T-cell regulation of polyclonal B-cell activation induced by extracts of oral bacteria associated with periodontal diseases

Destructive periodontitis lesions are determined by the nature of the lymphocytic response

It is now 35 years since Brandtzaeg and Kraus (1965) published their seminal work entitled "Autoimmunity and periodontal disease". Initially, this work led to the concept that destructive periodontitis was a localized hypersensitivity reaction involving immune complex formation within the tissues. In 1970, Ivanyi and Lehner highlighted a possible role for cell-mediated immunity, which stimulated a flurry of activity centered on the role of lymphokines such as osteoclast-activating factor (OAF), macrophage-activating factor (MAF), macrophage migration inhibition factor (MIF), and myriad others. In the late 1970s and early 1980s, attention focused on the role of polymorphonuclear neutrophils, and it was thought that periodontal destruction occurred as a series of acute exacerbations. As well, at this stage doubt was being cast on the concept that there was a neutrophil chemotactic defect in periodontitis patients. Once it was realized that neutrophils were primarily protective and that severe periodontal destruction occurred in the absence of these cells, attention swung back to the role of lymphocytes and in particular the regulatory role of T-cells. By this time in the early 1990s, while the roles of interleukin (IL)-1, prostaglandin (PG) E(2), and metalloproteinases as the destructive mediators in periodontal disease were largely understood, the control and regulation of these cytokines remained controversial. With the widespread acceptance of the Th1/Th2 paradigm, the regulatory role of T-cells became the main focus of attention. Two apparently conflicting theories have emerged. One is based on direct observations of human lesions, while the other is based on animal model experiments and the inability to demonstrate IL-4 mRNA in gingival extracts. As part of the "Controversy" series, this review is intended to stimulate debate and hence may appear in some places provocative. In this context, this review will present the case that destructive periodontitis is due to the nature of the lymphocytic infiltrate and is not due to periodic acute exacerbations, nor is it due to the so-called virulence factors of putative periodontal pathogens.

Effect of Fusobacterium nucleatum on the T and B cell responses to Porphyromonas gingivalis in a mouse model

T cell cytokine profiles and specific serum antibody levels in five groups of BALB/c mice immunized with saline alone, viable Fusobacterium nucleatum ATCC 25586, viable Porphyromonas gingivalis ATCC 33277, F. nucleatum followed by P. gingivalis and P. gingivalis followed by F. nucleatum were determined. Splenic CD4 and CD8 cells were examined for intracytoplasmic interleukin (IL)-4, interferon (IFN)-gamma and IL-10 by dual colour flow cytometry and the levels of serum anti-F. nucleatum and anti-P. gingivalis antibodies determined by an ELISA. Both Th1 and Th2 responses were demonstrated by all groups, and while there were slightly lower percentages of cytokine positive T cells in mice injected with F. nucleatum alone compared with the other groups immunized with bacteria, F. nucleatum had no effect on the T cell production of cytokines induced by P. gingivalis in the two groups immunized with both organisms. However, the percentages of cytokine positive CD8 cells were generally significantly higher than those of the CD4 cells. Mice immunized with F. nucleatum alone had high levels of serum anti-F. nucleatum antibodies with very low levels of P. gingivalis antibodies, whereas mice injected with P. gingivalis alone produced anti-P. gingivalis antibodies predominantly. Although the levels of anti-F. nucleatum antibodies in mice injected with F. nucleatum followed by P. gingivalis were the same as in mice immunized with F. nucleatum alone, antibody levels to P. gingivalis were very low. In contrast, mice injected with P. gingivalis followed by F. nucleatum produced equal levels of both anti-P. gingivalis and anti-F. nucleatum antibodies, although at lower levels than the other three groups immunized with bacteria, respectively. Anti-Actinobacillus actinomycetemcomitans, Bacteroides forsythus and Prevotella intermedia serum antibody levels were also determined and found to be negligible. In conclusion, F. nucleatum immunization does not affect the splenic T cell cytokine response to P. gingivalis. However, F. nucleatum immunization prior to that of P. gingivalis almost completely inhibited the production of anti-P. gingivalis antibodies while P. gingivalis injection before F. nucleatum demonstrated a partial inhibitory effect by P. gingivalis on antibody production to F. nucleatum. The significance of these results with respect to human periodontal disease is difficult to determine. However, they may explain in part differing responses to P. gingivalis in different individuals who may or may not have had prior exposure to F. nucleatum. Finally, the results suggested that P. gingivalis and F. nucleatum do not induce the production of cross-reactive antibodies to other oral microorganisms.

Large-scale early in vitro response to actinobacillus actinomycetemcomitans suggests superantigenic activation of T-cells

The mode of T-cell response to Actinobacillus actinomycetemcomitans is largely unknown. The present study sought to investigate the hypothesis that A. actinomycetemcomitans expresses superantigens, capable of antigen-non-specific T-cell activation. To that end, peripheral blood mononuclear cells were stimulated with A. actinomycetemcomitans, and T-cell expression of the early activation marker, CD69, was determined by flow cytometry. Results showed that A. actinomycetemcomitans activated a large number of T-cells with magnitude similar to that of staphylococcal enterotoxin superantigens. A. actinomycetemcomitans sonicate preferentially activated T-cells expressing Vbeta5.1 and Vbeta8, while the extracellular preparation activated Vbeta5.1+, Vbeta8+, and Vbeta12+ T-cells. T-cell response to A. actinomycetemcomitans was observed in the presence of autologous, as well as heterologous, antigen-presenting cells, suggesting a MHC-non-restricted response. Thus, the in vitro response to A. actinomycetemcomitans is characterized by large-scale T-cell activation in a Vbeta-specific and MHC-non-restricted manner, consistent with the involvement of superantigens.

Some effects of non-surgical therapy on gingival inflammatory cell subsets in patients with adult and early-onset periodontitis

BACKGROUND

Limited information is available to determine if there is a distinction in local cellular immunity between adult and early-onset periodontitis. Furthermore, the effect of scaling and root planing on various lymphocyte subsets is sparsely described.

METHODS

Clinical measurements were recorded and gingival biopsies were performed before and after scaling and root planing in 10 subjects with adult (AP) and in 10 with early-onset periodontitis (EOP). The specimens were cut into serial sections and, using the alkaline phosphatase-anti-alkaline phosphatase technique, monoclonal antibodies to CD20 (B-cells), CD30 (plasma cells), and CD45RO (T-memory cells) were applied, as well as polyclonal antibodies to alpha, gamma, and mu chains (Ig A, G, and M). Areas showing the largest infiltration cells were counted.

RESULTS

Mean counts of all cell phenotypes in the AP versus the EOP group did not show any significant differences before therapy (P >0.05). Following scaling and root planing, numbers of all phenotypes decreased in both groups. Comparing the data before and after therapy, P values were >0.05 in the AP group, except for IgA-positive cells. In the EOP group, the differences before and after therapy reached statistical significance (P<0.05) for all cell counts, except for IgM-positive cells. Furthermore, reduction of probing depth and gain of clinical attachment reached the 0.05 level of statistical significance only in EOP subjects.

CONCLUSIONS

Local cellular immunity in patients with adult onset periodontitis does not appear to differ from the immune response in patients with early onset periodontitis. Scaling and root planing causes a decrease in the inflammatory cells subsets tested, however, this decline seems to be more pronounced in EOP than in AP subjects.

Differential expression of costimulatory molecules in chronic inflammatory periodontal disease tissue

Although B cell activation and subsequent immunoglobulin production are the immunopathological features of chronic inflammatory periodontal disease, in situ expression of costimulatory molecules in humoral immunity has not been investigated. In the present study we examined the expression of CD40, CD40 ligand (CD40L), CD80, CD86, CD28 and cytolytic T lymphocyte-associated antigen-4 (CTLA-4) on lymphocytes immunohistochemically. Cryostat sections were prepared from the gingival tissue samples of 14 patients with moderate to advanced adult periodontitis. In vitro kinetics of the expression of CD40L and CTLA-4 by peripheral blood T cells and that of CD80 and CD86 by peripheral blood B cells were also investigated by flow cytometry. Positive percentage expression of CD40L, CD28 and CTLA-4, and CD40, CD80 and CD86 was calculated for the number of CD3+ and CD19+ cells, respectively. Flow cytometric analysis demonstrated that the expression of CD40L and CTLA-4 on T cells, and CD80 and CD86 on B cells of peripheral blood was up-regulated upon activation. While most T cells and B cells expressed CD28, and CD80 and CD86, respectively, in gingival tissues, the expression of CD40L and CTLA-4 was lower but highly variable between specimens. Furthermore, these two molecules seemed to be expressed reciprocally in the lesion. As both CD40L and CTLA-4 expression are induced transiently by stimulation, variability in the expression of the molecules may reflect immunological activities and participation in the regulation of B cell activation of the lesion.

HLA-D types and serum IgG responses to Capnocytophaga in diabetes and periodontitis

Serum IgG responses to the cell envelope proteins (CEPs) from Capnocytophaga sputigena, Capnocytophaga ochracea, and Capnocytophaga gingivalis were examined in periodontally healthy and periodontitis subjects, both with and without type 1 diabetes (n = 60). Serum IgG responses to CEPs were determined by immunoblotting with biotin-goat anti-human IgG and an alkaline phosphatase-streptavidin system. Reactivity was analyzed by transmission densitometry, digitization, and computer manipulation. The patients with diabetes showed significantly (p < 0.01) fewer responses to 14 CEPs (from 81 to 10 kDa) from C. sputigena, 5 CEPs (from 90 to 17 kDa) from C. gingivalis, and the 27-kDa CEP from C. ochracea than in the non-diabetic group. The periodontitis patients showed significantly (p < 0.01) fewer responses to the 25- and 11-kDa CEPs from C. sputigena, the 125- and 17-kDa CEPs from C. gingivalis, and the 42-kDa CEP from C. ochracea than in the periodontally healthy group. HLA-DR4, HLA-DR53, and HLA-DQw3 were associated with periodontitis, while only HLA-DR4 was associated with diabetes (p < 0.02). Significant (p < 0.01) correlations were found between HLA-DR2 and IgG reactivity patterns associated with non-diabetics, and between HLA-DR4 and IgG reactivity patterns associated with diabetic and periodontitis subjects. These results indicate that both type 1 diabetics and periodontitis subjects have a depressed IgG antibody profile to Capnocytophaga, which may account for an increased susceptibility to periodontitis infection. Periodontitis in type 1 diabetes may be related more to the HLA-D type and altered immune function than to the diabetes itself.

The induction of polyclonal B-cell activation and interleukin-1 production by the 75-kDa cell surface protein from Porphyromonas gingivalis in mice

The immunobiological activities of 75-kDa protein, fimbrial protein and lipopolysaccharide lipopolysaccharide prepared from whole cells of Porphyromonas gingivalis 381 were compared. The 75-kDa protein was mitogenic for BALB/c nu/nu, BALB/c and lipopolysaccharide-responsive C3H/HeN mouse spleen cells and for lipopolysaccharide-non-responsive C3H/HeJ mouse spleen cells. The response was significant in BALB/c mouse spleen cells incubated with 1-100 micrograms/ml of the 75-kDa protein. Furthermore, the 75-kDa protein exhibited polyclonal B-cell activation in murine spleen cells, which was similar to the lipopolysaccharide of P. gingivalis. In contrast, fimbriae from P. gingivalis did not, or only weakly, activated murine spleen cells. C3H/HeN mouse macrophages exposed to 10 micrograms/ml of the 75-kDa protein released large amounts of interleukin-1 (IL-1), which were maximal for 48 h, whereas IL-6 activity in macrophage supernatants was not detected throughout the culture period. These results suggest that the 75-kDa protein is a potent polyclonal B-cell activator and that it stimulates IL-1 production from murine peritoneal macrophages as well as lipopolysaccharide, which may play an important part in the inflammatory response during the development of periodontal diseases.

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.

IL-4- and IL-6-producing cells in human periodontal disease tissue

IL-4- and IL-6-producing cells in human periodontal disease tissues were investigated using immunohistochemical and in situ hybridization techniques. Immunohistochemical analysis demonstrated the presence of IL-4-producing cells within the CD45RO+ subset and the percentage of IL-4+ cells was significantly higher in periodontal lesions than in gingivitis tissues (p < 0.01). The percentage of IL-6-producing memory cells was higher in periodontal lesions compared with gingivitis tissues, although it was not statistically significant (p > 0.05). A reverse tendency in IL-4- and IL-6-positive cells was observed in a few individual cases. No IL-4 mRNA could be detected using the in situ hybridization technique. However, high levels of IL-6 mRNA were present in clinically healthy tissues, with a further increase in both epithelium and connective tissues affected by gingivitis, although only the former was significant (p < 0.025). There was a significant decrease in IL-6 mRNA in both the connective tissue (p < 0.025) and epithelium (p < 0.01) in periodontitis tissues compared with levels in gingivitis tissues. However, the levels of IL-6 mRNA in periodontal tissues were high compared with those of IL-1 mRNA, which was used in this study as a positive control. These results suggest that Th2-type cells may accumulate in periodontal lesions.

Assessment of interleukin-6 in the pathogenesis of periodontal disease

This study was performed to investigate the aspects of interleukin-6 (IL-6) production in both the gingival tissue and the peripheral blood of patients with periodontal disease and of periodontally healthy subjects. In addition, IL-6 expression in human gingival tissues was studied by reverse transcription-polymerase chain reaction analysis and by immunoperoxidase staining with anti-IL-6 monoclonal antibody. The levels of IL-6 in the culture supernatants from peripheral blood mononuclear cells (PBMC) stimulated with lipopolysaccharide and in serum were examined by bioassay. We detected IL-6 mRNA expression in all inflamed gingival tissues (17/17) examined and in 2/4 in healthy gingival tissues. IL-6 protein was detected mainly in endothelial cells, fibroblasts, and macrophages but not in the area containing T or B cells in the inflamed gingival tissues, and was not detected at all in healthy gingival tissues. There was no significant difference between the subjects with periodontal disease and those with healthy gingival tissues either in serum IL-6 levels or in the amount of IL-6 produced by PBMC. These results suggest that non-lymphoid cells in inflamed gingival tissue may contribute to the pathogenesis of periodontal disease via IL-6 production, and that the IL-6 produced in gingival tissue may not reflect the IL-6 levels in peripheral blood.

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.

Different responses in B cells induced by Porphyromonas gingivalis and Fusobacterium nucleatum

A phenotypic study had shown that gingival B cells respond differently to two periodontopathic bacteria, Porphyromonas gingivalis and Fusobacterium nucleatum. Further investigation now shows a reduction in the percentage of Ki-67 + T cells in cultures of gingival and peripheral blood mononuclear cells stimulated with P. gingivalis for 3 and 6 days, respectively, but no suppression of Ki-67 expression in B cells in response to either P. gingivalis or F. nucleatum. Depletion studies of cultures of peripheral blood mononuclear cells showed that in the absence of CD4 cells, the percentage of CD19+ and CD20+ B cells stimulated with P. gingivalis increased after 6 days whereas depletion of CD8 cells resulted in a rise in the percentage of F. nucleatum- and P. gingivalis-stimulated B cells, although this was not significant in the case of P. gingivalis. Specific antibody to P. gingivalis and F. nucleatum was found in culture supernatants of gingival but not of peripheral blood mononuclear cells, indicating a possible higher frequency of antigen-specific B cells in periodontal lesions. IgG was the predominant isotype in both gingival and control peripheral blood cultures, followed closely by IgA in gingival cultures. F. nucleatum stimulated higher levels of Ig in cultures of peripheral blood mononuclear cells than P. gingivalis or cells cultured in medium only, whereas in gingival cell cultures, stimulation by P. gingivalis appeared to result in higher levels of IgG. Also Ig was present at day 3 in gingival cultures, whereas in the blood cell cultures, Ig was only detected at day 6, further suggesting a degree of activation of of gingival B cells.(ABSTRACT TRUNCATED AT 250 WORDS)

A Comparison of T4:T8 Lymphocyte Ratio in the Periodontal Lesion of Healthy and HIV-Positive Patients

Previous reports describe a characteristic, rapidly progressive, periodontitis that is unique to patients who are seropositive for HIV antibody (Western blot +). The purpose of this study was to compare the T4 and T8 lymphocyte subpopulations in the peripheral blood and periodontal lesions of these HIV patients with those of healthy controls. T-cell subsets in peripheral blood were quantified by flow cytometry. The values from this analysis were used to calculate the peripheral T4:T8 lymphocyte ratio for each patient. Gingival tissue (papilla) was obtained from 8 HIV+ patients and from 6 healthy HIV- control patients during routine gingival surgery. The T-cell subpopulations in the gingival tissue were determined using serial cryostat sections that were labeled with monoclonal antibodies for T4 and T8 cells and developed using an avidin-biotin-peroxidase system. Six sections were taken from each of the 14 tissue specimens (one per patient). The sections were examined at 450 x and the mean number of T4 and T8 cells calculated for each section. These mean values were then used to determine the T4:T8 lymphocyte ratio for each tissue specimen. The peripheral blood analysis revealed a mean serum T4:T8 ratio of (2.07 +/- 0.455) for the controls and (0.58 +/- 0.26) for the HIV patients. The significantly lower T4:T8 ratio in HIV patients is consistent with their diagnosis. Although the results indicated that the mean T4:T8 lymphocyte ratio in the gingiva of controls was highly variable (2.70 +/- 1.344), the gingiva of HIV patients consistently exhibited a complete absence of T-cells.(ABSTRACT TRUNCATED AT 250 WORDS)

In situ characterization of mononuclear cells in marginal periodontitis of patients with Down's syndrome

An indirect immunofluorescence technique on cryostat sections was used to study the cellular composition in chronic marginal periodontitis (CMP) of patients with Down's syndrome (DS). The findings were compared with CMP lesions in otherwise normal patients (NP). The distribution and amount of CD22+ cells (B lymphocytes), CD3+ cells (pan T lymphocytes), CD4+ cells (helper T subset), CD8+ cells (suppressor/cytotoxic T subset), and CD11c+ cells (in tissue, mainly monocytes and macrophages) were investigated. Morphologic studies showed a denser inflammatory infiltrate in DS than in NP. Countings showed significant differences in cell distribution (p = 0.0003) and cell profiles (p = 0.0273) between the two groups. The median CD4+/CD8+ ratio in DS (2.73) was significantly higher (p = 0.0024) than found in gingival inflammatory lesions from NP (1.08). The present study shows that DS patients have a different, more pronounced, immune response in CMP than NP.

Phenotypic analysis of B-cells extracted from human periodontal disease tissue

B-cells extracted from periodontal disease tissue were analyzed for the presence of activation markers using a range of monoclonal antibodies. In adult periodontitis (AP), 6% of B-cells expressed the IL-2 receptor (CD25) compared with 1-2% in peripheral blood and healthy or marginal gingivitis (H/MG) gingival B-cells. There was also an increase in the mean percentage of IgD-positive B-cells and a decrease in CD21 and CD22 expression. In both AP and H/MG lesions, 20-22% of the B-cells expressed CD23 compared with less than 5% in peripheral blood. As B-cells are activated by day 3 in culture and start differentiating into immunoglobulin-secreting cells by day 6, B-cell phenotypes were assayed at these times in this study. Following stimulation with the periodontopathic bacterium Porphyromonas gingivalis, the expression of CD23, CD21 and CD22 on B-cells extracted from AP lesions remained relatively constant over the 6-d culture period. However, with Fusobacterium nucleatum stimulation, there was a significant decrease in CD23, CD21 and CD22 expression after 3 d in culture, which corresponds to the activation time for B-cells. These results show that B-cells extracted from periodontal disease tissue display a range of activation markers and on stimulation, demonstrate differing responses to individual periodontopathic bacteria.

Stimulation of lymphocytes in vitro by Bacteroides intermedius and Bacteroides (Porphyromonas) gingivalis sonicates

The present study was designed to assess whether the in vitro stimulation of lymphocytes by sonicates of Bacteroides intermedius and Bacteroides (Porphyromonas) gingivalis is antigen specific or non-specific. In addition, the role of T and B lymphocytes in these responses was assessed. Peripheral blood lymphocytes obtained from healthy volunteers were cultured in the presence of these bacterial preparations and the proliferative response was measured. In similar experiments the response of umbilical cord blood lymphocytes did not exceed background values. In limiting dilution experiments only 1:4000, 1:6800, and 1:8200 of the lymphocytes initially reacted to B. intermedius, which strongly argues for the antigen-specificity of the response. Purified T cells, in the presence of monocytes, proliferated when stimulated with B. intermedius and B. gingivalis. As for B cell stimulation, the bacterial extracts were capable of inducing IgM production, which appeared to be T cell dependent. These findings support the notion that B. intermedius and B. gingivalis induce specific T cell activation; secondarily, a T cell dependent, polyclonal B cell activation may occur.

Polyclonal B-cell activation in periodontitis

The evidence that periodontitis-associated bacteria contain potent PBA factors is very strong. Clearly, antibodies directed against non-oral antigens are produced in the inflamed periodontal lesion, and PBA appears to contribute to that production. It is also clear that B cells and plasma cells are the major cell types in the periodontal lesion. Furthermore, alterations in the regulation of B-cell responses to PBA factors are associated with severe periodontal disease. However, evidence demonstrating that activated B cells and plasma cells are directly involved in the pathogenic mechanisms leading to destruction of the periodontal support is still circumstantial. Polyclonal B-cell activation and potential pathways by which PBA-stimulated cells could be involved in periodontal destruction remain largely hypothetical. It appears that IL-1 is an important osteoclast-activating agent, and that LPS, which is a potent PBA factor in many systems, can elicit IL-1 production by B cells as well as by the monocyte/macrophage lineage. Recent data indicating that IL-1 is produced by numerous malignant B-cell lines lend support for the idea that B-cell IL-1 could be important in bone resorption. It is also likely that polyclonal activation may lead to production of autoantibody such as anti-type I and anti-type III collagens, and the destruction of self tissues through ADCC reactions, immune complex formation, and complement activation. Further research is needed to determine how the B cell/plasma cell may participate in tissue injury in periodontitis, and how the B-cell response to PBA factors is regulated.

In situ correlative immuno-identification of mononuclear infiltrates and invasive bacteria in diseased gingiva

The purpose of this study was to identify and quantify mononuclear cells and invasive bacteria in consecutive histological sections in diseased gingiva. Gingival biopsies were obtained from sites displaying evidences of severe periodontitis (pocket depth greater than 5 mm, bleeding on probing) in six patients. Specimens were frozen and serially sectioned at 8 micron in a cryostat. Monoclonal antibodies (mAb) directed against membrane markers of mononuclear infiltrate cells and rabbit polyclonal sera against specific bacteria shown to be invasive in association with an immunoperoxidase technique and specific point quantification were used. The mAb panel included Leu 1 (Pan T), Leu 2a (T suppressor/cytotoxic), Leu 3a (T helper/inducer), Leu 6 (Langerhans/dendritic), Leu 7 (NK/K), Leu M3 (monocyte/macrophage), and B7 (B cell). This methodology allows for in situ per cent quantification of mononuclear cell subsets along with identification and quantification of invasive bacteria in the same gingival tissue site. This may be a practical approach to establish the relationship between bacterial invasion and cellular immune response by the host. This technique enabled the characterization of the mononuclear infiltrate in relationship to specifically identified invasive bacteria in diseased gingiva.

In situ lymphocyte subpopulations from active versus stable periodontal sites

The purpose of this study was to evaluate lymphocyte subset densities and distributions within gingival biopsies from active sites (greater than or equal to 2 mm clinical attachment loss within three months of biopsy) versus clinically similar but stable or healthy sites. Small interproximal gingival biopsies representing at least one of each of the above categories were obtained from each of 20 periodontal maintenance patients. Serial cryostat sections displaying a cross section of the gingiva were labeled with monoclonal antibodies for (1) pan T cells, (2) T cytotoxic/suppressor cells, (3) T helper/inducer cells and (4) pan B cells and were developed using an avidin-biotin-peroxidase system. Lymphocyte populations were enumerated in repeatable fields from the sulcular, middle and oral one-third of each section. Relative proportions of the same lymphocyte subsets were analyzed in peripheral blood samples from the same patients using direct immunofluorescence. Pan B cells were significantly more prevalent in infiltrates from active sites than in stable (P less than 0.05) or healthy (P less than 0.01) sites. The T/B cell ratio was also significantly lower in active than stable biopsies (P less than 0.05), and in active biopsies versus blood (P less than 0.05). The T helper/T suppressor cell ratio did not vary significantly between blood and any gingival tissue disease group or location, but a trend toward lower relative numbers of T helper cells in the sulcular infiltrates of active sites was noted. These results support the premise that active periodontal sites display elevated B cell populations and abnormal immune regulation possibly involving the T helper cell subset.

Immunohistological analysis of experimental gingivitis in humans

Immunohistological analysis of experimental gingivitis in humans was carried out to provide a baseline for the study of immunoregulatory mechanisms in chronic inflammatory periodontal disease. Using a panel of monoclonal antibodies in an avidin biotin immunoperoxidase technique, T cell subsets were identified and the pattern of Class II major histocompatibility complex (MHC) antigens determined. Twenty third-year dental students took part in the study. Following the cessation of oral hygiene procedures, gingival biopsies were taken from each of five students at days 0, 4, 8 and 21 during the development of the inflammatory lesion. Each student had one biopsy which healed uneventfully. The T4:T8 ratio showed only slight variation over the time course of the lesion varying from 2.18:1 at day 0 to 2.48:1 at day 4. At all stages the T cells displayed both HLA-DR and HLA-DQ antigens, but less than 10% had detectable IL-2 receptors. The predominant macrophage population was acid phosphatase + ve, adenosine triphosphatase -ve, HLA-DR+ and HLA-DQ+ antigens suggesting an activated phagocytic population. During the development of the lesion, the number of intraepithelial Langerhans cells (T6+) increased but there appeared to be a discrepancy between HLA-DR and HLA-DQ expression on these cells. Similarly, the keratinocytes expressed HLA-DR but failed to express HLA-DQ at any stage. These results suggest that the developing gingival lesion is a well controlled lesion and follows a similar pattern to a controlled delayed type hypersensitivity (DTH) response.

Phenotypic analyses of mononuclear cells recovered from healthy and diseased human periodontal tissues

Mononuclear cells were recovered from the gingival tissues of normal individuals and from patients with periodontal disease. Lymphocyte phenotypic markers were identified by immunofluorescence after reaction with monoclonal antibodies to T-cell subset markers. The normal tissues exhibited T4/T8 ratios almost identical to those in the peripheral blood. The diseased tissue cell ratios were significantly reduced, in both the adult periodontitis and the juvenile periodontitis groups (P less than 0.01 and P less than 0.02, respectively), indicating alterations in the T-cell subset distribution in these tissues. Each diseased patient showed a much decreased T4/T8 ratio in the gingival lymphocytes when these were compared with the peripheral blood ratio from the same patient. The T4/T8 ratios of the more severe sites were significantly lower than those of the less severe sites in the same disease category. The decreases in subset ratios could be attributed to statistically significant reductions in T4+-lymphocyte recoveries relative to peripheral blood and also to slight relative increases in T8+ lymphocytes. A highly significant (P less than 0.001) correlation between the average probeable periodontal pocket depth and the T4/T8 ratio of each disease category was demonstrated. The relative recoveries of B cells from the various tissues did not differ between diseased and normal tissues. It is suggested that T-cell regulatory expression in gingival tissues is distinct from peripheral blood regulatory expression and that there is a local immunoregulatory imbalance in periodontal disease.

Possible mechanisms involved in the immunoregulation of chronic inflammatory periodontal disease

It is generally agreed that immunological mechanisms are involved in the pathogenesis of periodontal disease; however, regulation of these mechanisms has hitherto received scant attention. Regulatory networks exist at both a cellular and a molecular level. At the cellular level, the existence of helper (T4-positive) and suppressor (T8-positive) T lymphocytes, the expression of Class II major histocompatibility complex antigens, and the heterogeneity of macrophage subpopulations are central to an understanding of the regulatory mechanisms involved. It is only recently that studies of these separate components, in both humans and experimental animals, have begun to provide a basis for understanding the complex interactions occurring in periodontal disease. Studies using the human experimental gingivitis model have shown an immunoregulatory picture consistent with a controlled immunological reaction with an essentially normal T4:T8 ratio of 2.0. In contrast, studies utilizing cells extracted from adult periodontitis lesions have shown a reduced T4:T8 ratio (approximately 1.0) and an inability to respond in, or to stimulate, an autologous mixed lymphocyte reaction. Animal studies using athymic nude rats have supported the concept of a central role for T-cell control in periodontal disease and the possibility of an imbalance in this control with disease progression. These results are reviewed and areas of future research explored.

The autologous mixed lymphocyte reaction (AMLR) as a possible indicator of immunoregulation in chronic inflammatory periodontal disease

Immunoregulatory control at both a local and systemic level is likely to be an important factor in the control of chronic inflammatory periodontal disease, explaining, at least in part, the individual variations between patients as well as the cyclical nature of the disease process. The autologous mixed lymphocyte reaction (AMLR), which is due to the stimulation of T cells by autologous HLA-DR positive non-T cells in the absence of specific antigen, is thought to be an in vitro correlate of immunoregulation. It is possible therefore, that the AMLR may detect systemic immunoregulatory phenomena in chronic inflammatory periodontal disease and that aberrations in the AMLR may be a manifestation of the disease and in turn reflect disease activity. Recent evidence does in fact suggest that the peripheral blood AMLR may identify particular disease groups, provided age and time of peak responsiveness are taken into account and hence may have an epidemiological application. It remains to be determined, however, that when used in a longitudinal fashion, the AMLR does reflect individual disease activity. These results are reviewed and areas of future research discussed.

Effect of age and periodontal disease status in man on the spontaneous proliferation of peripheral blood lymphocytes

Spontaneous lymphocyte proliferation (SLP), as a measure of the autologous mixed-lymphocyte reaction (AMLR), was used to detect possible systemic immunoregulatory differences between periodontally-diseased subjects and age-matched controls. Forty-four subjects formed four groups; young-healthy (YH), young-diseased (YD), old-healthy (OH) and old-diseased (OD) based on clinical examination to assess loss of attachment and bleeding on gentle probing. The mean loss of periodontal attachment for the YD, OH and OD groups was 5.9, 3.3 and 6.0 mm respectively, and the mean bleeding index was 0.39, 0.18 and 0.44. Their SLP was assessed using peripheral-blood mononuclear cells on days 3, 5, 7, 9 and 11 in culture. The peak response for the YH group occurred at day 7; that of the OH group was not until day 9, suggesting that age may alter the kinetics of the reaction as a delay in peak responsiveness. Using log transformation, to reduce individual variations within each group, SPL of peripheral-blood mononuclears from diseased subjects was depressed at day 7 for the young age group (p less than 0.01) and at day 9 for the older group (p less than 0.05). Not all diseased subjects had a depressed response, suggesting that SPL per se may reflect current rather than past disease activity. It seems that SPL could identify particular disease groups provided age and time of peak responsiveness are taken into account.

Brucella fractions behave as nonspecific mitogens and polyclonal B-cell activators for human lymphocytes

Two lipid-A-free fractions which were extracted from Brucella melitensis and were designated PI and SF stimulated human unsensitized mononuclear cells to proliferate and to secrete immunoglobulins. Both of these effects were observed in cultures of peripheral blood, tonsils, and cord blood lymphocytes. Neither B cells nor T cells alone proliferated in the presence of these fractions, whereas the proliferative response of T cells plus B cells was largely independent of accessory cells. Polyclonal activation was estimated by counting the cells which secreted immunoglobulins of different isotypes into culture supernatants. This phenomenon was strongly T dependent.

Immunoregulation in severe generalized periodontitis

Severe generalized periodontitis (SGP) is an inflammatory disease which leads to extensive alveolar bone loss in young adults. Peripheral blood lymphocytes from SGP patients have been previously reported to exhibit an in vitro hyperproliferative response when exposed to B cell mitogens derived from Staphylococcus aureus and Actinomyces viscosus. Therefore hyperresponsiveness to B-cell mitogens could be an important pathogenic factor in the susceptibility to and progression of SGP. We have tested whether the hyperproliferative response of lymphocytes from SGP patients was due to (i) a functional deficiency of suppressor T cells, or (ii) to numerical alterations of lymphocytes. Supernatant fluids from concanavalin A-stimulated T cells from 14 SGP patients and 14 normal subjects were compared for their ability to suppress the IgM synthesis of B-cell mitogen-stimulated mouse splenocytes. No significant differences were noted in suppressor T-cell function between control subjects and SGP patients. However, SGP patients had significantly higher lymphocyte counts than control subjects, and there was a positive correlation between high lymphocyte counts and high mitogen-stimulated proliferation. SGP patients also had higher lymphocyte:monocyte ratios than control subjects, suggesting that a defect in macrophage-mediated suppression might be involved in the hyperproliferation phenomenon. Our data do not support the hypothesis that a suppressor T-cell defect is the cause of mitogen-induced hyperproliferative responsiveness of peripheral blood lymphocytes from SGP patients. Rather, hyperproliferation may be due to an expansion of the lymphocyte pool which responds to mitogens, or/and a regulatory disturbance which arises because of altered lymphocyte:macrophage ratios.

Activation of rat B lymphocytes by Actinobacillus actinomycetemcomitans

We examined the lymphoproliferative responses of cervical lymphocytes and splenocytes of homozygous (rnu/rnu) congenitally athymic nude and normal heterozygous (rnu/+) Rowett rats to whole cells of Actinobacillus actinomycetemcomitans, a suspected periodontal disease pathogen. Previously sensitized cells from immunized only, infected only, or immunized and infected, normal rats demonstrated proliferation in response to formalinized A. actinomycetemcomitans, but cells from nude rats did not proliferate. The maximum antigenic response was observed at day 5 of culture. A. actinomycetemcomitans caused cervical lymphocytes and splenocytes from untreated naive normal and nude rats to undergo increased DNA synthesis at day 2 of culture. Highly enriched nonsensitized spleen T cells prepared on a nylon wool column did not respond to A. actinomycetemcomitans, whereas enriched nonsensitized B cells proliferated. Differences in response were probably not attributable to contributions from macrophages in the T- or B-cell populations, since macrophage percentages were approximately the same in both preparations. T-cell reconstitution of nude rats with neonatal thymus cells from rnu/+rats resulted in partial recovery of T-cell function but had no effect on the mitogenic response to A. actinomycetemcomitans. It is suggested that the antigenic responses to A. actinomycetemcomitans are dependent on T cells and that A. actinomycetemcomitans cells have mitogenic activity for B cells. The potential importance of these findings in periodontal disease is discussed.

B-lymphocyte blastogenesis in response to periodontitis-associated bacteria. Kinetics and proportion of total response

A role for activated B-lymphocytes in mediating the initiation and/or progression of periodontal diseases has been proposed in previous work. The present study was conducted to: (1) assess the proportion of total lymphocyte blastogenic response to selected oral bacteria which is composed of T-cell and B-cell activation, respectively, and (2) to determine whether different kinetic patterns exist for the T-cell vs. the B-cell responses to these bacteria. Using lymphocyte rosetting and culturing techniques, rosette-positive and rosette-negative lymphocyte preparations were examined for blastogenic responsiveness following stimulation with a variety of both Gram-positive and Gram-negative periodontitis-associated bacteria. Results of these studies indicated that both peripheral blood lymphocytes (PBL) from healthy adults and cord blood lymphocytes (CBL) from placental afterbirths responded to these bacteria with similar kinetic patterns. The net PBL blastogenic response appeared to consist of an early B-cell response, which peaked at Days 2 or 3 of culture, followed by a later T-cell response, which peaked at Days 5 to 6 of culture. The B-cell response appeared to be T-cell-dependent in that B-cells cultured alone showed minimal thymidine uptake over the entire 6-day period, but the addition of irradiated T-cells to these B-cell cultures resulted in a greatly enhanced B-cell response.