HLA-D types and serum IgG responses to Capnocytophaga in diabetes and periodontitis

Serum IgG responses to the cell envelope proteins (CEPs) from Capnocytophaga sputigena, Capnocytophaga ochracea, and Capnocytophaga gingivalis were examined in periodontally healthy and periodontitis subjects, both with and without type 1 diabetes (n = 60). Serum IgG responses to CEPs were determined by immunoblotting with biotin-goat anti-human IgG and an alkaline phosphatase-streptavidin system. Reactivity was analyzed by transmission densitometry, digitization, and computer manipulation. The patients with diabetes showed significantly (p < 0.01) fewer responses to 14 CEPs (from 81 to 10 kDa) from C. sputigena, 5 CEPs (from 90 to 17 kDa) from C. gingivalis, and the 27-kDa CEP from C. ochracea than in the non-diabetic group. The periodontitis patients showed significantly (p < 0.01) fewer responses to the 25- and 11-kDa CEPs from C. sputigena, the 125- and 17-kDa CEPs from C. gingivalis, and the 42-kDa CEP from C. ochracea than in the periodontally healthy group. HLA-DR4, HLA-DR53, and HLA-DQw3 were associated with periodontitis, while only HLA-DR4 was associated with diabetes (p < 0.02). Significant (p < 0.01) correlations were found between HLA-DR2 and IgG reactivity patterns associated with non-diabetics, and between HLA-DR4 and IgG reactivity patterns associated with diabetic and periodontitis subjects. These results indicate that both type 1 diabetics and periodontitis subjects have a depressed IgG antibody profile to Capnocytophaga, which may account for an increased susceptibility to periodontitis infection. Periodontitis in type 1 diabetes may be related more to the HLA-D type and altered immune function than to the diabetes itself.

Expression of receptor beta-chain variable region by T cells in human periodontal disease

T cells play a major part in the immune response in periodontal diseases. In order to determine any selective T-cell receptor (TCR) beta-chain variable region (V beta) usage in the infiltrates of healthy/ gingivitis (H/G) and adult periodontitis (AP), cells were extracted from gingival biopsies, the CD4 and CD8 cells stained with antibodies to eight V beta regions, and two-colour flow cytometry used to analyse the data. The frequencies of CD4 and CD8 cells expressing each of the TCR-V beta families varied from 0 to 46% between individuals. A high percentage of CD4 and CD8 cells expressed the V beta 13 family in several AP biopsies, but, in a number of H/G tissues, a high percentage of T cells expressed up to three families including the V beta 13 region, these varying from individual to individual. The mean results showed a significantly greater percentage of V beta 5.2-3-positive CD4 cells (p = 0.003) and V beta 5.1- and 5.2-3-positive CD8 cells (p = 0.003 and 0.025, respectively) isolated from H/G than AP tissues. The percentage of V beta 3.1-positive CD4 cells extracted from H/G tissues was also higher but not quite significant at the 0.05 level (p = 0.051). Sections of gingival tissue in biopsies from H/G and AP were stained in situ; there were no significant differences in the mean expression of V beta 3.1-, 5.1- or 5.2-3-positive cells. A second aim was to determine the effect of Porphyromonas gingivalis on the TCR repertoire. There were no differences in the mean percentage of CD4 or CD8 cells expressing the eight TCR-V beta regions between the two groups after stimulation in vitro with P. gingivalis outer-membrane antigens. There was, however, a trend towards a decrease in the percentage of positive CD4 and CD8 T cells after culture with the antigen. This was significant for CD4 cells from H/G expressing the V beta 5.1 and 5.3 TCRs (p = 0.032 and p = 0.038, respectively). This trend was not evident for V beta 5.2-3-positive CD4 cells or V beta 5.1-positive CD8 cells isolated from both H/G and AP nor for V beta 3.1-positive CD8 cells from AP. The results show that there may be restricted V beta usage in gingival tissues, particularly in H/G tissues. The V beta 5 and 3.1 families may be selected for in the gingival tissues and may also be involved in P. gingivalis activation.

Cytokine messenger RNA expression in chronic inflammatory periodontal disease

It has previously been reported that, in periodontitis lesions, T cells with a memory/activated phenotype and with a type 2 cytokine profile accumulate in an oligoclonal fashion. Delineation of the role of cytokines in periodontal inflammation has, however, been complicated because of cross-regulation and because of their overlapping and often redundant effects. The aim of this study was to examine messenger RNA levels for interferon gamma, interleukin 4 (IL-4), IL-10, IL-12 and IL-13 in gingival tissues and peripheral blood mononuclear cells of patients with adult periodontitis. Reverse transcription polymerase chain reaction and subsequent image analysis was used to determine the level of mRNA for each cytokine. The mean expression of interferon gamma mRNA was significantly higher in peripheral blood mononuclear cells than in gingival tissues. In contrast, the mean expression of IL-10 mRNA was higher in gingival tissues than in peripheral blood mononuclear cells. This high expression of IL-10 mRNA was, in fact, seen in only 7 gingival tissue samples with the majority of samples showing levels similar to peripheral blood mononuclear cells. There was no difference in the mean expression of IL-12 p35 mRNA between gingival tissues and peripheral blood mononuclear cells. However, IL-12 p40 mRNA was expressed higher in gingival tissues than in peripheral blood mononuclear cells in 6 out of 16 samples with significant difference of mean expression. Like IL-10, gingival tissue samples and peripheral blood mononuclear cells expressed similar levels of IL-12 p40 mRNA. There was no difference in the mean expression of IL-13 in gingival tissues and peripheral blood mononuclear cells. Nevertheless, more peripheral blood mononuclear cell samples demonstrated high IL-13 mRNA expression than gingival tissue samples. IL-4 mRNA was weak but detectable in 3 gingival tissue samples. These results support the concept that cytokines form complex networks in periodontitis lesions and that their overlapping and redundant effects should be taken into account when considering the pathology of inflammatory periodontal disease. Dichotomous expression of IL-10 and IL-12 p40 mRNA in the periodontal lesion may be associated with disease entity.

Immunohistological study of lesions induced by Porphyromonas gingivalis in a murine model

A previous study used a mouse model to demonstrate protection after challenge with Porphyromonas gingivalis ATCC 33277. In the present study, this same model was used to determine the phenotype of cells recruited into the lesions during the course of the protective immune response after immunization with this periodontal pathogen. BALB/c mice were immunized with 100 micrograms of P. gingivalis outer membrane antigens per mouse weekly for 3 weeks followed by challenge with live organisms 3 weeks after the final immunization. Hematoxylin and eosin-stained sections showed inflammatory infiltrates in all lesions from control (immunized with adjuvant only) and immunized mice. The lesions developed central necrotic cores surrounded by neutrophils, phagocytic macrophages and lymphocytes. Neutrophils were the predominant cells in the lesions 1 day after challenge with significantly more in immunized than control mice. Acid phosphatase and nonspecific esterase-positive macrophages were detected at day 4 and became the predominant cells in the healing lesions. CD4- and CD8-positive T-cells were present from day 1, and while numbers increased over time, there were no significant differences in control or immunized mice. When mice were depleted of CD4 or CD8 cells prior to immunization with P. gingivalis, fewer neutrophils were found in the lesions 1 day after challenge compared with undepleted immunized mice. Acid phosphatase and nonspecific esterase-positive macrophages were not affected by T-cell depletion. The results suggest that the P. gingivalis-induced lesion in immunized BALB/c mice is consistent with a strong innate immune response involving the recruitment of neutrophils in the first instance which may be under the control of T cells. This is followed by the infiltration of phagocytic macrophages which are involved in the healing process and do not appear to be regulated by T cells.

CD29 expression on CD4+ gingival lymphocytes supports migration of activated memory T lymphocytes to diseased periodontal tissue

The cell surface phenotypes of CD+ cells extracted from inflammatory periodontal disease tissues were analyzed using two- and three-color immunofluorescence and flow cytometry. Cells extracted from both adult periodontal and localized juvenile periodontitis lesions showed a depressed CD4/CD8 ratio (1.0 +/- 0.1 adult periodontitis and 1.1 +/- 0.1 localized juvenile periodontitis) compared with cells recovered from normal/marginal gingivitis tissue (1.8 +/- 0.2) or with normal peripheral blood cells (2.1 +/- 0.1) or periodontal disease blood cells (2.1 +/- 0.1 and 1.7 +/- 0.1 for adult periodontitis and juvenile periodontitis, respectively). The monoclonal antibodies anti-2H4 and anti-4B4 were used to identify the CD45RA and CD29 antigens respectively on CD4+ T cells from the periodontal disease lesions. In peripheral blood. CD29+ cells accounted for 66-77% of the CD4+ population, and CD45RA+ cells accounted for 22-27% of the CD4+ subset. No differences in expression were found between peripheral blood lymphocytes from normal subjects and from periodontal disease patients. Two-color analyses of lymphocytes from periodontal diseased tissues showed that 87-89% of the CD4+ population were CD29+ and that 70-79% of the CD4+ cells were CD45RA+. Normal tissues contained significantly fewer CD4+CD29+ cells (56 +/- 4%) and CD4+CD45RA+ cells (40 +/- 4%) on average, and few, if any double-labelled cells could be accounted for. These data implied that a significant percentage of the CD4+ cells from the diseased tissues were both CD29+ and CD45RA+ and that these populations are found in quite different proportions in diseased periodontal tissue than in peripheral blood or nondiseased tissue. In further analyses using three-color cytometry the mean percentage of CD4+ CD29+ CD45RA+ lymphocytes extracted from periodontal disease lesions was 43 +/- 9% of the CD4+ population. These results suggest that CD4+ T lymphocytes in periodontal disease not only demonstrate varying levels of maturity but also that the accumulation of CD4+ T cells within the periodontal tissues may be a result of increased adhesion and transendothelial migration.

Efficacy of a dentifrice and oral rinse containing sanguinaria extract in conjunction with initial periodontal therapy

In the treatment of periodontal disease initial therapy aims at reducing marginal inflammation so allowing assessment of residual disease and further treatment options. The aim of the present study was to determine whether the use of a dentifrice and oral rinse containing sanguinaria extract led to a more rapid resolution of gingival inflammation following initial therapy. Thirty-four subjects, randomly assigned to one of two treatment groups, took part in this randomized double-blind parallel study. All subjects received initial therapy including oral hygiene instruction and scaling and root planing as required. One group also received an active dentifrice and oral rinse containing sanguinaria extract (an antiplaque agent) and zinc chloride. The other group received a placebo dentifrice and oral rinse. The gingival index (GI), plaque index (PLI) and probing pocket depths (PD) were recorded at six sites per tooth at baseline, two weeks after initial therapy and six weeks after initial therapy. There was no significant difference between the groups for any of the parameters at the baseline examination. Two weeks following initial therapy both groups showed a statistically significant increase in the number of sites with PLI of 0 or 1 (p < 0.0001) and a statistically significant increase in the number of sites with a GI of 0 or 1 (that is, no bleeding on probing), (p < 0.0001). Also there was a statistically significant increase in the number of sites with probing depths < or = 3 mm (p < 0.0001) compared with baseline. These changes were maintained through to six weeks post therapy. There was no significant advantage to the sanguinaria group. Results demonstrate that initial therapy in the form of oral hygiene instruction, scaling and root planing leads to a significant improvement in periodontal status which is maintained at least in the short term. Further, use of a dentifrice and oral rinse containing sanguinaria did not improve the efficacy of initial therapy.

The detection of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia using an ELISA in an adolescent population with early periodontitis

The aim of the study was to compare the occurrence and levels of A. actinomycetemcomitans, P. gingivalis, and P. intermedia in the subgingival plaque from sites with and without early periodontitis in adolescents using an ELISA. 47, 15- to 16-year-old adolescents (39 Indo-Pakistani, 8 white Caucasian) were examined for clinical attachment level, probing depth, supragingival plaque, subgingival calculus and bleeding on probing on the mesio-buccal and disto-buccal aspects of the 1st molars and the incisors. Based on the clinical data, 2 sites per subject were selected for subgingival plaque sampling 3 weeks later: in 32 subjects with loss of attachment > or = 1 mm, a diseased site (D) and a healthy comparison control site (C) were sampled; in 15 subjects in whom loss of attachment had not yet developed, 1 of the upper molar sites was selected, called the at-risk site (R), together with a C site. The presence and levels of A. actinomycetemcomitans, P. gingivalis, and P. intermedia were determined using an ELISA. The loss of attachment subgroup had significantly more pockets > or = 4 mm, subgingival calculus and bleeding on probing (p < 0.05). Significantly more of the D than C sites had P. gingivalis both at detectable and at measurable levels (p < 0.05). In subjects who had no loss in clinical attachment levels, fewer sampled sites harboured any of the suspected periodontopathogens investigated, and no significant differences were found between the R or C sites (p > 0.05). Although there was a significantly higher prevalence and extent of loss of attachment > or = 1 mm in the Indo-Pakistani subjects compared with the Caucasians (p < 0.05), no differences could be identified in the distribution of the bacteria. It is concluded that monitoring of the subgingival plaque may be useful in studies of early periodontitis in adolescents, and the role of P. gingivalis needs to be elucidated in prospective longitudinal investigations.

TCR V beta gene expression in lesional T lymphocyte cell lines in oral lichen planus

To study V beta gene expression in oral lichen planus (OLP) lesional T lymphocytes cell lines.

MATERIALS AND METHODS

Lesional T lymphocytes were isolated from eight OLP patients and cell lines established. The total RNA was extracted from these lymphocyte cell lines and reverse transcribed. cDNA was amplified by the polymerase chain reaction (PCR) using a panel of 26 V beta-specific oligonucleotide primers followed by qualitative analysis of the electrophoresed reaction products.

RESULTS

V beta 1, 2, 3, 5.1, 6.1-3, 7, 8, 9, 22, 23, and 24 were represented consistently in all of the OLP samples, V beta 11, 12, and 17 were consistently negative, while the other V beta families (V beta 4, 5.2-3, 10, 13.1, 13.2, 14, 15, 16, 18, 19, 20, and 21) were variable. V beta 22 and 23 were the most strongly expressed in all patients.

CONCLUSIONS

A limited T cell receptor (TCR) gene usage indicates a degree of oligoclonality within these lesional T lymphocyte cell lines from OLP. This implies that OLP may be an antigen-specific disease or linked to a limited number of superantigens.

Expression of CD1a monocytes cultured with supernatants from periodontally diseased gingival epithelial cells

Langerhans cells are believed to originate from the monocyte lineage and have been reported to increase in number with plaque accumulation and gingival inflammation. The aim of this study was to investigate the effects of local gingival epithelial factors on the induction of CD1a, a Langerhans cell phenotype, on monocyte rich populations.

MATERIALS AND METHODS

Peripheral blood monocyte rich in populations from healthy subjects were cultured for 24 h with either healthy gingival or periodontally diseased gingival epithelial supernatants. Additionally, the monocyte rich populations were cultured with cytokines IL-I alpha, IL-I beta, IL-6 and TNF-alpha which are known to be produced by epithelial cells or co-cultured with autologous epithelial cells. The per cent CD1a positive cells was determined using FACS analysis.

RESULTS

Healthy gingival supernatants did not induce CD1a expression in monocyte rich populations, however, a significant increase in per cent CD1a+ cells for monocyte rich populations cultured with five (P < 0.01) of six periodontal gingival epithelial supernatants was found. IL-I alpha or TNF-alpha (10 ng/well) resulted in a significant increase in the per cent CD1a+ cells (P < 0.01). Depletion of CD1a+ Langerhans cells from healthy gingival epithelium did not enhance induction of CD1a expression in monocyte rich populations. Monocyte rich populations cultured together with non-depleted epithelial cultures resulted in a decreased per cent of CD1a+ cells.

CONCLUSION

These findings indicated that epithelial factor/s associated with periodontally involved epithelia, may be involved in inducing a Langerhans cell phenotype in monocyte rich populations. The data also provide indirect evidence for a role of Langerhans cells in inhibiting induction of CD1a in healthy epithelium.

Biased expression of T cell receptor V beta genes in periodontitis patients

The aim of the present study was to investigate the hypothesis that there is selective activation and expansion of a limited repertoire of T cell receptor (TCR)-bearing T cells in periodontitis tissue. We studied TCR V beta gene expression in gingival tissues of periodontitis lesions and compared these with peripheral blood mononuclear cells (PBMC) from the same patients using polymerase chain reaction (PCR) amplification with 22 V beta-specific sense primers in combination with a common antisense C beta-specific primer. After initial therapy, gingival tissue specimens were obtained from 14 periodontitis patients at the time of periodontal surgery, and PBMC were also obtained from the same patients by density gradient centrifugation. Total RNA was extracted and analysed by reverse transcription PCR. The PCR products were electrophoresed on a 2% agarose gel and stained with ethidium bromide. For each product, gingival tissue and the respective peripheral blood were compared. The TCR repertoire identified in the PBMC in general overlapped with that of the gingival tissue. However, V beta 6 appeared to be over-expressed in the gingival tissues compared with the PBMC, but V beta 16 appeared to be under-expressed in the gingival tissues. Although it is not known whether this is due to antigen-specific activation or superantigen activation, the data suggest that there may be as yet uncharacterized T cell subsets in periodontal disease tissue.

Abnormal prostatic cells in ejaculates from men with prostatic cancer--a preliminary report

OBJECTIVE

To relate findings from a novel approach, ejaculate cytology, to the established reference, histopathology from transrectal ultrasonography (TRUS)-guided prostatic biopsies, in patients at risk of having prostatic cancer on the basis of an abnormal digital rectal examination (DRE) and/or an elevated serum prostate specific antigen (PSA). PATIENTS SUBJECTS AND METHODS: Thirty-seven men suspected of having prostatic carcinoma provided ejaculate specimens which were collected in Hanks solution. The specimens were centrifuged to form a pellet from which smears were made for cytological examination. Immunohistochemical staining for PSA and prostatic acid phosphatase (PAP) were performed on embedded blocks of these cells. TRUS-guided sextant biopsies were performed for histological specimens using standard clinical procedures. A control group of 32 men < 30 years of age, with no family history of prostatic cancer, also produced specimens of ejaculate which were processed similarly.

RESULTS

Frankly malignant and atypical prostatic cells were identified in ejaculate specimens from 14 of the 37 patients. Of 12 patients with TRUS biopsies positive for malignancy, nine (75%) had abnormal cells in their ejaculates. Furthermore, five of 25 patients with negative biopsies for adenocarcinoma also had abnormal ejaculate cytology; two of these five patients had high-grade prostatic intra-epithelial neoplasia (PIN). In the control group, no PSA- or PAP-positive prostatic epithelial cells were identified. Normal prostatic cells were not seen in any of the ejaculate specimens examined.

CONCLUSIONS

These results indicate that ejaculate cytology, which is a non-invasive and easily repeated investigation, may prove to be a useful approach in the early detection of cancer of the prostate. However, its value in this role, together with the clinical significance of cytological findings, needs to be established, especially in relation to PSA and TRUS biopsy.

Is there a role for tumor necrosis factor-alpha (TNF-alpha) in oral lichen planus?

Oral lichen planus (OLP) is a T cell-mediated inflammatory disease of the oral mucosa. T lymphocytes accumulate within OLP lesions by extravasation from the local microvasculature and subsequent migration to the oral epithelium. Tumor necrosis factor-alpha (TNF-alpha) is a cytokine involved primarily in T cell-mediated immunopathological reactions, and it is implicated in diseases which bear clinical and histological similarities to OLP. This review examines the role of TNF-alpha in the initiation and progression of OLP, and summarises evidence for a key role for TNF-alpha in this disease. A unifying hypothesis for the involvement of TNF-alpha in the immunopathogenesis of OLP is presented. Based on this model, a variety of current therapies are explained and several alternative approaches suggested.

High magnification in situ viewing of wound healing in oral mucosa

Microscope endoscopy is a technique which allows high resolution, non-invasive examination of soft tissues. This study employed microscope endoscopy to examine the process of healing following exposure of the oral mucosa to carbon dioxide laser radiation. On the wound boundaries, cellular debris and the laser-induced char layer were shed as epithelial migration occurred. Wounds healed by secondary intention, with complete epithelial closure by 72 hours. A marked vascular response was evident from 6 to 48 hours following wounding, a time period coincident with the known pattern of blood vessel activation and infiltration of the wound site by leukocytes. The use of microscope endoscopy as an adjunct to biopsy and other invasive diagnostic methods in the assessment and follow-up of soft tissue pathology may have value in clinical practice.

Establishment of peripheral blood and gingival T lymphocyte clones responsive to Porphyromonas gingivalis

T cells are central to the immune response to infection and studies have indicated a local immunoregulatory imbalance may exist in human periodontal disease. Since Porphyromonas gingivalis is generally recognized as a major periodontopathogen, the aim of this study was to establish T cell lines and clones specific to P. gingivalis from the gingival tissues and peripheral blood of P. gingivalis--infected subjects. Two subjects were selected from two groups of individuals (one from each group) established on the basis of P. gingivalis in their plaque and the presence of serum antibodies which react with P. gingivalis antigens. The two groups differed however in their clinical susceptibility (adult periodontitis) or resistance (gingivitis) to periodontal breakdown. The mean ages +/- standard error of the mean of the two groups were 47.9 +/- 2.2 and 49.6 +/- 3.7, respectively, so that resistance in the gingivitis group was related to the age of the subjects. T cell lines and clones were established from the peripheral blood of one patient from each of the two groups and also from the gingival tissues of the same periodontitis subject. This study has demonstrated the capability of establishing P. gingivalis-specific T cell lines and clones from P. gingivalis-infected subjects and FACS analysis of the T cell receptor variable regions demonstrated that the clones were indeed monoclonal. The CD4:CD8 ratios of the peripheral blood-derived T cell lines were 1.2 and 0.4 for the gingivitis-derived line and the periodontitis-derived line, respectively, thus supporting the clinical differences displayed by the two subjects.

Periodontics into the 21st century

In recent years advances in clinical techniques and procedures such as guided tissue regeneration and implants, have dominated periodontics. However, as we move towards the 21st century, emphasis is swinging 'back to basics' with the recognition that patient susceptibility to periodontal disease determines the ultimate outcome not only of the disease process but also of the treatment undertaken. In this context attention is returning to the host response and with the advent of clonal and molecular biological techniques, new insights are being gained into the nature of host susceptibility. Previous studies have suggested that a T-cell/macrophage immunoregulatory imbalance may exist locally in the periodontitis lesion and that this imbalance may be antigen specific. More recently, T-cell subsets have been dichotomized on the basis of their cytokine profiles. In general, Th1 cells produce IL-2 and IFN-gamma while Th2 cells produce IL-4, IL-5 and IL-6. The major function of Th1 cells is to mediate delayed type hypersensitivity. In contrast the major function of Th2 cells is to provide B-cell help. A model for periodontal disease has now been developed based on this functional dichotomy which provides a framework for the study of cytokine profiles in periodontal disease. Early studies in this context have demonstrated higher proportions of IL-4 and IL-13 producing cells in periodontitis tissues together with possible variations in IL-10 production. Clonal studies have shown that the selection of a particular cytokine profile is not antigen dependent and that differences may be due to the host susceptibility although this remains to be determined.

Cellular immunity and hypersensitivity as components of periodontal destruction

BACKGROUND

Cellular immunity has been implicated in periodontal destruction for over 25 years. Studies in the 1970s used lymphocyte transformation and lymphokine assays to establish a role for cell-mediated mechanisms in periodontal disease. Immunohistological studies subsequently showed that the formation of gingivitis followed a similar pattern to the formation of a delayed type hypersensitivity reaction. Further functional studies suggested that a T cell/macrophage immunoregulatory imbalance may exist locally in the periodontitis lesion and that this imbalance may be antigen specific. RECENT EVIDENCE: More recently, T cell subsets have been dichotomised on the basis of their cytokine profiles. In general, ThI cells produce IL-2 and IFN-gamma while Th2 cells produce IL-4, IL-5 and IL-6. The major function of Th1 cells is to mediate delayed type hypersensitivity. In contrast the major function of Th2 cells is to provide B cell help.

HYPOTHESIS

A model for periodontal disease has now been developed based on this functional dichotomy which provides a framework for the study of cytokine profiles in periodontal disease. Early studies in this context have demonstrated a higher proportion of IL-4 producing cells in periodontitis tissues suggesting a role for Th2 cells in the progressive lesion. Clonal studies have shown that the selection of a particular cytokine profile is not antigen dependent and that differences may be due to the host susceptibility although this remains to be determined.

CONCLUSION

These emerging data clearly establish a role for cell-mediated mechanisms in the control of periodontal destruction and raise the possibility that in the future cytokine therapy for the treatment of periodontal disease in susceptible subjects may become a viable option.

Microbiological and serological investigations of oral lesions in Papillon-Lefèvre syndrome

Microbiological and serological (enzyme linked immunosorbent assay) investigations were carried out, including karyotyping, on two Asian children with Papillon-Lefèvre syndrome. In case 1, a girl aged four years, the most prevalent putative periodontopathogens were Eikenella corrodens, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia (deciduous dentition) and Bacteroides gracilis, E corrodens and F nucleatum (permanent dentition). In case 2, a boy aged nine years, they were F nucleatum, P intermedia and P loeschii and E corrodens. Serum from case 2 showed a raised specific IgG antibody response to Actinomyces actino-mycetemcomitans serotype b. Thus, a wider range of species than hitherto reported may be associated with Papillon-Lefèvre syndrome, including A actino-mycetemcomitans and F nucleatum.

Characterization of T lymphocyte clones derived from Porphyromonas gingivalis infected subjects

Porphyromonas gingivalis plays a major role in the pathogenesis of periodontal disease, however some individuals with P. gingivalis infection do not experience periodontal breakdown. The aim of this study was to investigate the proliferative responses of two highly defined groups of subjects and to establish and characterize peripheral blood and gingival cell T cell lines and clones from subjects from these groups. The two groups were selected on the basis of P. gingivalis in their plaque and the presence of serum anti-P. gingivalis antibodies. Both groups therefore were seen to have P. gingivalis and to have responded to it. They however differed only in their clinical susceptibility (adult periodontitis) or resistance (gingivitis) to periodontal breakdown. Dose responses of peripheral blood mononuclear cells extracted from the subjects showed a trend towards a lower response by the adult periodontitis group to P. gingivalis outer membrane (OM) antigens. Peripheral blood T cell lines and clones responsive to P. gingivalis OM were established from a high responding gingivitis subject and a low responding adult periodontitis subject. Gingival T cell lines and clones were also derived from cells extracted from the periodontal tissues of the same periodontitis subject. The majority of T cells in the peripheral blood T cell line from the gingivitis subject were CD4 while those from the adult periodontitis subject were CD8. The gingival T cell line was CD3+ve CD4-ve and CD8-ve. All lines and clones proliferated slowly to P. gingivalis OM but phytohaemagglutinin (PHA) induced an increase in DNA synthesis in those derived from the gingivitis subject with little to no effect on those established from the adult periodontitis subject. Furthermore, PHA inhibited the proliferative response of the CD8 clone derived from the adult periodontitis subject. Phenotypic analysis demonstrated that all the peripheral blood clones expressed the alpha beta TCR while the gingival T cell clones expressed the gamma-delta TCR. All clones had the memory/primed CD45RO+ve phenotype and at least 80% of cells in each clone were HLA-DR+ve. A lower percent of gingival cells expressed CD45RA than the CD4 peripheral blood clones and the two CD8 clones also had a decreased CD45RA expression. The gingival T cell clones also expressed a low percent CD25 as did the CD8 clone derived from the adult periodontitis subject. The results suggest that clones derived from the gingivitis and adult periodontitis subject may be functionally different. The presence of gamma-delta T cells in adult periodontitis remains to be confirmed and their function determined.

Purification and characterization of Porphyromonas gingivalis outer membrane antigens

Porphyromonas gingivalis is strongly associated with periodontal disease. Significant titres of specific IgG antibodies to P. gingivalis can be found in healthy individuals and those with periodontitis. In this study, 22 outer membrane antigens ranging from 15.5 to 107.6 kDa were recognized by sera from persons with periodontitis and controls. Serum from individuals with periodontitis showed a significantly higher IgG response to a 31.4-kDa antigen (p < 0.05); serum from those with gingivitis demonstrated a significantly higher response to a 15.5-kDa antigen (p < 0.05). The response to the 15.5-kDa antigen might represent a protective immune response while that to the 31.4-kDa could serve as a marker for disease susceptibility. These two antigens were purified to homogeneity and their N-terminal amino acid sequences determined. The sequences did not correspond to any previously described P. gingivalis antigens. The role of these two antigens in the pathogenesis of periodontal disease remains to be determined.

Gamma delta T lymphocytes in human periodontal disease tissue

Gamma delta T cells have been implicated as playing a role in inflammatory and autoimmune conditions. In this study, a biotin-streptavidin peroxidase technique was used to determine the presence of T cells expressing alpha beta and gamma delta T cell receptors (TCR) in the inflammatory infiltrates of gingival tissue sections from gingivitis and adult periodontitis patients. The lesions were graded 1+ to 3+ according to the size of the infiltrate. alpha beta+ T cells predominated in all infiltrates with no differences in the mean percent (20 to 30%) according to size of lesion or to clinical status. A mean percent gamma delta T cells of 0.42 +/- 0.11 and 0.91 +/- 0.42 was demonstrated in 1+ infiltrates of gingivitis and adult periodontitis sections respectively. Although the mean percent gamma delta T cells increased in both gingivitis (2.09 +/- 0.54) and adult periodontitis sections (2.25 +/- 0.35) with increasing size of infiltrate, this was not statistically significant. However, when the mean proportion of gamma delta T cells of the total TCR bearing cells was determined, there was a significant 3 to 4 fold increase in adult periodontitis sections from 3.09 +/- 1.35 in 1+ lesions to 11.90 +/- 2.94 and 8.81 +/- 1.45 in 2+ and 3+ lesions respectively. A similar increase of the same magnitude occurred in gingivitis sections from 2.82 +/- 0.74 in 1+ lesions to 11.12 +/- 4.13 in 2+ lesions, but this was not significant (P = 0.055). There was no correlation between the increase in the proportion of gamma delta T cells and the T:B cell ratio or the CD4:CD8 ratio in individual lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Interleukin-1 (IL-1) bioactivity and inhibition of IL-1 bioactivity in supernatant fluid from cultured microphthalmic (mi) mice teeth of different ages

A functioning dental follicle and bone resorption are necessary for tooth eruption. In the microphthalmic (mi) mouse, bone resorption is defective and teeth fail to erupt. Local bone metabolism involves the production of cytokines such as interleukin-1 alpha (IL-1 alpha) and transforming growth factor-beta (TGF-beta). The production of these cytokines by dental tissues during eruption may be fundamental to tooth movement. Molars from mi mice were cultured and supernatants tested for the presence of these cytokines using bio-dot blotting and ELISA. A thymocyte bioassay was used to test supernatants for IL-1 bioactivity and IL-1 inhibition bioactivity. IL-1 alpha and TGF-beta were detected in all supernatants. Supernatants demonstrated no IL-1 bioactivity but inhibited IL-1 bioactivity which varied with concentration of supernatant, age and animal. This study demonstrated that cultured developing teeth secrete IL-1 alpha and TGF-beta however, concentrations varied in normal and pathological states. While IL-1 alpha was present in the supernatants, all demonstrated a variable ability to inhibit IL-1 bioactivity. This ability may influence local bone metabolism and hence tooth eruption.

Antibody responses of Porphyromonas gingivalis infected gingivitis and periodontitis subjects

Porphyromonas gingivalis demonstrates a strong association with adult periodontitis although some individuals with the infection do not experience attachment loss. Therefore differences in the immune response to this organism may be of importance to the outcome of the disease.

OBJECTIVE

The aim of this study was to determine whether P. gingivalis positive subjects with and without periodontal breakdown, reacted differently to P. gingivalis antigens as assessed by the pattern of serum antibody reactivity.

MATERIALS AND METHODS

Two highly defined groups of subjects were chosen for this study. Both demonstrated P. gingivalis in their plaque and both had responded to P. gingivalis as shown by the presence of serum antibodies. The two groups differed only in their apparent clinical susceptibility to periodontal breakdown. Western blots of P. gingivalis membrane antigens were probed with sera from the two groups to determine their reactivity to specific antigens.

RESULTS

Analysis of the immunoblots showed that there were no differences in either the total numbers of bands, or bands recognized by the majority of subjects in the gingivitis and adult periodontitis groups. There were however, four bands recognized by the majority of the gingivitis group and not by the majority of the adult periodontitis group, there being a significant difference (P = 0.03) in the recognition of the 91.4-kDa antigen band. A further five antigens of lower molecular weight were seen by the majority of the adult periodontitis group and not by the majority of the gingivitis group. When sera were tested against purified P. gingivalis LPS, the results indicated that the five antigens seen by the majority of the adult periodontitis group had molecular weights which were in the range exhibited by the LPS antigens.

CONCLUSION

These results suggest that gingivitis and adult periodontitis subjects with P. gingivalis infection, may recognize different P. gingivalis antigens.