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Introduction
Gliomas, the most prevalent primary tumors of the CNS with an incidence rate of 5.9 per 100,000 population, account for approximately 24% of all primary CNS tumors [1]. According to the fifth edition of the WHO classification of CNS tumors [2], gliomas are categorized into four groups, namely adult-type diffuse gliomas, pediatric-type diffuse low-grade gliomas, pediatric-type diffuse high-grade gliomas, and circumscribed astrocytic gliomas, and are stratified into grade 1 to 4 based on histological and molecular features. Despite the implementation of multimodal treatment approaches, gliomas generally have a bleak prognosis, with the most common subtype, glioblastoma (GBM), exhibiting a five-year survival rate of only 6.9% [1].
Periodontitis is a complex inflammatory disease that is triggered by subgingival dental biofilm and ultimately leads to irreversible damage to the supporting and surrounding structures of the teeth, such as the periodontal ligament and alveolar bone [3]. It is one of the most common chronic diseases in the population, with a prevalence estimated at 42.2% and 7.8% of individuals experiencing severe symptoms, including tooth loss, pain, and impaired chewing function [4].
Several studies have investigated the relationship between glioma and periodontitis. The initial study that specifically examined this connection conducted oral examinations and NMR spectroscopy analysis of salivary metabolites in both GBM patients and non-GBM controls. However, this study did not find any significant association between GBM and periodontitis [5]. Subsequently, another study focused on the association between oral microbiota and glioma grade. It discovered that the relative abundance of Porphyromonas, a crucial genus in the pathogenesis of periodontitis, decreased significantly in patients with high-grade glioma (HGG) compared to healthy controls, as determined through 16S rRNA gene sequencing [6]. In a more recent study, it was found that lipopolysaccharide (LPS) derived from Porphyromonas gingivalis, a classic periodontal pathogen, facilitated the proliferation and migration of glioma cells by activating the Akt signaling pathway. Additionally, patients with gliomas were found to have a higher prevalence of poor periodontal health compared to those with benign CNS tumors or the age-matched population from a national survey. Moreover, glioma patients with worse periodontal conditions exhibited a higher tumor proliferation index than those with better periodontal conditions [7]. A latest bioinformatics study based on mRNA expression data revealed that CXCR4, LY96, and...