Defective polymorphonuclear leukocyte formyl peptide receptor(s) in juvenile periodontitis

Juvenile periodontitis (JP) is a disease characterized by severe gingival infections. PMN from some JP patients exhibit abnormal chemotactic responsiveness when challenged with the synthetic formyl peptide, FMLP. While investigating PMN function in JP, we found a patient in whom abnormal PMN chemotactic responses to FMLP were associated with a defective population of PMN formyl peptide receptor(s) (FPR). JP PMN failed to respond chemotactically when challenged with FMLP, but exhibited normal chemotactic responses upon exposure to purified human C5a. Furthermore, JP PMN were capable of degranulating and generating superoxide anion radicals as well as normal PMN upon exposure to FMLP. Binding studies demonstrated that JP PMN had a diminution in the number of high-affinity FPR. Studies in which FPR was radiolabeled by chemical cross-linking demonstrated that JP PMN FPR exhibited the same molecular weight and N-linked glycosylation as normal PMN FPR. JP PMN FPR, however, was more resistant to papain cleavage than normal PMN FPR. Autoradiograms obtained from 2D-PAGE of normal and JP PMN FPR demonstrated decreased amounts of FPR isoforms in JP PMN.

Repair potential in localized juvenile periodontitis. A case in point

An aggressive form of localized juvenile periodontitis (LJP) in a 12-year old West African female is reported. The case was treated with scaling, root planing, debridement, and tetracycline therapy, which resulted in complete resolution of the disease, including elimination of periodontal inflammation, regeneration of lost periodontal structures, and spontaneous repositioning of teeth that had pathologically migrated. A hopelessly involved mandibular right first molar was successfully replaced by an incompletely developed maxillary third molar tooth bud whose roots and pulp structure continued to develop after autotransplantation. It is suggested, that LJP can be successfully treated without periodontal surgery and that the potential for repair in LJP cases is apparently greater than what one can anticipate in adult forms of periodontitis.

[The clinical and etiological study on juvenile periodontal disease]

Seven juvenile periodontally diseased patients were evaluated for clinical, microbiologic and local or systemic host factors. Three patients showed the localized from of periodontitis clinically and radiographically and by deep periodontal pockets associated with the molars and incisors. Four were in the generalized froms, in which in most cases all teeth were affected. The results in both diseased froms on the predominant cultivable subgingival microflora, the composition of which was not different from that in adult periodontitis, consisted of significantly increased proportions of Gram-negative anaerobic rods, Bacteroides sp. and B. gingivalis, Haemophilus sp. and H. actinomycetemcomitans were detected in 1/3 of the localized and 2/4 of the generalized periodontitis. They were of no value in distinguishing activity that enhanced disease in the generalized from. Elevated serum IgG responses were noted with B. gingivalis. No markedly functional abnormalities of neutrophils from peripheral blood have been demonstrated, however it might function with systemic factors, like an insulin-dependent diabetes. Morphologic characteristics of the oral and periodontal tissue in localized periodontitis were that the pattern of destruction was confined to specific teeth groups characterized by extensive the bucco-lingual width ratio of the dental crown to alveolar bone width. These observations indicate that the generalized form of juvenile periodontitis lesions were associated not only with the presence of subgingival bacteria, but also with conditions such as local morphologic and systemic or constitutional factors, individual variation in relation to destructive and protective aspects of the defense mechanisms.

[The involvement of the cerebral cortex, hypothalamus, pituitary and adrenal cortex in the development of periodontosis]

The authors emphasized in parodontosis patients functional alterations of hypothalamic centres with phagocytosis-stimulatory, vasomotor and neurotrophic functions and disturbances of the functional relationship between the hypothalamus (H), the ascendent reticular formation (RF) and the cerebral cortex (CC). Stimulatory therapy of this areas, especially by direct stimulation of the H improves the hypothalamic functions, the relationship between H and the RF and all the clinical status of parodontosis patients. In rabbits with experimental parodontosis have been found functional and histological alterations in cerebral cortex, and especially in hypothalamus, together with lesions in the hypothalamo-posthypophyso-neurosecretoric system, in the anterior pituitary (P) cells (for ACTH, TSH and FSH) as well as in zona fasciculares of the adrenal cortex (AC). This data, together with findings of other authors, prove that parodontosis is a diencephalopathy involving a whole system: CC-H-P-AC.

[Photoplethysmographic indices of hemodynamics in periodontal diseases]

In 120 patients the periodontal photoplethysmography was performed. Statistical analysis of the frequency-amplitude characteristics of the photoplethysmographic signal was useful for differential diagnosis of various forms and stages in periodontal diseases and for evaluation of the treatment efficiency.

[Pathophysiological analysis of rapidly progressive periodontitis]

Pathophysiological features were studied on 7 patients with rapidly progressive periodontitis but without any evidence of systemic disease, to analyse the clinical pathogenesis. The patients consisted of 5 females, 2 males, between the ages of 32 and 42 years. All patients had severe and rapid alveolar bone destruction on the basis of radiographic measurement. Abnormal serum levels of IgG and IgM were detected in some patients. Higher IgG level was found in 4 patients and higher IgM level was found in 2 patients. The proportion of lymphocyte subsets was calculated in mononuclear cells from peripheral blood of patients. Higher OKT4/OKT8 ratio was found in all patients. The percentage of OKT4 positive cells in 2 patients was higher than that in normal subjects while the percentage of OKT8 positive cells in 4 patients was lower than that in the healthy controls. Microorganisms from periodontal pockets were examined in 5 patients. Bacteriodes was isolated in all 5 patients and Haemophilus actinomycetemcomitans in 2 patients.

Neutrophil chemotactic behaviour in patients with early-onset forms of periodontitis (I). Leading front analysis in Boyden chambers

Despite some reports to the contrary, it is generally assumed that early-onset forms of periodontal disease (including both juvenile and rapidly progressive periodontitis) are associated with a defect in neutrophil (PMN) chemotactic behaviour. Using the Boyden chamber technique and N-formyl-methionyl-leucylphenylalanine (FMLP) to assess locomotion by the leading front method, we have failed to show any evidence for such depressed PMN locomotion. Indeed, when PMN chemotaxis and chemokinesis are considered in response to a range of chemoattractant doses our results indicate significant enhancement of all but random locomotion. When taken together with other studies, our results suggest that PMNs from patients with early-onset periodontitis may show abnormal locomotory behaviour which can either be enhanced or reduced in nature. The extent to which these results reflect in vitro methodology in uncertain and, furthermore, their in vivo significance is unclear.

Neutrophil chemotactic behaviour in patients with early-onset forms of periodontitis (II). Assessment using the under agarose technique

The locomotory behaviour of peripheral blood neutrophils (PMNs) from patients with juvenile (JP) and rapidly progressive (RPP) forms of early-onset periodontal disease was studied using the under agarose technique and n-formyl-methionyl-leucyl-phenylalanine (FMLP) as the chemotractant. PMNs from experimental patients showed normal random, chemotactic and chemokinetic locomotory behaviour when compared with control subjects. Further investigation of single-cell movements using time-lapse video analysis also failed to show any significant differences in locomotory behaviour between the PMNs of experimental and control individuals. We conclude that differences in technique may account for much of the variation which exists in the literature with respect to PMN locomotion in periodontal disease. In the final analysis, it is difficult to dispute direct observation of moving cells, and using this approach, we have been unable to confirm the presence of any PMN locomotory defect in our series of patients with early-onset periodontal disease.

Altered free cytosolic calcium changes and neutrophil chemotaxis in patients with juvenile periodontitis

Nearly 70-75% of patients with localized juvenile periodontitis (JP) have abnormal polymorphonuclear leukocytic (PMN) chemotaxis. The objective of this study was to determine whether the lower chemotactic response in PMNs from JP patients is associated with a defect in intracellular signal transduction, as measured by stimulus-induced changes in free cytosolic calcium (Ca2+) mobilization. We report that peptide chemoattractants such as N-formyl-methionyl-leucyl-phenylalanine (fMLP) and the complement fragment C5a in direct comparative studies induced lower amounts of initial Ca2+ mobilization in PMNs from JP patients than healthy controls, as monitored by intracellular fura-2 fluorescence. The initial resting levels of free cytosolic Ca2+ in PMNs from JP patients and normal individuals were found to be similar. fMLP and C5a both mobilized Ca2+ in PMNs in a dose-dependent manner. Treatment of PMNs from 0.16 to 20 nM fMLP and 0.2 to 20 nM C5a resulted in elevated levels of free cytosolic Ca2+. However, above 20 nM fMLP and 5 nM C5a concentrations the extent of total Ca2+ mobilization did not differ significantly. Although fMLP and C5a caused Ca2+ mobilization in PMN cells from JP and healthy control subjects, fMLP stimulation induced higher levels of free cytosolic Ca2+ mobilization in PMN cells from healthy control subjects (141.29 +/- 25.55 nM/2 x 10(6) PMNs), than PMNs from JP patients (62.33 +/- 23.76 nM/2 x 10(6) PMNs). Similarly C5a induced higher levels of Ca2+ mobilization in PMNs from healthy control individuals (130.43 +/- 18.26 nM Ca2+/2 x 10(6) PMNs)O, when compared to JP patients (49.92 +/- 14.92 nM Ca2+/2 x 10(6) PMNs).(ABSTRACT TRUNCATED AT 250 WORDS)

Chemotactic response of neutrophil polymorphonuclear leukocytes in juvenile periodontitis measured by the Leading Front method

Previous studies have implied that chemotaxis defects of neutrophil polymorphonuclear leukocytes (PMNs) can be found in approximately 75% of patients with juvenile periodontitis (JP). In the present study, the Leading Front (LF) method was used to study whether the chemotactic response of PMNs from JP-patients differed from that of adult periodontitis (AP) patients and periodontally healthy control individuals (C). Sixteen JP-patients, 21 AP-patients, and 13 C-individuals were studied. PMNs from each individual, and from a daily reference person were tested against three chemoattractants (N-f-Met-Leu-Phe (FMLP), casein (CA), bacterial chemotactic factor (BCF] and a neutral buffer (Gey's solution (GEY]. Regardless of the test solution a greater difference among individuals could be observed in the JP-group than in the other groups. Apart from this, there were no differences among the groups as regards CA, BCF, and GEY. However, with FMLP, the PMNs of the JP-group had a significantly greater migration distance as compared to the other groups. This finding can probably be ascribed to the fact that the LF method detects other aspects of the PMN response than do the methods used for earlier studies of JP. The finding, in this study, of an enhanced PMN response in JP as regards FMLP may be a reflection of the presence of a non-uniform PMN population whose composition in JP differs from that of the other groups.

Peripheral PMN cell activity in relation to treatment of juvenile periodontitis

Ten patients with untreated juvenile periodontitis (JP) showing an increased generation rate of free oxygen radicals from their peripheral polymorphonuclear neutrophils (PMN) as measured by luminol enhanced chemiluminescence (CL) were rechecked after treatment. The PMN cells from eight patients still reacted with higher CL after stimulation with Staph. aureus opsonized with autologous serum when related to pair-matched controls. The increased CL was not caused by adsorption of serum factors from untreated JP patients when assayed with healthy PMN cells. The increased CL found in peripheral PMN cells from patients with JP thus depends very little on the disease activity.

Neutrophil function in patients with localized juvenile periodontitis and with rapidly progressive periodontitis

PMN chemotactic function and oxydative metabolism were investigated in 13 patients with rapidly progressive periodontitis (RPP) and 9 patients with localized juvenile periodontitis (LJP) using a chemotaxis assay (CHA), luminol chemiluminescence (CL) and nitroblue-tetrazolium (NBT) tests. In the LJP patients there was a significantly lower CHA than in the RPP patients (less than 40%). Three out of the 13 RPP patients displayed a cell-dependent increase of CHA and in 3, the reduced CHA measured was serum-associated whilst among the 9 LJP patients, a cell-dependent defect of CHA was present in 5 patients, a serum-associated defect in one patient and a combined cell- and serum-associated defect was found in another patient. The average values of CL in the RPP patients were significantly lower (1309.3 +/- 814.2) than those measured in the LJP group (2208 +/- 826.9). In contrast, the mean NBT test values indicated a lower phagocytic function in the LJP patients than in the RPP ones suggesting also the presence of a serum-dependent factor in RPP and that of a combined cell- and serum-response in LJP. According to these results, the neutrophil dysfunction in RPP, as indicated by both the chemotaxis and the oxydative metabolism nature, was frequently associated with a serum factor.

Clinical immunologic and microbiologic features of active disease sites in juvenile periodontitis

Eight juvenile periodontitis (JP) patients with progressing disease were evaluated for clinical, immunologic, and microbiologic features. Clinically, bleeding on probing, pocket depth, and attachment level were unrelated to progressing disease. Only Actinobacillus actinomycetemcomitans was related to a marked increase in attachment loss when examined on both a site and patient basis. Eikenella corrodens was significantly elevated in progressing sites with A. actinomycetemcomitans as opposed to non-progressing sites harboring A. actinomycetemcomitans. Eikenella corrodens may function synergistically with A. actinomycetemcomitans to enhance disease in JP patients. Darkfield microscopy was of no value in distinguishing disease activity. All patients screened had elevated serum IgG levels to the same serotype of A. actinomycetemcomitans as that isolated from the subgingival flora. Other elevated serum IgG responses were noted to various organisms including F. nucleatum. B. intermedius, B. gracilus, B. gingivalis and E. corrodens.

The decreased antibacterial activity of oral polymorphonuclear leukocytes coincides with the occurrence of virus-carrying oral lymphocytes and epithelial cells

Patients suffering from periodontitis or periodontosis were selected for the study. Further subdivision of these groups was based on the presence or absence of herpes and/or adenoviruses in their oral lymphocytes and epithelial cells. The phagocytic and bactericidal activities of oral leukocytes isolated from the same individuals were compared with virus carriage. In the periodontitis group, 60.5%, and in the periodontosis group 61.5% of patients carried viruses, while this was established only in 21.1% of control cases. On the other hand, emigration and sulcular gathering of the less viable polymorphonuclear leukocytes was elevated but their phagocytotic activity was decreased among periodontitis patients. Bactericidal capacity was significantly lowered among those subjects who carried viruses in their cells, as compared with virus-free persons, especially in the periodontitis group. The functions of the polymorphonuclear leukocytes accumulated in the sulcus gingivalis may be modified by mediators released from the virus-carrying cells. These mediators could achieve a greater concentration locally, and the damaged leukocytes would not be able to eliminate the microbes continuously so that the accumulation of bacterial products, among them endotoxins, could lead to periodontal inflammation.

Association of an abnormality of neutrophil chemotaxis in human periodontal disease with a cell surface protein

Localized juvenile periodontitis (LJP) is characterized by severe, early-onset, molar and incisor bone loss; neutrophil chemotaxis disorders; and a high prevalence of Actinobacillus actinomycetemcomitans infection. LJP is further characterized by significant familial aggregation of the disease. Recent work in our laboratory has demonstrated the selective depletion of a surface glycoprotein of 110,000 Mr (GP110) from LJP neutrophils by using surface labeling with [14C]formaldehyde and autofluorography. The function of GP110 is unknown; however, it does not appear to be a chemotactic factor receptor. Rather, it is bound by a monoclonal antibody (NCD-1) that recognizes a neutrophil differentiation antigen and which itself alters neutrophil chemotactic and secreting functions. To quantify GP110 on LJP and normal neutrophils, fluorescein-labeled NCD-1 was bound to neutrophils and the amount of fluorescence was evaluated by using cytofluorography. Our results indicate that there is a quantifiable reduction (40%) of GP110 on the surface of LJP and GJP neutrophils, compared with controls. Other patients with neutrophil defects express normal quantities of GP110, suggesting disease specificity. Our data suggest that GP110 may be a useful disease marker for LJP and may provide a useful probe for the study of neutrophil chemotactic function and dysfunction.

Calcium concentrations in dental plaque of patients with juvenile and adult periodontitis

Calcium concentrations in plaque of patients with juvenile (JP) and adult (AP) periodontitis were compared. These calcium concentrations in JP patients were significantly (P less than 0.01) lower than in AP patients. Because JP patients are not intense calculus-formers, the finding that they have low calcium concentrations in plaque agrees with the authors' previous suggestion that calculus formation is a marker of high calcium concentrations in plaque. JP patients have good caries resistance in general, as was the case in this study. The finding that they have low calcium concentrations in plaque conflicts with the view that caries-resistant dentitions are usually associated with high concentrations of calcium in plaque.

Depressed leukotriene B4 chemotactic response of neutrophils from localized juvenile periodontitis patients

Previous studies have demonstrated that certain local juvenile periodontitis (LJP) patients possess neutrophils with an intrinsic chemotactic defect to the peptide chemoattractants f-met-leu-phe (FMLP) and C5a. In this investigation, the in vitro response of neutrophils to the chemotactic agent leukotriene B4 (LTB4) was examined. Those LJP patients who possessed defective chemotactic responses to FMLP and endotoxin activated serum (EAS) also had impaired chemotaxis to LTB4. Exogenous LTB4 failed to augment the impaired response to FMLP. Evidence for a global membrane defect in LJP neutrophils resulting in hyporesponsiveness to chemically diverse chemotactic agents is presented.

Neutrophil function in localized juvenile periodontitis. Phagocytosis, superoxide production and specific granule release

Patients with localized juvenile periodontitis (LJP) exhibit defective neutrophil functions to a variety of environmental and host stimuli. It is not clear, however, how many of the measurable functions are defective and whether individual patients exhibit single or multiple dysfunctions. The purpose of this study was to evaluate chemotaxis, phagocytosis, specific granule release and superoxide production in a group of 23 previously unreported LJP patients. Our results indicate that all 23 of these LJP patients exhibited chemotaxis depression to N-formyl-L-methionyl-L-leucyl-L-phenylalanine (FMLP) and endotoxin-activated serum (EAS). Smaller groups from the 23 chemotactically defective LJP group were used to test other function due to inability to obtain sufficient quantities of blood. Fourteen of 14 LJP patients tested exhibited defective phagocytosis. Ten LJP patients were evaluated for specific granule release, and 14 LJP patients were evaluated for superoxide production. Both granule release and superoxide production were found to be normal in chemotactically defective LJP patients. Since both defective and normal responses noted in the same neutrophil populations are mediated by the same receptor, it is hypothesized that the cellular defect lies in a post receptor pathway.

Periodontal destruction in Down's syndrome and in juvenile periodontitis. How close a similarity?

Advanced destruction of the periodontium, with similarities in alveolar distribution, age range, and diminished host responses of varying severity, may be seen in Down's syndrome and in juvenile periodontitis. This review compares and contrasts periodontal destruction and immunologic mechanisms in the two conditions. Both are characterized by raised serum immunoglobulins, selective cell-mediated immunodeficiencies, and defective neutrophil polymorphonuclear leukocyte chemotaxis. There is a possibility of defective monocyte chemotaxis in both conditions, although this is less clear in juvenile periodontitis. By contrast, antigen-induced DNA synthesis is enhanced in Down's syndrome, but reduced in juvenile periodontitis.

Healing following surgical and non-surgical treatment of juvenile periodontitis. A 5-year longitudinal study

The patient sample used in the present study comprised 16 young individuals who were referred for treatment of advanced periodontal disease. Based upon the age of the patients and the location of the diseased sites, the patients were divided into 2 groups; a juvenile periodontitis group (JP) and a post-juvenile periodontitis group (post-JP). The patients in the JP group had periodontal lesions only at first molars and incisors. All 16 subjects were in excellent general health and none had been treated with antibiotics during a period of at least 12 months prior to the 1st examination. At a baseline examination and 6, 24 and 60 months after active therapy, the diseased sites were examined regarding plaque, gingivitis, probing pocket depths, probing attachment level, recession of the gingival margin and marginal alveolar bone level. Following a case presentation and instruction in proper oral hygiene measures, the 16 subjects were subjected to periodontal treatment, utilizing a split mouth design. By random selection, the diseased sites in one side of the jaws were treated by scaling and root planing in conjunction with a "modified Widman flap" procedure, while in the contralateral jaw quadrants treatment was restricted to scaling and root planing. During the 1st 6 months following active therapy, the patients were subjected to professional tooth cleaning once every 4 weeks. Subsequently, the interval between the recall appointment was 3 months. 2 years after treatment, this maintenance care program was terminated. A final examination was performed 5 years after therapy. None of the patients involved in the trial received antibiotic treatment during the 5 years of observation. The findings of the present study revealed that the response of the periodontal tissues to therapy, both in the JP and the post-JP group of patients, was almost identical to that found for similar types of treatment in patients with adult periodontitis. The re-examinations performed after 6, 24 and 60 months following active therapy of JP and post-JP lesions revealed that excision of the granulation tissue in conjunction with flap elevation did not enhance the degree of probing pocket depth reduction, probing attachment gain and bone fill that occurred following meticulous root surface instrumentation.

Juvenile periodontitis

Juvenile periodontitis occurs in children and young adults and can be classified into: periodontitis which occurs in otherwise healthy individuals, and periodontitis which occurs in juveniles with systemic disease. The periodontitis which occurs in otherwise healthy individuals consists of two major forms: juvenile periodontitis, also called periodontosis or localized juvenile periodontitis (LJP), and generalized juvenile periodontitis which includes early onset adult periodontitis, recurrent necrotizing ulcerative periodontitis and the true generalized form of juvenile periodontitis. Periodontitis in systemically diseased individuals can be divided into three subgroups: juvenile periodontitis associated with primary neutrophil disorders, juvenile periodontal disease in which neutrophils are secondarily abnormal, and juvenile periodontitis associated with other diseases. Juvenile periodontitis is perhaps the best understood form of periodontal disease. A major infecting organism, Actinobacillus actinomycetemcomitans, is strongly associated with the disease, and may be an exogenous pathogen since it is not found in healthy individuals or in healthy sites in LJP patients. It is virulent with marked leukaggressive properties and it induces a marked antibody response in infected patients. Eradication of Actinobacillus actinomycetemcomitans requires attention to the fact that it invades the tissue and hence systemic antimicrobials or surgical excision of the tissues is necessary for eradication. Marked suppression of the organism from subgingival sites is associated with healing. Host responses in LJP have also been well described and most immune functions studied appear to be normal. The notable exception is neutrophil chemotaxis which is depressed. Associated with depressed neutrophil chemotaxis is a reduction of neutrophil receptors for several chemotactic factors including C5a, the fifth component of complement.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of data from clinical studies of localized juvenile periodontitis

Data from 27 subjects with localized juvenile periodontitis were used to compute estimates of the intraclass correlation coefficient for initial periodontal pocket depth measurements and total subgingival Actinobacillus actinomycetemcomitans counts, and for changes from pre- to post-treatment in periodontal pocket depth, probing attachment level and Actinobacillus actinomycetemcomitans counts. The estimates for the clinical parameters were considerably higher than those found in a similar study of adult periodontitis. On the average, the estimates for the intraclass correlation coefficients for Actinobacillus actinomycetemcomitans counts did not differ markedly from the corresponding estimates for the clinical parameters. Although the results of this study indicate that the major component of variability in parameters commonly used in studies of periodontal disease can be attributed to site-specific factors, sites within subjects cannot be considered statistically independent. For the analysis of data arising from studies of periodontal disease, it is recommended that statistical techniques, like the nested mixed effects analysis of variance model be employed, which account for this dependence. These techniques will allow meaningful biological questions concerning site-specific phenomenon to be answered. However, changes in clinical and microbiological parameters, when therapeutic measures are employed on localized juvenile periodontitis patients, are often dramatic enough to allow informal data presentation.

Dynamics of infection by leukotoxic strains of Actinobacillus actinomycetemcomitans in juvenile periodontitis

Juvenile periodontitis is associated with a high incidence of infection by Actinobacillus actinomycetemcomitans (Aa). The data presented indicate that the ability of Aa to destroy human PMNs is altered during the course of infection. Leukotoxic strains of Aa are characteristically found in isolates obtained from younger patients (6-12 years of age) but not in older subjects (13-25 years old). This suggests that the leukotoxin may be more important during early as opposed to more advanced phases of juvenile periodontitis.