In situ activated T lymphocytes in active versus stable periodontal lesions

Maintaining homeostatic control of periodontal bone tissue

Alveolar bone is a unique osseous tissue due to the proximity of dental plaque biofilms. Periodontal health and homeostasis are mediated by a balanced host immune response to these polymicrobial biofilms. Dysbiotic shifts within dental plaque biofilms can drive a proinflammatory immune response state in the periodontal epithelial and gingival connective tissues, which leads to paracrine signaling to subjacent bone cells. Sustained chronic periodontal inflammation disrupts "coupled" osteoclast-osteoblast actions, which ultimately result in alveolar bone destruction. This chapter will provide an overview of alveolar bone physiology and will highlight why the oral microbiota is a critical regulator of alveolar bone remodeling. The ecology of dental plaque biofilms will be discussed in the context that periodontitis is a polymicrobial disruption of host homeostasis. The pathogenesis of periodontal bone loss will be explained from both a historical and current perspective, providing the opportunity to revisit the role of fibrosis in alveolar bone destruction. Periodontal immune cell interactions with bone cells will be reviewed based on our current understanding of osteoimmunological mechanisms influencing alveolar bone remodeling. Lastly, probiotic and prebiotic interventions in the oral microbiota will be evaluated as potential noninvasive therapies to support alveolar bone homeostasis and prevent periodontal bone loss.

Th2 cytokines efficiently stimulate periostin production in gingival fibroblasts but periostin does not induce an inflammatory response in gingival epithelial cells

OBJECTIVES

This study aims to clarify whether gingival fibroblasts produce periostin in response to Th2 cytokines which are elevated in periodontitis lesion and, if so, whether periostin affects the inflammatory response and matrix-protein metabolism.

DESIGN

Human gingival fibroblasts, periodontal ligament cells and the gingival epithelial cell line epi4 were stimulated with interleukin-4 (IL-4), IL-13, tumour necrosis factor-α (TNF-α) and Porphyromonas gingivalis lipopolysaccharide (LPS). Periostin expression was analysed by real-time polymerase chain-reaction (PCR) and Western blotting. The expression of the IL-4 receptor α-chain was evaluated by immunocytochemistry. The effect of periostin on the production of inflammatory cytokines and the expression of matrix protein-related genes was analysed by real-time PCR and enzyme-linked immunosorbent assay (ELISA).

RESULTS

While IL-4 and IL-13 significantly induced periostin production in gingival fibroblasts and periodontal ligament cells, no effect was observed in epi4 cells. No stimulatory effect of TNF-α or P. gingivalis LPS on the production of periostin was observed. The effect of periostin on the production of inflammatory cytokines was weak in gingival fibroblasts; however, little or no effect was observed on periodontal ligament cells or epi4 cells. No significant effect of periostin on the expression of matrix protein-related genes was found.

CONCLUSION

The results suggest that gingival fibroblasts may be a source of periostin in periodontitis lesions but periostin has only a limited role either in the inflammatory response or in matrix-protein metabolism. Thus, the role of periostin in the cellular interaction between epithelial and mesenchymal cells in gingiva may be distinct from that of skin.

Immune processes in periodontal disease: a review

The inflammatory and immune processes in periodontitis are complex and, although a great deal of information is available, many questions remain. Variation in human susceptibility to periodontitis has long been accepted, but the pathological basis of this is poorly understood. Similarly, we know little of the differences, if any, between the pathology of chronic and aggressive periodontitis. Genetics and environmental influences play a role in the susceptibility process, but if and how that translates through the immune and inflammatory processes to produce the plasma cell-dominated lesions seen in periodontitis remain to be elucidated. This review will focus on immunological aspects of the inflammatory changes seen in gingivitis and periodontitis, addressing both humoral and cellular responses to the microbial insult from dental plaque. A tendency for an individual or site to form an extensive plasma cell infiltrate may indicate an inability to defend against periodontopathogens and thus a predisposition to periodontitis. The issues to be considered include: 1) homing of immune and inflammatory cells to target tissues; 2) their local proliferation and synthetic activity; 3) the cytokine profile of the leukocytes; 4) the immunoglobulin subclasses of locally produced antibodies; 5) mucosal and systemic immune characteristics of the response; 6) the humoral immune response in periodontal health and disease states; and 7) the antigenic target of the immune response in periodontal lesions.

Gingipains in the culture supernatant of Porphyromonas gingivalis cleave CD4 and CD8 on human T cells

Porphyromonas gingivalis has been shown to attack host defense systems through proteolytic cleavage of a wide variety of members of the systems. In this study, we examined the ability of P. gingivalis culture supernatant to alter the expression of human T cell surface proteins. As judged by flow cytometric analysis, detection of CD4 expression was completely eliminated by the supernatant, but CD8 was less sensitive. When the culture supernatant was added with reducing agents, proteolytic activity was enhanced, resulting in the cleavage of CD8. Mitogenic response of T cells to phytohemagglutinin or concanavalin A was decreased by the treatment of the cells with the culture supernatant of P. gingivalis. The three forms of gingipains (high molecular mass arginine-specific gingipain, arginine-specific gingipain 2 and lysine-specific gingipain) purified from the culture supernatant of P. gingivalis actively cleaved CD4 and CD8 on human T cells, indicating that proteolytic activity of the culture supernatant was due to gingipains. These results suggest that cysteine proteinases like gingipains released from P. gingivalis cleave T cell surface proteins and impede T cell function.

Osteoclastogenesis is enhanced by activated B cells but suppressed by activated CD8(+) T cells

Host immune response is known to contribute to the progression of periodontitis, and alveolar bone destruction in periodontitis is associated with enhanced osteoclast activity. Therefore, we evaluated the roles of activated lymphocyte subsets in osteoclastogenesis. Osteoclast precursors were co-cultured with activated lymphocytes (B, CD4(+) T, CD8(+) T) in the presence of either macrophage colony-stimulating factor (M-CSF) alone or M-CSF plus soluble receptor activator of NF-kappaB ligand (sRANKL), and subsequent differentiation into active osteoclasts was evaluated by a resorption assay. The activated B and CD4(+) cells, but not CD8(+) T cells, induced osteoclast differentiation in the presence of M-CSF alone. In the presence of M-CSF and sRANKL, B cells induced the formation of small but highly active osteoclasts and increased resorption, while CD8(+) T cells profoundly suppressed osteoclastogenesis. Co-culture using an insert well or supernatant suggested that both B and CD8(+) T cells acted on osteoclasts mostly via soluble proteins. Activated B cells expressed many osteoclastogenic factors including RANKL, TNF-alpha, IL-6, MIP-1alpha, and MCP-3. CD8(+) T cells expressed a substantial amount of osteoprotegerin (OPG) along with RANKL. However, blocking antibody to OPG did not reverse the suppression by CD8(+) T cells, suggesting that other factor(s) are involved. Taken together, activated B cells promoted osteoclastogenesis, while CD8(+) T cells inhibited the osteoclast formation via direct interaction. The results imply the importance of lymphocyte subpopulations in the development of periodontitis.

Local and systemic TCR V gene expression in advanced periodontal disease

The aim of the present investigation was to study the expression of specific alpha/beta T cell receptor (TCR) gene products in relation to some microbiological and immunological features of advanced destructive periodontitis. 21 individuals with advanced periodontal disease (diseased group) and 16 age- and sex-matched healthy subjects (healthy group) were recruited. Following a clinical examination of the diseased group, the 3 deepest interproximal sites in the upper and lower premolar- or molar segments (i.e., 12 sites in each individual) were selected for further analysis. Samples from the subgingival microbiota were obtained from the pocket of the selected sites and were prepared for a microbiological examination. The gingival tissue at one of the selected sites was also biopsied. Each excised soft tissue specimen was divided into 2 equal portions. One portion of the biopsy was prepared for histometric and morphometric analyses. The 2nd portion was snap frozen and prepared for immunohistochemical analysis. A sample of peripheral blood was obtained from each individual of the diseased and the healthy group and prepared for immunohistochemical analysis. The selected sites of the diseased group harbored varying numbers of microorganisms which have been associated with periodontal disease. The excised gingival tissue contained inflammatory lesions with substantial numbers of lymphocytes and plasma cells including T- and B-cells and a TCR V alpha/beta gene repertoire dominated by Vbeta 17. The TCR profile of the lesion, however, differed markedly from that of the circulating blood of the diseased subjects. While only minor differences were observed between the blood samples of the diseased and the healthy subjects regarding the TCR genes, CD5, HLA-DR and CD5+CD19 positive cells occurred in higher proportions in the blood samples of the subjects susceptible to periodontal disease than in healthy controls. It may be suggested that (i) TCR V alpha/Vbeta expression in peripheral blood samples of subjects with periodontal disease does not differ from that of healthy individuals, and (ii) the periodontitis lesion expresses a unique TCR repertoire in which the Vbeta 17 gene dominates.

Cytokine messenger RNA expression in chronic inflammatory periodontal disease

It has previously been reported that, in periodontitis lesions, T cells with a memory/activated phenotype and with a type 2 cytokine profile accumulate in an oligoclonal fashion. Delineation of the role of cytokines in periodontal inflammation has, however, been complicated because of cross-regulation and because of their overlapping and often redundant effects. The aim of this study was to examine messenger RNA levels for interferon gamma, interleukin 4 (IL-4), IL-10, IL-12 and IL-13 in gingival tissues and peripheral blood mononuclear cells of patients with adult periodontitis. Reverse transcription polymerase chain reaction and subsequent image analysis was used to determine the level of mRNA for each cytokine. The mean expression of interferon gamma mRNA was significantly higher in peripheral blood mononuclear cells than in gingival tissues. In contrast, the mean expression of IL-10 mRNA was higher in gingival tissues than in peripheral blood mononuclear cells. This high expression of IL-10 mRNA was, in fact, seen in only 7 gingival tissue samples with the majority of samples showing levels similar to peripheral blood mononuclear cells. There was no difference in the mean expression of IL-12 p35 mRNA between gingival tissues and peripheral blood mononuclear cells. However, IL-12 p40 mRNA was expressed higher in gingival tissues than in peripheral blood mononuclear cells in 6 out of 16 samples with significant difference of mean expression. Like IL-10, gingival tissue samples and peripheral blood mononuclear cells expressed similar levels of IL-12 p40 mRNA. There was no difference in the mean expression of IL-13 in gingival tissues and peripheral blood mononuclear cells. Nevertheless, more peripheral blood mononuclear cell samples demonstrated high IL-13 mRNA expression than gingival tissue samples. IL-4 mRNA was weak but detectable in 3 gingival tissue samples. These results support the concept that cytokines form complex networks in periodontitis lesions and that their overlapping and redundant effects should be taken into account when considering the pathology of inflammatory periodontal disease. Dichotomous expression of IL-10 and IL-12 p40 mRNA in the periodontal lesion may be associated with disease entity.

Cell-mediated immune system regulation in periodontal diseases

The adaptive immune system consists of humoral and cell-mediated immunity. T-lymphocytes are the key components of cell-mediated immunity. CD4+ helper T-lymphocytes facilitate B-cells to differentiate and produce specific antibodies, whereas CD8+ cytotoxic T-lymphocytes kill virally infected cells. Periodontal diseases have been associated with a variety of imbalances in the regulation of immune responses. Changes in the ratios of peripheral blood CD4+ and CD8+ T-lymphocytes, depressed proliferative responses of peripheral blood lymphocytes, and increased frequency of CD45RO+ memory T-lymphocytes in diseased tissues have been reported in individuals with various forms of periodontal disease. While some studies have shown an increased frequency of gamma delta + T-cells in periodontal lesions, the role of gamma delta + T-cells in periodontal disease remains controversial. The ability of putative periodontopathic bacteria selectively to stimulate certain V beta-expressing T-cells is intriguing and could determine whether a CD4+ Th1 or a CD4+ Th2 cell response is elicited. The prominence of a particular subset of helper T-cells within the periodontal lesion could be a reflection of the stage and activity of the disease, or the types of bacteria present. Regardless, longitudinal studies of the involvement of T-cell subsets and cytokines in periodontal disease are clearly needed.

In situ localization of cell synthesis and proliferation in periodontitis gingiva and tonsillar tissue

OBJECTIVE

Previous work indicates that large numbers of B and T cells accumulate in the periodontal soft tissues although we know little about cellular synthetic activity and proliferation in this site. The aim of this study was to examine lymphocytic cell synthetic activity and proliferation in periodontitis gingiva and compare this to a known site of leucocyte proliferation, namely the oropharyngeal tonsils.

MATERIALS AND METHODS

Messenger RNA (mRNA) and 28S ribosomal (28S rRNA) expressing cells in formalin-fixed/paraffin-embedded gingival and tonsillar tissue sections were detected by in situ hybridisation (ISH) using poly-deoxyribothymidine and 28S probes respectively. In addition S-phase proliferating and cycling cells were also detected by ISH with histone probes and by Ki-67 immunohistochemistry. Ten gingival biopsy samples were obtained from adult periodontitis patients and five tonsillar biopsies from tonsillectomy patients.

RESULTS

Both mRNA and 28S rRNA-expressing cells were detected in all the samples tested. Plasma cells showed the strongest signal for the two probes and slight to moderate staining could be seen in epithelium, fibroblasts and endothelial cells. In contrast, gingival lymphocytes were either weakly stained or were unstained for these probes of synthetic activity. In tonsils, most lymphocytes in germinal centres showed moderate staining and mantol zone cells were much more weakly stained. In gingival samples, histone mRNA-expressing and cycling (Ki-67) cells were detected in 4/10, 10/10 cases respectively. These positive cells were mainly basal and suprabasal epithelial cells and a few mononuclear cells, whereas most germinal centre lymphocytes (B cells) were positive for this probe. The number of Ki67 positive cells was greater than histone mRNA bearing cells both in gingiva and tonsillar tissue. In contrast, mantol zone cells (mainly T cells) were sparsely stained by probes of cell proliferation.

CONCLUSION

These results indicate that local proliferation of B cells does not occur in periodontitis gingiva in contrast with tonsillar tissue, although plasma cells showed strong synthetic activity in both tissues. T cells did not appear to proliferate greatly nor undergo active synthesis in either of these tissues. These findings substantiate previous hypotheses that specific leucocytes predominate in the gingival tissue through selective homing rather than by local proliferation.

Effects of T cell adoptive transfer into nude mice on alveolar bone resorption induced by endotoxin

Using the method of reconstitution of nude mice with T cells, we examined the effects of T cell on alveolar bone resorption induced by repeated injections of Escherichia coli endotoxin into periodontal tissue. Three mice groups (normal, nude and T cell reconstituted nude mice) were used. Endotoxin derived from E coli was repeatedly injected into the gingiva of the mice left mandibles every 48 h and the mice were killed on the day after the 1st, 4th, 7th, 10th, 13th and 20th injections of endotoxin. Alveolar bone resorption was examined histopathologically and histomorphometrically. Bone surfaces in contact with the osteoclast were defined as the site of active resorption and the ratios of active resorption were compared among the 3 mice groups. Consequently, no active resorption was found after the first injection of endotoxin in any group. After the 4th injection, active resorption was found in normal mice and T cell reconstituted nude mice and gradually rose with the increase in the injection frequency. In contrast, few osteoclasts were found even after the 10th injection in the nude mice. In addition, there were statistically significant differences between the normal mice and nude mice after the 4th and 10th injections (p < 0.05). These findings suggested that T cell influences periodontal bone destruction induced by local administration of endotoxin during the early phases.

Immunohistological characteristics of periodontal lesions associated with Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans infections

In this study, various phenotypes of infiltrating cells in the periodontium adjacent to pockets harboring Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans were evaluated. Furthermore, the pattern of class II antigen expression in the periodontal tissues was determined. Eight lesions were associated with the presence of P. gingivalis and 12 with A. actinomycetemcomitans. Predominant cells in the inflammatory infiltrate were T- and B-cells. In most biopsies T-cells dominated over B-cells. The proportion of P. gingivalis, but not of A. actinomycetemcomitans, was positively correlated to the total number of infiltrating cells in the tissue. A. actinomycetemcomitans sites demonstrated somewhat lower proportions of CD3+, CD4+ and CD19+ cells than P. gingivalis sites. However, the tendency of decreasing CD4+/CD8+ ratio with increasing number of A. actinomycetemcomitans indicates a local imbalance in immunoregulation. The frequency of class II antigen expression of both mononuclear and epithelial cells, a sign of immunological activation, was generally high.

Immunohistological analysis of T cell functional subsets in chronic inflammatory periodontal disease

IL-2, interferon-gamma (IFN-gamma), IL-4 and IL-6 producing T cells in periodontitis and gingivitis-affected human tissues were investigated by immunohistochemistry to clarify the relationship between T cell functional subsets and disease entity. Using alkaline-phosphatase anti-alkaline-phosphatase technique, the relative proportions of each cytokine-producing T cell were calculated in the crevicular 1/3, middle 1/3 and oral 1/3 areas selected in the connective tissue of sections. CD19:CD3 and CD4:CD8 ratios were determined on the serial sections. Compared with gingivitis tissues, the proportion of cytokine-producing cells in periodontitis-affected samples was higher overall in the crevicular 1/3 (P < 0.02). The middle 1/3 exhibited a higher percentage of cytokine-producing cells, except for IL-6-producing cells. Frequencies of cytokine-producing cells in the oral 1/3 did not differ. IL-4 was the prominent cytokine in periodontitis-affected tissues, with the highest proportion detected in the crevicular 1/3. The CD19:CD3 ratio was higher in periodontitis tissues irrespective of the location, indicating a B cell dominance in periodontitis lesions. Furthermore, a significant positive correlation between the proportion of IL-4-producing cells and the CD19:CD3 ratio was noted. The CD4:CD8 ratio consistently exceeded 2.0 in both periodontitis and gingivitis. These results suggest that immunoregulation of both periodontitis and gingivitis are T cell-dependent, but in periodontitis type 2 helper T cells predominate and thereby control B cell activation.

Some microbiological, histopathological and immunohistochemical characteristics of progressive periodontal disease

The aim of the present investigation was to study the local nature of human periodontal disease by assessing the microbiota and the composition of the tissue lesions at sites with progressive attachment loss in periodontitis susceptible subjects. 300 subjects with periodontal disease were monitored for 2 years without treatment. 8 subjects lost > 2 mm of attachment at > or = 3 sites during both the first and the second 12 month interval. These 8 subjects (progressive disease group; PD) were recalled for a microbiological and histopathological examination. A group of age- and sex-matched subjects were identified who during the 2 years of monitoring exhibited gingivitis and deep pockets, but no further attachment loss. This group of 11 subjects (non-progressive disease group; NPD) served as controls. From the 8 active disease subjects, > or = 1 interproximal site which had displayed disease activity (progressive disease active; PDA) and > or = 1 contralateral site without disease progression (progressive disease inactive; PDI) were sampled. From the 11 control subjects, 1 site/subject was sampled (NPD). The total number of viable micro-organisms (TVC) in the subgingival microbiota was estimated and a series of bacterial species were identified and enumerated. The gingival tissue of the sampling site was excised and the soft tissue prepared for morphometrical and immunohistochemical analyses. No differences were observed in the subgingival microbiota of the sample sites in the subjects who exhibited disease progression (PD) when compared with the subjects with periodontally diseased but stable conditions (NPD).(ABSTRACT TRUNCATED AT 250 WORDS)

Immunohistological analysis of memory T lymphocytes and activated B lymphocytes in tissues with periodontal disease

Memory T-cells and activated B-cells were identified in cryostat sections of adult periodontitis (AP) lesions and categorized in terms of frequency and distribution. Nineteen periodontitis biopsies were obtained at the time of periodontal surgery to remove residual periodontal pockets following the completion of initial preparation. Gingival tissues exhibited various degree of inflammation (GI of 0-2) but probing depths of > 4 mm and > 5 mm loss of attachment. As a control, 5 gingivitis specimens (GI of 1, probing depth and loss of attachment of < or = 3 mm) were obtained from premolar and third molar sites requiring extraction for either orthodontic treatment or pericoronitis. Serial cryostat sections (6 microns in thickness) were prepared from each biopsy, on which a double staining avidin-biotin immunoperoxidase and avidin-biotin alkaline phosphatase technique was used to identify CD4+, CD45RO+ memory T-cells and activated CD19+ B-cells expressing CD23 or CD25. In periodontitis lesions, the mean percentage of CD4+ cells expressing CD45RO was consistently high (65.9% in the crevicular (C) one-third (1/3), 61.2% in the middle (M) 1/3 and 62.5% in the oral (O) 1/3). This contrasts with the low mean percentage of CD4+, CD45RA+ naive T-cells (17.1% in the C 1/3, 14.8% in the M 1/3 and 12.4% in the O 1/3). In gingivitis specimens, the incidence of CD4+, CD45RO+ was 81.9% in the C 1/3, 81.1% in the M 1/3 and 89.0% in the O 1/3. This was higher than that of periodontitis biopsies. With CD4+, CD45RA+ the incidence was 10.0% in the C 1/3, 8.0% in the M 1/3, and 6.6% in the O 1/3 and the relationship to the periodontitis biopsies was reversed. However, the percentage of CD23+ and CD25+, CD19+ B-cells which were identified in 13 out of 19 samples from periodontitis varied significantly (0-100% for CD23, 0-36.2% for CD25) in spite of similar clinical status. The frequency of B-cells and activated B-cells in the gingivitis was much lower than that of periodontitis. These results indicate that both T-cells and B-cells were in active stage in periodontitis lesions. Differences of immunohistological features between gingivitis and periodontitis may be attributable to the heterogeneity of profiles of cytokine production by CD4+, CD45RO+ "memory' cells.

Development and characterization of Porphyromonas gingivalis-specific rat T-cell clones

Porphyromonas gingivalis has been implicated as a major pathogen in periodontitis. To determine the role of T cells in the regulation of this disease, a method was developed for the generation and characterization of rat T-cell clones with antigen specificity to P. gingivalis whole cells. The clones studied so far demonstrated a T-helper (Th) phenotype W3/13+, W3/25+, OX8- and OX22-. These T-cell clones proliferated in vitro in response to P. gingivalis, but not to other bacteria (Prevotella intermedia, Actinobacillus actinomycetemcomitans, Wolinella recta, Fusobacterium nucleatum, Streptococcus sanguis). Limiting dilution analysis showed W3/25+, OX8- T cells preferentially respond to P. gingivalis, rather than W3/25-, OX8+ T cells. P. gingivalis-reactive W3/25+ T cells belonged to the OX22- population, suggesting that the OX22- T cells may represent memory cells. All clones tested produced interferon gamma, but not interleukin 2. The cloned T-cell F1 significantly enhanced P. gingivalis-specific antibody production (p < 0.03). The availability of these cloned T cells should bring new insight into the mechanism by which T cells regulate oral health and periodontal disease.

Distribution of ICAM-1, LFA-3 and HLA-DR in healthy and diseased gingival tissues

Cell adhesion molecules are involved in recognition and effector aspects of the host response, including the control of migration of leukocytes into inflammatory sites. In this study we have demonstrated that the distribution of three cell-surface molecules involved in cell interactions, ICAM-1, LFA-3 and HLA-DR is distinct and different in healthy and diseased gingival tissue. ICAM-1 was consistently expressed by junctional epithelial cells in healthy gingiva and by pocket epithelium in diseased gingiva but was not detectable on the majority of keratinocytes in external gingival epithelium. ICAM-1 was also expressed by endothelial cells of gingival blood vessels and a subset of leukocytes in the infiltrated connective tissue in both healthy and diseased gingiva. HLA-DR and LFA-3 were also expressed by epithelial cells and endothelial cells but in patterns which were distinctly different from ICAM-1.

Determination of lymphocyte populations and subpopulations extracted from chronically inflamed human periodontal tissues

The lymphocyte populations and subpopulations extracted from inflamed periodontal tissues of patients with adult periodontitis were determined. 34 patients were grouped according to the gingival index score (GI) of 1, 2 and 3. Gingival tissue from 2 involved teeth was excised, treated with collagenase, and infiltrating cells were isolated and identified using monoclonal antibodies for lymphocyte sets and subsets. The % of CD3+ cells was about 54.5% in all 3 patient groups, but the percentage of CD22+ cells increased from 28.9 +/- 3.3% in the group with GI = 1 to 33 +/- 1.2% in the group with GI = 3. %s of CD4+ cells and activated CD4+ cells increased from 30.2 +/- 2.1% and 4.7 +/- 1.7% in the group with GI = 1 to 38.4 +/- 1.2% and 16.0 +/- 3.4% in the group with GI = 3, respectively, while in the same groups, the % of CD8+ cells decreased from 24.9 +/- 2.0% to 17.7 +/- 1.6%. These data indicate a possible importance of activated CD4+ cells in pathogenetic mechanisms of periodontitis.

Expression of interleukin-2 receptor and HLA-DR on lymphocyte subsets of gingival crevicular fluid in patients with periodontitis

Expression of interleukin-2 receptor (IL2R) and HLA-DR on lymphocytes of gingival crevicular fluid (GCF) was examined by two-color flow cytometric analysis. GCF from 15 patients with periodontitis was collected by crevicular washing. Mononuclear cells were isolated by Ficoll-paque gradient centrifugation from inflamed gingival tissue (GT) and peripheral blood (PB) sampled from each of the 15 patients. Lymphocyte subsets were detected by using monoclonal antibodies (mAb) of Leu 12 (CD19), Leu 4 (CD3), Leu 3a (CD4) and Leu 2a (CD8) directed to B cells, T cells, helper/inducer T cells (Th) and suppressor/cytotoxic T cells (Ts), respectively. Anti-IL2R (CD25) and anti-HLA-DR were used as lymphocyte activation markers. IL2R- or HLA-DR-positive fractions in Th, Ts and B cells were calculated. Percentage of IL2R-positive fraction in Th (IL2R+ Th) of GCF (34.0%) was significantly higher than those of GT (18.4%) and PB (13.7%). IL2R-positive fraction in B cells (IL2R+ B) of GCF was the highest among the three groups (23.9% in GCF, 12.5% in GT, 6.3% in PB). Ts did not express IL2R regardless of the origin of the samples. Compared with PB and GT, GCF showed significantly higher HLA-DR expression on Th and Ts in GCF (PB: 8.7% and 27.1%; GT: 27.9% and 50.3%; GCF: 44.7% and 65.3%). These results suggest that lymphocytes in GCF were highly activated and are related to the local host immune response in periodontitis.

Cell populations and episodic periodontal attachment loss in humans

The purpose of the present study was to assess possible associations between episodic probing attachment loss and cell populations in the supracrestal connective tissue in humans. 10 systemically healthy adult patients with untreated advanced periodontitis were monitored during a period of 10 months. At baseline and every month thereafter, probing attachment levels were measured at 6 sites of every tooth using an electronic pressure sensitive probe and flexible stents. Corresponding contralateral sites were identified where 1 site had lost 2 mm or more attachment within the previous month (P), and the other site had not (C). Supracrestal soft tissue biopsies were taken from these sites, processed and cut into 1 micron sections. Cell populations were identified in superficial and deep connective tissue areas by counting fibroblasts, macrophages, plasma cells, mast cells, granulocytes, lymphocytes, endothelial cells and the total number of inflammatory cells. Analysis of variance assessed differences in cell populations between P- and C-sites. There were statistically significantly higher numbers of fibroblasts in the standard areas of C-sites (p less than 0.0001). In P-sites, the numbers of macrophages, plasma cells, mast cells, lymphocytes and total inflammatory cells were significantly higher as compared to C-sites (p = 0.05-0.0001). There were no differences in cell populations between superficial and deep connective tissue areas within P- and C-sites (p greater than 0.2). Clinically assessed episodes of periodontal disease progression may be associated with site-specific shifts in inflammatory cell populations.

Immunologic mechanisms of pathogenesis in periodontal diseases: an assessment

Principal lines of evidence that immune reactions are central to the pathogenesis of periodontitis are reviewed. Necessary components of immunologic reactions are present in gingiva in the periodontal diseases. Differences between healthy and periodontitis patients with respect to some measures of immune function further indicate that immune reactions do occur in the gingiva during periodontitis. They are probably responsible for at least some of the destruction of connective tissue and bone that occurs. Classical antibody-mediated hypersensitivity reactions probably do not provide the reasons. Mechanisms are more likely to be found in the pro-inflammatory and tissue-degrading effects of cytokines released in host-protective, antigen-specific and polyclonal responses to oral bacterial constituents or products. Some evidence suggests that limitation of clinical destruction in localized early onset periodontitis (JP) may in part be a function of a protective antibody response which develops after an initial rapidly progressive infection. A relatively deficient immune responsiveness may allow progression to more severe and generalized disease (RPP). Suggestions are made for studies needed to confirm suspected pathogenetic mechanisms, approach resultant targeted therapies, and test hypotheses for contrasting roles of immune reactions in different clinical expressions of periodontitis.

Autoimmunity in periodontal disease

Periodontal disease in characterized by the loss of the normal supporting tissues of the teeth and a humoral and cellular immune response to bacterial antigen of dental plaque which accumulates at the dento-gingival junction. This review considers the evidence for the existence of an autoimmune component of the host immune response, the possible origin of such a response and the way in which such a host response may contribute to the changes observed in the periodontium in the disease.

The role of histopathology in the diagnosis and prognosis of periodontal diseases

The histological evaluation of surgical biopsies from affected tissues is a standard way of assessing pathological change and determining treatment in many diseases. In most forms of periodontal disease, however, this approach finds limited application. Here, we review what uses the histopathological approach has in the study and evaluation of the periodontal diseases. Current understanding of the changes in epithelial anatomy during pocket formation, the cellular composition and dynamics of the inflammatory infiltrate and the mechanisms of bone resorption and repair are reviewed from the perspective of the information available from microscopical investigation, including the uses and potential application of modern immunocytochemical methods to these questions. The usefulness of histological study of biopsy material is reassessed in the light of advances made in immunohistochemical techniques and their application to gingival inflammatory infiltrates and epithelia. Such techniques offer immediately valuable research opportunities with potential for diagnostic applications, noteably the recognition of phases of destructive activity and their differentiation from periods of effective host defence.

Episodic probing attachment loss in humans: histologic associations

Marginal periodontitis in humans is characterized by episodes of probing attachment loss followed by periods of quiescence. The purpose of the present study was to assess characteristics of the inflammatory infiltrate in periodontal lesions where episodic probing attachment loss had occurred within the previous month. In 10 systemically healthy adult human subjects with untreated advanced periodontitis, probing attachment levels were measured at baseline and every 30 days thereafter for 10 months. Measurements were made at six sites of every tooth using an acrylic onlay as a reference point and a pressure sensitive probe. Sites where double measurements confirmed that probing attachment loss of 2 mm or more had occurred within the previous month were identified (P-sites), as were corresponding contralateral non-progressing sites (C-sites). Biopsies of the supracrestal tissues were taken from these sites, processed, and cut in 1 mu sections for histologic evaluation. Counts of inflammatory cells in standard areas of the sections were compared between P and C sites. The results indicated that 5.04% of 1566 sites under investigation lost probing attachment during the 10-month observation period. Inflammatory cell counts were higher in P-sites as compared to C-sites. P-sites with more than 2 mm attachment loss (P greater than 2 sites) had significantly more inflammatory cells within standard areas at the apical end of the junctional epithelium than non-progressing C-sites (P less than 0.02). There was no significant difference in counts between P-sites progressing 2 mm (P-2 sites) and corresponding C-sites.(ABSTRACT TRUNCATED AT 250 WORDS)

Variation in the composition of gingival inflammatory cell infiltrates

Biopsy specimens were taken at gingivectomy from 18 adult patients undergoing treatment for chronic marginal periodontitis. They were embedded so that the cut surface of the gingiva was parallel to the top of the block to obtain a comprehensive view in a transversal plane of the inflammatory cell infiltrate near the bottom of the pocket. Sections were stained with HES or with toluidine blue for histological description, and acid alpha-naphthyl acetate esterase (ANAE) was used to differentially stain T lymphocytes, plasma cells and monocytes/macrophages. Sections stained with HES showed that the density and size of the cell infiltrates varied along the circumference of a tooth over very short distances and on various surfaces on neighbouring teeth. Differential counts of cells stained for ANAE demonstrated great variation in the composition of the cell infiltrates, particularly along the pocket epithelium. The predominating ANAE positive cell type in this area was T lymphocytes, while in the central connective tissue, plasma cells predominated. There was no systematic covariation between the localization of the gingiva (i.e. mesial, facial, etc.) and the composition of the cell infiltrates. The local variation in the composition of the cellular infiltrate most likely reflects local variability in the noxious substances (i.e. plaque composition) within the periodontal pocket, and in the resulting local inflammatory response.