M1/M2 macrophage polarity in elderly patients with periodontitis and diabetes mellitus


  • Cindy Ramadhan Putri Graduate Student of Dental Health Science, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
  • Retno Pudji Rahayu Department of Oral Pathology and Maxillofacial, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
  • Rini Devijanti Ridwan Department of Oral Biology, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia


periodontitis, diabetes mellitus, age, M1/M2 macrophage polarity


Background: Periodontitis is a common chronic infectious disease related to diabetes mellitus. The progression of periodontal damage under diabetic condition caused the imbalance of immune defense and inflammation where macrophage plays a role. Age also affects dysregulated macrophage function. Macrophage has the ability to change into an M1 or M2 phenotype.

Aim: This literature aimed to understand M1/M2 polarity in an elderly patient with periodontitis and diabetes mellitus.

Discussion: Periodontitis exacerbated by diabetes mellitus in elderly patients enhanced M1 phenotype macrophage via activation of TLR and overproduction of ROS, and suppressed M2 phenotype by fewer IL-4 receptors available for ligand binding in the elderly.

Conclusion: Enhanced M1 and suppressed M2 polarity in the elderly patient with periodontitis and diabetes mellitus might take responsibility for aggravated periodontal damage.


Berniyanti T, Wening GRS, Palupi R, Setyowati D, Putri CR. Low Levels of Tumor Necrosis Factor-α will Prevent Periodontitis Exacerbation in Type 2 Diabetes Mellitus. European Journal of Dentistry, 2022; 16(2):443-448. https://doi.org/10.1055/s-0041-1739442

Chentli F, Azzoug S, Mahgoun S. Diabetes mellitus in elderly. Indian Journal of Endocrinology and Metabolism, 2015; 19(6):744-752. https://doi.org/10.4103/2230-8210.167553

Costantini A, Viola N, Berretta A, Galeazzi R, Matacchione G, Sabbatinelli J, et al. Age-related M1/M2 phenotype changes in circulating monocytes from healthy/unhealthy individuals. Aging, 2018; 10(6):1268-1280. https://doi.org/10.18632/aging.101465

Covarrubias A, Byles V, Horng T. ROS sets the stage for macrophage differentiation. Cell Research, 2013; 23(8):984-985. https://doi.org/10.1038/cr.2013.88

Garaicoa-Pazmino C, Fretwurst T, Squarize CH, Berglundh T, Giannobile WV, et al. Characterization of macrophage polarization in periodontal disease. Journal of Clinical Periodontology, 2019; 46(8):830-839. https://doi.org/10.1111/jcpe.13156

Lee KY. M1 and M2 polarization of macrophages: a mini-review. Medical Biological Science and Engineering, 2019; 2(1):1-5. https://doi.org/10.30579/mbse.2019.2.1.1

Mahbub S, Deburghgraeve CR, Kovacs EJ. Advanced age impairs macrophage polarization. Journal of Interferon and Cytokine Research, 2012; 32(1):18-26. https://doi.org/10.1089/jir.2011.0058

Mukherjee S, Karmakar S, Babu SPS. TLR2 and TLR4 mediated host immune responses in major infectious diseases: A review. Brazilian Journal of Infectious Diseases, 2016; 20(2):193-204. https://doi.org/10.1016/j.bjid.2015.10.011

Murray PJ. Macrophage Polarization. Annual Review of Physiology, 2017; 79:541-566. https://doi.org/10.1146/annurev-physiol-022516-034339

Steen EH, Wang X, Balaji S, Butte MJ, Bollyky PL, Keswani SG. The Role of the Anti-Inflammatory Cytokine Interleukin-10 in Tissue Fibrosis. Advances in Wound Care, 2020; 9(4):184-198. https://doi.org/10.1089/wound.2019.1032

Sun X, Gao J, Meng X, Lu X, Zhang L, Chen R. Polarized Macrophages in Periodontitis: Characteristics, Function, and Molecular Signaling. Frontiers in Immunology, 2021; 12:1-18. https://doi.org/10.3389/fimmu.2021.763334

Viniegra A, Goldberg H, Çil Fine N, Sheikh Z, Galli M, Freire M, et al. Resolving Macrophages Counter Osteolysis by Anabolic Actions on Bone Cells. Journal of Dental Research, 2018; 97(10):1160-1169. https://doi.org/10.1177/0022034518777973

Wang W, Zheng C, Yang J, Li B. Intersection between macrophages and periodontal pathogens in periodontitis. Journal of Leukocyte Biology, 2021; 110(3):577-583. https://doi.org/10.1002/JLB.4MR0421- 756R

Yao Y, Xu XH, Jin L. Macrophage polarization in physiological and pathological pregnancy. Frontiers in Immunology, 2019; 10:1-13. https://doi.org/10.3389/fimmu.2019.00792

Yin L, Li X, Hou J. Macrophages in periodontitis: A dynamic shift between tissue destruction and repair. Japanese Dental Science Review, 2022; 58:336-347. https://doi.org/10.1016/j.jdsr.2022.10.002

Zhang B, Yang Y, Yi J, Zhao Z, Ye R. Hyperglycemia modulates M1/M2 macrophage polarization via reactive oxygen species overproduction in ligature-induced periodontitis. Journal of Periodontal Research, 2021; 56(5):991-1005. https://doi.org/10.1111/jre.12912




How to Cite

C. R. Putri, R. P. Rahayu, and R. D. Ridwan, “M1/M2 macrophage polarity in elderly patients with periodontitis and diabetes mellitus”, J. A. Med. Sci, vol. 2, no. 2, pp. 20–23, Oct. 2022.