Humoral immunity in root caries in an elderly population. 1

Oral Mucosal Immunity and HIV/SIV Infection

Human Immunodeficiency Virus (HIV) transmission through genital and rectal mucosa has led to intensive study of mucosal immune responses to HIV and to the development of a vaccine administered locally. However, HIV transmission through the oral mucosa is a rare event. The oral mucosa represents a physical barrier and contains immunological elements to prevent the invasion of pathogenic organisms. This particular defense differs between micro-compartments represented by the salivary glands, oral mucosa, and palatine tonsils. Secretory immunity of the salivary glands, unique features of cellular structure in the oral mucosa and palatine tonsils, the high rate of oral blood flow, and innate factors in saliva may all contribute to the resistance to HIV/Simian Immunodeficiency Virus (SIV) oral mucosal infection. In the early stage of HIV infection, humoral and cellular immunity and innate immune functions in oral mucosa are maintained. However, these particular immune responses may all be impaired as a result of chronic HIV infection. A better understanding of oral mucosal immune mechanisms should lead to improved prevention of viral and bacterial infections, particularly in immunocompromised persons with Acquired Immune Deficiency Syndrome (AIDS), and to the development of a novel strategy for a mucosal AIDS vaccine, as well as vaccines to combat other oral diseases, such as dental caries and periodontal diseases.

Immunoglobulins, antibody repertoire and B cell development

Swine share with most placental mammals the same five antibody isotypes and same two light chain types. Loci encoding lambda, kappa and Ig heavy chains appear to be organized as they are in other mammals. Swine differ from rodents and primates, but are similar to rabbits in using a single VH family (VH3) to encode their variable heavy chain domain, but not the family used by cattle, another artiodactyl. Distinct from other hoofed mammals and rodents, Ckappa:Clambda usage resembles the 1:1 ratio seen in primates. Since IgG subclasses diversified after speciation, same name subclass homologs do not exist among swine and other mammals unless very closely related. Swine possess six putative IgG subclasses that appear to have diversified by gene duplication and exon shuffle while retaining motifs that can bind to FcgammaRs, FcRn, C1q, protein A and protein G. The epithelial chorial placenta of swine and the precosial nature of their offspring have made piglets excellent models for studies on fetal antibody repertoire development and on the postnatal role of gut colonization, maternal colostrum and neonatal infection on the development of adaptive immunity during the "critical window" of immunological development. This chapter traces the study of the humoral immune system of this species through its various eras of discovery and compiles the results in tables and figures that should be a useful reference for educators and investigators.

Salivary sIgA and cortisol: markers for functional dependence in older adults

Elderly persons with health problems and physical limitations have reduced independence. Since poor functional ability is a known risk factor for disease among older populations, including oral disease, this study was undertaken to assess whether salivary defense factors and the stress hormone cortisol are significant markers for functional dependence. Oral examinations; salivary and microbial analyses; and interviews using the Activities of Daily Living (ADD index, the Mini Nutritional Assessment (MNA) and the Perceived Life Stress Questionnaire (PLSQ) were conducted for 123 dentate subjects. Of the subjects, 80 lived independently in the community or in apartments at the Baycrest Centre for Geriatric Care in Toronto, Canada, and 43 resided in the Baycrest nursing home or the Baycrest Hospital. Whole saliva samples were assayed for total secretory immunoglobulin A (sIgA), sIgA1, sIgA2, total protein and cortisol using ELISA. Dependent residents in the nursing home/hospital scored significantly lower in the nutritional assessment, had higher mean PLSQ scores, increased total protein and cortisol concentrations, and reduced salivary flow rates in comparison to ambulatory residents in the community/apartments. In multivariable logistic regression, factors associated with functional dependence were: being male, perceiving income as inadequate, having low salivary flow rate and drinking less than 5 cups of water per day. These results indicate that salivary flow and cortisol may be useful markers of functional dependence; however, the ability of these markers to predict functional decline cannot be confirmed until longitudinal studies are conducted.

Antibody repertoire development in swine

Swine belong to the Order Artiodactyla and like mice and humans, express IgM, IgD, IgG, IgE and IgA antibodies but a larger number of IgG subclasses. Like rabbits and chickens, expressed V(H) genes belong to the ancestral V(H)3 family and only 5 comprise >80% of the pre-immune repertoire. Since they use primarily two D(H) segments and have a single J(H) like chickens, junctional diversity plays a relatively greater role in repertoire formation than in humans and mice. Proportional light chain usage surprisingly resembles that in humans and is therefore distinctly different from the predominant kappa chain usage (>90%) of lab rodents and predominant lambda chain usage in other ungulates (>90%). The pre-immune V(kappa) repertoire also appears restricted since >95% of V(kappa)J(kappa) rearrangements use only a few members of the IGKV2 family and only J(kappa)2. Two V(lambda) families (IGLV3 and IGLV8) are used in forming the pre-immune repertoire. Antibodies that do not utilize light chains as in camelids, or the lengthy CDR3 regions seen in cattle that use V(H)4 family genes, have not been reported in swine. B cell lymphogenesis first occurs in the yolk sac but early VDJ rearrangements differ from mice and humans in that nearly 100% are in-frame and N-region additions are already present. Swine possess ileal Peyers patches like sheep which may be important for antigen-independent B cell repertoire diversification. The presence of pro B-like cells in interlobular areas of thymus and mature B cells in the thymic medulla that have switched to especially IgA in early gestation, is so far unique among mammals. The offspring of swine are believed to receive no passive immunity in utero and are precosial. Thus, they are a useful model for studies on fetal-neonatal immunological development. The model has already shown that: (a) colonization of the gut is required for responsiveness to TD and TI-2 antigens, (b) responsiveness due to colonization depends on bacterial PAMPs and (c) some viral pathogens can interfere with the establishment of immune homeostasis in neonates. Studies on swine reinforce concerns that caution be used when paradigms arising from studies in one mammal are extrapolated to other mammals, even when similarities are predicted by taxonomy and phylogeny. Swine exemplify a situation in which evolutionary diversification of the immune system is not characteristic of an entire order or even of other related systems in the same species.

Salivary IgA in response to periodontal treatment

There is evidence that the quantity of antigen load is crucial for the activation of IgA immune responses. In order to investigate the relevance of these findings in aggressive periodontitis, salivary antibody responses were measured during non-surgical and antibiotic treatment. Twenty-one patients with generalized aggressive periodontitis were monitored for total salivary IgA and IgA reactive to Porphyromonas gingivalis in resting and stimulated whole saliva. Non-surgical treatment included full-mouth professional tooth cleaning and subgingival scaling and root planing (SRP) under local anesthesia. Patients were recalled at 3 months and 6 months following systemic antibiotic treatment. Non-parametric statistics showed significant improvements in the clinical parameters in all patients. Between baseline and 4 wk following SRP, median concentrations of total IgA decreased both in resting (-46%) and in stimulated (-33%) saliva. The P. gingivalis-specific IgA activity showed a twofold increase at 4 wk after SRP. In addition to these changes, periodontal treatment of aggressive periodontitis did not appear to affect salivary IgA, and there were no significant correlations of IgA to the clinical parameters. In conclusion, salivary IgA responses during periodontal treatment were not found to have a diagnostic or prognostic significance.

Predominate HIV1-specific IgG activity in various mucosal compartments of HIV1-infected individuals

Evaluating mucosal humoral immunity is important for understanding local immunity induced by HIV infection or vaccination and designing prophylactic strategies. To characterize the mucosal humoral immunity following HIV infection, the levels of immunoglobulins (Igs), antibodies (Abs), and HIV1-specific Ab activity were evaluated in cervicovaginal secretions (CVS), saliva, breast milk, and sera of HIV-infected individuals. HIV1-specific IgG activity was significantly higher than that of IgA in CVS, saliva, and breast milk. The highest HIV1-specific IgG activity was found in breast milk. The data suggest that anti-HIV1 Abs in CVS were most likely serum derived. However, HIV1-specific Abs in saliva and breast milk were mainly locally produced. The prevalence of HIV1-specific Abs in seropositive subjects was 97% for IgG and 95% for IgA in CVS, 100% for IgG and 80% for IgA in saliva, and 59% for IgG and 94% for IgA in breast milk. These data provide evidence for both a better understanding of the nature of humoral mucosal responses after HIV1 infection and the development of strategies to induce desirable functional mucosal immunity for preventing HIV transmission.

New method for quantifying anti-HIV1-gp160 antibodies in saliva, cervicovaginal secretions, and serum of infected women

Antibody titers or units as measured by ELISA or similar assays represent only a semi-quantitative measurement of the antibody concentration. In the present study, a truly quantitative assay for evaluating antibody concentrations was developed. In the new assay, IgG and IgA antibody concentrations are expressed in absolute gravimetric units (weight/ml) rather than by more ambiguous terms such as titers or units. The procedure is based on the comparison of known concentrations of IgG or IgA bound to anti-F(ab)'(2) with the binding of an unknown concentration of antibodies to a specific antigen. We applied the new assay to the measurement of HIV1-gp160 specific IgG and IgA concentrations in cervicovaginal secretions (CVS), saliva, and sera of infected women. Measurement of antibody activity was obtained by comparing the amount of specific antibodies to the amount of total immunoglobulins found in the same compartment. Because of its quantitative and comparative nature, the assay was named comparative antibody gravimetric evaluation assay (CAGE).

Comparative studies on the interaction of proteins with a polydimethylsiloxane elastomer. II. The comparative antigenicity of primary and secondarily adsorbed IgG1 and IgG2a and their non-adsorbed counterparts

The antigenicity of bovine IgG1 and IgG2a adsorbed on a polydimethysiloxane (PEP) elastomer, on a widely used polystyrene (Imm 2, Dynatech) or immobilized as biotinylated proteins to streptavidin covalently bound to polystyrene (SA-PS) was compared using various monoclonal (mAbs) and polyclonal antibodies (pAb) to bovine IgG. The IgGs were either adsorbed as native proteins or pre-denatured with 6M Guanidine-HCl (Gu-HCl) or 6 M Gu-HCl/0.1% 2-mercaptoethanol. In special situations, bovine and human IgG was immobilized by secondary adsorption to an albumin monolayer adsorbed on either PEP or Imm 2. Results indicate that pre-denaturation of IgGs with 6 M Gu-HCl/2-mercaptoethanol destroys all antigenicity whereas those IgGs pretreated with 6 M-GuHCl are indistinguishable in their antigenicity from the IgGs adsorbed to either PEP or Imm 2 without such treatment. When immobilized on SA-PS, Gu-HCl-treated IgGs were significantly less detectable, especially when tested using mAbs. In general, IgGs adsorbed on PEP or Imm 2 were less antigenic than when immobilized on SA-PS. However, two monoclonals specific for the IgG2a(A2) allotypic variant, favored the adsorbed protein and one polyclonal best recognized the IgG2a(A1) variant adsorbed on Imm 2 rather than when adsorbed on PEP or immobilized on SA-PS. Both IgG1 and IgG2a, bound by apparent protein-protein interactions to an albumin monolayer, were significantly more detectable than when directly adsorbed on either Imm 2 or PEP. Using 125I-antibody or its Fab fragment to reduce steric hindrance in detection, we observed the same differences in detectability as when measured by enzyme-linked immunosorbent assay. Failure to identify a steric hindrance effect and the preference of some antibodies for adsorbed allotypic variants, support the concept of adsorption-induced conformational change (AICC). We conclude that proteins adsorbed as a monolayer on the PEP elastomer used to form the envelope of silicone breast implants are conformationally altered, but not necessarily to the same extent or the same manner as when adsorbed on polystyrene. The significantly great antigenicity of secondarily adsorbed IgG suggests that it may be present in near native conformation.

Comparative studies on the interaction of proteins with a polydimethylsiloxane elastomer. I. Monolayer protein capture capacity (PCC) as a function of protein pl, buffer pH and buffer ionic strength

Polydimethylsiloxane (PEP) is widely used in medical prostheses and therefore is in contact with plasma and secretory proteins. Two pair of globular proteins, lactoferrin (Lf) and transferrin (Trf), and bovine IgG1 and IgG2a, which differ substantially between pair members in their pl, were used to study the interaction of a PEP widely used in breast implants and soluble protein. Studies were done using iodinated proteins over a concentration range that resulted in an apparent protein monolayer. Secondary incubations with dilute protein solutions were needed to form the monolayer on PEP, possibly as a consequence of micro air bubbles trapped on its highly textured surface as shown by atomic force microscopy. Immunoassay quality polystyrene microtiter wells were used as controls. Adsorption studies were routinely performed at pH 4, 7 and 10 and at ionic strengths corresponding to 0.95, 9.5 and 90.0 mS. The protein capture capacity (PCC) of PEP for Lf and Trf was optimal at physiological pH and ionic strength and comparable under these conditions to that of Immulon 2 (Imm 2) microtiter wells. While increasing the ionic strength and pH further increases the PCC of Imm 2 for Lf and Trf, this markedly lowered the PCC of PEP for these proteins suggesting that initial polar interactions may precede subsequent hydrophobic bonding to PEP. This was tested using a hydrophilic variant of PEP, which when tested in a 90.0 mS buffer, showed a > five-fold lower PCC at neutral and alkaline pH. The greatly reduced PCC of the hydrophilic variant might also suggest that hydrophilic variants of silicone would be more biocompatible than those currently used. The PCC of PEP for the IgGs was less than that of Imm 2 but still optimal at physiological conditions. Consistent with the data on Lf/Trf, PCC progressively decreased with increasing ionic strength at alkaline pH. Differences in pl between the protein pairs had only a marginal effect on the PCC of PEP. Monolayer adsorption on both PEP and Imm 2 was slowly reversible and greater in the presence of free ligand (< 2% in 16 h) suggesting that the process follows Mass Law principles. However, even in the presence of non-ionic detergent and free ligand, 85-90% remained bound on either surface. Thus, desorption of proteins in the monolayer should not complicate subsequent immunochemical studies conducted on adsorbed monolayers.

Serum antibodies to commensal oral and gut bacteria vary with age

This study examined the relationship between serum antibody levels to selected bacteria from the commensal oral and gut flora with increased age in a healthy adult population. A total of 116 healthy subjects were studied consisting of the following age groups: 20-39 years (group A), 40-59 years (group B), 60-79 years (group C) and 80+ years (group D). Only significantly lower mean IgM antibody levels to Streptococcus mutans strain Guy's serotype c were observed in older age groups (P < 0.001). With Actinomyces viscosus NCTC 10951 significantly reduced IgM levels (P < 0.02) and significantly elevated IgA levels were observed with increased age (P < 0.05). IgA and IgG antibodies to Escherichia coli NCTC 10418 were increased significantly in the older age groups (P < 0.001), whilst a trend toward lower levels of IgM antibodies was recorded with age. No changes in IgA antibodies to Streptococcus faecalis NCTC 775 were observed but the lowest level of IgM antibodies were detected in the oldest age group (P < 0.05). Mean specific activity was decreased with age with IgM antibodies to the oral bacteria and increased with age with IgG and IgA antibodies to E. coli. Overall, our results suggest a general reduction in serum IgM antibody responses. This impairment in the circulatory IgM immune response may contribute to the increased occurrence of infections in the elderly.

Secretory IgA response in oral immunotherapy. Investigation in birch pollinosis

A rationale for oral immunotherapy (OIT) might be founded on two potential mechanisms: induction of a mucosal secretory IgA response, or induction of systemic hyporesponsiveness (oral tolerance). Previous studies have shown clinically that there is a beneficial effect of OIT in birch pollinosis, in both children and adults. During OIT, birch pollen antigens in enterocoated capsules were given to 20 adults (participating in a double-blind, placebo-controlled trial) and 10 children, all suffering from birch pollinosis. Saliva and tears (only adults) samples were collected before, during, and after OIT. Each sample was assayed for both IgA antibodies against birch pollen antigens and total IgA by enzyme-linked immunosorbent assay. IgA antibody levels were also expressed in relation to total IgA concentrations, to correct for variations in secretion and flow rate between subjects and at different times. Changes in birch-specific secretory IgA antibodies in saliva and tears could not explain the beneficial effect of OIT in birch pollinosis. Further studies in this field are warranted.

Unexpectedly high levels of some presumably protective secretory immunoglobulin A antibodies to dental plaque bacteria in salivas of both caries-resistant and caries-susceptible subjects

The role of salivary antibodies in protection against cariogenic bacteria is actually a matter of debate. Correlation between caries experience and naturally occurring antibodies was extensively investigated. Comparison of salivary antibodies from 21 caries-resistant and 22 caries-susceptible subjects was carried out by using a new quantitative method. Secretory immunoglobulin A (S-IgA) antibodies to Streptococcus sobrinus and Streptococcus sanguis cells were detected in all salivas and at similar levels in both groups. When assayed with two major antigens from S. sobrinus, i.e., protein antigen I/II and cell wall carbohydrates, only specific activities of antibodies to the protein component were increased (P < 0.01), but this occurred unexpectedly in the caries-susceptible group. Western blot (immunoblot) analysis with the culture supernatant and cell wall proteins from S. sobrinus showed the same antibody specificity in both groups. No selective increase of the protease-resistant S-IgA2 subclass was found, and avidities of antibodies to both antigen I/II and cell wall carbohydrates were similar. Our results demonstrate that naturally induced S-IgA antibodies against S. sanguis, S. sobrinus, and the major antigens of the latter are not sufficient to inhibit caries development.

The immunochemistry of sandwich ELISAs--VI. Greater than 90% of monoclonal and 75% of polyclonal anti-fluorescyl capture antibodies (CAbs) are denatured by passive adsorption

Quantitative data are presented showing that the method most commonly used to immobilize antibodies in microtiter immunoassays functionally inactivates most of the antibodies. These results were collected using five affinity purified polyclonal antibodies (pAbs) and six monoclonal antibodies (mAbs) specific for fluorescein (FLU) as capture antibodies (CAbs). These CAbs were tested for their ability to capture FLU4.2-BSA after immobilization by passive adsorption, the Protein-Avidin-Biotin-Capture (PABC) system or using previously adsorbed anti-globulins. Results indicate that under optimal conditions, < 10% of monoclonal capture antibody equivalents (CAbeqv) and congruent to 22% of polyclonal CAbeqv remain functional after passive adsorption. Immobilization via the PABC system improved the performance of mAbs by more than five-fold but had less than a two-fold effect on pAbs. Many CAbs immobilized using an anti-globulin retained full activity including the ability to bind two molecules of FLU4.2-BSA/molecule of CAb. The latter result is not necessarily a recommendation for the use of anti-globulin immobilization, since the number of functional CAbeqv per well is not significantly greater than that which can be achieved using passive adsorption.

Oral defense factors in the elderly

Continuously increasing proportion of elderly people in the human population creates new challenges for the dental care. Because the microbial etiology of the most common oral diseases, dental caries, endodontal and periodontal diseases, is not substantially different in different age groups, the altered host response during aging may modify the progression of these diseases. Most prevalent and severe change in the oral defense is hyposalivation or xerostomia but aging as such does not seem to reduce neither parotid nor whole salivary flow rate. However, submandibular and minor salivary glands produce less saliva at old age which may be the reason for the frequently reported symptoms of oral dryness even if the stimulated flow rate is normal. Concomitantly to the changes in the flow rate the daily output of many saliva-mediated defense factors declines but age-related impairment has been described only for specific IgA response to external antigens, for salivary opsonic activity, and for T-lymphocyte function. The non-immunoglobulin defense factors seem to act with full capacity over the entire life-span. Therefore, elderly people with normal salivary flow rate possess no special risk group for the development of oral diseases.

Humoral immunity in root caries in an elderly population. 2

Saliva specimens stored for 18 months at -20 degrees C with or without glycerol and the anti-protease benzamidine-HCl, lost all antibody activity for S. mutans. IgA activity in processed whole saliva decreased significantly after one week when stored either at 4 degrees C or -20 degrees C with or without glycerol, although it was stable in parotid saliva for at least 40 days. Loss of activity prior to processing was significant in the first 24 h, and the addition of 50% glycerol and storage at -70 degrees after processing, prevented loss of antibody activity in both whole and parotid saliva. Diurnal variations in IgA, lactoferrin and the IgA secretion rate were insignificant in parotid saliva but showed some fluctuations in whole saliva. Albumin and lactoferrin levels exhibited the greatest fluctuation in whole saliva specimens although IgA and IgA antibody levels were still more characteristic of the patient than the time of sampling. Monthly variations in IgA, IgA antibody activity and other parameters were least in parotid saliva and e.g., values for parameters that were high in patients samples on the first month, remained high during the 4-month study period. Statistical analyses showed a high correlation between values obtained for most of the 15 parameters that were measured in parotid and whole saliva specimens collected from greater than 20 patients during 2 successive visits. Whole saliva values for albumin, lactoferrin and albumin levels in parotid saliva, were most variable but differences were not significant. Hence, patients with very low or very high values, even in whole saliva, can be identified within the population on the basis of specimens collected at a single time.