Int J Stomatol ›› 2026, Vol. 53 ›› Issue (2): 239-246.doi: 10.7518/gjkq.2026006

• Reviews • Previous Articles    

Research progress on simvastatin prodrugs for periodontitis treatment

Yijing Guo(),Siyu Du,Yabing Chen,Lei Wang()   

  1. Dept. of Periodontology, Hospital of Stomatology, Jilin University, Changchun 130021, China
  • Received:2024-12-11 Revised:2025-01-16 Online:2026-03-01 Published:2026-02-13
  • Contact: Lei Wang E-mail:yjguo24@mails.jlu.edu.cn;wang_lei99@jlu.edu.cn
  • Supported by:
    Science and Technology Subject of Finance Department of Jilin Province(jcsz2023481-19);Science and Technology Research Project of Education Department of Jilin Province(JJKH20231235KJ);Project of Science and Technology Development of Jilin Province(YDZJ202301ZYTS013)

Abstract:

Periodontitis is a chronic inflammatory disease caused by plaque microbial infection. Initial therapy can remove dental plaque and calculus in periodontal pocket, and antibiotics can be used as adjuvant therapy to remove deep microorganisms. Simvastatin is a commonly used hypolipidemic drug with the effects of anti-inflammation, antibacterial, and bone formation promotion, providing a new possibility for periodontitis treatment. However, simvastatin has low water solubility, fast metabolism, and poor bone affinity, making it difficult to achieve effective concentration in periodontal tissue. Prodrug delivery has emerged as an effective strategy to improve its physicochemical and pharmacokinetic properties. Simvastatin-based prodrugs have demonstrated remarkably enhanced therapeutic efficacy against periodontitis. This study reviews the literature related to simvastatin prodrug local drug delivery system at home and abroad. We analyzed the reasons for the low bioavailability of simvastatin and expound its possible mechanism in periodontitis treatment, focusing on innovative strategies in prodrug design to enhance periodontal tissue targeting and improve drug release behavior. This work aimed to provide a reference for the construction and application of simvastatin prodrug delivery systems.

Key words: simvastatin, periodontitis, prodrug, biological availability, osteogenesis, inflammation, drug delivery systems

CLC Number: 

  • R781.4

TrendMD: 
[1] Abusleme L, Hoare A, Hong BY, et al. Microbial signatures of health, gingivitis, and periodontitis[J]. Periodontol 2000, 2021, 86(1): 57-78.
[2] Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation[J]. Nat Rev Immunol, 2015, 15(1): 30-44.
[3] Konkel JE, O’Boyle C, Krishnan S. Distal consequences of oral inflammation[J]. Front Immunol, 2019, 10: 1403.
[4] Kwon T, Lamster IB, Levin L. Current concepts in the management of periodontitis[J]. Int Dent J, 2021, 71(6): 462-476.
[5] Vinel A, Al Halabi A, Roumi S, et al. Non-surgical periodontal treatment: SRP and innovative therapeutic approaches[J]. Adv Exp Med Biol, 2022, 1373: 303-327.
[6] Gesto DS, Pereira CMS, Cerqueira NMFS, et al. An atomic-level perspective of HMG-CoA-reductase: the target enzyme to treat hypercholesterolemia[J]. Molecules, 2020, 25(17): 3891.
[7] Parihar SP, Guler R, Brombacher F. Statins: a viable candidate for host-directed therapy against infectious diseases[J]. Nat Rev Immunol, 2019, 19(2): 104-117.
[8] Pradeep AR, Kanoriya D, Singhal S, et al. Comparative evaluation of subgingivally delivered 1% alendronate versus 1.2% atorvastatin gel in treatment of chronic periodontitis: a randomized placebo-controlled clinical trial[J]. J Investig Clin Dent, 2017, 8(3): e12215.
[9] Abdin AA, Abd El-Halim MS, Hedeya SE, et al. Effect of atorvastatin with or without prednisolone on Freund’s adjuvant induced-arthritis in rats[J]. Eur J Pharmacol, 2012, 676(1/2/3): 34-40.
[10] Leung BP, Sattar N, Crilly A, et al. A novel anti-inflammatory role for simvastatin in inflammatory arthritis[J]. J Immunol, 2003, 170(3): 1524-1530.
[11] Yuan C, Zhou L, Cheng JY, et al. Statins as po-tential therapeutic drug for asthma[J]. Respir Res, 2012, 13(1): 108.
[12] Sommer IE, Gangadin SS, de Witte LD, et al. Sim-vastatin augmentation for patients with early-phase schizophrenia-spectrum disorders: a double-blind, randomized placebo-controlled trial[J]. Schizophr Bull, 2021, 47(4): 1108-1115.
[13] Greethurst AR, Galletti C, Giudice RL, et al. The use of statins as an adjunctive periodontal disease treatment: systematic review and meta-analysis[J]. Dent J, 2024, 12(6): 150.
[14] Fu QF, Shen SY, Sun PW, et al. Bioorthogonal chemistry for prodrug activation in vivo [J]. Chem Soc Rev, 2023, 52(22): 7737-7772.
[15] Markovic M, Ben-Shabat S, Dahan A. Prodrugs for improved drug delivery: lessons learned from recently developed and marketed products[J]. Pharmaceutics, 2020, 12(11): 1031.
[16] Fralish Z, Chen A, Khan S, et al. The landscape of small-molecule prodrugs[J]. Nat Rev Drug Discov, 2024, 23(5): 365-380.
[17] de Lima JM, Bonan PR, da Cruz Perez DE, et al. Nanoparticle-based chemotherapy formulations for head and neck cancer: a systematic review and perspectives[J]. Nanomaterials, 2020, 10(10): 1938.
[18] Shi SR, Zhang LY, Zhu MQ, et al. Reactive oxygen species-responsive nanoparticles based on PEGlated prodrug for targeted treatment of oral tongue squamous cell carcinoma by combining photodynamic therapy and chemotherapy[J]. ACS Appl Mater Interfaces, 2018, 10(35): 29260-29272.
[19] Hienz SA, Paliwal S, Ivanovski S. Mechanisms of bone resorption in periodontitis[J]. J Immunol Res, 2015, 2015: 615486.
[20] ten Dijke P, Fu JY, Schaap P, et al. Signal transduction of bone morphogenetic proteins in osteoblast differentiation[J]. J Bone Joint Surg Am, 2003, 85-A(): 34-38.
[21] Chamani S, Liberale L, Mobasheri L, et al. The role of statins in the differentiation and function of bone cells[J]. Eur J Clin Invest, 2021, 51(7): e13534.
[22] Feng C, Xiao L, Yu JC, et al. Simvastatin promo-tes osteogenic differentiation of mesenchymal stem cells in rat model of osteoporosis through BMP-2/Smads signaling pathway[J]. Eur Rev Med Pharmacol Sci, 2020, 24(1): 434-443.
[23] Wei LF, Teng F, Deng LQ, et al. Periodontal regene-ration using bone morphogenetic protein 2 incorporated biomimetic calcium phosphate in conjunction with barrier membrane: a pre-clinical study in dogs[J]. J Clin Periodontol, 2019, 46(12): 1254-1263.
[24] Venkatesan N, Thilanga Liyanage ADT, Castro-Núñez J, et al. Biodegradable polymerized simvastatin stimulates bone formation[J]. Acta Biomater, 2019, 93: 192-199.
[25] Zhou YH, Liu ZQ. Saliva biomarkers in oral disease[J]. Clin Chim Acta, 2023, 548: 117503.
[26] Pan WY, Wang QX, Chen QM. The cytokine network involved in the host immune response to pe-riodontitis[J]. Int J Oral Sci, 2019, 11(3): 30.
[27] Cheng R, Wu ZW, Li MM, et al. Interleukin-1β is a potential therapeutic target for periodontitis: a narrative review[J]. Int J Oral Sci, 2020, 12(1): 2.
[28] Mazurek-Mochol M, Bonsmann T, Mochol M, et al. The role of interleukin 6 in periodontitis and its complications[J]. Int J Mol Sci, 2024, 25(4): 2146.
[29] Dehnavi S, Sohrabi N, Sadeghi M, et al. Statins and autoimmunity: state-of-the-art[J]. Pharmacol Ther, 2020, 214: 107614.
[30] Buabeid M, Arafa ES A, Yaseen HS, et al. Anti-inflammatory effect of simvastatin by impeding TNF-α and interleukin-1ß pathways: antiangiogenic ac-tivity of simvastatin and simvastatin-loaded silver nanoparticles[J]. Artif Cells Nanomed Biotechnol, 2022, 50(1): 208-217.
[31] Grover HS, Kapoor S, Singh A. Effect of topical simvastatin (1.2 mg) on gingival crevicular fluid interleukin-6, interleukin-8 and interleukin-10 levels in chronic periodontitis‒a clinicobiochemical study[J]. J Oral Biol Craniofac Res, 2016, 6(2): 85-92.
[32] Xu WZ, Zhou W, Wang HZ, et al. Roles of Porphyromonas gingivalis and its virulence factors in pe-riodontitis[J]. Adv Protein Chem Struct Biol, 2020, 120: 45-84.
[33] Thangamani S, Mohammad H, Abushahba MF, et al. Exploring simvastatin, an antihyperlipidemic drug, as a potential topical antibacterial agent[J]. Sci Rep, 2015, 5: 16407.
[34] Ko HHT, Lareu RR, Dix BR, et al. In vitro antibacterial effects of statins against bacterial pathogens causing skin infections[J]. Eur J Clin Microbiol Infect Dis, 2018, 37(6): 1125-1135.
[35] Kamińska M, Aliko A, Hellvard A, et al. Effects of statins on multispecies oral biofilm identify simvastatin as a drug candidate targeting Porphyromonas gingivalis [J]. J Periodontol, 2019, 90(6): 637-646.
[36] Parolina de Carvalho RD, de Andrade Moreno J, Roque SM, et al. Statins and oral biofilm: simvastatin as a promising drug to control periodontal dysbiosis[J]. Oral Dis, 2024, 30(2): 669-680.
[37] Liu ST, Bertl K, Sun HC, et al. Effect of simvastatin on the osteogenetic behavior of alveolar osteoblasts and periodontal ligament cells[J]. Hum Cell, 2012, 25(2): 29-35.
[38] Sabandal MMI, Schäfer E, Imper J, et al. Simvastatin induces in vitro mineralization effects of primary human odontoblast-like cells[J]. Materials, 2020, 13(20): 4679.
[39] Fawaz A, Mohammed MM, Ismail A, et al. The influence of simvastatin on osteoblast functionality in the presence of titanium dioxide particles in-vitro [J]. Arch Oral Biol, 2024, 167: 106065.
[40] Dalcico R, de Menezes AM, Deocleciano OB, et al. Protective mechanisms of simvastatin in experimental periodontal disease[J]. J Periodontol, 2013, 84(8): 1145-1157.
[41] Santos BF, Souza EQ, Brigagão MR, et al. Local application of statins in the treatment of experimental periodontal disease in rats[J]. J Appl Oral Sci, 2017, 25(2): 168-176.
[42] Pradeep AR, Thorat MS. Clinical effect of subgingivally delivered simvastatin in the treatment of patients with chronic periodontitis: a randomized clinical trial[J]. J Periodontol, 2010, 81(2): 214-222.
[43] Ranjan R, Patil SR, Veena HR. Effect of in situ application of simvastatin gel in surgical management of osseous defects in chronic periodontitis‒a randomized clinical trial[J]. J Oral Biol Craniofac Res, 2017, 7(2): 113-118.
[44] Hasan F, Ikram R, Simjee SU, et al. Effectiveness of simvastatin 1% oral gel and mouthwash used as an adjunct treatment of scaling and root planning in the treatment of periodontal diseases[J]. Pak J Pharm Sci, 2019, 32(6): 2673-2677.
[45] Climent E, Benaiges D, Pedro-Botet J. Hydrophilic or lipophilic statins[J]. Front Cardiovasc Med, 2021, 8: 687585.
[46] Hirota T, Fujita Y, Ieiri I. An updated review of pharmacokinetic drug interactions and pharmacogene-tics of statins[J]. Expert Opin Drug Metab Toxicol, 2020, 16(9): 809-822.
[47] Todd PA, Goa KL. Simvastatin. A review of its pharmacological properties and therapeutic potential in hypercholesterolaemia[J]. Drugs, 1990, 40(4): 583-607.
[48] Park JB. The use of simvastatin in bone regeneration[J]. Med Oral Patol Oral Cir Bucal, 2009, 14(9): e485-e488.
[49] Pose E, Trebicka J, Mookerjee RP, et al. Statins: old drugs as new therapy for liver diseases[J]. J Hepatol, 2019, 70(1): 194-202.
[50] Jin H, Ji YB, Cui YT, et al. Simvastatin-incorpora-ted drug delivery systems for bone regeneration[J]. ACS Biomater Sci Eng, 2021, 7(6): 2177-2191.
[51] Ghaffari A, Pooresmaeil M, Namazi H, et al. New polymer systems based on polyethylene glycol: synthesis, characterization, and study of the solubility behavior[J]. Polym Bull, 2020, 77(11): 5663-5680.
[52] Mazumdar S, Chitkara D, Mittal A. Exploration and insights into the cellular internalization and intracellular fate of amphiphilic polymeric nanocarriers[J]. Acta Pharm Sin B, 2021, 11(4): 903-924.
[53] Jia ZS, Zhang YJ, Chen YH, et al. Simvastatin prodrug micelles target fracture and improve healing[J]. J Control Release, 2015, 200: 23-34.
[54] Bradley AD, Zhang YJ, Jia ZS, et al. Effect of sim-vastatin prodrug on experimental periodontitis[J]. J Periodontol, 2016, 87(5): 577-582.
[55] Morgan JAM, Singh A, Kurz L, et al. Extensive protein pyrophosphorylation revealed in human cell lines[J]. Nat Chem Biol, 2024, 20(10): 1305-1316.
[56] Liu HC, Tu JZ. Reduction of extrinsic tooth stain by a toothpaste containing 10% high cleaning silica, 0.5% sodium phytate and 0.5% sodium pyrophosphate: an 8-week randomised clinical trial[J]. BMC Oral Health, 2021, 21(1): 113.
[57] Chen NR, Ren RG, Wei X, et al. Thermoresponsive hydrogel-based local delivery of simvastatin for the treatment of periodontitis[J]. Mol Pharm, 2021, 18(5): 1992-2003.
[58] Chu EY, Vo TD, Chavez MB, et al. Genetic and phar-macologic modulation of cementogenesis via pyrophosphate regulators[J]. Bone, 2020, 136: 115329.
[59] Wang XB, Jia ZS, Almoshari Y, et al. Local application of pyrophosphorylated simvastatin prevents experimental periodontitis[J]. Pharm Res, 2018, 35(8): 164.
[60] Chytil P, Kostka L, Etrych T. HPMA copolymer-based nanomedicines in controlled drug delivery[J]. J Pers Med, 2021, 11(2): 115.
[61] Zhao G, Ren RG, Wei X, et al. Thermoresponsive polymeric dexamethasone prodrug for arthritis pain[J]. J Control Release, 2021, 339: 484-497.
[62] Xu XK, Jia ZS, Chen NR, et al. The development of thermoresponsive polymeric simvastatin prodrug for the treatment of experimental periodontitis in rats[J]. Mol Pharm, 2023, 20(11): 5631-5645.
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