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

Neutrophil Elastase and its Inhibitors in Human Gingival Crevicular Fluid during Experimental Gingivitis

The relative concentrations and absolute amounts of neutrophil elastase and its two inhibitors, α2-macroglobulin (α2-M) and alantitrypsin (α1-AT), were determined in gingival crevicular fluid (GCF) collected from six dental students who refrained from brushing the upper left or right quadrant during three weeks. Plaque and gingival indices and flow of GCF were measured before, during, and after the three weeks of no brushing. Functional elastase, representing the enzyme complexed with a2-M, was measured by use of a low-molecular-weight fluorogenic substrate. Elastolytic activity in GCF was also assayed by use of elastin as substrate. Antigenic elastase, representing the enzyme complexed with a 1-AT, as well as the inhibitors a2-M and al-AT were measured by ELISA. After three weeks of plaque accumulation, the concentrations of both functional and antigenic elastase increased by a factor of about 3, whereas the concentrations of the inhibitors increased in a much higher proportion. No free elastase could be detected in GCF, as evidenced by the Sephadex G-75 elution profile of GCF, by the negative results obtained when elastin was used as substrate, and by the demonstration that pure enzyme kept its activity against the low-molecular-weight substrate after being saturated by a2-M.

Alpha-2-Macroglobulin Levels in Gingival Crevicular Fluid Pre- and Post-scaling and Root Planing with Adjunctive Tetracycline Fibers in Chronic Periodontitis: A Randomized Controlled Trial

BACKGROUND

This split-mouth clinical study aimed to investigate levels of alpha-2-macroglobulin (a2M) in gingival crevicular fluid (GCF) of chronic periodontitis patients pre- and post-scaling and root planing (SRP) with or without adjunctive use of tetracycline fibers.

MATERIALS AND METHODS

In 30 patients of chronic periodontitis, samples of GCF were collected from the gingival sulcus before SRP. Recording of clinical parameters was conducted. This was followed by local drug delivery (LDD) of tetracycline fibers in test sites. In control sites, no LDD was done. Second samples of GCF were taken 90 days after treatment. Samples of crevicular fluid were analyzed to determine the levels of a2m.

RESULTS

A gain of clinical attachment (CAL) of 3.30 mm for SRP and LDD and for SRP alone was 1.62 mm (p < 0.001). The pocket probing depth was significantly decreased by 2.43 mm for SRP and LDD and for SRP alone was 1.61 mm (p < 0.001) after 90 days. Alpha-2-macroglobulin was significantly reduced in GCF by SRP and SRP and LDD after 90 days (p < 0.001).

CONCLUSION

Clinical and biochemical variables showed a more favorable outcome when SRP was combined with LDD of tetracycline fibers in management of patients suffering from chronic periodontitis.

Changes in gingival crevicular fluid levels of immunoglobulin A following therapy: association with attachment loss

BACKGROUND

In previous studies, we demonstrated that increased levels of immunoglobulin A (IgA) in gingival crevicular fluid (GCF) may be "protective", while increased levels of the polymorphonuclear lysosomal enzyme, beta-glucuronidase, in GCF were associated with increased risk of disease activity. In this study, we examined the effect of scaling and root planing (SRP) on the levels of beta-glucuronidase, IgG, and IgA in GCF over a 24-week period and compared these to clinical attachment loss (CAL).

METHODS

Twenty-nine patients with periodontal disease were examined for attachment level, probing depth, plaque, and bleeding on probing at 6 sites per tooth. GCF was collected from the mesial aspect of all teeth excluding third molars and analyzed for beta-glucuronidase, IgG, and IgA. After baseline data were collected, each patient received SRP, and GCF was collected again at 2, 4, 6, 8, 12, and 24 weeks post-SRP while clinical data were obtained at 4, 8, 12, and 24 weeks. In addition, we analyzed whether the magnitude of the IgA response to SRP would affect the rate of periodontal disease progression by examining GCF IgA levels at 2 time intervals: 2 to 4 weeks post-SRP and 6 to 12 weeks post-SRP.

RESULTS

Seventeen patients (58.6%) exhibited at least 1 site losing > or =2.5 mm of CAL during the 24-week study. Beta-glucuronidase in GCF was significantly decreased at 2 weeks following SRP and then demonstrated a gradual increase throughout the study period. Levels of IgA in GCF significantly increased following SRP, reaching a peak at 6 weeks and then gradually decreasing throughout the study. Furthermore, we found an inverse relationship between GCF IgA levels at 6 to 12 weeks post-SRP and the occurrence of CAL.

CONCLUSIONS

These results support the hypothesis that maintenance of high levels of IgA in GCF may be "protective" against periodontal attachment loss. Furthermore, levels of beta-glucuronidase appear to be a more sensitive indicator of gingival inflammation than clinical measures.

Host mediators in endodontic exudates. II. Changes in concentration with sequential sampling

Exudate is often found in the root canal of teeth requiring endodontic therapy. The aim of this study was to evaluate the relationship of sequential changes of different host mediators in endodontic exudates to clinical and radiographic findings. Thirty-two nonvital teeth with periapical symptoms were evaluated. Exudates were collected with filter paper strips every 3 min after opening of the pulp chamber. The concentrations of beta-glucuronidase, IgG, IgA, IgM, and interleukin-1 beta in the exudates were analyzed. In general, the concentration of the mediators in exudates from less involved lesions did not change over time. The exception was an increase in the IgM concentration when patients presented with percussion or palpation sensitivity. In contrast, in the more involved lesions, the concentrations of IgA and IgM increased as sampling progressed. The concentrations of beta-glucuronidase and interleukin-1 beta decreased over time in the more involved lesions. These data suggest that the amount of proinflammatory mediators in the canal and periapical lesion is limited. Furthermore, IgM seemed to be a marker for the severity of periapical lesions. This may relate to vascular permeability that allows passage of this larger molecule into the extravascular environment.

Host mediators in endodontic exudates. I. Indicators of inflammation and humoral immunity

Exudate is often found in the root canal when entering the chamber and canal of teeth with periapical lesions. The aim of this study was to determine possible relationships between clinical or radiographic findings and the concentrations of different host mediators in endodontic exudates. Thirty-two nonvital teeth with periapical symptoms were included in the study. A Clinical Periapical Index was developed to quantify clinical findings. Endodontic exudates were collected with methylcellulose filter paper strips every 3 min, after opening of the pulp chamber. The concentrations of the lysosomal acid glycohydrolase beta-glucuronidase, IgG, IgA, IgM, and interleukin-1 beta in the endodontic exudates were analyzed. The results demonstrated that exudates collected from teeth with suppuration (cloudy exudates), and teeth with higher periapical index scores (Orstavik et al., 1986) contained higher concentrations of beta-glucuronidase and interleukin-1 beta. Furthermore, when the periapical index indicated severe involvement, higher IgG was observed in the first samples. The exudates from patients who presented with a sinus tract or swelling contained higher concentrations of IgM, compared with the patients with only periapical sensitivity. Data showed that endodontic exudates from patient with endodontic lesions can be analyzed for host mediators, and differences in the mediators were seen with different clinical and radiographic symptoms.

Cathepsin B, alpha2-macroglobulin and cystatin levels in gingival crevicular fluid from chronic periodontitis patients

Gingival crevicular fluid (GCF) was collected from 16 molar and premolar sites in each of 20 chronic periodontitis patients before and after periodontal therapy using filter paper strips. These were eluted individually into buffer for determination of cathepsin B and its endogenous inhibitors, alpha2-macroglobulin and cystatin. Cathepsin B activity was assayed with a fluorogenic peptide substrate, alpha2-macroglobulin by enzyme-linked immunosorbent assay and cystatin activity by inhibition of papain. Total amounts of enzyme and inhibitor per GCF sample decreased after treatment and correlated positively with pocket depth and gingival, bleeding and plaque indices. These comparisons were nearly always statistically significant for pooled site data and sometimes so for mean patient values. The amounts of alpha2-macroglobulin and cystatin were greater than those of cathepsin B and, surprisingly, enzyme and inhibitor levels correlated positively with each other. Experiments with purified reagents, however, demonstrated that the cathepsin B: alpha2-macroglobulin complex was still active against the low molecular weight substrate and that cystatin levels in GCF are probably insufficient to inhibit the enzyme substantially These factors may explain why GCF cathepsin B activity reflects the clinical status of periodontal lesions and has been identified in another study as a promising indicator of disease progression.

Inflammatory and immune mediators in crevicular fluid from HIV-infected injecting drug users

Gingival crevicular fluid (GCF) levels of the polymorphonuclear leukocyte (PMN) lysosomal enzyme beta-glucuronidase (beta G), the pro-inflammatory cytokine interleukin 1 beta (IL-1 beta), and immunoglobulins (IgA, IgG, and IgM) were examined in 16 HIV seropositive (HIV+) and 10 HIV seronegative (HIV-) injecting drug users (IDU). Each subject received a periodontal examination including assessment of probing depth, attachment level, bleeding on probing, and plaque and calculus accumulation. GCF was collected from the mesial surfaces of premolar and molar teeth using filter paper strips. Although HIV+ subjects had a significantly lower number of peripheral blood CD4+ T cells/mm3 compared to HIV- subjects, there were no significant differences in mean probing depth, percentage of sites exhibiting bleeding on probing, or plaque and calculus accumulation between HIV- and HIV+ subjects. When the GCF components were analyzed, we found no significant differences between HIV- and HIV+ subjects in GCF levels of beta G, IL-1 beta, IgA or IgM, but GCF levels of IgG were significantly increased in HIV+ subjects. When sites were categorized by probing depth, no differences in the levels of beta G, IgA, IgG, and IgM existed between sites with probing depth < or = 3 mm compared to sites with probing depth > or = 4 mm in both HIV- and HIV+ IDU. However, levels of IL-1 beta in GCF were increased in the deeper sites (> or = 4 mm) in HIV+ IDU when compared to sites with PD < or = 3 mm. Analyzing GCF constituents in relation to the CD4 cell number, no differences were found between subjects with < or = 400 or > 400 CD4 cells/mm3 with respect to the levels of IL-1 beta, IgG, and IgM. However, the level beta G was significantly decreased in the HIV+ IDU with < or = 400 CD4 cells when compared to those with > 400 CD4 cells/mm3, while levels of IgA were significantly higher in HIV+ subjects with < or = 400 CD4 cells/mm3. Our results suggest that levels of IgG, and in immunodeficient subjects IgA were increased in GCF of HIV+ IDU while decreased levels of beta G were found in immunodeficient HIV+ IDU. These findings may be local manifestations of systemic alterations and suggest that analysis of GCF may provide insight into the immune and inflammatory responses of HIV-infected individuals to periodontal microorganisms.

alpha 1-Proteinase inhibitor in gingival crevicular fluid of humans with adult periodontitis: serpinolytic inhibition by doxycycline

The serum protein, alpha 1-proteinase inhibitor (alpha 1-PI), defends the host against serine proteinases, e.g. PMN elastase. Using a rabbit anti-serum against human alpha 1-PI, this protein in GCF was quantified from a standard curve constructed from dot-blot analysis and characterized by Western blot. GCF was collected on filter paper strips from healthy (H), gingivitis (G) and adult periodontitis (AP) patients, then extracted with Tris/NaCl/CaCl2 buffer, pH 7.6. alpha 1-PI concentration increased with G and was highest in AP subjects. H sites only showed intact alpha 1-PI (52 kDa); no degradation fragments (48 kDa) were detected. In G and AP subjects, alpha 1-PI degradation fragments were seen in 17% and 71% of GCF samples, respectively. Both collagenase and alpha 1-PI-degrading activities in GCF increased with severity of inflammation (GCF flow). Moreover, the alpha 1-PI degrading (or serpinolytic) activity was characterized as a matrix metalloproteinase, probably collagenase, based on its in vitro response to a panel of different proteinase inhibitors including doxycycline. We propose: (1) that collagenase promotes periodontal breakdown not only by degrading collagen, but also by depleting alpha 1-PI regulation of elastase and other serine-proteinases, thereby favoring a broader attack on extracellular matrix (ECM) constituents, and (2) based on a recent longitudinal double-blind study using the techniques described above for alpha 1-PI analysis, that low-dose doxycycline administration to humans with adult periodontitis can inhibit this broad cascade of ECM degradation.

The potential role of alpha 2-macroglobulin in the control of cysteine proteinases (gingipains) from Porphyromonas gingivalis

Porphyromonas gingivalis is closely associated with the development of some forms of periodontitis. The major cysteine proteinases released by this bacterium hydrolyze peptide bonds only after arginyl (gingipain R) or lysyl residues (gingipain K). No target protein inhibitors have been identified for either enzyme, leading us to investigate their inhibition by human plasma alpha 2-macroglobulin (alpha 2M). Both 50- and 95 kDa gingipain R were efficiently inhibited by alpha 2M, whereas the catalytic activity of gingipain K could not be eliminated. All 3 enzymes were, however, inhibited by a homologous macroglobulin from rat plasma, alpha 1-inhibitor-3 (alpha 1I3). alpha-Macroglobulins must be cleaved in the so-called "bait region" in order to inhibit proteinases by a mechanism involving physical entrapment of the enzyme. A comparison of the amino acid sequences of the 2 macroglobulins indicates that the lack of lysyl residues within the bait region of alpha 2M protects Lys-specific proteinases from being trapped. On this basis, other highly specific proteinases might also not be inhibited by alpha 2M, possibly explaining the inability of the inhibitor to control proteolytic activity in some bacterially induced inflammatory states, despite its abundance (2-5 mg/ml) in vascular fluids.

Detection of stable and active periodontitis sites by clinical assessment and gingival crevicular acute-phase protein levels

The aim of the present study was to investigate whether incipient periodontal disease breakdown could be associated with changes in gingival crevicular fluid (GCF) acute-phase protein levels. In addition, the potential of clinical indices to act as predictors of significant attachment level (AL) change was investigated. AL measurements were taken at baseline and 3 months using the Florida Probe stent handpiece from a total of 384 sites in 38 patients. The average standard deviation of duplicate AL measurements was 0.423. When the tolerance method was used to detect significant AL change, 3.9% of the sites lost attachment. When a less stringent criterion of AL change of > or = 1 mm was used 9.9% of the sites lost attachment during the 3-month period. With the exception of probing depth, baseline clinical parameters failed to predict AL change. Fourteen active periodontitis sites that demonstrated significant attachment loss were paired to stable periodontitis sites within the same patient. The levels of four acute-phase proteins, namely alpha 2-macroglobulin (alpha 2-M), alpha 1-antitrypsin (alpha 1-AT), transferrin (TF) and lactoferrin (LF), and also albumin (Alb) were assessed in the same gingival crevicular fluid sample using sandwich ELISAs. Results were expressed either as ng/30 s and ng/microgram Alb. Acute-phase protein levels in GCF failed to differentiate between active and stable periodontitis sites at baseline. In conclusion, the degree of gingival inflammation of the tissues adjacent to the crevice/pocket seems to influence the levels of protease inhibitors and iron-binding proteins in GCF to a greater extent than probing attachment loss.

Elevated conversion of alpha-2-macroglobulin to the complexed form in gingival crevicular fluid from adult periodontitis patients

The broad spectrum protease inhibitor, alpha 2-macgrolobulin (alpha 2M), is one of the host's principal regulators of both endogenous and exogenous proteases and is likely to have an important role in the regulation of proteolytic activity at inflammatory sites. We have determined the amount of complexed (com alpha 2M) and total alpha 2M (tot alpha 2M) in gingival crevicular fluid (GCF) harvested from shallow and deep sites in adult periodontitis (AP) patients (n = 21). An ELISA technique was developed to measure both forms of alpha 2M in the same sample utilizing a monoclonal antibody (MAb) specific for the complexed form. In addition, protease activity towards human serum albumin (Prot1), transferrin (Prot2) and N alpha-benzoyl-L-arginine 7-amido-4-methylcoumarin-hydrochloride (BAAMc; Prot3) were determined in a second GCF sample from the same site. Plasma alpha 2M concentrations were only positively correlated (p = 0.0163) with GCF tot alpha 2M from highly inflamed sites. We observed a significant positive correlation between tot alpha 2M and proteolytic activity in GCF from deep sites but not from shallow sites (Prot1: p = 0.002; Prot2: p = 0.005). A similar correlation between tot alpha 2M and proteolytic activity was found at highly inflamed sites (Prot1: p = 0.014; Prot2: p = 0.002). A very high proportion of the tot alpha 2M in GCF was in the complexed form at both shallow (71.14% +/- 29.13) and deep sites (68.17% +/- 28.5) Com alpha 2M was positively correlated with proteolytic activity only in deep sites (Prot1: p = 0.015; Prot2: p = 0.031). Our results suggest that the concentration of tot alpha 2M in the gingival crevice is positively associated with the amount of proteolytic activity at the site and that protease activities in GCF may only partly explain the high percentage conversion alpha 2M to the complexed form. The high level of alpha 2M inactivation in GCF from AP patients reported here may have significance not only in view of its role as a broad spectrum protease inhibitor but also through the differential effects of native vs complexed alpha 2M on the regulation of immune responses.

Immunoglobulin isotypes in gingival crevicular fluid: possible protective role of IgA

In order to simultaneously assess the local humoral immune and polymorphonuclear leukocyte (PMN) responses in periodontal disease, IgG, IgM, and IgA, as well as the PMN lysosomal enzyme beta-glucuronidase (beta G), were examined in gingival crevicular fluid (GCF) from patients with varying degrees of periodontal pathology. Evaluations were made before and after conservative therapy (scaling and root planing). Thirty patients with varying degrees of periodontal pathology, ranging from mild inflammatory gingivitis to moderate periodontitis, were studied. GCF was collected from the mesial surfaces of all teeth. The presence of the 3 immunoglobulin isotypes was determined by enzyme linked immunosorbent assays (ELISA), while total beta G activity in GCF was determined by a fluorometric assay. Clinical parameters were obtained from 6 sites per tooth. Our data indicate that prior to treatment, total beta G activity is strongly related to the severity of periodontal disease as measured by mean probing attachment level (AL; r = 0.89; P < .005), mean probing depth (PD; 4 = 0.89; P < .0005) and percentage of sites exhibiting bleeding on probing (% BOP; r = 0.49; P < .005). Following treatment, no statistically significant relationship of disease severity and beta G is found. The concentrations of IgG and IgM in GCF do not follow a specific pattern when related to disease severity. In contrast, prior to treatment the concentration of IgA is negatively correlated to mean AL (r = -0.54; P < .005), mean PD (r = -0.59; P < .005), and % BOP (r = -0.47, P < .005).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute-phase proteins in gingival crevicular fluid during experimentally induced gingivitis

The dynamics of four acute-phase proteins were investigated in gingival crevicular fluid (GCF) during the course of a 21 day experimental gingivitis study. These acute-phase proteins were the protease inhibitors alpha 2-macroglobulin (alpha 2-M) and alpha 1-antitrypsin (alpha 1-AT) and the iron-binding proteins transferrin (TF) and lactoferrin (LF). 6 healthy volunteers ceased all oral hygiene procedures for 3 weeks. GCF was sampled at seven day intervals from two sites per subject by paper strips for 30 s during the experimental gingivitis period and for two additional weeks after the reinstitution of oral hygiene. The mainly serum derived alpha 2-M, alpha 1-AT and TF exhibited very similar dynamics which reflects their common origin in GCF. Their levels increased significantly from baseline and remained high for at least one week after the reinstitution of oral hygiene measures (repeated measures MANOVA; alpha 2-M: p = 0.015; alpha 1-AT: p = 0.012; TF: p = 0.02). This probably reflects increased vascular permeability in the gingivae and, to a lesser degree, local production by gingival inflammatory cells. In contrast to the serum derived acute-phase proteins, the neutrophil derived LF rose significantly from baseline (repeated measures MANOVA; p = 0.001) but dropped rapidly after the reinstitution of oral hygiene measures. This could be because dental plaque was removed and thus neutrophil chemotactic agents in the crevice were decreased.

Altered relation between granulocyte elastase and alpha-2-macroglobulin in gingival crevicular fluid from sites with periodontal destruction

Granulocyte elastase activity and alpha-2-macroglobulin (alpha-2-MG) were studied in the gingival crevicular fluid (GCF) from 3 categories of sites in 6 patients with gingivitis and 6 patients with periodontitis. 6 inflamed sites in each gingivitis patient were sampled on paper strips and 12 sites, 6 with and 6 without attachment loss and periodontal pockets, were selected in each periodontitis patient. To avoid the influence of increase GCF volume from deep pockets, the elastase activity and the alpha-2-MG were calculated per microliters of GCF. The proteolytic activity of elastase was measured with a low molecular weight substrate and the antiprotease, alpha-2-MG, with ELISA. The measured activity could be ascribed to elastase that had been released into the gingival tissues and into the GCF prior to sampling. In the periodontitis patients, the sites with tissue destruction had a significantly higher elastase activity per site and per microliters GCF and a significantly lower alpha-2-MG per microliters than the 2 other categories of sites without tissue destruction. The destructive inflammation seems to be associated with increased release of elastase, either from more numerous or from more active granulocytes and with an increased proteolytic consumption of the inhibitor accompanied by the fast elimination of the protease-inhibitor-complex. In conclusion, the study shows a strong relationship between elastase activity and tissue destruction, a finding that supports the pathogenic theory of an involvement of granulocytes and their proteolytic enzymes in the mechanism of periodontal destruction.

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.

Role of matrix metalloproteinases in human periodontal diseases

Matrix metalloproteinases (MMP) are a family of proteolytic enzymes that mediate the degradation of extracellular matrix macromolecules, including interstitial and basement membrane collagens, fibronectin, laminin, and proteoglycan core protein. The enzymes are secreted or released in latent form and become activated in the pericellular environment by disruption of a Zn(++)-cysteine bond which blocks the reactivity of the active site. The major cell types in inflamed and healthy periodontal tissues (fibroblasts, keratinocytes, endothelial cells, and macrophages) are capable of responding to growth factors and cytokines, as well as to products released from the microbial flora by induction of transcription of 1 or more MMP genes. Cytokines that are likely to regulate expression of MMP genes in periodontal tissues include IL-1, TNF-alpha, and TGF-alpha. In addition, triggered PMN leukocytes which express only 2 MMP (PMN-CL and Mr 92K GL) release these enzymes from specific granule storage sites in response to a number of stimuli. The evidence that MMP are involved in tissue destruction in human periodontal diseases is still indirect and circumstantial. Cells isolated from normal and inflamed gingiva are capable of expressing a wide complement of MMP in culture and several MMP can be detected in cells of human gingiva in vivo. In addition, PMN-CL and Mr 92K GL are readily detected in gingival crevicular fluid from gingivitis and periodontitis patients. Osteoclastic bone resorption does not appear to directly involve MMP, but a body of evidence suggests that bone resorption is initiated by removal of the osteoid layer by osteoblasts by means of a collagenase-dependent process.

Matrix metalloproteinases: a review

Matrix metalloproteinases (MMPs) are a family of nine or more highly homologous Zn(++)-endopeptidases that collectively cleave most if not all of the constituents of the extracellular matrix. The present review discusses in detail the primary structures and the overlapping yet distinct substrate specificities of MMPs as well as the mode of activation of the unique MMP precursors. The regulation of MMP activity at the transcriptional level and at the extracellular level (precursor activation, inhibition of activated, mature enzymes) is also discussed. A final segment of the review details the current knowledge of the involvement of MMP in specific developmental or pathological conditions, including human periodontal diseases.

The ability of gingival crevicular fluid acute phase proteins to distinguish healthy, gingivitis and periodontitis sites

3 acute phase proteins, from the local gingival inflammatory response, were examined for their ability to distinguish healthy, gingivitis and periodontitis sites. Indirect competitive immunoassays were developed for the quantification of alpha 2-macroglobulin (alpha 2-M) and transferrin (TF), and for alpha 1-antitrypsin (alpha 1-AT), a double antibody sandwich assay was produced. Healthy (25), gingivitis (31) and periodontitis (28) sites were sampled with filter paper strips (2 x 13 mm) and the volume assessed with the Periotron 6000. The samples were eluted in phosphate-buffered saline and analyzed for alpha 2-M, alpha 1-AT and TF. The results were expressed as absolute amounts per sample (ng/30 s) and on a concentration basis (ng/microliter of GCF). Higher GCF absolute amounts of alpha 2-M, alpha 1-AT and TF were consistently obtained from diseased (gingivitis and periodontitis) sites than healthy sites (p less than 0.005). Absolute amounts of GCF alpha 2-M, alpha 1-AT and TF were increased in periodontitis sites over gingivitis sites, although these differences were not statistically significant (p greater than 0.1). When the results were expressed on a concentration basis, alpha 2-M levels from diseased sites were significantly higher than healthy sites (p less than 0.01). In addition, GCF TF concentration was increased in periodontitis compared to healthy sites (p = 0.03).

Correlation analysis for clinical and gingival crevicular fluid parameters at anatomically related gingival sites

This study was designed to evaluate the relationship of certain clinical and biochemical measures of periodontal pathology at anatomically related gingival sites. The maxillary first molar--second bicuspid region was studied in patients with gingivitis and periodontitis. The mesiobuccal site on the first molar was compared to the mesiopalatal and direct buccal sites on the molar and the distobuccal site on the second bicuspid. Probing depth, attachment level, gingival index, gingival crevicular fluid (GCF) volume, and GCF levels of the lysosomal enzyme B-glucuronidase (BG), the cytoplasmic enzyme lactate dehydrogenase, IgG and the protease-inhibitor alpha-2-macroglobulin were studied. For the 3 anatomical pairs that were analyzed, the correlation coefficients for the GCF constituents were generally higher than the correlations for the clinical parameters. The mean correlations for the GCF constituents were higher for the periodontitis patients as compared to the gingivitis patients. For the periodontitis patients, BG activity was correlated at adjacent proximal sites, approached significance at adjacent papillary sites, but was not significantly correlated at adjacent facial-proximal sites. This data suggests that sampling of BG activity from a mesiobuccal site provides information about the anterior papillary unit. In contrast, IgG in GCF collected from the mesiobuccal site on the first molar was significantly correlated with the total IgG in the 3 other sites.(ABSTRACT TRUNCATED AT 250 WORDS)

The relationship of serum IgG antibody titers to periodontal pathogens to indicators of the host response in crevicular fluid

In this study; the relationship of indicators of the local host response in gingival crevicular fluid (GCF) to the serum antibody titer to periodontal pathogens was examined. 15 patients with chronic adult periodontitis were studied. GCF was collected and analyzed for the total amount of IgG, IgM, the lysosomal enzyme B-glucuronidase (BG) and alpha-2-macroglobulin (alpha 2M). At the same examination, serum from these patients was collected, and enzyme-linked immunosorbent assays used to determine the serum IgG antibody titer to a panel of 17 periodontal pathogens (Actinobacillus actinomycetemcomitans (3 strains), Bacteroides gingivalis (4), Eikenella corrodens (2), Wolinella recta, Bacteroides intermedius (3), Fusobacterium nucleatum, and 3 Capnocytophaga species). Using Spearman rank order correlation analysis, correlation coefficients were calculated to relate the 4 indicators of host response in GCF to the serum IgG antibody titer to each of the 17 micro-organisms. The mean correlation between total IgG in GCF and the serum IgG antibody titer was positive (r = +0.30), and statistically significant correlations between total IgG in GCF and serum IgG antibody titer were observed for one strain of B. intermedius and C. ochracea. A weaker positive correlation was observed for IgM (r = 0.18). In contrast, the mean correlation between total BG in GCF and the serum antibody titer was negative (r = -0.34). Statistically significant negative correlations were observed for all 3 strains of A. actinomycetemcomitans, one strain of E. corrodens and W. recta. The mean correlation for alpha 2M was r = -0.06. These data suggest that elevated BG activity in GCF, believed to be a marker for lysosomal enzyme released from polymorphonuclear leukocytes in the crevicular environment, may be associated with a reduced serum IgG antibody response to suspected periodontal pathogens. Furthermore, these findings imply that the development of a serum IgG antibody response to suspected periodontal pathogens is consistent with a protective host response.

Synthesis of alpha 2-macroglobulin in human gingiva: a study of the concentration of macroglobulin and albumin in gingival fluid and serum

Albumin and alpha 2-macroglobulin were analysed in gingival fluid collected by filter paper strips from 6 volunteers before, during and after 10 days of dental plaque accumulation. The two proteins were also determined in samples of venous blood at the beginning of abstention from tooth brushing and 10 days later. A nephelometric technique was used for the analysis of albumin, but alpha 2-macroglobulin was determined by ELISA. The plaque and gingival indices, as well as the flow of gingival fluid, increased significantly during the period of plaque accumulation and then returned to baseline values. The concentrations of the two proteins in blood remained within normal limits. In gingival fluid, however, the concentration of albumin increased about two-fold at the peak of inflammation, while that of alpha 2-macroglobulin increased as much as 6 times. The enhanced passage of alpha 2-macroglobulin into the gingival sulcus in comparison to the entirely plasma-derived albumin was consistent with the concept that the greater excretion of globulin during inflammation must be due to an increased local synthesis.

The relationship of prostaglandins to cAMP, IgG, IgM and alpha-2-macroglobulin in gingival crevicular fluid in chronic adult periodontitis

Gingival crevicular fluid, collected from 8 patients with chronic adult periodontitis before and 21 days after root planing and scaling, was analysed for prostaglandin E2, 6KPGF1 alpha, cAMP, IgG, IgM and alpha-2-macroglobulin, and their inter-relationship evaluated. There was a significant decrease in the levels of prostaglandin E2, IgG, IgM and alpha-2-macroglobulin after treatment, whereas the levels of 6KPGF1 alpha and cAMP remained essentially unchanged. The level of prostaglandin E2 decreased by 35%, IgG by 32%, IgM by 90%, and alpha-2-macroglobulin by 79%. There was a significant degree of correlation between prostaglandin E2 and 6KPGF1 alpha and cAMP before treatment but not after, but no correlation between prostaglandin E2 and IgG, IgM and alpha-2-macroglobulin either before or after. This correlation pattern indicates the involvement of E2, prostaglandin 6KPGF1 alpha and cAMP in inflammation in the periodontium. The changes in IgG, IgM and alpha-2-macroglobulin reflect yet another mechanism of host response which appears to be independent of prostaglandins.

Within-mouth correlations for indicators of the host response in gingival crevicular fluid

Gingival crevicular fluid was collected from multiple sites in patients with chronic adult periodontitis, and analysed for the lysosomal enzymes beta-glucuronidase and arylsulphatase, the cytoplasmic enzyme lactate dehydrogenase, total IgA, IgG and IgM and the protease inhibitor alpha 2-macroglobulin. The within-mouth (intraclass) correlation coefficients were calculated to describe the relationship between samples collected from individual patients. Data collected at baseline and 3 months after root planing and scaling were analysed, as was the change between examinations. Volume of crevicular fluid demonstrated the smallest intraclass correlation coefficient (0.16 at baseline, 0.12 at 3 months; 0.11 change), while probing depth and enzyme activity had moderate intraclass correlations (i.e. 0.36, 0.36, 0.26 for beta-glucuronidase). Immunoglobulin and alpha 2-macroglobulin activity in the fluid had the strongest correlations (i.e. 0.64, 0.57, 0.65 for IgG). The correlations for anatomically related teeth within a quadrant (molar, non-molar) were equivalent to or greater than the correlation for all samples within a mouth. Examined by tooth type, the intraclass correlations for volume of crevicular fluid, probing depth, beta-glucuronidase, arylsulphatase and lactate dehydrogenase were higher for non-molar teeth. In contrast, intraclass correlations for IgA, IgG, IgM and alpha 2-macroglobulin in samples from molar teeth were either equivalent to or greater than the correlations for non-molar samples. Calculation of intraclass correlation coefficients for such data can (1) indicate the degree of variability present in multiple samples of crevicular fluid collected from individual patients, (2) provide information about the source of host mediators in the fluid, and (3) help identify appropriate sampling strategies for the fluid.