Leukotoxic effects of Actinobacillus actinomycetemcomitans. Modulation by serum components

The role of antibody, complement and neutrophils in host defense against Actinobacillus actinomycetemcomitans

A. actinomycetemcomitans is a facultative Gram-negative coccobacillus which has been implicated in the etiology and pathogenesis of localized juvenile periodontitis and has also been recognized for its potential to cause serious extraoral infections, particularly endocarditis. The polymorphonuclear neutrophil has been suggested to play a key role in host resistance to periodontopathic organisms, as indicated by the association between defective production or function of these phagocytic cells and severe periodontal disease. This association has engendered interest in the study of the interaction between neutrophils and A. actinomycetemcomitans, as well as the role of immunoglobulin and complement in facilitating this interaction. The objective of this review is to summarize current knowledge of the nature and consequences of the interaction between A. actinomycetemcomitans and the host defense triad consisting of neutrophils, complement and immunoglobulin.

Killing of human myelomonocytic leukemia and lymphocytic cell lines by Actinobacillus actinomycetemcomitans leukotoxin

The purified leukotoxin of Actinobacillus actinomycetemcomitans kills human leukemic cell lines (e.g., HL-60, U937, and KG-1) and human T- and B-cell lines (e.g., JURKAT, MOLT-4, Daudi, and Raji) in a dose- and time-dependent manner. The 50% effective doses for these cell lines are similar to those established for human polymorphonuclear leukocytes and monocytes. In contrast, other human and nonhuman tumor cell lines are not susceptible to the leukotoxin. These human leukemia and lymphoid cell lines will serve as useful model systems with which to study the molecular specificity and mechanism(s) of action of the actinobacillus leukotoxin.

Immunosuppressive properties of Actinobacillus actinomycetemcomitans leukotoxin

Actinobacillus actinomycetemcomitans produces a leukotoxin that kills human polymorphonuclear cells (PMNs) and monocytes but not lymphocytes. In this study, we examined A. actinomycetemcomitans leukotoxin for its ability to alter human peripheral blood lymphocyte (HPBL) responsiveness. After a 90-min exposure to the leukotoxin, all monocytes were killed and HPBL responsiveness to mitogens and antigens was significantly inhibited. The ability of the leukotoxin to inhibit HPBL responses was not surprising, since monocytes and macrophages are required for many lymphocyte functions. However, we were unable to totally restore HPBL responsiveness when adherent autologous monocytes were added back to cultures of leukotoxin-treated lymphocytes. These studies demonstrate that A. actinomycetemcomitans leukotoxin may also exert nonlethal effects directly on lymphocytes. Furthermore, impaired lymphocyte function did not appear to be the result of indirect effects of products released by dying monocytes. Although it is not clear how A. actinomycetemcomitans acts to cause disease, several investigators have proposed that impaired host defenses may play a pivotal role. Several studies have demonstrated defects in PMN, monocyte, and lymphocyte function in patients with periodontal disease. These findings, along with the data presented in this paper, support the hypothesis that patients who harbor A. actinomycetemcomitans could suffer from local or systemic immune suppression. The effects of this suppression may be to enhance the pathogenicity of A. actinomycetemcomitans itself or that of some other opportunistic organism.

Replacement therapy of the prevention of dental disease

Certain laboratory-derived and naturally occurring oral bacteria are promising effector strains for the replacement therapy of dental infectious diseases. In the case of dental caries, several types of low-acid-producing mutants of Streptococcus mutans and a natural variant of S. salivarius have been found that are virtually non-cariogenic. Laboratory rats can be readily and persistently infected with these micro-organisms. Once infected, the animals become much more resistant to infection by wild-type (disease-causing) strains of S. mutans. Thus, in the laboratory rat, replacement therapy has proved successful in providing lifelong resistance to dental caries following a single application of an effector strain. Attempts to extend these findings to humans have required a search for effector strains that can both colonize well and, in addition, displace indigenous, wild-type strains of S. mutans. A mutant of a strain of S. mutans producing a bacteriocin-like molecule has been found that appears to be well-suited for this purpose.

Replacement therapy may also find a practical application in the prevention and cure of certain periodontal diseases. Hydrogen peroxide-producing streptococci are invariably found in plaque taken from healthy gingiva; they are rarely found in samples from active disease sites of patients with juvenile or refractory periodontitis. In vitro, peroxide production by these streptococci inhibits the growth of Actinobacillus actinomycetemcomitans and several other presumed periodontal pathogens. Bacterial interactions of this sort have also been directly demonstrated to occur in vivo. Thus, natural inhibitors in plaque may be essential for maintenance of periodontal health. Patients lacking such inhibitors may be treated by replacement therapy to restore the composition of their plaque flora to one that is conducive to health.

Cell surface hydrophobicity of Actinobacillus actinomycetemcomitans Y4

Oral bacteria colonize the dento-gingival tissues in a selective manner. Hydrophobic reactions have been suggested as one of the major mechanisms of adhesion. Hydrophobicity of Actinobacillus actinomycetemcomitans Y4 (Aa) cells was studied in vitro using adherence to the liquid hydrocarbon, octane. Adherence of Aa cells to octane varied from 60-90%, depending on the medium in which they were grown, age of the culture and the buffer in which the assay was carried out. These data suggest that Aa is a hydrophobic bacterium, the hydrophobicity of which is expressed to a varying degree, and may have a rôle in its adherence to oral tissues.

Leukotoxic activity in Actinobacillus (Haemophilus) actinomycetemcomitans isolated from periodontal disease patients

Leukotoxic activity in Actinobacillus (Haemophilus) actinomycetemcomitans isolated from patients with rapidly progressive periodontitis (RP), gingivitis (G), and juvenile periodontitis (JP), and several oral bacteria, was determined by observation of morphological changes in polymorphonuclear leukocytes (PMNs). Many A. actinomycetemcomitans isolates yielded both rough-surfaced and umbonate-shaped colonies (A-type), and smooth-surfaced and convex-shaped colonies (B-type), when stock cultures were streaked on agar medium. Both types of cells were identical in terms of Gram stain, cell morphology, sugar fermentation profile, nitrate reduction and cellular fatty acid composition. Sonic extracts were prepared from 32 A. actinomycetemcomitans strains isolated from patients and from 3 American Type Culture Collection (ATCC) strains. Sonic extracts from 8 isolates and 2 ATCC strains induced sphering of PMNs during a 45-50 min period of incubation at 37 C. Extracts from the other oral bacteria had no effects on PMN morphology. The sphered PMNs were found by their fluorochromatic-negative reactions to be damaged cells. The leukotoxic substance was heat-sensitive (56 C, 30 min), trypsin-sensitive and did not induce sphering of PMNs at 4 C. There was no clear correlation between colony type and leukotoxicity. Among 8 leukotoxic strains, 5 were isolates from an RP patient.

Precipitating antibody against lipopolysaccharide of Haemophilus actinomycetemcomitans in human serum

Approximately 6% of 50 tested human sera possessed precipitating antibody against lipopolysaccharide from Haemophilus actinomycetemcomitans (Actinobacillus actinomycetemcomitans).

Oxidative and nonoxidative killing of Actinobacillus actinomycetemcomitans by human neutrophils

Actinobacillus actinomycetemcomitans is a facultative gram-negative microorganism which has been implicated as an etiologic agent in localized juvenile periodontitis and in subacute bacterial endocarditis and abscesses. Although resistant to serum bactericidal action and to oxidant injury mediated by superoxide anion (O2-) and hydrogen peroxide (H2O2), this organism is sensitive to killing by the myeloperoxidase-hydrogen peroxide-chloride system (K.T. Miyasaki, M.E. Wilson, and R.J. Genco, Infect. Immun. 53:161-165, 1986). In this study, we examined the sensitivity of A. actinomycetemcomitans to killing by intact neutrophils under aerobic conditions, under anaerobic conditions, and under aerobic conditions in the presence of the heme-protein inhibitor sodium cyanide. Intact neutrophils killed opsonized A. actinomycetemcomitans under aerobic and anaerobic conditions, and the kinetics of these reactions indicated that both oxidative and nonoxidative mechanisms were operative. Oxidative mechanisms contributed significantly, and most of the killing attributable to oxidative mechanisms was inhibited by sodium cyanide, which suggested that the myeloperoxidase-hydrogen peroxide-chloride system participated in the oxidative process. We conclude that human neutrophils are capable of killing A. actinomycetemcomitans by both oxygen-dependent and oxygen-independent pathways, and that most oxygen-dependent killing requires myeloperoxidase activity.

Reaction of human sera from juvenile periodontitis, rapidly progressive periodontitis, and adult periodontitis patients with selected periodontopathogens

The levels of serum antibody reactive to selected periodontopathogens were determined in 182 clinically characterized patients: 35 healthy control, 50 juvenile periodontitis, 42 adult periodontitis and 55 rapidly progressive periodontitis. Reactive antibody levels were determined using an enzyme-linked immunosorbent assay with whole cell preparations of Bacteroides gingivalis, Capnocytophaga (Bacteroides) ochraceus, Fusobacterium nucleatum and Actinobacillus actinomycetemcomitans (Y-4) serving as antigens. Increased reactivity to B. gingivalis and F. nucleatum was observed in all three disease groups studied while antibody reactive to A. actinomycetemcomitans was increased in juvenile and rapidly progressive periodontitis. Antibody levels reactive to C. ochraceus in healthy subjects did not differ from those observed in any disease patient groups. Possible implications in the etiology and progression of the diseases coupled with environmental changes which occur in the econiche of the periodontal pocket are described.

The cellular host response in juvenile periodontitis. A review

The current knowledge on the cellular, host-response features in juvenile periodontitis (JP) has been reviewed. The chemotaxis of the polymorphonuclear leukocytes (PMNs), known to be defective in JP, is modulated by serum factors and bacteria. The interactions of the putative etiologic pathogen Actinobacillus actinomycetemcomitans (A.a.) and the enzyme lysozyme with PMNs modify the host defense. Data on the phagocytic capacity of the peripheral blood and gingival crevice PMNs in JP are still controversial. The monocytes exhibit similar alterations as PMNs in interaction with A.a., but the reports on defective monocyte chemotaxis are conflicting. Both bacterial challenge and genetic factors may regulate the lymphocyte response in JP.

Actinobacillus actinomycetemcomitans in human periodontal disease

Recent evidence implicates Actinobacillus actinomycetemcomitans in the etiology of localized juvenile periodontitis. This paper reviews the morphological, biochemical and serological charcteristics of A. actinomycetemcomitans, evidence incriminating it as a periodontopathogen, its importance in human nonoral infections, and virulence factors which may be involved in the pathogenesis of A. actinomycetemcomitans infections. A. actinomycetemcomitans is a non-motile, gram-negative, capnophilic, fermentative coccobacillus which closely resembles several Haemophilus species but which does not require X or V growth factors. The organism has been categorized into 10 biotypes based on the variable fermentation of dextrin, maltose, mannitol, and xylose and into 3 serotypes on the basis of heat stable, cell surface antigens. A. actinomycetemcomitans' primary human ecologic niche is the oral cavity. It is found in dental plaque, in periodontal pockets, and buccal mucosa in up to 36% of the normal population. The organism can apparently seed from these sites to cause severe infections throughout the human body such as brain abscesses and endocarditis. There is a large body of evidence which implicates A. actinomycetemcomitans as an important micro-organism in the etiology of localized juvenile periodontitis including: (1) an increased prevalence of the organism in almost all localized juvenile periodontitis patients and their families compared to other patient groups; (2) the observation that localized juvenile periodontitis patients exhibit elevated antibody levels to A. actinomycetemcomitans in serum, saliva and gingival crevicular fluid; (3) the finding that localized juvenile periodontitis can be successfully treated by eliminating A. actinomycetemcomitans from periodontal pockets; (4) histopathologic investigations showing that A. actinomycetemcomitans invades the gingival connective tissue in localized juvenile periodontitis lesions; (5) the demonstration of several pathogenic products from A. actinomycetemcomitans including factors which may: (a) facilitate its adherence to mucosal surfaces such as capsular polysaccharides; (b) inhibit host defense mechanisms including leukotoxin, a polymorphonuclear leukocyte chemotaxis inhibiting factor, and a lymphocyte suppressing factor (c) cause tissue destruction such as lipopolysaccharide endotoxin, a bone resorption-inducing toxin, acid and alkaline phosphatases, collagenase, a fibroblast inhibiting factor and an epitheliotoxin.(ABSTRACT TRUNCATED AT 400 WORDS)

Defective neutrophil and monocyte motility in patients with early onset periodontitis

Several studies have documented suppressed polymorphonuclear neutrophil (PMN) chemotaxis in most patients with juvenile periodontitis. In contrast, data regarding PMN chemotaxis in patients with rapidly progressive periodontitis are very limited, and monocyte (MN) chemotaxis and random migration of PMNs or MNs from these patients have not been studied previously. Accordingly, we examined cell motility of PMNs and MNs from 27 patients with rapidly progressive periodontitis, 5 patients with juvenile periodontitis, and 37 normal control subjects by using a microchamber technique and the synthetic peptide N-formylmethionyl-leucyl-phenylalanine (FMLP) as the chemoattractant. As a group, PMNs and MNs from patients with rapidly progressive periodontitis manifested significantly enhanced random migration relative to control cells (P less than 0.001), suppressed directed migration (chemotaxis) at FMLP doses of 10(-9) and 10(-8) M (P less than 0.05), and enhanced directed migration at a dose of 10(-6) M FMLP (P less than 0.01). In contrast, PMNs from patients with juvenile periodontitis exhibited normal random migration, and directed migration was significantly suppressed at all doses of FMLP tested (P less than 0.05). An abnormality of either PMN or MN motility was observed in 26 of 27 patients with rapidly progressive periodontitis. Enhanced random migration was seen in PMNs in 63%, MNs in 39%, and both cell types in 26% of the patients. Suppressed chemotaxis was seen in PMNs in 85%, in MNs in 74%, and in both cell types in 69% of the patients. The prevalence and magnitude of abnormalities in motility were somewhat lower in treated than in untreated patients. Thus, most, if not all, of this subgroup of patients with early onset, highly destructive periodontitis have abnormalities in PMN or MN motility, and these defects may differ from those seen in cells from patients with the juvenile form of the disease.

Plaque and systemic disease: a reappraisal of the focal infection concept

The review presented here covers metastatic local and systemic disease secondary to the accumulation of plaque or the formation of other pathogenic microbial depots in the mouth. At least 3 pathways may link oral infection to secondary disease, to wit metastatic infection due to transient bacteremia, metastatic immunological injury, and metastatic toxic injury. The available evidence is presented and examples are provided. They concern among others such divergent diseases as acute bacterial myocarditis, infective endocarditis, brain abscess, uveitis and iridocyclitis, trigeminal and atypical facial neuralgia, unilateral facial paralysis, fever of "unknown' origin, and neutrophil dysfunction.

Rapidly advancing periodontitis in a patient with sarcoidosis. A case report

A brief review of sarcoidosis is presented. It is a multisystem granulomatous disease of unknown etiology. Typically the sarcoidosis patient manifests depressed T-cell function but has hyperactive B-cells. This case report deals with a 27-year old black female who was diagnosed as having sarcoidosis. Prior to the onset of the disease, radiographs taken of her periodontium revealed incipient alveolar bone loss. Two years after the apparent onset of the sarcoidosis, periapical radiographs manifested advanced destruction of the alveolar bone. In addition to the usual clinical indices, the effect of the patient's serum on cultures of normal PMNs and Actinobacillus actinomycetemcomitans (A. a.) was studied. The serum from this patient inhibited the leukotoxic effect of the (A. a.) organism. A similar effect has been observed in juvenile patients with rapidly advancing periodontitis.

Human immune responses to oral microorganisms. II. Serum antibody responses to antigens from Actinobacillus actinomycetemcomitans and the correlation with localized juvenile periodontitis

Human serum antibody responses to antigens from a suspected oral pathogen, Actinobacillus actinomycetemcomitans (Aa), were studied. IgG and IgM isotype antibodies to four antigen preparations, sonicate antigen (SA), leukotoxin (LT), group carbohydrate (LG), and lipopolysaccharide (LPS), were determined using an ELISA. An ELISA inhibition technique was developed to show that human serum antibodies reacting with the LT, LG, or LPS materials were binding to different antigenic moieties in each preparation. Cross-sectional studies of serum IgG antibodies showed that patients with localized juvenile periodontitis (LJP) had a greater frequency of occurrence and a higher level of antibodies to the SA (82%), LT (70%), and LG (62%) antigens compared to all other diseased (11-46%) or normal (4-13%) groups. Serum IgM antibodies to LPS were increased in LJP, generalized juvenile periodontitis, and adult periodontitis patients compared to all other groups. Therefore, while both IgG and IgM antibodies were found against various Aa antigens, the detection of IgG antibodies was most clearly associated with the specific disease classification of LJP. Blocking studies suggested that the human serum responses were specific for the Aa antigens and that the LT, LG, and LPS comprise major antigenic determinants on the organisms to which human serum antibody reacts.

Periodontal status associated with chronic neutropenia

A case of chronic neutropenia in a 12-year-old boy is reported. The patient presented with severe gingival inflammation and alveolar bone loss. Immunologic analysis of the patient's serum revealed the presence of precipitating antibodies against antigenic components of Actinobacillus actinomycetemcomitans Y4 and 652. It was also found that the serum neutralized the leukotoxic activity of Actinobacillus actinomycetemcomitans Y4. The etiology and the pathogenesis of periodontal disease in neutropenic patients are discussed in view of these findings.

Phospholipids inhibit cytotoxic effects of Actinobacillus actinomycetemcomitans leukotoxin on human polymorphonuclear leukocytes

Isolated human peripheral blood neutrophils were exposed to sonic extracts of Actinobacillus actinomycetemcomitans. Such bacterial preparations contain a potent leukotoxin which rapidly kills the leukocytes as reflected by cellular uptake of trypan blue, extracellular release of lactate dehydrogenase, or discharge of 51Cr from pre-labeled cells. Exogenous phospholipids with a glycerol skeleton esterified by fatty acids or positively charged liposomes inhibited cytotoxic phenomena. The data suggest that cell damage may involve the interaction of leukotoxin with phospholipids in the neutrophil cell membrane and that exogenous lipids either compete for or sterically block binding of the leukotoxin to these moieties in the membrane.

Membrane receptors on human neutrophils in oral bacterial infections

Experiments were performed to examine the function of neutrophil membrane receptors in oral bacterial infections. For this purpose, Fc and C3b receptors on human peripheral blood neutrophils and exudate neutrophils obtained from subcutaneous abscesses were studied by using the rosette-forming method.

The development of an altered gingival crevicular microflora in the alloxan-diabetic rat

The microflora of the rat gingival crevice were examined at various time intervals after inducing experimental diabetes. A variety of Gram-positive and Gram-negative cocci and short rods were isolated from the normal rat crevice. Within a week after alloxan administration, Leptotrichia buccalis was detected for the first time. Other features in the diabetic animals included an increased frequency of isolation of Proteus spp., Lactobacillus spp. and decrease of Escherichia coli. Occasionally, a decrease was also observed in Bacteroides spp. and Streptococcus spp. No difference was observed between diabetic and non-diabetic animals in the isolation of Selonomonas, Campylobacter, Bifidobacterium and Actinomyces. Plaque accumulation was markedly increased in the diabetic rats. It was concluded that the change in gingival microflora resulted from diabetes-induced alterations in the sulcular environment (such as increased substrate levels, e.g. glucose and urea, and decreased oxygen) and that the microbiological changes preceded the depending of the periodontal pocket.