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Review Open Access

Oral microbiota: Roles and treatment in radiation injury (Review)

  • Authors:
    • Jiaqin Song
    • Lei Xia
  • View Affiliations / Copyright

    Affiliations: Department of Cancer Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Immunotherapy, Chongqing 401336, P.R. China
    Copyright: © Song et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 472
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    Published online on: August 8, 2025
       https://doi.org/10.3892/ol.2025.15218
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Abstract

While radiotherapy for malignant tumors increases the rate of local control for patients, it also inevitably causes damage to the surrounding normal tissues, resulting in different types and degrees of radiation injury (RI). RI has a significant negative impact on quality of life. However, there is no viable method for preventing and treating these complications. The oral microbiota plays a key role in the development of numerous categories of RI, such as radiation‑induced brain injury, radiation‑induced oral injury and radiation‑induced lung injury. The aim of the present review is to clarify the potential mechanisms of RI and provide a comprehensive overview of the association between 10 distinct categories of RI and oral microbiota, thereby shedding light on novel clinical approaches for the prevention and treatment of RI based on modulating oral microbiota. This may open new avenues for targeted interventions.
View Figures

Figure 1

Multiple paths allow oral bacteria
and their metabolites to reach different organs in the body. Oral
bacteria and their metabolites can: (a) Enter into the blood
vessels and travel to different organs through the bloodstream, (b)
colonize the esophagus, stomach and intestines through the
digestive tract via swallowing, (c) enter the brain by breaking
through the blood-brain barrier, (d) enter the lungs through the
saliva and (e) return to the liver through the intestinal veins in
the intestinal tract.

Figure 2

Molecular mechanisms of the oral
microbiota that are involved in RI. (a) Initiation of the
inflammatory response: The LPS of Gram-negative bacteria stimulates
TLRs, which in turn trigger an inflammatory cascade response,
release TNF-α, IL-6 and other inflammatory factors, and activate
the NK-κB pathway (16,17). (b) Involvement in DNA damage: The
key proteins involved in DNA damage repair, Ku and p53, are
expressed less frequently, while γH2AX is expressed more
frequently, in oral bacteria, suggesting both increased DNA damage
and inadequate DNA repair (18).
(c) Contribution to oxidative stress: The oral microbiota decrease
Nrf-2 activity, worsen oxidative stress and increase inflammation
via the GSK-3β/BH4/eNOS/Nrf2 pathway. LPS also activates NOS1 and
upregulates iNOS, and Nrf-2 controls the expression of antioxidant
enzymes to protect cells and reduce oxidative stress (19). (d) Additional mechanisms: The oral
microbiota can upregulate Hsp90α and activate the
tetrahydrobiopterin (MLKL), which causes cytoplasmic membrane
rupture and cellular necrosis (20). Oral microbial OMVs can activate the
NLRP3 inflammasome and increase IL-1β production, aggravating
cellular inflammation (21). MLKL,
mixed lineage kinase domain-like pseudokinase; LPS,
lipopolysaccharide; TLR, Toll-like receptor; NOS1, nitric oxide
synthase 1; OMV, outer membrane vesicle.; ROS, reactive oxygen
species; NLRP3, nucleotide-binding oligomerization domain-like
receptor family pyrin domain-containing 3; GSK-3β, glycogen
synthase kinase 3β; Nrf-2, nuclear factor erythroid 2-related
factor 2; γH2AX, phosphorylated histone H2AX; MCP-1, monocyte
chemoattractant protein-1; CRP, C-reactive protein; iNOS, inducible
nitric oxide synthase.

Figure 3

Oral microbiota-based therapeutic
approaches for RI. Useful approaches include: (a) Good oral hygiene
practices, (b) low-carbohydrate meals, (c) healthy lifestyle
choices, (d) Probiotics, prebiotics and synbiotics, (e) oral
microbiota transplantation, and (f) antibiotics and inhibitors.
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Copy and paste a formatted citation
Spandidos Publications style
Song J and Xia L: Oral microbiota: Roles and treatment in radiation injury (Review). Oncol Lett 30: 472, 2025.
APA
Song, J., & Xia, L. (2025). Oral microbiota: Roles and treatment in radiation injury (Review). Oncology Letters, 30, 472. https://doi.org/10.3892/ol.2025.15218
MLA
Song, J., Xia, L."Oral microbiota: Roles and treatment in radiation injury (Review)". Oncology Letters 30.4 (2025): 472.
Chicago
Song, J., Xia, L."Oral microbiota: Roles and treatment in radiation injury (Review)". Oncology Letters 30, no. 4 (2025): 472. https://doi.org/10.3892/ol.2025.15218
Copy and paste a formatted citation
x
Spandidos Publications style
Song J and Xia L: Oral microbiota: Roles and treatment in radiation injury (Review). Oncol Lett 30: 472, 2025.
APA
Song, J., & Xia, L. (2025). Oral microbiota: Roles and treatment in radiation injury (Review). Oncology Letters, 30, 472. https://doi.org/10.3892/ol.2025.15218
MLA
Song, J., Xia, L."Oral microbiota: Roles and treatment in radiation injury (Review)". Oncology Letters 30.4 (2025): 472.
Chicago
Song, J., Xia, L."Oral microbiota: Roles and treatment in radiation injury (Review)". Oncology Letters 30, no. 4 (2025): 472. https://doi.org/10.3892/ol.2025.15218
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