Immunochemical comparison of proteins in human gingival pocket fluid, serum and saliva

The IgG antibody profile to various antigen regions of hepatitis C virus differs in oral fluid and serum of patients with chronic hepatitis C

Antibodies to hepatitis C virus (HCV) can be detected not only in serum but also in oral fluid. The aim of the study was to determine IgG antibody reactivity directed to six antigen regions of HCV in oral fluid and to evaluate the significance of the antibody pattern in oral fluid compared to serum. Oral fluid and serum samples of 32 HCV viremic patients were collected to detect antibodies to six antigen regions incorporated as antigen bands into modified commercial updated third generation line immuno-assay. Compared to serum, a significantly lower cumulative antibody response and reactivity to five HCV antigens was found in oral fluid. The significantly highest prevalence of oral fluid reactivity was recorded with antigen C1 (78%), whereas in serum the most significantly frequent reactivity was detected with antigen NS3 (100%). The absence of antibody reactivity with antigen E2 was similar in both body fluids. The discrepancy in antibody pattern to HCV antigens between oral fluid and serum indicates the possible existence of local viral replication, viral mutants, viral inhibitors in oral cavity and, most probably, leakage of the muco-vascular barrier.

Hepatocyte growth factor in gingival crevicular fluid and the distribution of hepatocyte growth factor-activator in gingival tissue from adult periodontitis

Hepatocyte growth factor (HGF), also known as scatter factor, is a broad-spectrum and multifunctional cytokine required for the development, growth and regeneration of various organs and tissues. The expression of HGF in human gingival fibroblasts is induced by inflammatory cytokines such as interleukin 1. Thus, although it is possible that content of HGF in gingival crevicular fluid (GCF) in periodontitis is increased, this has not so far been reported because the volume of GCF is too small to determine HGF by the available enzyme-linked immunosorbent assay (ELISA). A recently developed, highly sensitive ELISA for HGF, with a detection limit of 1 pg/ml sample, has now enabled HGF to be measured in GCF.The mean HGF content in GCF from sites with clinically healthy gingiva, defined by the absence of overt signs of gingival inflammation and a probing depth (PD) <3 mm, was 1.7 ng/ml, and that of periodontitis, defined by obvious alveolar bone loss detected by radiographic examination and a PD> or =3 mm, was 3.23 ng/ml. Although treating the periodontitis did not significantly decrease the HGF concentration despite significantly improved clinical scores such as PD and Gingival Index, the total amount of HGF in GCF did decrease significantly after treatment. HGF was expressed by gingival fibroblasts and inflammatory cells as determined by in situ hybridization. HGF-activator (HGFA), which converts inactive pro-HGF to active mature HGF, was detected in gingival epithelial cells by immunostaining. The expression of HGFA was also confirmed in gingival tissue by reverse transcription-polymerase chain reaction (RT-PCR). These findings indicate that HGF is synthesized and activated in gingiva that is clinically healthy or associated with periodontitis.

Parotid salivary S-IgA antibodies during experimental gingivitis in smokers and non-smokers

Persons who smoke display a less pronounced increase of gingival bleeding in the experimental gingivitis model as compared with non-smokers. The aim of the present study was to investigate whether this could partly be explained by differences in levels of parotid total secretory IgA (S-IgA) or parotid S-IgA reactive with selected oral microorganisms. Parotid saliva samples were obtained from 11 smoking and 14 non-smoking volunteers, at baseline, after 5 and 14 days of full mouth experimental gingivitis. Output levels of total S-IgA and of specific S-IgA reactive with cell extracts from Actinobacillus actinomycetemcomitans, Actinomyces naeslundii, Campylobacter rectus, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Peptostreptococcus micros, Streptococcus gordonii and Streptococcus mutans were determined in the samples by means of ELISA. Smokers and non-smokers were found to have similar output levels (microg/min) of total S-IgA, and the values did not significantly change during the experimental gingivitis trial. Parotid salivary outputs (units/min) of the bacteria-specific S-IgA at baseline and at days 5 and 14, were not different between smokers and non-smokers; no changes were observed during the experimental gingivitis trial. The present observations indicate that total S-IgA and bacteria-specific S-IgA in saliva are not main factors that can explain the less pronounced increase of gingival bleeding in the experimental gingivitis model in smokers as compared with non-smokers.

Gingival crevicular fluid: biomarkers of periodontal tissue activity

The lack of precise clinical criteria for assessment of periodontal disease has led to a search for alternative means of determining active disease sites, prognosis of future sites of breakdown, and response to therapy. This review highlights the potential array of biomarkers present in gingival crevicular fluid and which may relate to existing or predicted tissue regions undergoing metabolic change and derived from bacterial or host-cell-derived products. Among the former may be listed endotoxin, amines, butyrate, and a variety of enzymes and their inhibitors, such as trypsin-like proteases and bacterial collagenase. Arising from host cells is a variety of leucocytic hydrolase enzymes, lactoferrin, and lysozyme. These appear to be useful inflammatory markers and may be distinguished from products of connective tissue breakdown which include collagenous and non-collagenous products, including collagen peptides, osteonectin, and fibronectin. The proteoglycans have found particular favor as biomarkers of possible bone-resorptive activity. Attention has also been directed at the immune response, including comment on immunoglobulins, complement, eicosanoids, and cytokines. This review lists available information on the presence of these in gingival sulcus fluid and wherever possible relates their presence to disease activity.

Effect of antibody in gingival crevicular fluid on early colonization of exposed root surfaces by mutans streptococci

The effect of antibody to Streptococcus mutans in gingival crevicular fluid (GCF) on the recolonization of cleaned buccal root surface sites by indigenous mutans streptococci was studied. Seven subjects (mean age = 64 years) were selected from a population of 28 on the basis of the presence of appropriate sites with and without detectable immunoglobulin G (IgG) antibody in GCF to formalin-killed S. mutans and adequate levels of mutans streptococci in saliva available for root surface recolonization. Root surfaces exposed to GCF that did or did not contain antibody were then cleaned and sampled for residual plaque organisms (total cultivable flora and mutans streptococci) directly after cleaning (time 0) as well as 24 h later. One subject failed to recolonize at 24 h at any (antibody-positive or antibody-negative) experimental site. For each of the remaining 6 subjects, the mean levels of mutans streptococci (mean percentage of total flora) were lower at sites with IgG antibody to S. mutans in GCF than at antibody-negative sites in the same subject. In each of the 6 subjects, the site with the highest recolonization level was antibody-negative. Comparison based on intrasubject randomization of sites suggested diminished recolonization of mutans streptococci at sites with antibody 24 h after cleaning. The results support the idea that antibody in GCF can modify the early colonization of gingival root surface areas by potentially cariogenic plaque bacteria such as mutans streptococci.

Effects of treatment on antibody titer to Porphyromonas gingivalis in gingival crevicular fluid of patients with rapidly progressive periodontitis

Twenty-eight patients diagnosed as having rapidly progressive periodontitis (RPP) were enrolled in a study in which samples of subgingival microflora were harvested from test teeth and assayed for the presence of Porphyromonas gingivalis, and GCF collected and analyzed by ELISA for specific antibody for P. gingivalis. Clinical conditions were measured and recorded, and treatment by scaling and root planing provided at baseline and at 3, 6, 9, and 12 months. Reduction in pocket depth, stabilization of attachment level, and resolution of inflammation were comparable to previously reported values. By 3 months, mean and median specific antibody concentration had decreased, and continued to decrease through 12 months. The proportion of samples in which specific antibody was not detectable increased from 27% at baseline to 73% at month 12. GCF samples from sites at which P. gingivalis was present had greater than 2-fold higher median specific antibody than samples from P. gingivalis-negative sites. At baseline, specific antibody titer of 30-second GCF samples positively correlated with pocket depth, and GCF volume significantly correlated with antibody titer and concentration, and with pocket depth. In addition, change in specific antibody titer of 30-second samples from baseline to both 6 and 12 months correlated positively with pocket depths. Thus sites infected by P. gingivalis manifested high levels of specific antibody, and levels were related to clinical status. Following treatment, antibody levels decreased significantly as pocket depths decreased, attachment levels stabilized, and inflammation resolved.

The host response in gingival crevicular fluid: potential applications in periodontitis clinical trials

Traditional clinical variables of periodontal pathology have only limited value as indicators for future disease progression in patients with adult periodontitis. Consequently, other aspects of the periodontal lesion are being examined for their diagnostic utility. Analysis of the host response in gingival crevicular fluid (GCF) is among the most intensely studied of these new diagnostic approaches. Specific indicators of the humoral immune response, cellular immune response, and acute inflammatory response have been identified in GCF. The relationship of indicators of the humoral immune response to active periodontal disease is equivocal. Specific indicators of the cellular immune response in GCF may ultimately prove to be important diagnostically, but the relationship of any specific marker to active periodontal disease has not been reported. In contrast, the acute inflammatory response in GCF has been extensively studied and a number of factors appear to be associated with an increased risk for future disease progression. Indicators of enhanced polymorphonuclear leukocyte activity, (lysosomal beta-glucuronidase, lysosomal collagenase), prostaglandin E2, and an indicator of acute tissue destruction (the cytoplasmic enzymes aspartate aminotransferase) have been associated with the occurrence of clinical attachment loss. An example of the application of a GCF marker in a periodontitis clinical trial is provided by describing the relationship of lysosomal beta-glucuronidase in GCF at baseline and 2 weeks following root planing and scaling to the occurrence of disease activity during the following 6 months. Persistently elevated levels of this enzyme were related to clinical attachment loss. The positive, negative, and total predictive values for beta-glucuronidase as an identifier of clinical attachment loss were 86%, 71%, and 76%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunoglobulin-degrading enzymes in localized juvenile periodontitis

Previous reports have indicated the association of periodontal diseases with elevated levels of serum immunoglobulin G (IgG) antibodies to periodontally relevant bacteria. Recent results from this laboratory suggest that enzymes proteolytic for immunoglobulins are important virulence factors of several periodontal bacteria. Specifically, enzymes from Porphyromonas (Bacteroides) gingivalis culture supernatant fluid (SF) cleaved human IgG (4 subclasses), IgA1 and IgA2, IgM, IgD and IgE. Proteolytic enzymes from Actinobacillus actinomycetemcomitans culture SF cleaved IgG, IgA and IgM. An enriched Ig proteolytic preparation from Capnocytophaga ochracea culture SF was shown to extensively cleave all 4 subclasses of human IgG. Extensive degradation of IgG and IgA in crevicular fluid samples on SDS-PAGE from periodontal disease sites of localized juvenile periodontitis (LJP) patients in comparison to little degradation in healthy sites indicated the potential role the proteolytic enzymes from periodontopathogenic bacteria may play in situ. Treatment of IgG with P. gingivalis, A. actinomycetemcomitans and C. ochracea SF resulted in similar patterns of degradation. LJP patients had significantly higher levels of IgG and IgA proteolytic activity in whole saliva than age-, sex-, and race-matched periodontal disease-free controls. However, not all of the proteolytic activity could be ascribed to bacterial proteases since neutrophils are also present in large numbers at diseased sites. Using similar techniques, lysates of neutrophils from healthy controls cleaved IgG, IgA and IgM. The observation of enhanced Ig cleavage activity in crevicular fluid and saliva in LJP patients suggest a role for Ig proteolytic enzymes in LJP.

Host mediators in gingival crevicular fluid: implications for the pathogenesis of periodontal disease

During the past few years, a considerable number of studies have examined different aspects of the host response in gingival crevicular fluid (GCF), including the relationship of specific markers to the active phases of periodontal disease. Various indicators of the acute inflammatory response (the lysosomal enzymes beta-glucuronidase and collagenase, the cytoplasmic enzyme aspartate aminotransferase, and the arachidonic acid metabolite PGE2) have been shown to be associated with clinical attachment loss in chronic adult periodontitis in man and experimental periodontitis in animal models. In contrast, the relationship of indicators of the humoral immune response in GCF to active periodontal disease is equivocal. Furthermore, a number of indicators of the cellular immune response have been identified recently in GCF (i.e., Interleukin-1 alpha, IL-1 beta, tumor necrosis factor-alpha), but their relationship to active phases of periodontal disease have not been studied. The polymorphonuclear leukocyte (PMN) is the cellular hallmark of acute inflammation. Evidence from the GCF studies suggests that hyperreactivity of these cells plays a critical role in the active phases of some forms of periodontal disease. Metabolic activation of PMN can be associated with a number of potentially destructive reactions. The major effector mechanism for tissue destruction that can be specifically identified with the PMN is the synergistic effect of the release of PMN proteases and the generation of reactive oxygen metabolites by these cells. Priming of the PMN, where the PMN response is enhanced by agents that do not initiate the response, may be an important mechanism for PMN activation in the crevicular environment; for example, cytokines such as IL-1 beta and TNF-alpha, and lipopolysaccharides released from subgingival Gram-negative bacteria, can serve this function. The hypothesis proposed here argues that in addition to the severe forms of periodontal disease that have been associated with qualitative or quantitative PMN defects, tissue destruction in the periodontum can be observed with hyperreactivity of these cells. These differing conclusions do not create a dilemma, but may represent opposite ends of a balance that is no longer in equilibrium.

Protein composition of crevicular fluid before and after treatment

Crevicular fluid (CF) analysis is a potential tool for site-specific diagnosis of periodontal disease activity. In this study, CF was collected using a novel washing method from 91 sites in 18 adult periodontitis patients both before and after conventional periodontal treatment. The sites studied were classified according to their clinical status and the number of polymorphonuclear leukocytes (PMN's) in CF samples. CF proteins were analyzed from individual sites with gel electrophoresis (SDS-PAGE). Furthermore, both the cell-bound and soluble neutral proteolytic activities of the samples were determined. Albumin was the main protein both in healthy and slightly inflamed sites. The most severely inflamed sites were characterized by high levels of low molecular weight (LMW) proteins (mol. weight ca. 12,000) and strong cell-bound neutral proteolytic activity. Scaling and root planing reduced both the LMW proteins and neutral proteolytic activity markedly in pockets responding well to treatment. The levels of the LMW proteins in CF correlated with the cell-bound neutral proteolytic activity, which reflected the number of PMN's in the sample. The present results suggest that the appearance of the LMW proteins in CF is associated with the periodontal inflammatory status of the site.

An in vivo model for the identification of serum proteins in the acquired subgingival pellicle

The present study describes an in vivo model for the collection of the subgingival pellicle adsorbed to tooth surface, and the identification of some serum proteins within this layer. Clean dentin slabs were prepared from freshly extracted teeth, and then placed subgingivally for 2 h. The dentin slabs with their adsorbed pellicle layer were processed for transmission electron microscopy. Thin sections were made from the specimens, and treated with antisera to human immunoglobulins and albumin. The reactions were visualized by means of protein A-gold complex, which allowed semiquantification of the serum proteins. The indicator proteins were all identified within the pellicle material, but their amounts and distribution varied. Albumin demonstrated higher amounts in the pellicle layer than other proteins, followed by IgA, IgG, and IgM in descending order. The model described seems useful for studying the acquired subgingival pellicle under varying degrees of disease and health.

Antibody to collagen type I in gingival crevicular fluid

Gingival crevice fluid (GCF) was collected from inflamed sites in 20 patients before and 6 weeks after treatment. Levels of IgG to human collagen Type I were measured in the GCF and autologous serum using an enzyme-linked immunosorbent assay and compared with levels in control sera. IgG antibody to collagen was detected in GCF at significantly (P less than 0.01) higher levels than in control sera, but these levels were not significantly (P greater than 0.05) different from those in autologous sera. The levels of IgG antibody in GCF and autologous sera did not alter significantly (P greater than 0.05) after treatment. IgG antibody to collagen Type I is present in GCF in the diseased and healing state.

The protein composition of gingival crevicular fluid sampled from male adolescents with no destructive periodontitis: baseline data of a longitudinal study

Gingival crevicular fluid (GCF) is a promising source for markers of destructive periodontal diseases activity. As the initial stage of a longitudinal study into the characterization of disease markers, GCF sampled from 104 sites in 74 adolescents was examined via sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS/PAGE). In this population, which had varying degrees of gingivitis but little evidence of destructive periodontitis, there was a highly homologous GCF protein profile. The plasma components, albumin, transferrin and IgG, were major constituents of all samples. In addition, a second group of non-plasma derived proteins, with molecular weights 37 kDa, 47 kDa, 57 kDa and 59 kDa, was also commonly detected. The high frequency of occurrence of these components suggests that they may represent products of normal turnover of the periodontal tissues. Analysis of GCF sampled from patients with progressing destructive disease revealed a different SDS/PAGE profile particularly with respect to proteins of non-plasma origin. It is anticipated that the major metabolic changes which accompany the destruction of the tissues during future disease episodes in the adolescent study population will be discernible as alterations to the GCF protein profile.

Non-invasive intravital fluorescent microscopy of the hamster gingiva

Several attempts have been made to visualize the gingival microcirculation of small animals. Most of these attempts have required surgical procedures without control of the local tissue environment. In our current study of the hamster gingiva, a tissue bath was designed to allow microcirculatory observations of the periodontium of the superior incisors without the need for invasive surgical procedures and with controlled pH and temperature of the bathing solution. Dextrans (m.w. = 70,000 and m.w. = 150,000), bovine serum albumin (mw = 66,210) or a globulin fraction (mw = greater than 450,000 less than 825,000) were conjugated to fluorescein isothiocyanate and injected into the animal. Fluorescent images, produced by epi-illumination, were analyzed for the light intensity of the interstitium. There was a large and rapid increase in light intensity (leakage of the macromolecules) near the venules while capillaries of the gingival margin developed interstitial fluorescence at a slower rate and with a lower maximal effect. Molecular weight, shape or charge of the macromolecular or age of the animal did not affect the results. This new preparation could be used to study the contribution of the microcirculation to gingivitis, the role of gingivitis in the development of periodontal disease, or the effects of drugs and hormones on the microcirculation of the gingiva.

Detection of high-risk groups and individuals for periodontal diseases: laboratory markers from analysis of gingival crevicular fluid

Gingival crevicular fluid is regarded as a promising medium for the detection of markers of periodontal diseases activity. The collection protocols are straight forward and non-invasive and can be performed at specific sites of interest in the periodontium. Because the fluid accumulates at the gingival margin, it will contain potential markers derived not only from the host tissues and serum but also the subgingival microbial plaque, and thus an extremely broad range of candidate molecules may be investigated. However, the ability to successfully describe indicators of current disease activity and predictors of future disease is dependent not only upon the choice of the biochemical marker but also on the accurate description of the health status of the sample sites using currently available clinical and radiographic methods. Areas of study which currently show the most promise involve the analysis of host enzyme activities directed against components of the extracellular matrix, the nature of the glycosaminoglycans released into the sulcus and the concentration in gingival crevicular fluid of certain mediators of the inflammatory process, most notably prostaglandin E2.

The effect of treatment on IgG, IgA, IgM and alpha-2-macroglobulin in gingival crevicular fluid from patients with chronic adult periodontitis

With a technique for sampling, processing and analysis of gingival crevicular fluid (GCF) that allows multiple constituents to be analysed from a sample collected on a filter paper strip, we have examined IgG, IgA, IgM and alpha-2-macroglobulin (alpha 2M) in GCF from patients with chronic adult periodontitis. Clinical data and GCF were collected before and 3 months after root planing and scaling, and analysed to determine trends for the population. A statistically-significant decrease in the percentage of sites with bleeding on probing, erythema and supragingival plaque was observed 3 months after therapy. The mean amount of each glycoprotein in GCF decreased dramatically at 3 months. In contrast, the mean volume of GCF was virtually identical at the two evaluations. The IgG/IgA and IgG/IgM ratios in GCF were elevated when compared with human serum suggesting the preferential occurrence of IgG in GCF. Correlation of the four glycoproteins with GCF volume and with enzyme markers of the acute inflammatory response in GCF revealed a relationship between arylsulphatase (a lysosomal enzyme), fluid influx, and the passage of larger molecular-weight glycoproteins (alpha 2M, IgM) into the gingival crevice.

Hyaluronic acid and hyaluronidase activity in gingival exudate from sites of acute ulcerative gingivitis in man

Gingival exudates from sites of acute ulcerative gingivitis (AUG) and chronic gingivitis (CG) in adults were investigated by cellulose-acetate electrophoresis for the hyaluronic acid (HA) content and assayed for the levels of HA-degrading enzymes. HA was the only glycosaminoglycan (GAG) in gingival exudate from CG sites. HA was not detected at untreated AUG sites but was evident, at increasing levels, after two and seven days of effective antibacterial treatment. In AUG exudates, the total HA-degrading enzyme activity, of bacterial origin, decreased to approx. 30 and 10 per cent of the high initial levels after two and seven days of treatment respectively, to that level found at sites of CG. The specific activity of HA-degrading enzyme of lysosomal origin was low initially and increased with treatment to a level comparable to CG. The notable absence of HA from gingival exudate from sites of untreated AUG thus appears to result from the increased levels of bacterial hyaluronidase. Electrophoresis of gingival exudate may be an indirect method of monitoring the rate of response of AUG to different antibacterial treatments.

The oral immune system: dynamics of salivary immunoglobulin production in the inbred mouse

In the oral cavity, salivary immunoglobulins (Igs) are the principal mediators of specific immunity. Using carbachol to stimulate saliva flow, we investigated, in a kinetic study, individual variations in salivary Ig concentrations in 23 adult BALB/c mice using an enzyme-linked immunosorbant assay (ELISA). It appeared that salivary Ig concentrations are highly variable in individual mice (IgA: 3-81 micrograms/mL; IgG: 0-2.9 micrograms/mL; IgM: 0.002-0.14 microgram/mL). In individual mice stimulated at different times over a 3 week period there are considerable variations both in salivary Ig concentrations and in their respective ratio. Broad variations were also found in the levels of specific IgA and IgG antibodies to three indigenous oral murine bacteria. Present data thus indicate that among genetically identical mice of the same age and sex, sharing identical diet, there is considerable heterogeneity in salivary Igs. As this heterogeneity was mimicked at the cellular level in major and minor salivary gland-associated B-cells, it appears that antibody dynamics in the oral cavity could reflect the adaptive capacity of the oral immune system to local antigenic challenge.

Salivary IgA, lysozyme and beta 2-microglobulin in periodontal disease

The concentrations of IgA, lysozyme and beta 2-microglobulin (beta 2-m) were quantitated in wax-stimulated mixed saliva from 28 patients with severe periodontitis and from 28 healthy controls. The mutual correlations between IgA, lysozyme and beta 2-m were determined. In patients with periodontitis decreased lysozyme concentrations were detected when compared with controls (P less than 0.05). The correlation between IgA and beta 2-m concentrations was highly significant in both groups studied (P less than 0.0001, and P less than 0.002), whereas beta 2-m and lysozyme concentrations were positively correlated in patients but not in controls. In addition, a significant correlation between IgA and lysozyme was found only in periodontal patients (P less than 0.001).

Local antibody responses in periodontal diseases

The relationship between local and systemic host antibody responses, colonization of subgingival plaque by periodontal disease-associated microorganisms and the progression of periodontal disease was assessed in 61 patients. Serum antibody levels to a battery of oral microorganisms were determined by an enzyme-linked immunosorbent assay (ELISA), and an organism to which each patient exhibited a significantly elevated IgG response was chosen for further study. To detect the presence of the specific microorganism, plaque samples were obtained and examined using a seroELISA. Static crevicular fluid (SCF) samples were also obtained from all teeth and analyzed for IgG antibody to the homologous organism. A modification of the standard ELISA using biotin and avidin allowed a 5- to 10-fold increase in sensitivity for detection of IgG antibody in serum and SCF. Comparison of the distribution of elevated SCF antibody and the presence of the corresponding microorganism in each patient showed that the proportion of agreement was 54 to 78% in the samples. Schematic representation of the temporal relationship between the organism, the host response and disease activity were prepared to explain the results obtained in investigations of these parameters and to provide a testable hypothetical framework for future studies.

Fluctuations in crevicular and salivary anti-A. viscosus antibody levels in response to treatment of gingivitis

Experimental gingivitis studies support a pathogenic rôle for Actinomyces viscosus because of its numerical predominance in disease-associated plaques. The aims of the present investigation were to quantify specific crevicular IgG against A. viscosus before and after conventional gingivitis treatment and to determine whether salivary IgA and IgG against A. viscosus and A. naeslundii would be affected concomitantly. 6 subjects with generalized gingivitis were selected. Examinations were made before and after treatment and included collection of unstimulated saliva, paraffin-stimulated saliva and crevicular material as well as measurements of clinical parameters. The immunoglobulins were estimated by an ELISA assay using whole bacterial cells as antigen. Crevicular IgG against A. viscosus WVU 627 was demonstrated in pre- and post-treatment samples with a tendency towards increased values in the post-treatment samples. Salivary IgA and IgG against A. viscosus were also demonstrated in pre- and post-treatment samples. There were tendencies towards increased IgA values for paraffin-stimulated saliva and increased IgG values for unstimulated saliva in the post-treatment samples. Salivary IgA and IgG values against A. naeslundii ATCC 12104 were either not detected or barely detectable in both pre- and post-treatment samples. A. naeslundii B 74 IgG values were also rather low. As for A. viscosus WVU 627, anti-B 74 IgA values demonstrated a post-treatment increase for most subjects, especially for unstimulated saliva for which all post-treatment values were elevated. It is interesting to note that saliva samples showed changes similar to crevicular material, considering that salivary IgA is most likely derived from a different source. Together, elevated crevicular and salivary antibody concentrations might account for some of the beneficial effects of periodontal therapy by scaling.

Relationship between gingival crevicular fluid and serum antibody titers in young adults with generalized and localized periodontitis

The objective of the present study was to determine the relationship between concentrations of antibodies in serum and those in gingival crevicular fluid (GCF) of patients with juvenile periodontitis and severe periodontitis. Most antigens used to quantitate antibodies were obtained from a panel of bacteria associated with juvenile periodontitis or severe periodontitis. We further investigated variation in antibody titer among different periodontal sites and the extent to which antibody in GCF is locally derived. Titers of antibody, total immunoglobulin G (IgG), and human serum albumin were determined with sensitive radioimmunoassays. The relationship between serum and GCF antibody was complex. Both person-to-person variability and marked variability within the same subject were found among different sites of similar clinical status. The site-to-site variability was found not only for antibody reactive with periodontal organisms, but also for antitetanus toxoid, total IgG, and even human serum albumin. Generally the variability was in the degree of depression of the level in GCF relative to that in serum. However, anti-Bacteroides gingivalis and anti-Actinobacillus actinomycetemcomitans in GCF often exceeded the level in serum. When antibody titers in serum and GCF were calculated per milligram of human serum albumin, most of the apparent depressions of antibody in GCF disappeared. The ratio of antibody in serum to that in GCF approached unity for all organisms except B. gingivalis and A. actinomycetemcomitans Y4, which were markedly elevated. Furthermore, the level of IgG per milligram of human serum albumin in GCF was about twice the level in serum. We believe that human serum albumin reflects serum contribution to the GCF, and we therefore attribute the increased level of IgG per milligram of albumin in GCF to local synthesis. It appears that anti-B. gingivalis and anti-A. actinomycetemcomitans represent an important portion of this local antibody synthesis, since most seropositive patients with severe or juvenile periodontitis had at least one site elevated, and the magnitudes of the elevations were large in many sites. Those sites yielding elevated antibody exhibited no obvious differences in clinical parameters of probeable depth or attachment level as compared with sites in which antibody levels in GCF were similar to serum levels. Elevated antibody in GCF may relate to changes in disease activity that are not detectable by usual clinical measures.

Chemical and morphological studies of the acquired pellicle formed subgingivally on dentin in vivo

The morphological appearance and chemical composition of the subgingival pellicle were studied, using Auger analysis and scanning and transmission electron microscopy. A pellicle was formed on pieces of dentin (2 X 2 X 1 mm), prepared from freshly extracted teeth after root planing. The dentin slabs were inserted for 2 h into healthy gingival sulci. Control slabs cemented supragingivally were used for comparison. The results confirmed the presence of an organic film on the surface of all slabs. Auger analysis of the organic film showed the presence of Ca in the supragingival integument but not in the subgingival integument. The subgingival pellicle was in all cases thicker than the supragingival pellicle. The transmission and scanning electron microscopy observations confirmed the presence of a film essentially free of bacteria on the subgingival specimens and also indicated a possible morphological difference between the supra- and sub-gingival pellicle.

Flow and albumin content of early (pre-inflammatory) gingival crevicular fluid from human subjects

Gingival fluid was collected with glass capillaries tubing from the upper premolar area in a group of 7 volunteers, after allowing dental plaque to accumulate for 12-36 h, and in a group of patients with gingivitis. Whereas no fluid could be collected in the absence of plaque, increasing amounts were recovered during plaque accumulation, in the absence of clinical signs of gingival inflammation. The ratios of albumin concentrations in gingival fluid and plasma also increased significantly with increasing time of plaque accumulation. These fluid:plasma ratios of albumin concentrations were significantly lower than the ratios found for the inflamed sites in the second group of patients. These results support the hypothesis that, in an early inflammatory response, the fluid is not a typical inflammatory exudate and is probably modulated by an osmotic gradient.

Host responses in periodontal diseases

Great progress has been made in our understanding of the pathogenesis of periodontal disease, the primary role of bacteria as etiologic agents, and the critical modifying role of host responses. It is useful to consider several stages in the pathogenesis of periodontal disease - (a) colonization, (b) invasion, (c) destruction, and (d) healing - and to place into perspective the various host responses as they may affect each of these four stages (Table 5). With respect to colonization, although very little direct evidence is available, it is reasonable to suggest that antibodies, either secretory or serum-derived, acting by virtue of their ability to block attachment, could inhibit colonization by immune reduction of adherence mechanisms. With respect to invasion of the tissue, it appears that phagocytes, particularly the neutrophils, are important, acting in concert with opsonic antibody and complement in ingesting and killing the periodontal microflora before or during the early invasive process. A major advance in our understanding of the pathogenesis of periodontal diseases is the realization that the virulence of periodontopathic bacteria relates to their leukaggressive properties, allowing them to evade neutrophil protective mechanisms. Invasion of the periodontal tissues by bacterial products may be inhibited by the complexing of these products with antibody with the formation of antigen-antibody complexes that are phagocytosed and digested, particularly by scavenger phagocytes such as the macrophage. With respect to the destructive phase of periodontal disease, it is clear that the direct effect of lymphocytes mediated either through direct cytotoxic activity, or through biologically-active destructive lymphokines (such as alpha-lymphotoxin and osteoclast activating factor), can lead to tissue destruction. Macrophages, through the production of monokines, collagenase, and reactive oxygen species, can also lead to tissue destruction. The direct effects of bacterial toxins or enzymes which can lead to tissue destruction can be inhibited by complexing with antitoxic or enzyme-neutralizing antibodies. With respect to healing and fibrosis, very little direct information is available; however, it is possible that the lymphocytes and macrophages affect fibrosis by the production of chemotactic factors for fibroblasts which would be expected to bring them to the area of periodontal inflammation and also by production of fibroblast-activating factors, which then cause the fibroblasts to proliferate and produce collagen which replaces lost collagen or results in fibrosis.(ABSTRACT TRUNCATED AT 400 WORDS)

Immunohistochemical demonstration of plasma protein in squamous epithelium of formalin-fixed, paraffin-embedded oral mucosa

The distribution of immunoglobulins and fibrinogen in normal and inflamed oral mucosa was examined by direct immunofluorescence using enzyme-treated sections of formalin-fixed, paraffin-embedded tissue. Plasma proteins were found inter- and intracellularly in the surface epithelium in most of the normal and all of the inflamed mucosal specimens. This diffusion of plasma proteins into the surface epithelium was shown to contribute to the appearance of edematous epithelial cells and eosinophilic bodies ("keratin pools"). The results clearly demonstrate that oral epithelium is not to be regarded as a covering membrane isolated from the underlying connective tissue. Furthermore, the study confirms that immunohistochemical studies can be performed on enzyme-pretreated sections of routinely fixed and embedded tissue although it is emphasized that the method is not of universal applicability.

Increased IgA levels in saliva during pregnancy

The level of IgA in saliva of pregnant and non-pregnant women was measured. Stimulated whole saliva was collected from pregnant women. Also included was a group of menstruating women from whom saliva was collected in springtime as well as in autumn in each phase of the menstrual cycle. There was a marked increase in the IgA level in saliva of the pregnant women. The IgA level was especially high during late pregnancy and postpartum. No significant differences in IgA were found between the three phases of the menstrual cycle.

Immune responses to anaerobic gram-negative bacteria in health and disease

In the serum of healthy and sick persons antibodies to Bacteroidaceae and Veillonella have been detected. The antibody titres to these anaerobic bacteria are commonly low, in adults, however, higher than in children. High antibody titres could be found in patients suffering from Crohn's disease and in cancer patients. Immune responses to anaerobic bacteria occur in periodontal processes, too. These antibodies belong mainly to the IgM class of immunoglobulins. On the contrary, antibodies observed in patients with sepsis belong to the IgG class.

Immunoglobulins in human dental calculus demonstrated with the peroxidase-antiperoxidase (PAP) method

IgG and IgA were demonstrated in both sub- and supragingival dental calculus. Their distribution followed mainly incremental lines in the calculus. Most likely they originated from saliva and gingival fluid. Immunoglobulins which are adsorbed to crystals in biologic tissues may slow down the growth rate of the crystals. It was thus suggested that the incremental lines may be caused by the accumulation of IgG and IgA on the surface of dental calculus with a subsequent arrest in growth.

Salivary immunoglobulin A antibodies and recovery from challenge of Streptococcus mutans after oral administration of Streptococcus mutans vaccine in humans

Heat-killed Streptococcus mutans was administered orally in two periods of 1 week to six subjects in an attempt to affect the salivary immunoglobulin A (IgA) response to this bacterium. Enzyme-linked immunosorbent assays were used to detect specific IgA antibody activity, and an immunofluorescent assay was used for measurement of total IgA in parotid saliva. The salivary IgA response to S. mutans was compared with that against a noncross-reacting antigen preparation from Escherichia coli and with antibody responses in five sham-immunized subjects. No change in salivary IgA response to S. mutans was observed after oral administration of this organism. Significantly less streptomycin-resistant S. mutans could be recovered from the six test subjects than from the five controls after the first of two challenges with streptomycin-resistant microorganisms. At the day of the first challenge, a significantly higher IgA antibody response to all tested antigens was observed in the test group than in the control group. The data show that this difference was not related to the oral administration of S. mutans but rather was an occasional finding. The coincidence of a rapid elimination of the challenge strain and a high IgA antibody response to S. mutans supports the concept that salivary IgA antibodies could have a biological significance in the human defense against cariogenic microorganisms.

Degradation of immunoglobulins A2, A2, and G by suspected principal periodontal pathogens

Attention has recently been focused on immunoglobulin A1 (IgA1) protease production as a possible virulence factor of bacteria implicated in meningitis and gonorrhea. This report demonstrates that suspected principal etiological agents in destructive periodontal disease include bacteria capable of degrading IgA1, IgA2, and IgG. Representative strains of Bacteroides melaninogenicus subsp. melaninogenicus and Capnocytophaga cleaved IgA1 but not IgA2 in the hinge region to yield intact Fab and Fc fragments. All Capnocytophaga strains also cleaved IgG in the same way. The majority of strains of Bacteroides asaccharolyticus and B. melaninogenicus subsp. intermedius caused complete degradation of both IgA1 and polyclonal IgG. However, some strains left the Fc part of IgA1 intact. Several strains were also capable of completely decomposing IgA2 and S-IgA. Significant IgA-cleaving enzyme activity was detected in whole subgingival dental plaque collected from patients with destructive periodontal disease. The results indicate that colonization of the subgingival area by B. asaccharolyticus, B. melaninogenicus, and Capnocytophaga spp. can induce a local paralysis of the immune defence mechanisms, thereby facilitating the penetration and spread of potentially toxic substances, lytic enzymes, and antigens released by the entire subgingival microflora.

Glycosaminoglycans of human gingival epithelium and connective tissue

The glycosaminoglycan (GAG) components of the proteoglycans (PG) in the epithelial and connective tissue extracellular compartments of human gingivae have been determined. Following proteolytic digestion of the separated tissues. GAG were identified electrophoretically. These were hyaluronic acid (HA), heparan sulfate (HS), dermatan sulfate (DS) and chondroitin-4 sulfate (ChS-4). Neither ChS-6 nor keratan sulfate (KS) was observed. Confirmation of the nature of the molecular species was obtained by the use of Streptomyces hyaluronidase, chondroitinase AC II and degradation with nitrous acid. Quantitatively, the major GAG component of the epithelial specimens was HS (59.6%), whilst DS (60.6%) constituted the major GAG of human gingival connective tissue.

Association between bacterial agglutinins and immunoglobulin A in human saliva

Two distinct peaks were obtained when human parotid saliva was separated on a Sepharose 2B column. The bacterial agglutinating activity was concentrated to the void volume fractions whereas the IgA was found in the beginning of the second, large peak. Unfractionated saliva as well as the pooled agglutinin fractions, or a mixture of agglutinin and IgA, all induced the aggregation of KPSK2, a Streptococcus mutans serotype c strain. By adding anti-human-IgA antiserum to the whole saliva or to the mixture of agglutinin and IgA, the aggregation reaction could be eliminated. In order to achieve this effect the agglutinin and IgA had to be mixed prior to the addition of anti-IgA. Addition of anti-IgA antiserum to the agglutinin fraction only did not impair the aggregation of bacteria. The homologous reactions with anti-IgG antiserum did not give any inhibition effect. However, when human IgG was added to the saliva, or to the agglutinin, before the addition of anti-IgG, the aggregation of KPSK2 was again impaired. The data in this paper indicate that the agglutinins and the IgA antibodies in saliva may be normally associated with each other.

Gingival fluid fucose to protein ratios as indicators of the severity of periodontal disease

Total fucose and protein was measured in gingival fluid samples collected from 16 human subjects. A significantly higher total protein concentration was found for the control (clinically normal) group when compared to the experimental (severe clinical inflammation) group. This is probably due to the higher gingival flow rate found in the experimental group. The total fucose analyses showed no statistical difference between both groups, but when fucose to protein ratios were studied, a significantly higher ratio was found for the experimental group when compared to the controls. This probably represents the breakdown of plasma and tissue glycoproteins which may occur as a result of inflammation.

The immunopathogenesis of progressive chronic inflammatory periodontal disease

Natural, humoral and cellular immune mechanisms have all been implicated in the pathogenesis of chronic inflammatory periodontal disease. However, confusion still exists as to the role played by each of these immunological mechanisms. Recently, characterization of the cell types within the progressive lesion has been established, in which four recognizable zones were described. Immediately subjacent to the epithelium lining the periodontal pocket both polymorphonuclear leukocytes (PMN's) and macrophages were seen, while cells deeper in the tissues had the morphological appearance of lymphocytes. The majority of these lymphocytes had a B-cell phenotype although a few T-cells and macrophages were found. On the advancing front of the lesion the cells had the morphological appearance of plasma cells, the majority of which contained IgG. Other cells found in this region had the morphology of plasma cells yet contained no cytoplasmic immunoglobulin, but they did contain substantial amounts of lysosomal enzymes. Similar cells have previously been described in periodontal disease; their frequent association with fibroblasts may suggest that they are important in the pathogenesis. Deposits of IgG and fibrin were found in the fibrous tissue band surrounding the lesion. These results are reviewed and, although the zones described were not anatomically distinct, by describing the lesion in this way it was possible to establish a convenient model to explain the immunopathogenesis of progressive chronic inflammatory periodontal disease. In this respect, progressive chronic inflammatory periodontal disease in man should be considered as a B-cell lesion.