Chemokines in human periodontal disease tissues

An immunoperoxidase technique was used to examine IP-10 (interferon-gamma inducible protein 10), RANTES (regulated on activation normal T cell expressed and secreted), MCP-1 (monocyte chemoattractant protein-1), and MIP-1 alpha (macrophage inflammatory protein-1 alpha) in gingival biopsies from 21 healthy/gingivitis and 26 periodontitis subjects. The samples were placed into 3 groups according to the size of infiltrate. MIP-1 alpha+ cells were more abundant than the other chemokines with few MCP-1+ cells. The mean percent MIP-1 alpha+ cells was higher than the percent MCP-1+ cells (P = 0.02) in group 2 (intermediate size infiltrates) lesions from periodontitis subjects, other differences not being significant due to the large variations between tissue samples. Analysis of positive cells in relation to CD4/CD8 ratios showed that with an increased proportion of CD8+ cells, the mean percent MIP-1 alpha+ cells was significantly higher in comparison with the mean percent RANTES+ and MCP-1+ cells (P < 0.015). Endothelial cells were MCP-1+ although positive capillaries were found on the periphery of infiltrates only. Keratinocyte expression of chemokines was weak and while the numbers of healthy/gingivitis and periodontitis tissue sections positive for IP-10, RANTES and MCP-1 reduced with increasing inflammation, those positive for MIP-1 alpha remained constant for all groups. In conclusion, fewer leucocytes expressed MCP-1 in gingival tissue sections, however, the percent MIP-1 alpha+ cells was increased particularly in tissues with increased proportions of CD8 cells and B cells with increasing inflammation and also in tissues with higher numbers of macrophages with little inflammation. Further studies are required to determine the significance of MIP-1 alpha in periodontal disease.

Cytokines in periodontal disease: where to from here?

Numerous studies have attempted to elucidate the cytokine networks involved in chronic periodontitis, often with conflicting results. A variety of techniques were used to study cells in situ, cells extracted from gingival tissues, peripheral blood mononuclear cells, purified cell populations, and T cell lines and clones. Bacterial components, including sonicates, killed cells, outer membrane components, and purified antigens, have all been used to stimulate cells in vitro, making comparisons of cytokine profiles difficult. As it is likely that different cells are present at different disease stages, the inability to determine disease activity clinically is a major limitation of all these studies. In the Context of tissue destruction, cytokines such as IL-1, IL-6 and IL-18 are likely to be important, as are their regulating cytokines IL-10 and IL-11. In terms of the nature of the inflammatory infiltrate, two apparently conflicting hypotheses have emerged: one based on direct observations of human lesions, the other based on animal experimentation and the inability to demonstrate IL-4 mRNA in gingival extracts. In the first of these, Th1 responses are responsible for the stable lesion, while in the second Th2 responses are considered protective. Using Porphyromonas gingivalis-specific T cell lines we have shown a tendency for IFN-gamma production rather than IL-4 or IL-10 when antigen is presented with peripheral blood mononuclear cells which may contain dendritic cells. It is likely that the nature of the antigen-presenting cell is fundamental in determining the nature of the cytokine profile, which may in turn open up possibilities for new therapeutic modalities.

Costimulatory molecules in human periodontal disease tissues

An immunoperoxidase technique was used to examine CD28, CD152, CD80 and CD86 positive cells in gingival biopsies from 21 healthy/gingivitis and 26 periodontitis subjects. The samples were placed into 3 groups (small, intermediate, large) according to the size of the infiltrate. The percent CD28+ T cells in the connective tissue infiltrates was highly variable with no differences between the healthy/gingivitis and periodontitis groups. While there was an increase in positive cells in intermediate infiltrates from both healthy/gingivitis (28.5%) and periodontitis (21.4%) patients compared with small infiltrates (8.6% and 11.8%, respectively), this was not significant, although the percent CD28+ T cells did increase significantly in tissues with increased proportions of B cells relative to T cells (p=0.047). A mean of less than 5% infiltrating T cells were CD152+ which was significantly lower than the mean percent CD28+ T cells in intermediate healthy/gingivitis lesions (p = 0.021). The mean percent CD80+ and CD86+ B cells and macrophages was 1-7% and 8-16%, respectively, the difference being significant in intermediate healthy/gingivitis tissues (p = 0.012). Analysis of these cells in relation to increasing numbers of B cells in proportion to T cells and also to macrophages, suggested that CD80 was expressed predominantly by macrophages while CD86 was expressed by both macrophages and B cells. Few endothelial cells expressed CD80 or CD86. Keratinocytes displayed cytoplasmic staining of CD80 rather than CD86 although the numbers of positive specimens in the healthy/gingivitis and periodontitis groups reduced with increasing inflammation. In conclusion, percentages of CD28, CD152, CD80 and CD86 did not reflect differences in clinical status. However, the percent CD28+ T cells increased with increasing size of infiltrate and with increasing proportions of B cells suggesting increased T/B cell interactions with increasing inflammation. The percent CD152+ cells remained low indicating that CD152 may not be involved in negative regulation of T cells in periodontal disease. CD80 and CD86 have been reported to promote Th1 and Th2 responses, respectively, and the higher percent CD86+ cells suggests a predominance of Th2 responses in both healthy/gingivitis and periodontitis tissues. Nevertheless, other factors including cytokines themselves and chemokines which modulate T cell cytokine profiles must be monitored to determine the nature of Th1/Th2 responses in periodontal disease.

Dental education in Queensland: II. Principles of curriculum design

A modern dental curriculum must produce graduates who are competent to practise in a variety of settings immediately upon graduation; cognisant of community needs and the social milieu in which they serve their patients' health needs; able to anticipate and cope with changes following graduation; committed to self-improvement, willing to change to reflect best clinical practice; and equipped with skills for self-assessment and lifelong learning. This requires the appropriate balance of emphasis on educational content and educational process. This paper outlines the design considerations underlying the new BDSc curriculum at the University of Queensland. This curriculum uses an integrated rather than subject-based approach, with student-centred modes of learning as the principal learning style. Active learning strategies develop critical thinking and clinical problem-solving skills. Learning occurs in the context of a clinical situation (either overt or implied). Year 2 provides the major scientific foundations, and later years build upon this base, particularly through problem-based learning. Senior clinical staff involved in teaching in earlier parts of the course, help provide an overt clinical context to learning activities. The integrated curriculum model provides clinically relevant education in basic sciences and scientifically based education in clinical care. The curriculum has a focus on outcomes and on preparation for general practice. Importantly, it has an open and transparent structure, and each component is linked explicitly with the competencies expected of the new dental graduate.

Dental education in Queensland I: the 1-3-1 model

Dental education worldwide is under great pressure. This pressure is being driven not only by changing patterns of oral disease but also by economic factors both inside and outside universities. Technological advances and changing educational philosophies across the board also impact significantly on what we do and how we do it. This article outlines how the School of Dentistry at The University of Queensland is responding to these pressures within the context of local political, educational and economic realities. The so-called 1-3-1 model that has been adopted involves one year of basic science, three years of applied dental science and one year of extramural clinical practice. This model represents a partnership with the Queensland Department of Health and will: Involve dental education and the Dental School in the provision of health care to the community. Place the Dental School in a position to influence the delivery and quality of oral health care in the population and to assume some of the responsibility for it. Provide a wide range of clinical and community experiences for students prior to graduation. Allow the adoption of modern teaching methods such as Problem Based Learning (PBL) in Years II-IV with all the additional benefits e.g. communication skills. Provide an extended clinical period for the acquisition and development of clinical and technical skills prior to graduation. Be cost-effective both to the university and the health service. Allow for outside input without compromising the knowledge and research base. It is recognised that while the 1-3-1 model may meet the demands of a large, decentralised state such as Queensland, it may not be suitable for all institutions. In this context diversity in approach is one of the strengths of dental education, nationally and internationally.

Periodontal implications of immunodeficient states: manifestations and management

The importance of the immune system in modulating the host response to plaque is well recognised, and in this context the immune system is clearly a risk/modifying factor for human periodontal disease. This review examines the periodontal manifestations of subjects with immunodeficiencies and considers potential preventive protocols for the periodontal management of these patients.

The influence of genetic variation on the splenic T cell cytokine and specific serum antibody responses to Porphyromonas gingivalis in mice

BACKGROUND

T cell cytokine profiles in the spleens and anti-Porphyromonas gingivalis antibodies in the sera of P. gingivalis-immunized BALB/c (H-2d), CBA/CaH (H-2k), C57BL6 (H-2b), and DBA/2J (H-2d, C5 deficient) mice were examined.

METHODS

Mice were immunized either by intraperitoneal injections of P. gingivalis outer membrane antigens and Freund's incomplete adjuvant weekly for 3 weeks or sham-immunized with PBS and adjuvant, followed by subcutaneous challenge with live organisms 1 week after the final immunization. Spleens were excised and blood samples collected by heart puncture at 0 and 7 days after challenge. Splenic CD4 and CD8 cells were stained for intracytoplasmic interleukin (IL)-4, interferon (IF)-gamma, and IL-10 and levels of anti-P. gingivalis antibodies in the serum samples determined by ELISA.

RESULTS

Lesion sizes in immunized BALB/c mice remained stable for the 7-day experimental period. Immunized CBA/CaH and C57BL6 mice exhibited large lesions at day 1 reducing by day 7 particularly in the latter strain. Lesions in immunized DBA/2J mice were still larger than the other strains at day 7. With the exception of DBA/2J mice, sham-immunized mice demonstrated lesions which did not show signs of healing by day 7. T cell cytokine responses in sham-immunized mice at day 0 were low, increasing to a variable degree by day 7 after challenge in the 4 strains. Immunized BALB/c mice demonstrated intermediate T cell responses while generally exhibiting a stronger IFN-gamma response than IL-4 or IL-10. Immunized CBA/CaH and C57BL6 mice showed weak T cell cytokine responses while immunized DBA/2J displayed the strongest T cell responses particularly in regard to IL-4 positive cells. Sham-immunized mice had low levels of serum anti-P. gingivalis antibody levels at day 0 with levels increasing significantly by day 7 after challenge. Antibody levels in immunized mice seemed to correlate with lesion sizes. Immunized C57BL6 mice had the highest antibody levels followed by CBA/CaH, BALB/c with DBA/2J exhibiting low levels. The T cell and B cell antibody responses in each strain appeared to exhibit an inverse relationship.

CONCLUSIONS

This study has shown that genetic differences at the level of H-2 haplotype induce variations in the local and T and B cell responses to P. gingivalis antigens. The responses of DBA/2J mice which have the same haplotype as BALB/c mice suggest that factors other than H-2 haplotype such as the C5 deficiency may influence this immune response. The significance of the specific antibody and T cell responses and of their inverse relationship to susceptibility to periodontal disease remains to be determined.

Chemokine expression in Porphyromonas gingivalis-specific T-cell lines

Autologous non-T cells (monocytes and B cells) were added to Porphyromonas gingivalis-specific T cell lines established from 9 healthy adults together with P. gingivalis outer membrane antigens for 4-6, 16-18, 24 and 48 h. Flow cytometry was employed to analyze the CD4 and CD8 cells, monocytes and B cells for intracytoplasmic IP-10 (interferon-gamma inducible protein 10), MCP-1 (monocyte chemoattractant protein 1), MIP-1 alpha (macrophage inflammatory protein 1 alpha) and RANTES (regulated on activation normal T cell expressed and secreted) at the four time periods. All cell types were positive for each chemokine throughout the 48-h time period. There were significantly fewer MCP-1-positive cells compared with the other 3 chemokines. However, the percentages of MCP-1, MIP-1 alpha- and RANTES-positive CD8 cells were significantly higher than the percentages of positive CD4 cells in all cultures. IP-10-positive CD4, CD14-positive monocytes and CD19-positive B cells were predominant compared with MIP-1 alpha- and RANTES-positive cells at 24 h. In conclusion, the present study has shown that P. gingivalis-specific T cells, monocytes and B cells produce chemokines in response to P. gingivalis outer membrane antigens, IP-10 being predominant, with MCP-1 being significantly reduced in comparison with IP-10, MIP-1 alpha and RANTES. Increased percentages of CD8 cells were induced to produce chemokines in comparison with CD4 cells, indicating a more preferential action on CD8 rather than CD4 cells.

The surface effect of dentifrices

The aim of this study was to evaluate clinically three commercially available dentifrices and to determine any surface effects on tooth or gingival surfaces. Sixty-four participants were included in this study and were allocated randomly to one of four treatment groups by an independent person to ensure the investigators were unaware of the brushing material used. All toothbrushes and dentifrices were distributed by this independent person. The treatment groups were: Group 1--brush with water; Group 2--brush with Colgate (Baking Soda and Peroxide); Group 3--brush with Macleans (Whitening); Group 4--brush with Colgate (Sensation Whitening). All participants were requested to brush both morning and evening in their customary fashion using only the designated toothpaste, or water, for four weeks. All participants were required to use the same toothbrush type. No other oral hygiene products such as mouth rinses or dental floss were used during the trial period. Prior to commencement of the brushing period, all participants received a full clinical examination recording the status of the soft and hard tissues including a gingival index (Löe and Silness) to record gingival condition. A polyvinyl siloxane impression was taken of the six anterior teeth and gingival tissues at the commencement of the trial. After four weeks, a second full clinical examination was made and further silicone impressions were taken of the anterior teeth. All impressions were cast in epoxy resin for investigation with light and electron microscopy. Participants were also asked to answer a questionnaire relating to the toothpaste used. The results of this study indicated that no significant clinical differences were recorded for any dentifrice or water and there was no significant difference in gingival index scores over the four week period. Patient responses to each dentifrice varied according to individual patient preferences and expectations and no consistent findings could be determined. Light and electron microscopy indicated that tooth and gingival surface changes that occurred over the four week period with any of the dentifrices were similar to, and not significantly different from, changes seen with the use of water alone. These results indicate that none of the dentifrices tested was harmful to teeth or soft tissues.

Selective expansion of T cells in gingival lesions of patients with chronic inflammatory periodontal disease

Chronic inflammatory periodontal diseases are characterized by a cellular infiltrate and are similar in many respects to other chronic inflammatory diseases. While periodontopathic bacteria have been recognized as the principal causative agent and the immune response to these bacteria is thought to be responsible for the tissue destruction, the full aetiological spectrum is still incompletely understood. In addition to many cell types such as polymorphonuclear leucocytes and macrophages, T cells have been implicated in pathogenesis and are considered to have regulatory roles in progression of the disease. Based on our recent studies demonstrating biased expression of several Vbeta families in periodontitis tissues, the aim of this study was to characterize further the T cells relevant to the disease process by reverse transcription-polymerase chain reaction-single-strand conformation polymorphism (RT-PCR-SSCP) and subsequent nucleotide sequence analysis of complementarity-determining region 3 (CDR3) of the TCR beta-chain. In spite of the likely involvement of numerous bacteria, the present study has clearly shown the oligoclonality of infiltrating T cells in periodontitis lesions in contrast to low clonality of peripheral blood T cells as evidenced by the appearance of distinct bands in gingival tissue samples and smear pattern of peripheral blood on SSCP gels. These were confirmed by the DNA sequencing of the CDR3 of Vbeta16 of selected samples. The analysis of deduced amino acid sequences demonstrated amino acid motifs in the CDR3 region of the periodontitis lesion-derived sequences from each patient. The results indicate that gingival tissue-infiltrating T cells recognizing a limited number of antigens or epitopes are involved in the disease process.

Ante-dependence modeling in a longitudinal study of periodontal disease: the effect of age, gender, and smoking status

BACKGROUND

It is generally accepted that periodontal disease progresses by a series of bursts that are interspersed by periods of stability or even gain of attachment. In order to analyze longitudinal data on a patient's disease experience, it is necessary to use models which accommodate serial dependence. Ante-dependence between the results of a series of periodontal examinations over time can be modeled using a Markov chain. This model describes temporal changes in patients' levels of disease in terms of transition probabilities, which allow for both regression and progression of the disease. The aim of the present study was to demonstrate the use of a Markov chain model to analyze data from a longitudinal study investigating the progression of periodontal disease in an adult population.

METHODS

The study population consisted of 504 volunteers; however, only 456 were included in the analysis because the remaining 48 subjects did not give consecutive data. Subjects were examined at baseline, 6 months, and 1, 2, and 3 years. Probing depths (PD) were recorded using an automated probe. Disease was defined as four or more sites with PD > or = 4 mm. Markov chain modeling was used to determine the effect of age, gender, and smoking on the natural progression and regression (healing) of periodontal disease.

RESULTS

Smoking and increasing age had no effect on the progression of disease in this population, but did have a significant effect (P values < or = 0.05) in reducing the regression of disease; i.e., their effect on disease appears to be inhibition of the natural healing process. Gender had no significant effects.

CONCLUSIONS

These results demonstrate how ante-dependence modeling of longitudinal data can reveal effects that may not be immediately apparent from the data, with smoking and increasing age being seen to inhibit the healing process rather than promote disease progression.

Changes in the periodontal status of patients undergoing bone marrow transplantation

BACKGROUND

Patients receiving an HLA-matched bone marrow transplant (BMT) from a relative or unrelated donor undergo a permanent alteration of their immune system, followed by a prolonged period of immunodeficiency. This study aimed to examine alterations in the periodontal status of patients over 6 months post-bone marrow transplantation.

METHODS

Thirty-seven patients scheduled for bone marrow transplantation participated in this study. One calibrated examiner carried out periodontal examinations (clinical and radiographic) immediately prior to and at 3 and 6 months after transplantation. All patients followed an intense oral care program. Subgingival plaque samples were analyzed by enzyme-linked immunosorbent assay (ELISA) for the presence of Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, and Prevotella intermedia. Data were subjected to statistical analyses to determine the relationships between the frequency distribution of the radiographic and clinical variables over time.

RESULTS

Gains in clinical attachment level (CAL) of > or =2 mm at 4 or more sites from baseline to 6 months post-BMT were noted in 9/16 patients (56%), while 6/16 (38%) patients experienced a loss of CAL > or =2 mm at 4 or more sites in the same period. At a site level, 4.8% of sites exhibited a gain in CAL > or =2 mm between baseline and 3 months post-BMT while 2.3% of sites showed a loss of CAL > or =2 mm in the same period. From baseline to 6 months, a gain in CAL of > or =2 mm was recorded at 3.1% of sites, and 2.4% of sites experienced a loss of > or =2 mm. A significant improvement in the gingival index occurred between all sequential time periods when assessed at a site level. At a patient level, 11/18 (61%) patients showed a significant change in gingival index between baseline and 3 months and 10/16 (63%) between baseline and 6 months. There was no significant relationship between clinical changes and the prevalence of the periodontal pathogens at the various time periods.

CONCLUSIONS

An improvement in periodontal health was recorded between baseline and 6 months post-transplantation. Most of the improvement in periodontal status was noted in the first 3 months after BMT, with a slight decline in periodontal health between 3 and 6 months post-transplant. No significant alteration was noted in the prevalence of periodontal pathogens during the study period.

A histological study of the effect of growth hormone on odontogenesis in the Lewis dwarf rat

The effect of growth hormone (GH) on the dentition has been described in children with pituitary dwarfism where teeth fail to form; those that do form tend to be reduced in size and the eruption potential is diminished. The aim here was to examine the effect of GH on odontogenesis via molar development in Lewis (control), dwarf (Dw) and Dw GH-treated (Dw+GH) rats aged 3, 6, 9, 12 and 15 days. Dw+GH animals received a twice-daily dose (65 microg/kg) of GH which commenced at 2 days of age. Animals were killed, mandibles removed, processed to embedding in paraffin, sectioned and stained for histological examination of molar morphology during development. Variations in enamel mineralization and root development were observed. In 6-day-old animals, enamel mineralization was delayed in Dw and Dw+GH animals. Root initiation was evident at 6 days of age in controls but was not observed until 9 days of age in Dw and Dw+GH animals. At 12 days of age, maturation of enamel in Dw and Dw+GH animals remained delayed. By 15 days of age no variation in tooth development was evident. These data indicate that enamel mineralization is affected by the level of circulating GH in the rat. A specific deficiency of GH did not appear to delay bone resorption prior to tooth emergence.

T-cell antigen specificity in humans following stimulation with Porphyromonas gingivalis

The effects of Porphyromonas gingivalis stimulation on T-cell clonality and cytokine mRNA expression in peripheral blood mononuclear cells from individuals with gingivitis and periodontitis were investigated. Clonality of T cells was investigated by reverse transcription-polymerase chain reaction (RT-PCR) and single-strand conformation polymorphism analysis. Cytokine mRNA expression was investigated by RT-PCR. Whereas unstimulated mononuclear cells did not demonstrate obvious clonality, clonal expansion was found in most Vbeta families after stimulation. However, there was no relation between clonal change and disease category or the presence of P. gingivalis infection. Messenger RNA for interferon-gamma and interleukin-13 was upregulated whereas interleukin-4 and -10 were downregulated following P. gingivalis stimulation. Interleukin-12p35 demonstrated no consistent pattern. This study supports the concept that P. gingivalis stimulates T cells in an antigen-specific fashion. It further suggests that peripheral blood T cells may preferentially produce interferon-gamma and interleukin-13 in response to P. gingivalis stimulation irrespective of disease or P. gingivalis status.

Apoptosis in Porphyromonas gingivalis-specific T-cell lines

Fluorescence-activated cell sorter analysis and transmission electron microscopy were used to determine the presence of apoptotic cells in Porphyromonas gingivalis-specific T-cell lines established from the peripheral blood of 10 P. gingivalis-infected individuals. P. gingivalis outer membrane antigens were presented to the T cells by autologous Epstein-Barr virus-transformed B cells for 6, 24, 48 and 72 h. Transmission electron microscopy demonstrated the presence of typical apoptotic cells in all cultures. Annexin V-positive cells were present at low concentrations at all 4 four periods. A mean of approximately 2-3% of the CD4 cells and 1-3.5% of the CD8 cells were annexin V-positive, with an increase to around 5.5% positive CD4 cells at 6 h in wells containing P. gingivalis compared with cultures not containing antigen. This difference was not, however, significant at the 0.05 level (P = 0.073). The mean (+/- standard error) CD4:CD8 ratios of the T-cell lines when first established using peripheral blood mononuclear cells as antigen-presenting cells was significantly higher (5.2 +/- 1.1) than when transformed B cells were used as antigen-presenting cell (1.2 +/- 0.5). While this study has shown apoptosis occurring in the T-cell lines, it has not shown definitively that the reversion in the CD4:CD8 ratio in the P. gingivalis-specific T cells following antigen presentation by autologous Epstein-Barr virus-transformed B cells is due to apoptosis of a CD4 population. Alternatively, the reversion in the CD4:CD8 ratio could be due to a selective proliferation of the CD8 population which, in turn, could be relevant to the immunopathology of periodontal disease induced by P. gingivalis.

The proportion of interleukin-4, interferon-gamma and interleukin-10-positive cells in Porphyromonas gingivalis--specific T-cell lines established from P. gingivalis-positive subjects

T-cell cytokine profiles in ten adult periodontitis and seven age-matched healthy or gingivitis subjects were determined. Porphyromonas gingivalis-specific T-cell lines were established from the peripheral blood of these individuals all of whom had past or present evidence of P. gingivalis infection. FACS analysis was used to determine the percentage of CD4- and CD8-positive cells in each line staining for cytoplasmic interleukin (IL)-4, interferon-gamma and IL-10. There were no differences in the mean percentage of IL-4-, interferon-gamma- or IL-10-positive T cells between the two groups. However, the individual profiles showed that the CD4 cells in five of the seven healthy or gingivitis lines had a higher proportion of interferon-gamma-positive cells, with two lines demonstrating higher percentages of IL-10- and/or IL-4-positive CD4 cells. Five of the ten adult periodontitis lines demonstrated either equal or higher percentages of IL-4-positive and/or IL-10-positive CD4 cells. With respect to the CD8 cells, two of the seven lines established from the healthy or gingivitis subjects and six of the ten adult periodontitis lines showed profiles with a higher percentage IL-4- and/or IL-10-positive cells. When the total T-cell contribution (CD4 plus CD8) for each T-cell line was determined from the individual CD4:CD8 ratios, only one of the healthy or gingivitis lines showed a profile with a higher proportion of IL-10-positive cells, while the results for the adult periodontitis lines were the same as indicated for the CD4 cell profiles, with five lines showing a higher percentage of IL-4- and/or IL-10-positive cells. In conclusion, this study has shown that in P. gingivalis-responsive T-cell lines established from adult periodontitis and healthy or gingivitis subjects, there was a predominant trend towards a higher percentage of interferon-gamma positive cells than either IL-4- or IL-10-positive cells. However, there were variations from this trend, although whether these variations indicate true susceptibility to progressive disease has yet to be determined.

Distribution of interleukin-2, -4, -10, tumour necrosis factor-alpha and transforming growth factor-beta mRNAs in oral lichen planus

In the present study, MRNA for the cytokines interleukin-2 (IL-2), IL-4, IL-10 tumour necrosis factor-alpha (TNF-alpha) and transforming growth factor beta-1 (TGF-beta-1) were investigated in oral lichen planus (OLP) lesions using in situ hybridization with 35S-labelled oligonucleotide probes on frozen tissue sections. In addition, the expression of interferon-gamma (IFN-gamma), IL-10 and IL-4 mRNAs was analysed in cultured lesional T lymphocytes from oral lichen planus by polymerase chain reaction. Cells expressing mRNA for IL-2, IL-4, IL-10, TNF-alpha and TGF-beta 1 were found in all the biopsies studied. Approximately 1-2% of the total number of infiltrating cells in the lesions were positive for each of the different cytokine mRNAs. Most biopsies contained basement membrane-oriented, mRNA-positive cells. In the cultured T-cell lines, message for IFN-gamma was detected in all the patients, IL-10 in all but one, and IL-4 in just one of the seven patients investigated. The results suggest that mRNA for both pro- and anti-inflammatory cytokines, i.e., mixed T-helper 1 (TH1) and TH2 cytokine profiles, are generated simultaneously by a limited number of cells in chronic lesions of OLP.

Antigen-specific T-cell receptor V beta expression in Porphyromonas gingivalis-specific T-cell lines

FACS analysis was used to determine the expression of 15 T-cell receptor V beta families on CD4 and CD8 cells in Porphyromonas gingivalis specific T-cell lines established from eight P. gingivalis-positive adult periodontitis and seven P. gingivalis-positive healthy or gingivitis subjects. All 15 T-cell receptor V beta families were expressed by the T-cell lines, although a significantly higher proportion of the CD4 cells expressed the 5.2-3 V beta region compared with the other 14 families, including the 5.3 region, suggesting that it is the 5.2 family which is overexpressed. This was also true for the CD8 cells, with the exception of the 3.1 region in adult periodontitis T-cell lines and the 3.1, 13.1/13.3 and 21.3 regions in healthy or gingivitis lines. Between the two clinical groups, a significantly lower percentage of 13.1/13.3-positive CD8 cells was noted in the adult periodontitis lines compared with the healthy or gingivitis lines. There was a significant reduction in DNA synthesis by the lines in the presence of P. gingivalis outer membrane antigens and fixed irradiated lymphoblastoid cell lines compared with cultures containing untreated irradiated lymphoblastoid cell lines and in cultures containing anti-class II major histocompatibility complex antibody in comparison with all other cultures. The results of this study have shown that P. gingivalis preferentially induces the T-cell receptor V beta 5.2 family on CD4 and CD8 cells in P. gingivalis-specific T-cell lines and that activation of T cells by P. gingivalis outer membrane antigens may be by antigen-specific rather than superantigen activity.

Cytokine profiles of lesional and splenic T cells in Porphyromonas gingivalis infection in a murine model

T cell cytokine profiles in the spleens and Porphyromonas gingivalis-induced lesions of P. gingivalis-immunized mice were examined. BALB/c mice were immunized with P. gingivalis outer membrane (OM) antigens/mouse weekly for 3 weeks followed by challenge with live organisms 2 weeks after the final immunization. Control mice were immunized with PBS. Spleens were excised at 0 and 4 days and lesions at 1, 4, and 7 days after challenge. Splenic and lesional CD4 and CD8 cells were stained for intracytoplasmic interleukin (IL)-4, interferon (IFN)-gamma, and IL-10. More than 50% of the T cells in the spleens of immunized mice were IFN-gamma positive at day 0 which was significantly higher than for IL-4 or IL-10, these levels decreasing significantly 4 days after challenge. Less than 6% of the T cells in sham immunized mice were cytokine positive at day 0, although at day 4, there was a significant increase in the percent IL-10 positive CD4 cells and IL-4 and IL-10 positive CD8 cells. There were no differences in the percent IL-4, IFN-gamma, or IL-10 positive T cells in the lesions of immunized mice, but there was a dramatic decrease at day 7 to very low levels in control mice. In conclusion, the results of the present study show a predominant Th1 response in the spleens of BALB/c mice after immunization with P. gingivalis OM antigens, suggesting that a protective immune response to P. gingivalis may involve a strong IFN-gamma response.

Detection of clonotypic changes of T cells after stimulation with Porphyromonas gingivalis

The aim of this study was to investigate whether Porphyromonas gingivalis stimulation would induce a selective activation and expansion of a limited T-cell receptor V beta repertoire or T-cell clonotype. Using samples from patients with chronic inflammatory periodontal diseases, we examined TCRBV gene usage and T-cell clonotypes of peripheral blood mononuclear cells incubated in the presence or absence of P. gingivalis outer membrane through a combination of reverse transcription polymerase chain reaction (RT-PCR) and subsequent single strand conformation polymorphism (SSCP) analysis. There was no difference in the mean expression for most BV families with or without P. gingivalis outer membrane in the culture. However, in individual cases, a few BV gene families did become overexpressed or underexpressed following stimulation, although a consistent pattern did not emerge. SSCP analysis showed that several new distinct bands appeared after stimulation, indicating distinct clonal accumulations, although the number of distinct bands decreased in most cases. These data suggest that clonotypic change occurred following stimulation with P. gingivalis outer membrane. Furthermore, the possibility of superantigen stimulation by P. gingivalis is unlikely to be due to the small change in BV gene usage and clonal T-cell accumulations with P. gingivalis outer membrane stimulation, as evidenced by SSCP. Thus, RT-PCR and SSCP analysis is useful in evaluating the host response to periodontopathic antigens.

Effect of increased community and professional awareness of plaque control on the management of inflammatory periodontal diseases

Data from CPITN studies indicate that severe periodontitis affects approximately 10 per cent of most populations. These data have remained static for a number of years. Of interest, however, is that despite the dramatic increase in the use of oral hygiene aids, efforts by the dental profession in oral hygiene instruction, and the associated general improvement in oral hygiene levels in the community, the incidence of severe chronic inflammatory periodontal disease has remained largely unaffected. The effects of changing oral hygiene may be reflected in slight shifts in the mild and moderate classifications of periodontal disease but the prevalence of advanced disease in presumably susceptible subjects has remained relatively unchanged. The ramifications of relatively non-specific plaque control measures in the management of advanced disease in susceptible subjects are still unclear and it may not be until the adoption of a more specific approach to the control of specific pathogens which inhabit the subgingival biofilm that major changes in the general incidence of the severe inflammatory periodontal diseases will be seen.

Characterization of serum antibodies to Porphyromonas gingivalis in individuals with and without periodontitis

Although Porphyromonas gingivalis is a defined pathogen in periodontal disease, many subjects control the infection without experiencing loss of attachment. Differences in host susceptibility to the disease may be reflected in the pattern of humoral antibodies against specific P. gingivalis antigens. The aim of this study was to determine the presence of antibodies against immunodominant P. gingivalis antigens as well as the isotype and subclass of anti-P. gingivalis antibodies against outer membrane antigens in four groups of patients: P. gingivalis-positive, 1) with and 2) without periodontitis, and P. gingivalis-negative, 3) with and 4) without periodontitis. Antigens of molecular weight 92, 63, and 32 kDa and lipopolysaccharide were found to be immunodominant. Group 1 subjects showed a significantly higher response to the 92 and 63 kDa antigens compared with other groups. The response to lipopolysaccharide was significantly higher in group 1, and lower in group 4 than in groups 2, 3. Immunoglobulin G1 (IgG1), IgG2 and IgM antibodies against P. gingivalis outer membrane were present in all subjects, while only some subjects were seropositive for IgG3, IgG4 and IgA. There were no differences in concentrations for IgG1, IgG3 and IgM. The IgG2 concentration in group 4 was significantly higher than in groups 1 and 2, while the IgG4 concentration in group 4 was significantly lower than in other groups. The frequency of seropositivity for IgG4 and IgA was lowest in group 4, while IgG3 seropositivity was almost exclusively seen in healthy patients in groups 2, 4. These findings suggest that the presence of IgG3 may reflect non-susceptibility to the disease, while lack of IgG4 may be indicative of periodontal health and lack of infection.

Cytokine profiles of cells extracted from humans with periodontal diseases

FACS analysis was used to determine the percent interferon (IFN)-gamma-, interleukin (IL)-4-, IL-10-, and CD30-positive T-cells extracted from adult periodontitis (AP) and healthy/gingivitis (H/G) subjects. Additionally, the percentages of IL-1 beta-, IL-10- and IL-12-producing B-cells and macrophages were ascertained. The percent IL-10+ CD8 cells extracted from AP lesions was decreased compared with H/G tissues (p = 0.033), and the percent CD30+ CD4 (p = 0.001) and CD30+ CD8 (p = 0.028) cells was higher in AP than in H/G tissues. The percentages of IL-1 beta + macrophages (p = 0.003) and IL-12+ B-cells (p = 0.034) were both higher in AP lesions than in H/G tissues. The specific effect of Porphyromonas gingivalis on the cytokine profiles of peripheral blood mononuclear cells isolated from P. gingivalis-infected AP and H/G patients was also determined. While there were no significant differences in the percent cytokine-positive T-cells after stimulation with P. gingivalis outer membrane antigens (OM) for 6 days compared with cells incubated in medium only, the percent CD30+ CD4 cells increased significantly (p = 0.047 and p = 0.063 for AP and H/G groups, respectively). There was also an increase in the percent IL-1 beta + B-cells from AP patients (p = 0.029), and the percent IL-12+ monocytes from AP and H/G subjects was higher than the percent IL-12+ B-cells, both after stimulation with P. gingivalis OM (p = 0.005 for the AP group and p = 0.058 and therefore not quite significant for the H/G group) and when incubated in medium alone (p = 0.016 and p = 0.015 for AP and H/G groups, respectively). This study has shown that IL-10+ CD8 cells may be significant in gingival lesions, and that CD30+ T-cells indicative of Th2 or Th0 cells may play a role in progressive periodontal disease. This study has also shown that B-cells produce IL-1 in the gingival lesion and that P. gingivalis may be significant in the induction of B-cell-induced IL-1.