Impact of Anticholinergic Medication on Salivary Function; Exploring Potential Genetic Markers for Dry Mouth

所有年龄段的药物使用不断增加，导致20%的美国成年人服用五种或更多种药物。 多药疗法（Polypharmacy）超过500种药物通常在多药治疗中处方（例如，抗抑郁药， 尿解痉剂和精神抑制剂）具有抗胆碱能（AC）特性， 神经调节的信号。由于毒蕈碱受体在体内的分散分布，AC 药物有很多副作用。除了最严重的中枢毒性认知障碍， 运动障碍和精神病，这可能导致谵妄，最常见的外周副作用是口干。干 口腔的特征是唾液分泌减少（少涎），咀嚼导致生活质量受损 或吞咽问题，口腔干燥（口干症），说话困难，粘膜变化， 龋齿和牙齿脱落率增加。口干导致对细菌定植的易感性增加 以及口腔和上呼吸道感染。然而，没有数据可以预测 药物引起的口干严重程度或确定牙科患者中这些药物的AC负担 患者在识别中年高危口腔干燥症患者方面存在显著的研究空白 当口腔健康受到不可逆转的损害时，老年人的口腔健康将受到影响。我们设计了一个 队列研究有两个目的来解决这些问题。在目标1中，我们将评估 AC负荷和口干的结果，包括90名中老年人的小唾液腺（SG）的流速， 老年患者（45-64岁）。我们将确定高AC负荷（通过AC药物评分（ADS）量化） 和血液中的血清AC活性（SAA），与更严重的口干症状相关， 基线和两年的随访。我们将使用唾液流速（未刺激的整体）评估口干 唾液和次要SG）和与口干相关的口腔健康测量，包括口腔干燥，龋齿， 和口腔健康影响概况。为此，我们将研究小SG流量筛选的可行性， 口腔干燥的护理测试。在目标2中，我们将探讨CYP 450基因多态性是否能预测口干 严重性。最近的研究报告了AC副作用在非活动性遗传病患者中的患病率增加。 负责AC药物代谢清除的肝细胞色素P450酶的变体。我们将分析 来自患者血液的DNA用于CYP 2D 6和CYP 2C 19酶的遗传变异并比较口腔健康 结果与口干之间的穷人和正常代谢表型。我们建议研究 口干药物遗传学是否为口腔健康结果的个体间差异提供了证据， 确定具有可预测的AC药物诱导的口干严重程度的患者。我们的首要目标是 探索性研究旨在建立AC负荷与口腔健康结果之间的临床相关性， 这可以支持未来对口干的潜在因果关系和风险计算的调查 发展

The growing medication use in all ages led to the fact that 20% of the US adult population take five or more drugs (polypharmacy). Over 500 medications commonly prescribed in polypharmacy (e.g., antidepressants, urinary antispasmodics, and psycholeptics) possess anticholinergic (AC) properties blocking the muscarinic signaling of neural regulation. Due to the scattered distribution of muscarinic receptors in the body, AC medications have a wide range of side effects. Besides the most severe central toxicity of cognitive impairment, dyskinesia, and psychosis, which can lead to delirium, the most frequent peripheral side effect is dry mouth. Dry mouth is characterized by reduced saliva secretion (hyposalivation), impaired quality of life by causing chewing or swallowing problems, complaints of oral dryness (xerostomia), speaking difficulties, mucosal changes, increased rate of dental caries, and tooth loss. Dry mouth causes increased susceptibility to bacterial colonization and infections in the oral cavity and the upper respiratory tract. However, no data are available on predicting medication-induced dry mouth severity or determining the AC burden from these medications among dental patients. There is a significant research gap in identifying high-risk xerostomia patients in the middle-aged population before reaching older ages when damage to oral health is irreversible. We designed a prospective cohort study with two aims for addressing these questions. In Aim 1., we will evaluate the correlation between AC burden and dry mouth outcomes, including the flow rates of the minor salivary glands (SG) in 90 middle- aged patients (45-64 years). We will determine whether high AC burden, quantified by the AC drug score (ADS) and serum AC activity (SAA) in blood, is associated with more severe dry mouth symptoms, measured at baseline and follow-ups for two years. We will assess dry mouth using saliva flow rates (unstimulated whole saliva and minor SGs) and oral health measures associated with dry mouth, including xerostomia, dental caries, and oral health impact profile. In this aim, we will examine the feasibility of minor SG flow screening as a point- of-care test for dry mouth. In Aim 2., we will explore whether CYP450 genetic polymorphisms predict dry mouth severity. Recent studies reported an increased prevalence of AC side effects in patients with inactive genetic variants of liver cytochrome P450 enzymes responsible for the metabolic clearance of AC drugs. We will analyze DNA from patients’ blood for the genetic variations of CYP2D6 and CYP2C19 enzymes and compare oral health outcomes associated with dry mouth between poor and normo-metabolizing phenotypes. We propose to study whether dry-mouth pharmacogenetics provides evidence for inter-individual variability in oral health outcomes to identify patients with predictable severity of AC medication-induced dry mouth. The overarching goal of our explorative study is to establish clinically relevant associations between AC burden and oral health outcomes, which can support future investigations of potential causal relationships and risk calculations for dry mouth development.