Chemiluminescence in the assessment of polymorphonuclear leukocyte function in chronic inflammatory periodontal disease

Superoxide dismutase activity in gingiva in type-2 diabetes mellitus patients with chronic periodontitis

OBJECTIVE

Antioxidant defence reduces in diabetes mellitus (DM) and periodontitis. This study investigates antioxidant enzyme; superoxide dismutase (SOD) activity in gingiva and blood glucose and lipid levels in type-2 DM patients and systemically healthy individuals with chronic periodontitis (CP).

MATERIALS AND METHODS

Periodontal parameters, blood glycated-haemoglobin (HbA1c), glucose and lipid levels, and gingival-SOD activities (spectrophotometric assay) were measured in 17 DM patients with CP (DMCP), 17 systemically healthy CP patients, 18 periodontally healthy DM patients (DMPH), and 17 healthy controls (PH).

RESULTS

Periodontal parameters were higher in periodontitis groups than the controls (p<0.05), while there was no difference between the periodontitis groups and between the control groups. HbA1c, glucose, and triglyceride levels were higher in diabetic groups than the non-diabetic groups (p<0.05). Low-density lipoprotein (LDL), very-LDL and cholesterol values of the DMCP group did not significantly differ from the CP group. No differences existed between diabetic patients with and without periodontitis in HbA1c, glucose, and lipid levels and the same was true for non-diabetic patients with and without periodontitis. Gingival-SOD activity was lower in periodontitis groups than the matched control groups (p<0.05). DMPH group had the highest and CP group had the lowest SOD levels. There were correlations between periodontal parameters, gingival-SOD activity, HbA1c, glucose and high-density lipoprotein (HDL) levels.

CONCLUSION

The results suggest that gingival-SOD activity increases in diabetes and decreases in periodontitis and relations may exist between gingival-SOD activity, periodontal status, HbA1c, glucose and HDL levels. The higher gingival-SOD activity in diabetes may be attributed to an adaptive mechanism in the tissue.

Total antioxidant capacity and superoxide dismutase activity levels in serum and gingival crevicular fluid in post-menopausal women with chronic periodontitis

OBJECTIVES

Menopause has been linked with oxidative stress and decreased antioxidant (AO) defence. A connection has been established between menopause and certain periodontal conditions. The objective of this study is to compare serum and gingival crevicular fluid (GCF) total antioxidant capacity (TAOC) and superoxide dismutase (SOD) concentrations in post-menopausal patients with chronic periodontitis (PMCP) with those of pre-menopausal chronic periodontitis patients (CP).

MATERIAL AND METHODS

Thirty-two PMCP patients, 31 CP patients, 25 post-menopausal periodontally healthy controls (PMPH) and 26 pre-menopausal controls (PH) were studied. After clinical measurements and samplings, serum and GCF TAOC and SOD concentrations were established in turn using an automated TAOC assay and spectrophotometric end point measurement. The results were analysed statistically.

RESULTS

Serum and GCF TAOC and SOD concentrations were significantly lower in menopause and periodontitis (p<0.05). The lowest values were in the PMCP group, whereas the highest values were in the PH group. While the effect of menopause was more evident in serum antioxidant analysis, the effect of periodontitis was observed to be more apparent in GCF.

CONCLUSIONS

A decrease in systemic and local AO defence was observed owing to both menopause and periodontitis. The lowest AO values in the PMCP group suggest that menopause may be a risk factor for periodontitis.

Oxidative injury and inflammatory periodontal diseases: the challenge of anti-oxidants to free radicals and reactive oxygen species

In recent years, there has been a tremendous expansion in medical and dental research concerned with free radicals, reactive oxygen species, and anti-oxidant defense mechanisms. This review is intended to provide a critical, up-to-date summary of the field, with particular emphasis on its implications for the application of "anti-oxidant therapy" in periodontal disease. We have reviewed the nomenclature, mechanisms of actions, features, and sources of most common free radicals and reactive oxygen species, as well as analyzed the typical biological targets for oxidative damage. Based on a review of direct and indirect anti-oxidant host defenses, particularly in relation to the key role of polymorphonuclear neutrophils in periodontitis, we review current evidence for oxidative damage in chronic inflammatory periodontal disease, and the possible therapeutic effects of anti-oxidants in treating and/or preventing such pathology, with special attention to vitamin E and Co-enzyme Q.

Skin chamber technique for study of in vivo exudated human neutrophils

The development of new techniques for isolation of neutrophils extravasated in vivo have been essential for studying the dynamics of the inflammatory response in humans. Methods for generating inflammatory skin reactions were first presented in the mid 1950s, and later a skin blistering technique based on suction was introduced. With this procedure, small areas of denuded dermis, called "skin windows", are created and covered with special chambers containing a medium that attracts exudated neutrophils. By comparing the neutrophils collected in such chambers with those isolated from peripheral blood, it is possible to investigate the functional modifications that neutrophils undergo when attracted to an inflammatory process. The skin-blister chamber technique represents an aseptic, non-traumatic and reproducible model of inflammation that can be used to study in vivo activated human neutrophils. The background, methodological aspects and options of this technique are described, together with the functional characteristics of exudated neutrophils.

Increase of heat-shock protein and induction of gamma/delta T cells in peritoneal exudate of mice after injection of live Fusobacterium nucleatum

Fusobacterium nucleatum and Actinobacillus actinomycetemcomitans are Gram-negative rod periodontal pathogens. The peritoneal cavity of Institute of Cancer Research (ICR) mice was used as the local infection model. In vivo production of heat-shock proteins (hsp) was studied by injection of 1/10 minimum lethal dose (MLD) of each live bacteria into mice. Heat-shock proteins 70 and 60 were examined in the extract of peritoneal exudate cells (PEC) from mice injected intraperitoneally with either F. nucleatum or A. actinomycetemcomitans by using sodium dodecylsulphate-polyacrylamide gel electrophoresis and immunoblotting analysis. Although hsp are present in PEC without injection of the bacteria, both hsp increased and reached a peak on day 3 after F. nucleatum injection but not after A. actinomycetemcomitans. Kinetic study of gamma/delta cells in PEC after injection of bacteria showed that the increase of gamma/delta T cells was observed only in the PEC from mice injected with F. nucleatum but not A. actinomycetemcomitans. The gamma/delta T cells in PEC were either CD3+ and CD4+ or CD3+ and CD8+. The differential cell count of PEC suggested that gamma/delta T-cell induction is related to the expansion of the macrophage population. The phagocytic and chemiluminescence responses of macrophages against the same bacteria were compared after intensive immunization with live F. nucleatum and A. actinomycetemcomitans. Elevations of chemiluminescence response and phagocytic function by immunization were observed in the macrophages of mice immunized with F. nucleatum. These results suggest the sequential appearance of hsp, gamma/delta T cells and macrophage activation after fusobacterial infection.

Increased release of free oxygen radicals from peripheral neutrophils in adult periodontitis after Fc delta-receptor stimulation

The release of free oxygen radicals and degranulation was studied in neutrophils from 14 patients with adult periodontitis and 14 age- and sex-matched healthy controls. The neutrophils were activated by Fc gamma-receptor stimulation, using Staphylococcus aureus opsonized with gamma globulin. Release of oxygen radicals was measured as luminol-enhanced chemiluminescence. Degranulation was assessed as release of elastase, measured with a specific substrate and as release of lactoferrin measured with ELISA. The neutrophils from the patients showed a significantly higher chemiluminescence and a slightly higher release of elastase, whereas the release of lactoferrin was the same in both groups. In contrast, the ratio between the 2 degranulation products, elastase and lactoferrin, was significantly higher in the group with periodontitis. A flow cytometric analysis of the membrane expression of the adhesion molecules CD 11a, CD 11b, CD 15, CD 16, CD 35 and Mel 14 showed no differences in the median immunofluorescence between the 2 groups. This study showed a more than 2-fold higher release of free oxygen radicals from Fc-gamma-receptor stimulated neutrophils compared with healthy controls, which indicates a specific neutrophil-associated host response in adult periodontitis.

Ex vivo studies of polymorphonuclear neutrophils from patients with early-onset-periodontitis (II). Chemiluminescence response analysis

Previous studies have indicated that oxygen-free radicals may cause damage to the periodontal tissues. This study compared the luminol-dependent chemiluminescence response (after stimulation with either opsonized zymosan or phorbol myristate acetate (PMA) of peripheral blood polymorphonuclear leukocytes (PMN) isolated from human subjects with a healthy periodontium (n = 7), gingivitis (n = 8), adult periodontitis (n = 8), or early-onset periodontitis (n = 17). These results were also compared with those obtained in a larger reference group which consists of 50 subjects without infection or inflammation, selected on the basis of laboratory investigations. An enhanced response was defined as being 2 standard deviations above the reference group mean; a reduced response was defined as being 2 standard deviations below this mean. Although PMN from patients with either gingivitis or periodontitis were often functionally activated (when compared to the PMN from the reference group), no significant differences could be found between the 4 groups, with regard to the chemiluminescence response means obtained in a basal state or after stimulation.

Polymorphonuclear leukocyte chemiluminescence induced by Actinobacillus actinomycetemcomitans and Haemophilus aphrophilus in serum and saliva

The ability of different strains of Actinobacillus actinomycetemcomitans (A.a.) and Haemophilus aphrophilus (H.a.) to trigger activation of an oxidative burst in human polymorphonuclear leukocytes (PMNL) was examined by measuring the luminol-amplified light emission--chemiluminescence (CL)--from these cells. Bacterial cells were incubated with PMNL from one healthy subject, in the presence of either active serum, heat-inactivated serum, saliva, or saliva and active serum. In the presence of active serum, all five H.a. strains and two out of five A.a. strains triggered a CL response. The CL induced in the presence of heat-inactivated serum was considerably less than that achieved with fresh serum. In the presence of only saliva, all strains induced considerably weaker CL responses than those induced in the presence of saliva with active serum. In the presence of serum, intracellular reactions appeared to be the main source of CL, while addition of saliva and active serum increased the extracellular CL. The results indicate that strain-dependent differences exist among A.a. strains in their ability to trigger the oxygen-dependent bactericidal mechanisms of human PNML. In contrast, the CL patterns of H.a. strains were equivalent. Various factors in the environment, such as activated complement and salivary compounds, affect the interaction of these species with neutrophils.

Increased oxidative product formation by peripheral blood polymorphonuclear leukocytes in human periodontal diseases

We examined the oxidative burst (hydrogen peroxide-dependent oxidative product formation) of polymorphonuclear leukocytes (PMNL) in the peripheral blood from the patients with various types of periodontal diseases including localized juvenile (LJP), generalized juvenile (GJP) and adult periodontitis (AP). Heparinized peripheral blood was obtained from 15 LJP, 13 GJP and 52 AP patients and from 30 healthy control subjects. The oxidative product (2',7'-dichlorofluorescein; DCF) formation of PMNL by stimulation with phorbol myristate acetate myristate acetate was evaluated by a rapid quantitative assay using flow cytometry. The results indicated that all patient groups contained variable populations with normal or increased DCF formation, while the control subjects exhibited DCF formation as a single population. No significant differences in average DCF formation were found among the three patient groups. Although individual patients gave various values, the average DCF formation of the three patient groups was much higher than that of the control group. Statistical analysis revealed a significant positive correlation between DCF formation and the clinical periodontal parameters on an individual basis. Furthermore, after initial periodontal treatment, DCF formation decreased to normal levels. These results suggest that the capacity of peripheral blood PMNL to mount oxidative burst reactions might reflect the inflammatory status of periodontal disease.

Phagocytic response modifying reactivity of enzymatic cell wall digests of Nocardia opaca

Aqueous extracts (ENOCW) and enzymatic digests of purified Nocardia opaca cell wall fragments, virtually free of muramyl peptides, were monitored for their phagocytic response modifying reactivity on polymorphonuclear leucocytes, separated or unseparated in whole human blood. In the presence of ENOCW a 74% increased production of superoxide during the respiratory burst of TPA-activated polymorphonuclear leukocytes was observed, as compared to the unprimed control. Delipidation of this preparation resulted in a further increase in reactivity (144%). Even in the presence of whole human blood, as a model for competitive binding in biological fluids, an enhanced generation of superoxide by TPA activated blood phagocytes remained detectable. A 37-75% decreased phagocytic reactivity in samples of HIV-seropositive blood was considerably restored in the presence of ENOCW.

Some immunological findings in adult periodontitis

There is little doubt that immunological mechanisms play an important role in chronic inflammatory periodontal disease. At the same time, it is recognized that patient susceptibility is ultimately responsible for the clinical manifestation of the disease. In this context, the present study was undertaken to examine a range of systemic immunological parameters in patients with adult periodontitis (AP), so as to test the hypothesis that a specific pattern would identify diseased--possibly 'at risk'--patients. These parameters included serum IgA, IgG, IgM, IgD, C3, transferrin, the presence of circulating immune complexes, and the number of circulating T (E-rosette forming) cells. One hundred and forty AP patients and 70 healthy controls were examined. Following a complex statistical analysis only the levels of IgG, IgM and IgD were significantly increased in adult periodontitis (p less than 0.05) while an increase in circulatory immune complexes was significant only for separate statistical tests. Although statistically different, the levels seen in AP patients were still within the normal range hence the clinical significance of the findings is such that it is unlikely that these systemic immunological parameters per se do define an 'at risk' population.

Chemiluminescence of peripheral polymorphonuclear leukocytes from adult periodontitis patients

Polymorphonuclear leukocytes (PMN's) constitute a primary host resistance factor against infection. This study investigated the chemiluminescent (CL) response of peripheral blood PMN's isolated from human subjects with adult periodontitis. 32 subjects were categorized on the basis of age and periodontal disease status into 4 equal groups--young healthy, young diseased, old healthy and old diseased. PMN CL was stimulated using heat-killed, serum-opsonized Fusobacterium nucleatum--a specific periodontopathic gram-negative anaerobe, and Escherichia coli as a gram-negative control organism. The results showed a statistically significant enhancement (p less than 0.05) in the CL response, which was cell associated, in the young diseased subjects. This was not seen in the old subjects (p greater than 0.05), suggesting that in periodontal disease in young subjects the peripheral blood PMNs may be in a metabolically activated state. There was nevertheless a degree of variability between individual subjects within each of the 4 clinical groups.