Crevicular and salivary fibronectin before and after gingivitis treatment

Quantitative evaluation of the vasculature and fibronectin localization in gingival connective tissue of smokers and non-smokers

BACKGROUND

It has been shown that tobacco is a significant risk factor for periodontal disease. The reason for decreased gingival bleeding in smokers is not known. The aim of the present study was to demonstrate the localization of fibronectin in the extracellular matrix of the inflamed gingiva of smokers and non-smokers and to evaluate the chronic effect of smoking on the gingival microvessel number (NVES) and vascular surface density (VSD).

METHODS

Seventy-four (74) adult patients with periodontitis were included in this investigation. Of these patients, 38 were smokers and 36 were non-smokers. Probing depths (PD), papillary bleeding index (PBI) of both groups, and the smoking habits of the smokers were recorded. Biopsy specimens obtained during periodontal surgery were prepared to evaluate fibronectin distribution and to quantitate the vasculature.

RESULTS

The mean VSD values of smokers and non-smokers were 6.721 +/- 1.845 and 5.721 +/- 3.118 (mean +/- SD), and the mean NVES of smokers and non-smokers was 31.582 +/- 11.810 and 30.145 +/- 15.442, respectively. The difference between the mean PD and PBI values of the 2 groups was not statistically significant. The location of the biopsy specimen, whether in the anterior or posterior area of the mouth, did not lead to any statistically significant differences between the groups. In addition, the number of years smoked and the tobacco brand used did not result in statistically significant differences. The most intense staining of fibronectin was observed beneath the epithelium around the blood vessels of the uppermost region of the connective tissue, showing a fibrillar and diffuse distribution; however, there was no significant difference between smokers and non-smokers.

CONCLUSION

The results of the present study indicate that smoking does not affect the vascular surface density, number of vessels per mm2 stroma, or fibronectin distribution in subepithelial gingival connective tissue.

The pathogenesis of ventilator-associated pneumonia: I. Mechanisms of bacterial transcolonization and airway inoculation

Ventilator-associated pneumonia (VAP) is an infection of the lung parenchyma developing in patients on mechanical ventilation for more than 48 h. VAP is associated with a remarkably constant spectrum of pathogenic bacteria, most of which are aerobic Gram-negative bacilli (AGNB) and, to a lesser extent Staphyloccus aureus. Most authorities agree that VAP develops as a result of aspiration of secretions contaminated with pathogenic organisms, which appear to be endogenously acquired. These pathogens gain access to the distal airways by mechanical reflux and aspiration of contaminated gastric contents and also by repetitive inoculation of contaminated upper airway secretions into the distal tracheobronchial tree. Persistence of these organisms in the upper airways involves their successful colonization of available surfaces. Although exogenous acquisition can occur from the environment, the rapidity at which critically ill patients acquire AGNB in the upper airways in conjunction with the low rate of AGNB colonization of health-care workers exposed to the same environment favors the presence of endogenous proximate sources of AGNB and altered upper airway surfaces that are rendered receptive. Proximate sources of AGNB remain unclear, but potential sites harboring AGNB prior to illness include the upper gastrointestinal tract, subgingival dental plaque, and the periodontal spaces. Following illness or antibiotic therapy, competitive pressures within the oropharynx favor AGNB adherence to epithelial cells, which lead to oropharyngeal colonization. Similar dynamic changes in contiguous structures (oropharynx, trachea, sinuses, and the upper gastrointestinal tract) lead to the transcolonization of these structures with pathogenic bacteria. Following local colonization or infection, these structures serve as reservoirs of AGNB capable of inoculating the lower airways. As the oropharynx becomes colonized with AGNB, contaminated oropharyngeal secretions reach the trachea, endotracheal tube, and ventilator circuit. Contaminated secretions pooled above the endotracheal tube cuff gain access to the trachea and inner lumen of the endotracheal tube by traversing endotracheal tube cuff folds. Amorphic particulate deposits containing AGNB form along the endotracheal tube and are capable of being propelled into the distal airways by ventilator-generated airflow or by tubing manipulation. Bacteria embedded within this type of amorphous matrix are particularly difficult for the host to clear. If host defenses fail to clear the inoculum, then bacterial proliferation occurs, and the host inflammatory response progresses to bronchopneumonia.(ABSTRACT TRUNCATED AT 400 WORDS)

Saliva-bacterium interactions in oral microbial ecology

Saliva is thought to have a significant impact on the colonization of microorganisms in the oral cavity. Salivary components may participate in this process by one of four general mechanisms: binding to microorganisms to facilitate their clearance from the oral cavity, serving as receptors in oral pellicles for microbial adhesion to host surfaces, inhibiting microbial growth or mediating microbial killing, and serving as microbial nutritional substrates. This article reviews information pertinent to the molecular interaction of salivary components with bacteria (primarily the oral streptococci and Actinomyces) and explores the implications of these interactions for oral bacterial colonization and dental plaque formation. Knowledge of the molecular mechanisms controlling bacterial colonization of the oral cavity may suggest methods to prevent not only dental plaque formation but also serious medical infections that may follow microbial colonization of the oral cavity.

Identification of Porphyromonas gingivalis components that mediate its interactions with fibronectin

Porphyromonas (Bacteroides) gingivalis W12 binds and degrades human plasma fibronectin. In the presence of the protease inhibitor N-alpha-p-tosyl-L-lysyl chloromethyl ketone, P. gingivalis cells accumulated substantial amounts of 125I-fibronectin as a function of incubation time. Fibronectin binding was specific, reversible, and saturable. The Kd for the reaction was estimated to be on the order of 100 nM, and there was an average of 3.5 x 10(3) fibronectin binding sites per cell. Unlabeled fibronectin inhibited the binding of 125I-fibronectin to bacteria; however, fibrinogen was an even more efficient inhibitor of 125I-fibronectin binding. Unrelated proteins were without effect on fibronectin binding. A fibronectin-binding component (Mr, 150,000) was identified in sodium dodecyl sulfate-solubilized P. gingivalis. Fibronectin was degraded into discrete peptides by P. gingivalis W12. The degradation of fibronectin was inhibited by N-alpha-p-tosyl-L-lysyl chloromethyl ketone. Two P. gingivalis components (Mrs, 120,000 and 150,000) degraded fibronectin in substrate-containing gels following sodium dodecyl sulfate-polyacrylamide gel electrophoresis. In a previous study (M. S. Lantz, R. D. Allen, T. A. Vail, L. M. Switalski, and M. Hook, J. Bacteriol. 173:495-504, 1991), we found that the same strain of P. gingivalis bound and subsequently degraded human fibrinogen via apparently distinct cell surface components of molecular sizes similar to those of components now implicated in the binding and degradation of fibronectin. These results raise the possibility that the two ligands are recognized and modified by the same components on P. gingivalis W12. In support of this hypothesis, unlabeled fibrinogen effectively inhibited the binding of 125I-fibronectin to bacteria and blocked 125I-fibronectin binding to a P. gingivalis ligand-binding component (Mr, 150,000 immobilized on a nitrocellulose membrane.

Gingival crevicular fluid fibronectin degradation in periodontal health and disease

The molecular forms of fibronectin (FN) in gingival crevicular fluid of five subjects with at least two sites exhibiting clinical signs of inflammation and pockets of at least 4 mm (test group) and five subjects with clinically healthy periodontium (control group) were investigated. Samples were collected with standard filter paper strips. In the test group samples from both diseased and healthy sites were collected. After collection the test group received one episode of periodontal treatment (scaling and root planning). The sampling and clinical recording were repeated for the diseased sites after about 2 wk. The crevicular fluid FN was analyzed using sodium dodecyl sulphate gel electrophoresis followed by western blotting with polyclonal antibodies against FN. Both intact FN and FN fragments were found in all samples. A larger proportion of FN was in degraded form in the diseased sites than in the healthy or the treated sites. FN was also degraded into smaller peptide fragments in the diseased than in the treated sites. These results suggest that crevicular fluid FN is partially degraded both in periodontal health and disease and that the degree of degradation of FN increases with periodontal inflammation and decreases with periodontal treatment.