissue inhibitor of matrix metalloproteinase (TIMP)-1: a pilot study about the relationship with periodontal status and MMP-9(-1562C/T) gene promoter polymorphism. Arch Oral Biol 2011;56:401-11.  Back to cited text no. 19
Li G, Yue Y, Tian Y, Wang M, Liang H, Liao P, Chow LW Association of matrix metalloproteinase (MMP)-1, 3, 9, interleukin (IL)-2, 8 and cyclooxygenase (COX)-2 gene polymorphisms with chronic periodontitis in a Chinese population. Cytokine 2012;60:552-60.  Back to cited text no. 20
Hadi CA, Suhartono W, Sulijaya B, Sarwono AT, Yuniastuti M, Auerkari EI Distribution of matrix metalloproteinase–9 (Mmp-9)–1562 C/T gene polymorphism in Indonesian males with periodontitis. J Int Dent Med Res 2017;10:778-81.  Back to cited text no. 21
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  [Table 1], [Table 2], [Table 3]


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