1
|
Ebersole JL, Kirakodu SS, Nguyen LM, Gonzalez OA. Periodontitis-resistant and -susceptible matriline regulation of gingival transcriptome in nonhuman primates. J Periodontal Res 2023; 58:1171-1187. [PMID: 37638662 DOI: 10.1111/jre.13162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/20/2023] [Accepted: 07/07/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE This report identified if gingival gene expression transcriptomes demonstrated unique profiles that discriminated periodontitis-susceptible (PDS) and periodontitis-resistant (PDR) animals in health and disease. BACKGROUND Nonhuman primates generally organize their social groups based upon matriline origin. We have used a multi-generational colony of rhesus macaques to identify matrilines presenting with significant differences in periodontitis (e.g., earlier age onset, greater prevalence, and severity). METHODS Animals from 12 to 23 years of age (n = 17; 8 - PDR, 9 - PDS) were entered into a ligature-induced periodontitis trial. Gingival biopsies were taken at baseline and 0.5, 1, 3, and 5 months post-ligation, and microarray analysis was used to quantify gene expression in samples at each time point. RESULTS Over 1000 genes showed significant (p < .01) differences in the PDR versus PDS animals at baseline. The frequency of differences generally decreased during the disease process, and increased with resolution (i.e., 5 months). A nearly 2:1 ratio of elevated gene levels was noted in baseline PDR samples that included up-regulated MMPs, Fc receptors, chemokines, interleukins, and innate immune receptors, and down-regulated genes particularly related to epithelial biology. Most dramatically, there was a skewed differential expression of adaptive immune response genes in the PDR and epithelial cell structure/function genes in PDS samples. CONCLUSIONS The results demonstrate substantive differences in gingival tissue response capacity/programming in PDR and PDS samples that may contribute to the differences in clinical outcomes related to the heritability of disease risk through matrilines.
Collapse
Affiliation(s)
- J L Ebersole
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
- Center for Oral Health Research, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA
| | - S S Kirakodu
- Center for Oral Health Research, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA
| | - L M Nguyen
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - O A Gonzalez
- Center for Oral Health Research, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA
- Division of Periodontology, College of Dentistry, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
2
|
Future Drug Targets in Periodontal Personalised Medicine—A Narrative Review. J Pers Med 2022; 12:jpm12030371. [PMID: 35330371 PMCID: PMC8955099 DOI: 10.3390/jpm12030371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 02/08/2023] Open
Abstract
Periodontal disease is an infection-driven inflammatory disease characterized by the destruction of tooth-supporting tissues. The establishment of chronic inflammation will result in progressive destruction of bone and soft tissue changes. Severe periodontitis can lead to tooth loss. The disease has complex pathogenesis with an interplay between genetic, environmental, and host factors and pathogens. Effective management consists of plaque control and non-surgical interventions, along with adjuvant strategies to control inflammation and disrupt the pathogenic subgingival biofilms. Recent studies have examined novel approaches for managing periodontal diseases such as modulating microbial signaling mechanisms, tissue engineering, and molecular targeting of host inflammatory substances. Mounting evidence suggests the need to integrate omics-based approaches with traditional therapy to address the disease. This article discusses the various evolving and future drug targets, including proteomics, gene therapeutics, vaccines, and nanotechnology in personalized periodontal medicine for the effective management of periodontal diseases.
Collapse
|
3
|
Vaernewyck V, Arzi B, Sanders NN, Cox E, Devriendt B. Mucosal Vaccination Against Periodontal Disease: Current Status and Opportunities. Front Immunol 2021; 12:768397. [PMID: 34925337 PMCID: PMC8675580 DOI: 10.3389/fimmu.2021.768397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
Approximately 9 out of 10 adults have some form of periodontal disease, an infection-induced inflammatory disease of the tooth-supporting tissues. The initial form, gingivitis, often remains asymptomatic, but this can evolve into periodontitis, which is typically associated with halitosis, oral pain or discomfort, and tooth loss. Furthermore, periodontitis may contribute to systemic disorders like cardiovascular disease and type 2 diabetes mellitus. Control options remain nonspecific, time-consuming, and costly; largely relying on the removal of dental plaque and calculus by mechanical debridement. However, while dental plaque bacteria trigger periodontal disease, it is the host-specific inflammatory response that acts as main driver of tissue destruction and disease progression. Therefore, periodontal disease control should aim to alter the host's inflammatory response as well as to reduce the bacterial triggers. Vaccines may provide a potent adjunct to mechanical debridement for periodontal disease prevention and treatment. However, the immunopathogenic complexity and polymicrobial aspect of PD appear to complicate the development of periodontal vaccines. Moreover, a successful periodontal vaccine should induce protective immunity in the oral cavity, which proves difficult with traditional vaccination methods. Recent advances in mucosal vaccination may bridge the gap in periodontal vaccine development. In this review, we offer a comprehensive overview of mucosal vaccination strategies to induce protective immunity in the oral cavity for periodontal disease control. Furthermore, we highlight the need for additional research with appropriate and clinically relevant animal models. Finally, we discuss several opportunities in periodontal vaccine development such as multivalency, vaccine formulations, and delivery systems.
Collapse
Affiliation(s)
- Victor Vaernewyck
- Laboratory of Immunology, Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, United States
- Veterinary Institute for Regenerative Cures (VIRC) School of Veterinary Medicine, University of California, Davis, CA, United States
| | - Niek N. Sanders
- Laboratory of Gene Therapy, Department of Veterinary and Biosciences, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Eric Cox
- Laboratory of Immunology, Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Bert Devriendt
- Laboratory of Immunology, Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| |
Collapse
|
4
|
Guo C, Lu R, Wang X, Chen S. Antibacterial activity, bio-compatibility and osteogenic differentiation of graphene oxide coating on 3D-network poly-ether-ether-ketone for orthopaedic implants. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:135. [PMID: 34704134 PMCID: PMC8550550 DOI: 10.1007/s10856-021-06614-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/03/2021] [Indexed: 05/05/2023]
Abstract
Poly-ether-ether-ketone (PEEK) has attracted increasing attention as a promising orthopaedic implant material owing to its excellent mechanical properties and biocompatibility. However, its antibacterial properties must be improved as an implant material. In this study, PEEK was sulfonated to obtain a porous surface, and graphene oxide (GO) was deposited to form a coating with antibacterial activity and biocompatibility. After PEEK was sulfonated for different durations, GO was deposited on the surface to prepare the coating (SPEEK-GO), which was then characterised using scanning electron microscopy (SEM), Raman spectroscopy, and contact angle measurements. The in vitro study included antimicrobial and cellular tests. The results showed that the PEEK sulfonated using a 10-min treatment exhibited a uniform porous structure and provided a better basal surface for the deposition of GO. The SPEEK-GO coating displayed strong antibacterial activity against two common dental pathogens. It exhibited good adhesion and proliferation of MC3T3-E1. Moreover, it showed osteogenic differentiation as bone implant material.
Collapse
Affiliation(s)
- Cui Guo
- Laboratory of Biomaterials and Biomechanics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Tiantan Xili No.4, Beijing, 100050, People's Republic of China
| | - Ran Lu
- Laboratory of Biomaterials and Biomechanics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Tiantan Xili No.4, Beijing, 100050, People's Republic of China
| | - Xin Wang
- Laboratory of Biomaterials and Biomechanics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Tiantan Xili No.4, Beijing, 100050, People's Republic of China
| | - Su Chen
- Laboratory of Biomaterials and Biomechanics, Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, School of Stomatology, Capital Medical University, Tiantan Xili No.4, Beijing, 100050, People's Republic of China.
| |
Collapse
|
5
|
Zidar A, Kristl J, Kocbek P, Zupančič Š. Treatment challenges and delivery systems in immunomodulation and probiotic therapies for periodontitis. Expert Opin Drug Deliv 2021; 18:1229-1244. [PMID: 33760648 DOI: 10.1080/17425247.2021.1908260] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Periodontitis is a widespread illness that arises due to disrupted interplay between the oral microbiota and the host immune response. In some cases, conventional therapies can provide temporary remission, although this is often followed by disease relapse. Recent studies of periodontitis pathology have promoted the development of new therapeutics to improve treatment options, together with local application using advanced drug delivery systems.Areas covered: This paper provides a critical review of the status of current treatment approaches to periodontitis, with a focus on promising immunomodulation and probiotic therapies. These are based on delivery of small molecules, peptides, proteins, DNA or RNA, and probiotics. The key findings on novel treatment strategies and formulation of advanced delivery systems, such as nanoparticles and nanofibers, are highlighted.Expert opinion: Multitarget therapy based on antimicrobial, immunomodulatory, and probiotic active ingredients incorporated into advanced delivery systems for application to the periodontal pocket can improve periodontitis treatment outcomes. Translation of such adjuvant therapy from laboratory to patient is expected in the future.
Collapse
Affiliation(s)
- Anže Zidar
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Julijana Kristl
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Petra Kocbek
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Špela Zupančič
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
6
|
An T, Chen Y, Li M, Liu Y, Zhang Z, Yang Q. Inhibition of experimental periodontitis by a monoclonal antibody against Porphyromonas gingivalis HA2. Microb Pathog 2021; 154:104633. [PMID: 33667618 DOI: 10.1016/j.micpath.2020.104633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 12/12/2022]
Abstract
It is known that complexes of the multi-protein, gingipain, possess heme binding domains (hemagglutinin 2, HA2) that bind hemoglobin to provide heme and iron to the bacterium, Porphyromonas gingivalis. The DHYAVMISK peptide sequence was proposed to act as an inhibitor of hemin binding, and thus, it might be used to control or prevent periodontal disease. In this study, we created a monoclonal antibody (mAb) that targeted the DHYAVMISK peptide, aimed to determine whether it could inhibit the growth of P. gingivalis in vitro, and block its induction of experimental periodontitis and subsequent bone loss. Peptide DGFPG-DHYAVMISK conjugated to KLH (DK-KLH) was synthetic, and injected subcutaneously into BALB/c mice to generate specific mAbs with the hybridoma technique. We isolated mAb 1H11, which showed specific binding to DK. When we incubated these mAbs with P. gingivalis in vitro for 18 h, bacterial growth was significantly lower in cultures treated with mAb 1H11 compared to those treated with control (PBS; P < 0.05). Next, we induced experimental periodontitis in mouse models with a silk ligature and a P. gingivalis infection. When we injected the mAbs into the gingival sulcus, the group treated with mAb 1H11 displayed a reduction in bone loss compared to the other treatment groups. Thus, mAb 1H11 might provide protection against a P. gingivalis infection. Accordingly, this antibody could serve as a candidate therapy for periodontitis or other infections caused by P. gingivalis.
Collapse
Affiliation(s)
- Ting An
- Beijing Institute for Dental Research, Capital Medical University School of Stomatology, China
| | - Yuanyuan Chen
- Beijing Institute for Dental Research, Capital Medical University School of Stomatology, China
| | - Mingxia Li
- Beijing Institute for Dental Research, Capital Medical University School of Stomatology, China
| | - Ying Liu
- Beijing Institute for Dental Research, Capital Medical University School of Stomatology, China
| | - Zilu Zhang
- Beijing Institute for Dental Research, Capital Medical University School of Stomatology, China
| | - Qiubo Yang
- Beijing Institute for Dental Research, Capital Medical University School of Stomatology, China.
| |
Collapse
|
7
|
Myneni SR, Brocavich K, Wang H. Biological strategies for the prevention of periodontal disease: Probiotics and vaccines. Periodontol 2000 2020; 84:161-175. [DOI: 10.1111/prd.12343] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Srinivas Rao Myneni
- Department of Periodontology Stony Brook School of Dental Medicine Stony Brook University Stony Brook NY USA
| | - Kristen Brocavich
- Department of Periodontology Stony Brook School of Dental Medicine Stony Brook University Stony Brook NY USA
| | - Howard Wang
- Department of Periodontology Stony Brook School of Dental Medicine Stony Brook University Stony Brook NY USA
| |
Collapse
|
8
|
Hashemi S, Sepehrizadeh Z, Setayesh N, Kadkhoda Z, Faramarzi MA, Shahverdi AR, Glogauer M, Amin M. PerioVax3, a key antigenic determinant with immunoprotective potential against periodontal pathogen. Microb Pathog 2019; 135:103661. [PMID: 31400445 DOI: 10.1016/j.micpath.2019.103661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 08/06/2019] [Indexed: 12/18/2022]
Abstract
Treponema (T.) denticola is one of the key etiological agents in the development of periodontitis. The major outer sheath protein (Msp) of T. denticola has been shown to mediate pathogenesis and to facilitate adhesion of T. denticola to mucosal surfaces. This study aimed to find short polypeptides in the amino acid sequence of Msp which may be immunogenic and might elicit protective antisera against T. denticola. The complete msp sequence was divided into six fragments and the corresponding genes were cloned and expressed. Antisera against the polypeptides were raised in rabbits and fragment 3 (F3), hereinafter called PerioVax3 was the most potent fragment of the Msp in terms of yielding high titer antiserum. An adhesion assay was done to examine the inhibitory effects of antisera on the attachment of T. denticola to human gingival fibroblasts (HGFs) and human fibronectin. Antiserum against PerioVax3 significantly inhibited attachment of T. denticola to the substratum. Also, antiserum against PerioVax3 inhibited detachment of HGFs upon T. denticola exposure. To begin examining the clinical relevance of this work, blood samples from 12 sever periodontitis patients were collected and the sera were used in western blotting against the recombinant polypeptides. Periodontitis patient antisera exclusively detected PerioVax3 in western blotting. The data suggest that PerioVax3 carries epitopes that may trigger humoral immunity against T. denticola, which may protect against its adhesion functions. The complexity of periodontitis suggests that PerioVax3 may be considered for testing as a component of an experimental multivalent periodontal vaccine in further preclinical and clinical studies.
Collapse
Affiliation(s)
- Saba Hashemi
- Department of Pharmaceutical Biotechnology, Biotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Zargham Sepehrizadeh
- Department of Pharmaceutical Biotechnology, Biotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Setayesh
- Department of Pharmaceutical Biotechnology, Biotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Kadkhoda
- Department of Periodontology, School of Dentistry, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Ali Faramarzi
- Department of Pharmaceutical Biotechnology, Biotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Shahverdi
- Department of Pharmaceutical Biotechnology, Biotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Michael Glogauer
- Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Mohsen Amin
- Department of Drug and Food Control, Recombinant Vaccine Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; The Institute of Pharmaceutical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
9
|
Huang N, Shimomura E, Yin G, Tran C, Sato A, Steiner A, Heibeck T, Tam M, Fairman J, Gibson FC. Immunization with cell-free-generated vaccine protects from Porphyromonas gingivalis-induced alveolar bone loss. J Clin Periodontol 2019; 46:197-205. [PMID: 30578564 PMCID: PMC7891626 DOI: 10.1111/jcpe.13047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/11/2018] [Accepted: 12/15/2018] [Indexed: 12/19/2022]
Abstract
Introduction Periodontal diseases (PD) are complex oral inflammatory diseases initiated by keystone bacteria such as Porphyromonas gingivalis. A vaccine for PD is desirable as clinical treatment involves protracted maintenance strategies aimed to retain dentition. Although prior immunization approaches targeting P. gingivalis have reported variable success in limiting facets of disease such as oral bone loss, it remains that a vaccine for this disease may be attainable. Aim To investigate cell‐free protein synthesis (CFPS) as a platform to produce vaccinable targets suitable for efficacy testing in a P. gingivalis‐induced murine oral bone loss model. Materials and Methods Recombinantly generated P. gingivalis minor fimbriae protein (Mfa1), RgpA gingipain hemagglutinin domain 1 (HA1), and RgpA gingipain hemagglutinin domain 2 (HA2) were combined in equivalent doses in adjuvants and injected intramuscularly to immunize mice. Serum levels of protein‐specific antibody were measured by ELISA, and oral bone levels were defined by morphometrics. Results Recombinantly generated P. gingivalis proteins possessed high fidelity to predicted size and elicited protein‐specific IgG following immunization. Importantly, immunization with the vaccine cocktail protected from P. gingivalis elicited oral bone loss. Conclusion These data verify the utility of the CFPS technology to synthesize proteins that have the capacity to serve as novel vaccines.
Collapse
Affiliation(s)
- Nasi Huang
- Department of Medicine, Section of Infectious Diseases, School of Medicine, Boston University, Boston, Massachusetts
| | | | - Gang Yin
- Sutro BioPharma, South San Francisco, California
| | - Cuong Tran
- Sutro BioPharma, South San Francisco, California
| | - Aaron Sato
- Sutro BioPharma, South San Francisco, California
| | - Alex Steiner
- Sutro BioPharma, South San Francisco, California
| | | | - Michelle Tam
- Sutro BioPharma, South San Francisco, California
| | | | - Frank C Gibson
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, Florida
| |
Collapse
|
10
|
Kamińska M, Aliko A, Hellvard A, Bielecka E, Binder V, Marczyk A, Potempa J, Delaleu N, Kantyka T, Mydel P. Effects of statins on multispecies oral biofilm identify simvastatin as a drug candidate targeting Porphyromonas gingivalis. J Periodontol 2018; 90:637-646. [PMID: 30506795 DOI: 10.1002/jper.18-0179] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/08/2018] [Accepted: 11/17/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Statins effectively reduce risk of cardiovascular-related morbidity and mortality in patients with hyperlipidemia, hypertension, or type 2 diabetes. In addition to lowering cholesterol levels, several studies have attributed statins with immunomodulatory and bactericidal properties. Therefore, the aim of this study was to investigate statins' antimicrobial activity against periodontal homeostasis bacteria. METHODS Statin effect on bacterial growth was tested using planktonic monocultures and multibacterial biofilms. The latter consisted of five microbial species (Porphyromonas gingivalis, Fusobacterium nucleatum, Actinomyces naeslundii, Tannerella forsythia, and Streptococcus gordonii) associated with dysbiosis of the oral microbiota underlying establishment and perpetuation of periodontitis. RESULTS All four tested statins efficiently inhibited P. gingivalis growth and significantly decreased the cumulative bacterial load in developing and established biofilms. Simvastatin was most efficient and decreased P. gingivalis counts more than 1,300-fold relative to the control. CONCLUSIONS These findings suggest that similar effects on bacterial composition of the dental plaque may occur in vivo in patients on statins, thus, leading to a shift of the oral microbiome from a dysbiotic to a more homeostatic one. Simvastatin, being highly effective against P. gingivalis while not affecting commensal microbiota, possesses many properties qualifying it as a potential adjunctive treatment for chronic periodontitis. Further studies are needed to evaluate whether similar effects on bacterial composition of the dental plaque may occur in vivo in patients on statins, thus, leading to a shift of the oral microflora from dysbiotic to a more homeostatic one.
Collapse
Affiliation(s)
- Marta Kamińska
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
| | - Ardita Aliko
- Department of Clinical Science, Broegelmann Research Laboratory, University of Bergen, Bergen, Norway
| | - Annelie Hellvard
- Małopolska Center of Biotechnology, Jagiellonian University, Kraków, Poland
| | - Ewa Bielecka
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
| | - Veronika Binder
- Department of Clinical Science, Broegelmann Research Laboratory, University of Bergen, Bergen, Norway
| | - Agata Marczyk
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
| | - Jan Potempa
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland.,Department of Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, USA
| | - Nicolas Delaleu
- Institute of Oncology Research, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,2C SysBioMed, Contra, Switzerland
| | - Tomasz Kantyka
- Małopolska Center of Biotechnology, Jagiellonian University, Kraków, Poland
| | - Piotr Mydel
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland.,Department of Clinical Science, Broegelmann Research Laboratory, University of Bergen, Bergen, Norway
| |
Collapse
|
11
|
Park EJ, Kwon EY, Kim HJ, Lee JY, Choi J, Joo JY. Clinical and microbiological effects of the supplementary use of an erythritol powder air-polishing device in non-surgical periodontal therapy: a randomized clinical trial. J Periodontal Implant Sci 2018; 48:295-304. [PMID: 30405937 PMCID: PMC6207796 DOI: 10.5051/jpis.2018.48.5.295] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/27/2018] [Indexed: 12/16/2022] Open
Abstract
Purpose This study was undertaken to evaluate the clinical and microbiological effects of an erythritol powder air-polishing device (EPAP) as a supplement to scaling and root planing (SRP) therapy in patients with moderate chronic periodontitis. Methods Clinical and microbiological evaluations were performed at 21 sites treated with SRP (control) and 21 sites treated with SRP+EPAP (test). All examinations were performed before treatment, 1 month after treatment, and 3 months after treatment. Results There were no significant clinical differences between the test group and the control group. Microbiological analysis revealed that the relative expression level of Porphyromonas gingivalis was significantly lower in the test group than in the control group at 1 month after treatment. Clinical and microbiological results showed improvements at 1 month compared to baseline; in contrast, the results at 3 months after treatment were worse than those at 1 month after treatment. Conclusions In this study, both SRP and SRP+EPAP were clinically and microbiologically effective as non-surgical periodontal treatments. In particular, the SRP+EPAP group showed an antimicrobial effect on P. gingivalis, a keystone bacterium associated with the onset of chronic periodontitis, in a short-term period. Periodic periodontal therapy, at intervals of at least every 3 months, is important for sustaining the microbiological effects of this treatment.
Collapse
Affiliation(s)
- Eon-Jeong Park
- Department of Periodontology and Institute of Translational Dental Sciences, Pusan National University School of Dentistry, Yangsan, Korea.,Department of Periodontology and Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
| | - Eun-Young Kwon
- Dental Clinic Center, Pusan National University Hospital, Busan, Korea
| | - Hyun-Joo Kim
- Department of Periodontology and Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
| | - Ju-Youn Lee
- Department of Periodontology and Institute of Translational Dental Sciences, Pusan National University School of Dentistry, Yangsan, Korea.,Department of Periodontology and Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
| | - Jeomil Choi
- Department of Periodontology and Institute of Translational Dental Sciences, Pusan National University School of Dentistry, Yangsan, Korea.,Department of Periodontology and Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
| | - Ji-Young Joo
- Department of Periodontology and Institute of Translational Dental Sciences, Pusan National University School of Dentistry, Yangsan, Korea.,Department of Periodontology and Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Korea
| |
Collapse
|
12
|
Hajishengallis G, Korostoff JM. Revisiting the Page & Schroeder model: the good, the bad and the unknowns in the periodontal host response 40 years later. Periodontol 2000 2018; 75:116-151. [PMID: 28758305 DOI: 10.1111/prd.12181] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In their classic 1976 paper, Page & Schroeder described the histopathologic events and the types of myeloid cells and lymphocytes involved in the initiation and progression of inflammatory periodontal disease. The staging of periodontal disease pathogenesis as 'initial', 'early', 'established' and 'advanced' lesions productively guided subsequent research in the field and remains fundamentally valid. However, major advances regarding the cellular and molecular mechanisms underlying the induction, regulation and effector functions of immune and inflammatory responses necessitate a reassessment of their work and its integration with emerging new concepts. We now know that each type of leukocyte is actually represented by functionally distinct subsets with different, or even conflicting, roles in immunity and inflammation. Unexpectedly, neutrophils, traditionally regarded as merely antimicrobial effectors in acute conditions and protagonists of the 'initial' lesion, are currently appreciated for their functional versatility and critical roles in chronic inflammation. Moreover, an entirely new field of study, osteoimmunology, has emerged and sheds light on the impact of immunoinflammatory events on the skeletal system. These developments and the molecular dissection of crosstalk interactions between innate and adaptive leukocytes, as well as between the immune system and local homeostatic mechanisms, offer a more nuanced understanding of the host response in periodontitis, with profound implications for treatment. At the same time, deeper insights have generated new questions, many of which remain unanswered. In this review, 40 years after Page & Schroeder proposed their model, we summarize enduring and emerging advances in periodontal disease pathogenesis.
Collapse
|
13
|
Ebersole JL, Graves CL, Gonzalez OA, Dawson D, Morford LA, Huja PE, Hartsfield JK, Huja SS, Pandruvada S, Wallet SM. Aging, inflammation, immunity and periodontal disease. Periodontol 2000 2018; 72:54-75. [PMID: 27501491 DOI: 10.1111/prd.12135] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2015] [Indexed: 12/29/2022]
Abstract
The increased prevalence and severity of periodontal disease have long been associated with aging, such that this oral condition affects the majority of the adult population over 50 years of age. Although the immune system is a critical component for maintaining health, aging can be characterized by quantitative and qualitative modifications of the immune system. This process, termed 'immunosenescence', is a progressive modification of the immune system that leads to greater susceptibility to infections, neoplasia and autoimmunity, presumably reflecting the prolonged antigenic stimulation and/or stress responses that occur across the lifespan. Interestingly, the global reduction in the host capability to respond effectively to these challenges is coupled with a progressive increase in the general proinflammatory status, termed 'inflammaging'. Consistent with the definition of immunosenescence, it has been suggested that the cumulative effect of prolonged exposure of the periodontium to microbial challenge is, at least in part, a contributor to the effects of aging on these tissues. Thus, it has also been hypothesized that alterations in the function of resident immune and nonimmune cells of the periodontium contribute to the expression of inflammaging in periodontal disease. Although the majority of aging research has focused on the adaptive immune response, it is becoming increasingly clear that the innate immune compartment is also highly affected by aging. Thus, the phenomenon of immunosenescence and inflammaging, expressed as age-associated changes within the periodontium, needs to be more fully understood in this era of precision and personalized medicine and dentistry.
Collapse
|
14
|
Shimizu Y, Iwasaki T, Tajima T, Yuba E, Kono K, Watarai S. Induction of antibody response in the oral cavity of dogs following intraocular (eye drop) immunization with Porphyromonas gingivalis cell lysate incorporated in pH-sensitive fusogenic polymer-modified liposomes. J Vet Med Sci 2016; 79:290-298. [PMID: 27916762 PMCID: PMC5326933 DOI: 10.1292/jvms.16-0338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Induction of mucosal immune responses against Porphyromonas gingivalis within the oral cavity of dogs was studied by immunizing with pH-sensitive fusogenic polymer (MGluPG)-modified liposome-associated cell lysate. Dogs immunized with P. gingivalis cell lysate-containing MGluPG-modified liposomes by intraocular (eye drop) route displayed significant levels of P. gingivalis cell lysate-specific serum IgG and IgA as well as mucosal IgA antibodies in saliva secretion. Serum and salivary antibodies generated by intraocularly immunized with MGluPG-modified liposome-associated P. gingivalis cell lysate revealed a significant aggregation activity against P. gingivalis, whereas serum and saliva from dogs receiving MGluPG-modified liposomes unentrapping P. gingivalis cell lysate did not show the aggregation activity against P. gingivalis. Furthermore, P. gingivalis-specific antibodies in saliva of immunized dogs inhibited the adherence of P. gingivalis to cultured HeLa cells. More importantly, salivary antibodies induced by intraocular immunization with P. gingivalis cell lysate-containing MGluPG-modified liposomes significantly inhibited the coaggregation of P. gingivalis with Actinomyces naeslundii and the cell damage activity of P. gingivalis against FaDu cells, an oral epithelial cell. These results suggest that intraocularly administered P. gingivalis cell lysate-containing MGluPG-modified liposomes should be an effective mucosal vaccine against P. gingivalis infection in dogs and may be an important tool for the prevention of periodontitis.
Collapse
Affiliation(s)
- Yosuke Shimizu
- Division of Veterinary Science, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Izumisano, Osaka 598-8531, Japan
| | | | | | | | | | | |
Collapse
|
15
|
Maekawa T, Briones RA, Resuello RRG, Tuplano JV, Hajishengallis E, Kajikawa T, Koutsogiannaki S, Garcia CAG, Ricklin D, Lambris JD, Hajishengallis G. Inhibition of pre-existing natural periodontitis in non-human primates by a locally administered peptide inhibitor of complement C3. J Clin Periodontol 2016; 43:238-49. [PMID: 26728318 DOI: 10.1111/jcpe.12507] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2015] [Indexed: 11/26/2022]
Abstract
AIM Human periodontitis is associated with overactivation of complement, which is triggered by different mechanisms converging on C3, the central hub of the system. We assessed whether the C3 inhibitor Cp40 inhibits naturally occurring periodontitis in non-human primates (NHPs). MATERIALS AND METHODS Non-human primates with chronic periodontitis were intra-gingivally injected with Cp40 either once (5 animals) or three times (10 animals) weekly for 6 weeks followed by a 6-week follow-up period. Clinical periodontal examinations and collection of gingival crevicular fluid and biopsies of gingiva and bone were performed at baseline and during the study. A one-way repeated-measures anova was used for data analysis. RESULTS Whether administered once or three times weekly, Cp40 caused a significant reduction in clinical indices that measure periodontal inflammation (gingival index and bleeding on probing), tissue destruction (probing pocket depth and clinical attachment level) or tooth mobility. These clinical changes were associated with significantly reduced levels of pro-inflammatory mediators and decreased numbers of osteoclasts in bone biopsies. The protective effects of Cp40 persisted, albeit at reduced efficacy, for at least 6 weeks following drug discontinuation. CONCLUSION Cp40 inhibits pre-existing chronic periodontal inflammation and osteoclastogenesis in NHPs, suggesting a novel adjunctive anti-inflammatory therapy for treating human periodontitis.
Collapse
Affiliation(s)
- Tomoki Maekawa
- Department of Microbiology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Research Center for Advanced Oral Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Ruel A Briones
- College of Dentistry, Manila Central University, Caloocan City, Philippines
| | - Ranillo R G Resuello
- Simian Conservation Breeding and Research Center (SICONBREC), Makati City, Philippines
| | - Joel V Tuplano
- Simian Conservation Breeding and Research Center (SICONBREC), Makati City, Philippines
| | - Evlambia Hajishengallis
- Division of Pediatric Dentistry, Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tetsuhiro Kajikawa
- Department of Microbiology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sophia Koutsogiannaki
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Daniel Ricklin
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John D Lambris
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - George Hajishengallis
- Department of Microbiology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
16
|
Hajishengallis G, Lamont RJ, Graves DT. The enduring importance of animal models in understanding periodontal disease. Virulence 2016; 6:229-35. [PMID: 25574929 PMCID: PMC4601315 DOI: 10.4161/21505594.2014.990806] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Whereas no single animal model can reproduce the complexity of periodontitis, different aspects of the disease can be addressed by distinct models. Despite their limitations, animal models are essential for testing the biological significance of in vitro findings and for establishing cause-and-effect relationships relevant to clinical observations, which are typically correlative. We provide evidence that animal-based studies have generated a durable framework for dissecting the mechanistic basis of periodontitis. These studies have solidified the etiologic role of bacteria in initiating the inflammatory response that leads to periodontal bone loss and have identified key mediators (IL-1, TNF, prostaglandins, complement, RANKL) that induce inflammatory breakdown. Moreover, animal studies suggest that dysbiosis, rather than individual bacterial species, are important in initiating periodontal bone loss and have introduced the concept that organisms previously considered commensals can play important roles as accessory pathogens or pathobionts. These studies have also provided insight as to how systemic conditions, such as diabetes or leukocyte adhesion deficiency, contribute to tissue destruction. In addition, animal studies have identified and been useful in testing therapeutic targets.
Collapse
Affiliation(s)
- George Hajishengallis
- a Department of Microbiology; Penn Dental Medicine; University of Pennsylvania ; Philadelphia , PA , USA
| | | | | |
Collapse
|
17
|
Torres PJ, Fletcher EM, Gibbons SM, Bouvet M, Doran KS, Kelley ST. Characterization of the salivary microbiome in patients with pancreatic cancer. PeerJ 2015; 3:e1373. [PMID: 26587342 PMCID: PMC4647550 DOI: 10.7717/peerj.1373] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/13/2015] [Indexed: 12/15/2022] Open
Abstract
Clinical manifestations of pancreatic cancer often do not occur until the cancer has undergone metastasis, resulting in a very low survival rate. In this study, we investigated whether salivary bacterial profiles might provide useful biomarkers for early detection of pancreatic cancer. Using high-throughput sequencing of bacterial small subunit ribosomal RNA (16S rRNA) gene, we characterized the salivary microbiota of patients with pancreatic cancer and compared them to healthy patients and patients with other diseases, including pancreatic disease, non-pancreatic digestive disease/cancer and non-digestive disease/cancer. A total of 146 patients were enrolled at the UCSD Moores Cancer Center where saliva and demographic data were collected from each patient. Of these, we analyzed the salivary microbiome of 108 patients: 8 had been diagnosed with pancreatic cancer, 78 with other diseases and 22 were classified as non-diseased (healthy) controls. Bacterial 16S rRNA sequences were amplified directly from salivary DNA extractions and subjected to high-throughput sequencing (HTS). Several bacterial genera differed in abundance in patients with pancreatic cancer. We found a significantly higher ratio of Leptotrichia to Porphyromonas in the saliva of patients with pancreatic cancer than in the saliva of healthy patients or those with other disease (Kruskal–Wallis Test; P < 0.001). Leptotrichia abundances were confirmed using real-time qPCR with Leptotrichia specific primers. Similar to previous studies, we found lower relative abundances of Neisseria and Aggregatibacter in the saliva of pancreatic cancer patients, though these results were not significant at the P < 0.05 level (K–W Test; P = 0.07 and P = 0.09 respectively). However, the relative abundances of other previously identified bacterial biomarkers, e.g., Streptococcus mitis and Granulicatella adiacens, were not significantly different in the saliva of pancreatic cancer patients. Overall, this study supports the hypothesis that bacteria abundance profiles in saliva are useful biomarkers for pancreatic cancer though much larger patient studies are needed to verify their predictive utility.
Collapse
Affiliation(s)
- Pedro J Torres
- Department of Biology, San Diego State University , San Diego, CA , United States
| | - Erin M Fletcher
- Department of Medical Sciences, Harvard University , Boston, MA , United States
| | - Sean M Gibbons
- Graduate Program in Biophysical Sciences, University of Chicago , Chicago, IL , United States ; Institute for Genomics and Systems Biology, Argonne National Laboratory , Lemont, IL , United States
| | - Michael Bouvet
- Department of Surgery, University of California, San Diego , La Jolla, CA , United States
| | - Kelly S Doran
- Department of Biology, San Diego State University , San Diego, CA , United States ; Department of Pediatrics, University of California San Diego School of Medicine , La Jolla, CA , United States
| | - Scott T Kelley
- Department of Biology, San Diego State University , San Diego, CA , United States
| |
Collapse
|
18
|
Abstract
Periodontitis is an infectious disease that affects the tooth-supporting tissues and exhibits a wide range of clinical, microbiological and immunological manifestations. The disease is associated with and is probably caused by a multifaceted dynamic interaction of specific infectious agents, host immune responses, harmful environmental exposure and genetic susceptibility factors. This volume of Periodontology 2000 covers key subdisciplines of periodontology, ranging from etiopathogeny to therapy, with emphasis on diagnosis, classification, epidemiology, risk factors, microbiology, immunology, systemic complications, anti-infective therapy, reparative treatment, self-care and affordability issues. Learned and unlearned concepts of periodontitis over the past 50 years have shaped our current understanding of the etiology of the disease and of clinical practice.
Collapse
|
19
|
Acquisition of oral microbes and associated systemic responses of newborn nonhuman primates. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2013; 21:21-8. [PMID: 24173024 DOI: 10.1128/cvi.00291-13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The acquisition and development of the complex oral microbiome remain ill defined. While selected species of oral bacteria have been examined in relation to their initial colonization in neonates, a more detailed understanding of the dynamics of the microbiome has been developed only in adults. The current investigation used a nonhuman primate model to document the kinetics of colonization of the oral cavities of newborns and infants by a range of oral commensals and pathogens. Differences in colonization were evaluated in newborns from mothers who were maintained on an oral hygiene regimen pre- and postparturition with those displaying naturally acquired gingivitis/periodontitis. The results demonstrate distinct profiles of acquisition of selected oral bacteria, with the transmission of targeted pathogens, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, being passed on primarily from mothers with gingivitis/periodontitis. This colonization resulted in defined patterns of systemic antibody responses in the infants. The significant relative risk measures for infection with the pathogens, as well as the relationship of oral infection and blood serum antibody levels, were consistent with those of the newborns from mothers with gingivitis/periodontitis. These findings indicate that the early acquisition of potentially pathogenic oral bacterial species might impact the development of mucosal responses in the gingiva and may provide an enhanced risk for the development of periodontitis later in life.
Collapse
|
20
|
Dashper SG, O'Brien-Simpson NM, Bhogal PS, Franzmann AD, Reynolds EC. Purification and characterization of a putative fimbrial protein/receptor ofPorphyromonas gingivalis. Aust Dent J 2013. [DOI: 10.1111/j.1834-7819.1998.tb06097.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
21
|
Ebersole JL, Dawson DR, Morford LA, Peyyala R, Miller CS, Gonzaléz OA. Periodontal disease immunology: 'double indemnity' in protecting the host. Periodontol 2000 2013; 62:163-202. [PMID: 23574466 PMCID: PMC4131201 DOI: 10.1111/prd.12005] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
During the last two to three decades our understanding of the immunobiology of periodontal disease has increased exponentially, both with respect to the microbial agents triggering the disease process and the molecular mechanisms of the host engagement maintaining homeostasis or leading to collateral tissue damage. These foundational scientific findings have laid the groundwork for translating cell phenotype, receptor engagement, intracellular signaling pathways and effector functions into a 'picture' of the periodontium as the host responds to the 'danger signals' of the microbial ecology to maintain homeostasis or succumb to a disease process. These findings implicate the chronicity of the local response in attempting to manage the microbial challenge, creating a 'Double Indemnity' in some patients that does not 'insure' health for the periodontium. As importantly, in reflecting the title of this volume of Periodontology 2000, this review attempts to inform the community of how the science of periodontal immunology gestated, how continual probing of the biology of the disease has led to an evolution in our knowledge base and how more recent studies in the postgenomic era are revolutionizing our understanding of disease initiation, progression and resolution. Thus, there has been substantial progress in our understanding of the molecular mechanisms of host-bacteria interactions that result in the clinical presentation and outcomes of destructive periodontitis. The science has embarked from observations of variations in responses related to disease expression with a focus for utilization of the responses in diagnosis and therapeutic outcomes, to current investigations using cutting-edge fundamental biological processes to attempt to model the initiation and progression of soft- and hard-tissue destruction of the periodontium. As importantly, the next era in the immunobiology of periodontal disease will need to engage more sophisticated experimental designs for clinical studies to enable robust translation of basic biologic processes that are in action early in the transition from health to disease, those which stimulate microenvironmental changes that select for a more pathogenic microbial ecology and those that represent a rebalancing of the complex host responses and a resolution of inflammatory tissue destruction.
Collapse
|
22
|
Fan X, Wang Z, Ji P, Bian Y, Lan J. rgpA DNA vaccine induces antibody response and prevents alveolar bone loss in experimental peri-implantitis. J Periodontol 2012; 84:850-6. [PMID: 22917113 DOI: 10.1902/jop.2012.120251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Peri-implantitis is one of many reasons for dental implant failure. This study is designed to prevent experimental peri-implantitis by arginine-specific gingipain A (rgpA) DNA vaccine. METHODS The bilateral mandibular second and third premolars from 15 male beagle dogs were extracted, and 60 implants were immediately implanted. Three months after implantation, the animals were randomly divided into groups A, B, and C and immunized with plasmid vector-rgpA, heat-killed Porphyromonas gingivalis, and plasmid vector, respectively. Cotton ligatures infiltrated with P. gingivalis were placed in the submarginal position around the neck of the implants to induce peri-implantitis. Clinical measurements, including probing depth (PD) and bleeding on probing, were recorded every 2 weeks postoperatively, and P. gingivalis-specific immunoglobulin G (IgG) in serum and secretory IgA (sIgA) in saliva were quantitatively analyzed by enzyme-linked immunosorbent assay at the same time. Animals were sacrificed after 6 weeks, 50-μm undecalcified histologic sections were prepared using methylene blue dye, and bone loss around implants was measured. RESULTS Higher levels of IgG in serum and sIgA in saliva could be measured in groups A and B but not in group C after immunization. There were statistical differences (P <0.05) between, before, and after immunization, but no difference was found between groups A and B (P >0.05). Both peri-implant PD and bone loss in group A were significantly less than in groups B and C. CONCLUSIONS IgG and sIgA could be generated by immunization with rgpA DNA vaccine, which could significantly slow down bone loss in the experimental peri-implantitis canine model.
Collapse
Affiliation(s)
- Xin Fan
- Department of Prosthodontics, Dental School, University of Shandong, Jinan City, Shandong Province, China
| | | | | | | | | |
Collapse
|
23
|
Rutger Persson G. Rheumatoid arthritis and periodontitis - inflammatory and infectious connections. Review of the literature. J Oral Microbiol 2012; 4:JOM-4-11829. [PMID: 22347541 PMCID: PMC3280043 DOI: 10.3402/jom.v4i0.11829] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 01/23/2012] [Accepted: 01/23/2012] [Indexed: 12/20/2022] Open
Abstract
An association between oral disease/periodontitis and rheumatoid arthritis (RA) has been considered since the early 1820s. The early treatment was tooth eradication. Epidemiological studies suggest that the prevalence of RA and periodontitis may be similar and about 5% of the population are aged 50 years or older. RA is considered as an autoimmune disease whereas periodontitis has an infectious etiology with a complex inflammatory response. Both diseases are chronic and may present with bursts of disease activity. Association studies have suggested odds ratios of having RA and periodontitis varying from 1.8:1 (95% CI: 1.0–3.2, NS) to 8:1 (95% CI: 2.9–22.1, p<0.001). Genetic factors are driving the host responses in both RA and periodontitis. Tumor necrosis factor-α, a proinflammatory cytokine, regulates a cascade of inflammatory events in both RA and periodontitis. Porphyromonas gingivalis is a common pathogen in periodontal infection. P. gingivalis has also been identified in synovial fluid. The specific abilities of P. gingivalis to citrullinate host peptides by proteolytic cleavage at Arg-X peptide bonds by arginine gingipains can induce autoimmune responses in RA through development of anticyclic citrullinated peptide antibodies. In addition, P. gingivalis carries heat shock proteins (HSPs) that may also trigger autoimmune responses in subjects with RA. Data suggest that periodontal therapies combined with routine RA treatments further improve RA status.
Collapse
Affiliation(s)
- G Rutger Persson
- Department of Periodontics and Department of Oral Medicine, University of Washington, Seattle, WA, USA; Oral Health Sciences, University of Kristianstad, Kristianstad, Sweden; and Department of Periodontology, University of Bern, Bern, Switzerland
| |
Collapse
|
24
|
Koh EM, Kim J, Kim TG, Moon JH, Oh JH, Lee JY, Jang YS. Cloning and characterization of heavy and light chain genes encoding the FimA-specific monoclonal antibodies that inhibit Porphyromonas gingivalis adhesion. Microbiol Immunol 2011; 55:199-210. [PMID: 21223367 DOI: 10.1111/j.1348-0421.2011.00305.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
FimA of Porphyromonas gingivalis, a major pathogen in periodontitis, is known to be closely related to the virulence of these bacteria and has been suggested as a candidate for development of a vaccine against periodontal disease. In order to develop a passive immunization method for inhibiting the establishment of periodontal disease, B hybridoma clones 123-123-10 and 256-265-9, which produce monoclonal antibodies (Mabs) specific to purified fimbriae, were established. Both mAbs reacted with the conformational epitopes displayed by partially dissociated oligomers of FimA, but not with the 43 kDa FimA monomer. Gene sequence analyses of full-length cDNAs encoding heavy and light chain immunoglobulins enabled classification of the genes of mAb 123-123-10 as members of the mVh II (A) and mVκ I subgroups, and those of mAb 256-265-9 as members of the mVh III (D) and mVκ I subgroups. More importantly, 50 ng/mL of antibodies purified from the culture supernatant of antibody gene-transfected CHO cells inhibited, by approximately 50%, binding of P. gingivalis to saliva-coated hydroxyapatite bead surfaces. It is expected that these mAbs could be used as a basis for passive immunization against P. gingivalis-mediated periodontitis.
Collapse
Affiliation(s)
- Eun-Mi Koh
- Department of Molecular Biology, Chonbuk National University, Jeonju, Korea
| | | | | | | | | | | | | |
Collapse
|
25
|
Graves DT, Li J, Cochran DL. Inflammation and uncoupling as mechanisms of periodontal bone loss. J Dent Res 2010; 90:143-53. [PMID: 21135192 DOI: 10.1177/0022034510385236] [Citation(s) in RCA: 181] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Periodontal disease is characterized by both inflammation and bone loss. Advances in research in both these areas have led to a new appreciation of not only each field but also the intimate relationship between inflammation and bone loss. This relationship has resulted in a new field of science called osteoimmunology and provides a context for better understanding the pathogenesis of periodontal disease. In this review, we discuss several aspects of the immuno-inflammatory host response that ultimately results in loss of alveolar bone. A proposal is made that periodontal inflammation not only stimulates osteoclastogenesis but also interferes with the uncoupling of bone formation and bone resorption, consistent with a pathologic process. Furthermore, arguments based on experimental animal models suggest a critical role of the spatial and temporal aspects of inflammation in the periodontium. A review of these findings leads to a new paradigm to help explain more fully the impact of inflammation on alveolar bone in periodontal disease so that it includes the effects of inflammation on uncoupling of bone formation from resorption.
Collapse
Affiliation(s)
- D T Graves
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, USA.
| | | | | |
Collapse
|
26
|
Dhingra K, Vandana K. Prophylactic Vaccination Against Periodontal Disease: A Systematic Review of Preclinical Studies. J Periodontol 2010; 81:1529-46. [DOI: 10.1902/jop.2010.100138] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
27
|
Choi JI, Seymour GJ. Vaccines against periodontitis: a forward-looking review. J Periodontal Implant Sci 2010; 40:153-63. [PMID: 20827324 PMCID: PMC2931303 DOI: 10.5051/jpis.2010.40.4.153] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Accepted: 07/02/2010] [Indexed: 12/18/2022] Open
Abstract
Periodontal disease, as a polymicrobial disease, is globally endemic as well as being a global epidemic. It is the leading cause for tooth loss in the adult population and has been positively related to life-threatening systemic diseases such as atherosclerosis and diabetes. As a result, it is clear that more sophisticated therapeutic modalities need to be developed, which may include vaccines. Up to now, however, no periodontal vaccine trial has been successful in satisfying all the requirements; to prevent the colonization of a multiple pathogenic biofilm in the subgingival area, to elicit a high level of effector molecules such as immunoglobulin sufficient to opsonize and phagocytose the invading organisms, to suppress the induced alveolar bone loss, or to stimulate helper T-cell polarization that exerts cytokine functions optimal for protection against bacteria and tissue destruction. This article reviews all the vaccine trials so as to construct a more sophisticated strategy which may be relevant in the future. As an innovative strategy to circumvent these barriers, vaccine trials to stimulate antigen-specific T-cells polarized toward helper T-cells with a regulatory phenotype (Tregs, CD4+, CD25+, FoxP3+) have also been introduced. Targeting not only a single pathogen, but polymicrobial organisms, and targeting not only periodontal disease, but also periodontal disease-triggered systemic disease could be a feasible goal.
Collapse
Affiliation(s)
- Jeom-Il Choi
- Department of Periodontology, Pusan National University School of Dentistry, Yangsan, Korea
| | | |
Collapse
|
28
|
Casarin RCV, Del Peloso Ribeiro É, Mariano FS, Nociti Jr FH, Casati MZ, Gonçalves RB. Levels of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, inflammatory cytokines and species-specific immunoglobulin G in generalized aggressive and chronic periodontitis. J Periodontal Res 2010; 45:635-42. [DOI: 10.1111/j.1600-0765.2010.01278.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
29
|
Jong RAM, van der Reijden WA. Feasibility and therapeutic strategies of vaccines against Porphyromonas gingivalis. Expert Rev Vaccines 2010; 9:193-208. [PMID: 20109029 DOI: 10.1586/erv.09.156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Periodontitis is a chronic infectious disease that is highly prevalent worldwide and is characterized by inflammation of the gums, and loss of connective tissue and bone support. The Gram-negative anerobic bacterium Porphyromonas gingivalis is generally accepted as the main etiological agent for chronic periodontitis. The objective of this paper is to elucidate the feasibility of achieving protection against periodontitis though immunization against P. gingivalis. Until now, animal studies have showed no complete protection against P. gingivalis. However, current knowledge about P. gingivalis structures could be applicable for further research to develop a successful licensed vaccine and alternative therapeutic strategies. This review reveals that a multicomponent vaccine against P. gingivalis, which includes structures shared among P. gingivalis serotypes, will be feasible to induce broad and complete protection.
Collapse
Affiliation(s)
- Rosa A M Jong
- Department of Oral Microbiology, Academic Centre for Dentistry Amsterdam, Universiteit van Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.
| | | |
Collapse
|
30
|
Pathirana RD, O'Brien-Simpson NM, Reynolds EC. Host immune responses to Porphyromonas gingivalis antigens. Periodontol 2000 2010; 52:218-37. [DOI: 10.1111/j.1600-0757.2009.00330.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
31
|
Cappelli D, Steffen MJ, Holt SC, Ebersole JL. Periodontitis in pregnancy: clinical and serum antibody observations from a baboon model of ligature-induced disease. J Periodontol 2009; 80:1154-65. [PMID: 19563297 PMCID: PMC4096487 DOI: 10.1902/jop.2009.080199] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Chronic oral infections that elicit host responses leading to periodontal disease are linked with various sequelae of systemic diseases. This report provides seminal information on the clinical and adaptive immunologic characteristics of a baboon model of ligature-induced periodontitis during pregnancy. METHODS Female Papio anubis were evaluated for periodontal health at baseline. Ligatures were tied around selected teeth to initiate oral inflammation and periodontitis. Then the animals were bred. At midpregnancy ( approximately 90 days), a clinical evaluation was performed, and additional ligatures were tied on teeth in the contralateral quadrants to maintain progressing periodontitis throughout pregnancy. A final clinical evaluation was done for all experimental teeth after delivery, and ligatures were removed. Serum was collected at all sampling intervals for the determination of antibody levels to a group of 20 oral bacteria. Unligated animals served as controls. RESULTS At baseline, 16% of animals exhibited minimal plaque and gingival inflammation without periodontal disease. The remaining baboons demonstrated varying levels of inflammation/bleeding, and approximately 20% of the population had periodontal pocketing (>3 mm). Ligated animals expressed increased levels of inflammation and increased probing depths and clinical attachment loss (AL) and could be stratified into multiple subsets postligation based upon changes in clinical parameters at midpregnancy and at delivery. Baboons were categorized into disease susceptibility groups (periodontal disease susceptibility 1 through 4) that described the extent/severity of induced disease during pregnancy. Control animals showed minimal periodontal changes during gestation. Significant differences in serum antibody to multiple oral bacteria were found in animals presenting with periodontitis at baseline and during the 6 months of ligature-induced disease. A significant correlation to antibody to P. gingivalis, which was sustained throughout ligation and pregnancy, was observed with disease presentation. CONCLUSIONS The clinical presentation at baseline, reflecting the natural history of oral disease in these animals, suggests individual variation that is reflected in the characteristics of the adaptive immune responses to oral bacteria. The variability in the response to ligation with resulting periodontal disease provides a model to document prospectively the relationship between oral and systemic health outcomes.
Collapse
Affiliation(s)
- D Cappelli
- Dental School, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | | | | |
Collapse
|
32
|
Abstract
Toll-like receptors (TLRs) are central mediators of innate antimicrobial and inflammatory responses and play instructive roles in the development of the adaptive immune response. Thus when stimulated by certain agonists, TLRs serve as adjuvant receptors that link innate and adaptive immunity. However, when excessively activated or inadequately controlled during an infection, TLRs may contribute to immunopathology associated with inflammatory diseases, such as periodontitis. Moreover, certain microbial pathogens appear to exploit aspects of TLR signalling in ways that enhance their adaptive fitness. The diverse and important roles played by TLRs suggest that therapeutic manipulation of TLR signalling may have implications in the control of infection, attenuation of inflammation, and the development of vaccine adjuvants for the treatment of periodontitis. Successful application of TLR-based therapeutic modalities in periodontitis would require highly selective and precisely targeted intervention. This would in turn necessitate precise characterization of TLR signalling pathways in response to periodontal pathogens, as well as development of effective and specific agonists or antagonists of TLR function and signalling. This review summarizes the current status of TLR biology as it relates to periodontitis, and evaluates the potential of TLR-based approaches for host-modulation therapy in this oral disease.
Collapse
Affiliation(s)
- George Hajishengallis
- Department of Periodontics/ Oral Health and Systemic Disease, School of Dentistry, University of Louisville Health Sciences Center, Louisville, KY 40292, USA
- Department of Immunology and Microbiology, School of Medicine, University of Louisville Health Sciences Center, Louisville, KY 40292, USA
| |
Collapse
|
33
|
Tam V, O'Brien-Simpson NM, Pathirana RD, Frazer LT, Reynolds EC. Characterization of T Cell Responses to the RgpA-Kgp Proteinase-Adhesin Complexes ofPorphyromonas gingivalisin BALB/c Mice. THE JOURNAL OF IMMUNOLOGY 2008; 181:4150-8. [DOI: 10.4049/jimmunol.181.6.4150] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
34
|
|
35
|
Hardham J, Sfintescu C, Evans RT. Evaluation of cross-protection by immunization with an experimental trivalent companion animal periodontitis vaccine in the mouse periodontitis model. J Vet Dent 2008; 25:23-7. [PMID: 18512622 DOI: 10.1177/089875640802500107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Companion animal periodontal disease is one of the most prevalent diseases seen by veterinarians. The goal of this study was to evaluate the vaccine performance of a trivalent canine periodontitis vaccine in the mouse oral challenge model of periodontitis. Mice vaccinated subcutaneously with an inactivated, whole-cell vaccine preparation of Porphyromonas denticanis, Porphyromonas gulae, and Porphyromonas salivosa displayed significantly reduced alveolar bone loss in response to heterologous and cross-species challenges as compared to sham vaccinated animals. Based on the results of these studies, a periodontitis vaccine may be a useful tool in preventing the initiation and progression of periodontitis caused by the most commonly isolated pigmenting anaerobic bacteria in animals.
Collapse
Affiliation(s)
- John Hardham
- Pfizer Inc., Veterinary Medicine Research and Development, Kalamazoo, MI 49001, USA.
| | | | | |
Collapse
|
36
|
Interleukin-1beta modulates proinflammatory cytokine production in human epithelial cells. Infect Immun 2008; 76:2080-9. [PMID: 18332211 DOI: 10.1128/iai.01428-07] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Periodontitis is a chronic human inflammatory disease initiated and sustained by dental plaque microorganisms. A major contributing pathogen is Porphyromonas gingivalis, a gram-negative bacterium recognized by Toll-like receptor 2 (TLR2) and TLR4, which are expressed by human gingival epithelial cells (HGECs). However, it is still unclear how these cells respond to P. gingivalis and initiate inflammatory and immune responses. We have reported previously that HGECs produce a wide range of proinflammatory cytokines, including interleukin-6 (IL-6), IL-8, granulocyte-macrophage colony-stimulating factor, tumor necrosis factor alpha (TNF-alpha), and IL-1beta. In this study, we show that IL-1beta has a special role in the modulation of other inflammatory cytokines in HGECs challenged with P. gingivalis. Our results show that the increased production of IL-1beta correlates with the cell surface expression of TLR4, and more specifically, TLR4-normal HGECs produce fourfold more IL-1beta than do TLR4-deficient HGECs after challenge. Moreover, blocking the IL-1beta receptor greatly reduces the production of "secondary" proinflammatory cytokines such as IL-8 or IL-6. Our data indicate that the induction of IL-1beta plays an important role in mediating the release of other proinflammatory cytokines from primary human epithelial cells following challenge with P. gingivalis, and this process may be an inflammatory enhancement mechanism adopted by epithelial cells.
Collapse
|
37
|
Sharma DCG, Prasad SBM, Karthikeyan BV. Vaccination against periodontitis: the saga continues. Expert Rev Vaccines 2007; 6:579-90. [PMID: 17669011 DOI: 10.1586/14760584.6.4.579] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Periodontal disease can be considered to be one of the most common chronic inflammatory diseases inflicting humans. With the advent of advanced molecular diagnostic techniques, a better understanding of the role of specific pathogens and the contributory role of the host immune response in the initiation and progression of periodontal disease has been possible - although not completely. However, successful vaccine development that fully utilizes the current level of understanding has not yet occurred for human use. This paper reviews various in vitro, animal studies and human trials undertaken to develop a vaccine against periodontal disease, with emphases on the shortfalls of these efforts and future prospects of developing a successful vaccine against periodontal disease.
Collapse
Affiliation(s)
- Dileep C G Sharma
- Department of Periodontics, KGF College of Dental Sciences, Kolar Gold Fields, Karnataka, India.
| | | | | |
Collapse
|
38
|
Gemmell E, Yamazaki K, Seymour GJ. Destructive periodontitis lesions are determined by the nature of the lymphocytic response. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 2007; 13:17-34. [PMID: 12097235 DOI: 10.1177/154411130201300104] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
Collapse
Affiliation(s)
- E Gemmell
- School of Dentistry, The University of Queensland, Brisbane, Australia.
| | | | | |
Collapse
|
39
|
Hamada N, Watanabe K, Tahara T, Nakazawa K, Ishida I, Shibata Y, Kobayashi T, Yoshie H, Abiko Y, Umemoto T. The r40-kDa outer membrane protein human monoclonal antibody protects against Porphyromonas gingivalis-induced bone loss in rats. J Periodontol 2007; 78:933-9. [PMID: 17470029 DOI: 10.1902/jop.2007.060245] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Porphyromonas gingivalis has been implicated as an important pathogen in the development of adult periodontitis, and its colonization of subgingival sites is critical in the pathogenic process. We recently reported the construction and characterization of human immunoglobulin G isotype clones, which were specifically reactive with recombinant (r) 40-kDa outer membrane protein (OMP) of P. gingivalis. The aim of this study was to investigate the efficacy of human monoclonal antibody (hMAb) against r40-kDa OMP of P. gingivalis to the protection alveolar bone loss by P. gingivalis in rats. METHODS The role of 40-kDa OMP in the adherence of P. gingivalis to human gingival epithelial cells (HGECs) was examined by preincubating with r40-kDa OMP hMAb before adding the HGECs. Moreover, we used a rat model to examine the effect of the anti-r40-kDa OMP hMAb in alveolar bone loss by oral infection. Forty-six days after the last infection, the periodontal bone level was assessed morphometrically on defleshed rat jaws. RESULTS The adherence to HGECs was reduced by 84% compared to adherence levels without the antibody. P. gingivalis could not be detected from rats in a P. gingivalis-non-infected group and a group that was administered the anti-r40-kDa OMP hMAb. The bone loss in P. gingivalis-infected animals that were administered the anti-r40-kDa OMP hMAb was significantly lower than that of P. gingivalis-infected rats. CONCLUSIONS Our results suggest that transchromosomic mouse-derived hMAb against r40-kDa OMP of P. gingivalis protects against periodontal bone loss. This newly constructed anti-r40-kDa OMP hMAb was used to protect against periodontal diseases caused by P. gingivalis infection.
Collapse
Affiliation(s)
- Nobushiro Hamada
- Division of Microbiology, Department of Infection Control, Kanagawa Dental College, Kanagawa, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Page RC, Lantz MS, Darveau R, Jeffcoat M, Mancl L, Houston L, Braham P, Persson GR. Immunization of Macaca fascicularis against experimental periodontitis using a vaccine containing cysteine proteases purified from Porphyromonas gingivalis. ACTA ACUST UNITED AC 2007; 22:162-8. [PMID: 17488441 DOI: 10.1111/j.1399-302x.2007.00337.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Periodontitis is a common infectious disease to which Porphyromonas gingivalis has been closely linked, in which the attachment tissues of the teeth and their alveolar bone housing are destroyed. We conducted a study to determine if immunization using a purified antigen could alter the onset and progression of the disease. METHODS Using the ligature-induced model of periodontitis in Macaca fascicularis, we immunized five animals with cysteine protease purified from P. gingivalis and used an additional five animals as controls. Alveolar bone loss was measured by digital subtraction radiography. RESULTS Immunization induced high titers of specific immunoglobuin G serum antibodies that were opsonic. Total bacterial load, levels of P. gingivalis in subgingival plaque and levels of prostaglandin E(2) in gingival crevicular fluid were significantly reduced. Onset and progression of alveolar bone loss was inhibited by approximately 50%. No manifestations of toxicity were observed. CONCLUSIONS Immunization using a purified protein antigen from P. gingivalis inhibits alveolar bone destruction in a ligature-induced periodontitis model in M. fascicularis.
Collapse
Affiliation(s)
- R C Page
- Department of Periodontics, and Regional Clinical Dental Research Center, School of Dentistry, Indiana University, Indianapolis, IN, USA.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Pathirana RD, O'Brien-Simpson NM, Visvanathan K, Hamilton JA, Reynolds EC. Flow cytometric analysis of adherence of Porphyromonas gingivalis to oral epithelial cells. Infect Immun 2007; 75:2484-92. [PMID: 17339349 PMCID: PMC1865753 DOI: 10.1128/iai.02004-06] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
By using fluorescence microscopy, fluorescently labeled Porphyromonas gingivalis W50 was shown to adhere to oral epithelial (KB) cells as discrete cells or small cell aggregates, whereas P. gingivalis ATCC 33277 bound as large cell aggregates. Flow cytometric analysis showed that for P. gingivalis W50 there was a logarithmic relationship between the bacterial cell ratio (BCR), that is the number of bacterial cells to KB cells, and the percentage of KB cells with W50 cells attached. This percentage of KB cells with W50 attached reached a plateau of approximately 84% cells at a BCR of 500:1. In contrast, a quadratic relationship was observed between BCR and the percentage of KB cells with P. gingivalis ATCC 33277 attached, reaching a maximum of 47% at a BCR of 100:1 but decreasing to 7% at a BCR of 1,000:1. The lower binding of ATCC 33277 at high cell concentrations was attributed to autoaggregation. P. gingivalis W50 cells treated with an inhibitor (Nalpha-p-tosyl-L-lysine chloromethyl ketone [TLCK]) of its RgpA-Kgp proteinase-adhesin complex exhibited significantly reduced binding to KB cells than to untreated cells, suggesting a role for proteinase activity in binding to KB cells. Competitive inhibition with purified proteinase-active and TLCK-inactivated RgpA-Kgp complex significantly decreased the adherence of P. gingivalis W50 cells to KB cells. Furthermore, isogenic mutants of P. gingivalis W50 lacking the kgp gene product, but not the rgpA or rgpB gene products, exhibited significantly decreased adherence to KB cells compared to the wild type.
Collapse
Affiliation(s)
- Rishi D Pathirana
- Cooperative Centre for Oral Health Science, School of Dental Science, The University of Melbourne, 720 Swanston Street, Melbourne, Victoria 3010, Australia
| | | | | | | | | |
Collapse
|
42
|
Pathirana RD, O'Brien-Simpson NM, Veith PD, Riley PF, Reynolds EC. Characterization of proteinase-adhesin complexes of Porphyromonas gingivalis. MICROBIOLOGY-SGM 2006; 152:2381-2394. [PMID: 16849802 DOI: 10.1099/mic.0.28787-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Proteinase-adhesin complexes of Porphyromonas gingivalis wild-type and RgpA and Kgp mutants were extracted using a Triton X-114 procedure and purified using arginine-affinity chromatography. The complexes were then characterized by peptide mass fingerprinting (PMF) and their equilibrium binding constants, immunogenicity and ability to induce protection as vaccines in the murine lesion model determined. The Triton X-114 procedure resulted in consistently higher yield and specific activity of the wild-type (wt) complex compared with that produced by the previously published sonication method. PMF and N-terminal sequencing of the purified wt complex showed that it consisted of the previously identified Arg-specific proteinase RgpA(cat), the Lys-specific proteinase Kgp(cat) and adhesin domains RgpA A1, RgpA A2, RgpA A3, Kgp A1 and Kgp A2. However, analysis of the 30 kDa band in the wt complex, previously suggested to be RgpA A4, indicated that this band contained C-terminally truncated Kgp A1 (which has an identical N-terminus to RgpA A4) as well as the HagA A1* adhesin. Analysis of the Triton X-114 extracted complexes from the P. gingivalis isogenic mutants kgp (RgpA complex) and rgpA (Kgp complex) suggested that the Kgp complex consisted of Kgp(cat), Kgp A1 and Kgp A2/HagA A2 and that the RgpA complex consisted of RgpA(cat), RgpA A1, HagA A1*, RgpA A2 and RgpA A3. Each of the complexes was found to have equilibrium binding constants (K(D)) in the nanomolar range for fibrinogen, fibronectin, haemoglobin, collagen type V and laminin. However, the Triton-wt complex exhibited significantly lower K(D) values for binding to each host protein compared with the sonication-wt complex, or the Triton-RgpA complex and Triton-Kgp complex. Furthermore, the Triton-wt complex induced a stronger antibody response to the A1 adhesins and tended to be more effective in providing protection in the mouse lesion model compared with the sonication-wt complex.
Collapse
Affiliation(s)
- Rishi D Pathirana
- Cooperative Research Centre for Oral Health Science, School of Dental Science, The University of Melbourne, 720 Swanston Street, Victoria, 3010, Australia
| | - Neil M O'Brien-Simpson
- Cooperative Research Centre for Oral Health Science, School of Dental Science, The University of Melbourne, 720 Swanston Street, Victoria, 3010, Australia
| | - Paul D Veith
- Cooperative Research Centre for Oral Health Science, School of Dental Science, The University of Melbourne, 720 Swanston Street, Victoria, 3010, Australia
| | - Peter F Riley
- Cooperative Research Centre for Oral Health Science, School of Dental Science, The University of Melbourne, 720 Swanston Street, Victoria, 3010, Australia
| | - Eric C Reynolds
- Cooperative Research Centre for Oral Health Science, School of Dental Science, The University of Melbourne, 720 Swanston Street, Victoria, 3010, Australia
| |
Collapse
|
43
|
Frazer LT, O'Brien-Simpson NM, Slakeski N, Walsh KA, Veith PD, Chen CG, Barr IG, Reynolds EC. Vaccination with recombinant adhesins from the RgpA-Kgp proteinase-adhesin complex protects against Porphyromonas gingivalis infection. Vaccine 2006; 24:6542-54. [PMID: 16839648 DOI: 10.1016/j.vaccine.2006.06.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Revised: 06/06/2006] [Accepted: 06/09/2006] [Indexed: 11/25/2022]
Abstract
Porphyromonas gingivalis is a pathogen associated with chronic periodontitis, an inflammatory disease of the supporting tissues of the teeth. A major virulence factor for P. gingivalis is the RgpA-Kgp proteinase-adhesin complex. We have prepared the following recombinant proteins corresponding to domains/regions of the RgpA-Kgp complex; rRgpA(cat), rRgpA(A1), rRgpA(A2), rRgpA(A4), rRgpA(A1)(784-1009), rRgpA(A1)(911-1009), rKgp(A1) and rKgp(A1)(759-989). The ability of each recombinant protein to attenuate P. gingivalis infection, when used as a vaccine, in the murine lesion model was determined. All of the recombinant adhesin domains were found to significantly attenuate P. gingivalis infection with the most effective being rKgp(A1) and rKgp(A1)(759-989) followed by rRgpA(A1), rRgpA(A1)(784-1009) and rRgpA(A1)(911-1009). The predominant antibody isotype was IgG1. The A1 adhesins, which gave the best protection, contain specific motifs implicated in binding to host tissue. Immunisation with rRgpA(cat) had no effect on P. gingivalis infection. As well as detecting the Kgp(A1) adhesin in a Western blot, the rKgp(A1) and rKgp(A1)(759-989) antisera were also immunoreactive with the A1 and A3 adhesins of RgpA and HagA. Flow cytometric analysis indicated that rKgp(A1) and rRgpA(A1) antisera recognised native antigen on P. gingivalis whole cells. Furthermore, the rKgp(A1) and rKgp(A1)(759-989) antisera exhibited a similar immunoreactive profile with outer membrane preparations of all P. gingivalis serotypes and clinical isolates tested. The recombinant A1 adhesin therefore has potential in the development of a P. gingivalis vaccine.
Collapse
Affiliation(s)
- Leanne T Frazer
- Cooperative Research Centre for Oral Health Science, School of Dental Science, The University of Melbourne, 720 Swanston Street, Victoria 3010, Australia
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Rams TE, Listgarten MA, Slots J. Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis subgingival presence, species-specific serum immunoglobulin G antibody levels, and periodontitis disease recurrence. J Periodontal Res 2006; 41:228-34. [PMID: 16677293 DOI: 10.1111/j.1600-0765.2005.00860.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The biological and clinical effects of antibody against periodontal pathogenic bacteria are incompletely understood. This study evaluated the inter-relationships among periodontal levels of cultivable Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis, species-specific serum immunoglobulin G (IgG) antibody levels, and periodontitis disease activity. MATERIAL AND METHODS Forty-three adults who had previously been treated for periodontitis and who also harbored cultivable A. actinomycetemcomitans or P. gingivalis were evaluated semiannually for clinical disease recurrence over a 36-month period. Each patient provided subgingival microbial samples, for the recovery of A. actinomycetemcomitans and P. gingivalis, from the two deepest pockets in each dentition sextant. A. actinomycetemcomitans and P. gingivalis serum IgG antibody levels were assessed using enzyme-linked immunosorbent assay (ELISA), together with whole-cell sonicate extracts from A. actinomycetemcomitans serotypes a-c and P. gingivalis ATCC 33277. Data were analyzed using the Mantel-Haenszel chi-square and Fisher exact two-tailed tests. RESULTS Eighteen (60.0%) of 30 A. actinomycetemcomitans-positive subjects, and 10 (76.9%) of 13 P. gingivalis-positive subjects, exhibited recurrent periodontal breakdown within 36 months of periodontal therapy. Nineteen (67.9%) of the 28 patients with active periodontitis had A. actinomycetemcomitans or P. gingivalis serum antibody levels below designated threshold values. In comparison, 10 (66.7%) of 15 culture-positive clinically stable subjects showed A. actinomycetemcomitans or P. gingivalis serum antibody levels above threshold values. The difference between specific antibody levels in periodontitis-active and periodontitis-stable patients was statistically significant (p = 0.032). CONCLUSIONS Serum levels of IgG antibodies against A. actinomycetemcomitans or P. gingivalis in periodontitis-stable patients were higher than those in patients with active periodontitis. The results suggest that elevated levels of IgG antibody against A. actinomycetemcomitans and P. gingivalis have a detectable protective effect against periodontal infections with these microorganisms.
Collapse
Affiliation(s)
- T E Rams
- Temple University School of Dentistry, Philadelphia, PA, USA
| | | | | |
Collapse
|
45
|
Taubman MA, Valverde P, Han X, Kawai T. Immune response: the key to bone resorption in periodontal disease. J Periodontol 2006; 76:2033-41. [PMID: 16277573 DOI: 10.1902/jop.2005.76.11-s.2033] [Citation(s) in RCA: 300] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Periodontal disease infection with oral biofilm microorganisms initiates host immune response and signs of periodontitis, including bone resorption. This review delineates some mechanisms underlying the host immune response in periodontal infection and alveolar bone resorption. Activated T lymphocytes have been historically implicated in experimental periodontal bone resorption. An experimental rat adoptive transfer/gingival challenge periodontal disease model has been demonstrated to require antigen-specific T lymphocytes and gingival instillation of antigen and LPS for bone resorption. Interference with costimulatory interactions between T cells and antigen-presenting cells abrogated bone resorption, further emphasizing the significance of immune response in periodontal disease. Receptor activator of nuclear factor kappaB ligand (RANKL), a critical osteoclast differentiation factor, is expressed on T lymphocytes in human periodontal disease as determined by immunohistochemical and confocal microscopic analyses. Interference with RANKL by systemic administration of osteoprotegerin (OPG), the decoy receptor for (and inhibitor of) RANKL, resulted in abrogation of periodontal bone resorption in the rat model. This finding indicated that T cell-mediated bone resorption is RANKL-dependent. In additional experiments, treatment of T cell-transferred rats with kaliotoxin (a scorpion venom potassium channel inhibitor) resulted in decreases in T-cell RANKL expression, diminished induction of RANKL-dependent osteoclastogenesis, and abrogation of bone resorption, implicating an important role of immune response/RANKL expression in osteoclastogenesis/bone resorption. In other experiments, adoptive transfer of antigen-specific, RANKL-expressing B cells, and infection with the antigen-bearing Actinobaccillus actinomycetemcomitans gave rise to periodontal bone resorption, indicating that B cells also have the capacity to mediate bone resorption, probably via RANKL expression. In humans, prominent T lymphocytes have been identified in periodontal disease, and diseased tissues showed elevated RANKL mRNA expression, as well as decreased OPG mRNA expression. Mononuclear cells from periodontal lesions involving T cells and B cells of patients induced osteoclastogenesis in vitro. In summary, a biofilm interface initiates immune cell infiltration, stimulating osteoclastogenesis/bone resorption in periodontal disease. This resorption can be ameliorated by inhibition of RANKL activity or by diminishing immune cell stimulation. These two procedures, if localized, have the potential to lead to the prevention or therapeutic management of periodontal disease and therefore require further study.
Collapse
Affiliation(s)
- Martin A Taubman
- Department of Immunology, The Forsyth Institute, Boston, MA 02115, USA.
| | | | | | | |
Collapse
|
46
|
Affiliation(s)
- G Rutger Persson
- Department of Periodontology and Fixed Prosthodontics, School of Dental Medicine, Univerisity of Bern, Bern ,Switzerland and Departments of Periodontology and Oral Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
47
|
Abstract
BACKGROUND The infectious aetiology of periodontitis is complex and no curative treatment modality exists. Palliative therapy is available. AIMS To review the evidence that active or passive immunization against periodontitis provides immune protection. MATERIAL AND METHODS PubMed (Medline), the National Institutes of Health, the Food and Drug Administration, and the Center for Disease Control electronic databases were searched to extrapolate information on immune responses to immunization against periodontitis. RESULTS Studies in non-human primate models using ligature-induced experimental periodontitis suggest that antibody responses by active immunization against Porphyromonas gingivalis can safely be induced, enhanced, and obtained over time. Immune responses to whole bacterial cell and purified protein preparations considered as vaccine candidates have been evaluated in different animal models demonstrating that there are several valid vaccine candidates. Data suggest that immunization reduces the rate and severity of bone loss. It is also, temporarily, possible to alter the composition of the subgingival microflora. Natural active immunization by therapeutic interventions results in antibody titre enhancement and potentially improves treatment outcomes. Passive immunization of humans using P. gingivalis monoclonal antibodies temporarily prevents colonization of P. gingivalis. Probiotic therapy may be an alternative approach. Regulatory and safety issues for human periodontal vaccine trials must be considered. Shared infectious aetiology between periodontitis and systemic diseases may enhance vaccine effort developments. CONCLUSIONS Proof of principle that active and passive immunization can induce protective antibody responses is given. The impact of natural immunization and passive immunization in humans should be explored and may, presently, be more feasible than active immunization studies.
Collapse
Affiliation(s)
- G Rutger Persson
- Department of Periodontology and Fixed Prosthodontics, Division of Oral Microbiology, University of Berne, Berne, Switzerland.
| |
Collapse
|
48
|
Houri-Haddad Y, Soskolne WA, Halabi A, Shapira L. The effect of immunization on the response to P. gingivalis infection in mice is adjuvant-dependent. J Clin Periodontol 2005; 32:933-7. [PMID: 16104955 DOI: 10.1111/j.1600-051x.2005.00768.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Studies on vaccines against the periodontal pathogen Porphyromonas gingivalis have produced conflicting results, but no consideration has been given to the role of different adjuvants in these vaccines. We have previously shown that an intra-chamber challenge with heat-killed P. gingivalis was modified by immunization with different adjuvants. This study tested the hypothesis that different adjuvants in P. gingivalis vaccines would differentially modify the host response to a live P. gingivalis infection. RESULTS Using P. gingivalis-infected subcutaneous chambers in mice, we show that vaccination with P. gingivalis in alum attenuated the pro-inflammatory cytokine levels at the site of infection, while the vaccine containing incomplete Freund's adjuvant did the opposite. Although both vaccines induced a similar humoral IgG response, P. gingivalis-induced abscesses were significantly smaller in the alum-adjuvant group. CONCLUSIONS The results suggest that the immune response and the resultant protection to a P. gingivalis infection, in P. gingivalis-vaccinated mice, are adjuvant-dependent.
Collapse
Affiliation(s)
- Yael Houri-Haddad
- Department of Periodontology, Faculty of Dental Medicine, Hadassah and Hebrew University Medical Centers, Jerusalem, Israel.
| | | | | | | |
Collapse
|
49
|
Hardham J, Reed M, Wong J, King K, Laurinat B, Sfintescu C, Evans RT. Evaluation of a monovalent companion animal periodontal disease vaccine in an experimental mouse periodontitis model. Vaccine 2005; 23:3148-56. [PMID: 15837214 DOI: 10.1016/j.vaccine.2004.12.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2004] [Revised: 12/17/2004] [Accepted: 12/21/2004] [Indexed: 11/24/2022]
Abstract
Periodontal disease in companion animals is clinically similar to that of human periodontal disease. Despite the usage of veterinary procedures and antibiotic therapy, the disease still remains as one of the most highly prevalent disorders seen by veterinarians. The goal of this study was to evaluate the immunogenic properties and vaccine performance of a monovalent canine periodontal disease vaccine in the mouse oral challenge model of periodontitis. Mice vaccinated subcutaneously with inactivated, whole-cell bacterin preparations of Porphyromonas gulae displayed both high titers of anti-P. gulae specific antibodies and significantly reduced alveolar bone loss in response to homologous, heterologous, and cross-species challenge. Based on the results of these studies, a periodontal disease vaccine may be a useful tool in preventing the progression of periodontitis in animals.
Collapse
Affiliation(s)
- John Hardham
- Pfizer Inc., Veterinary Medicine Research and Development, 301 Henrietta Street, Kalamazoo, MI 49001, USA.
| | | | | | | | | | | | | |
Collapse
|
50
|
de Lillo A, Booth V, Kyriacou L, Weightman AJ, Wade WG. Culture-independent identification of periodontitis-associated Porphyromonas and Tannerella populations by targeted molecular analysis. J Clin Microbiol 2005; 42:5523-7. [PMID: 15583276 PMCID: PMC535285 DOI: 10.1128/jcm.42.12.5523-5527.2004] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Periodontitis is the commonest bacterial disease of humans and is the major cause of adult tooth loss. About half of the oral microflora is unculturable; and 16S rRNA PCR, cloning, and sequencing techniques have demonstrated the high level of species richness of the oral microflora. In the present study, a PCR primer set specific for the genera Porphyromonas and Tannerella was designed and used to analyze the bacterial populations in subgingival plaque samples from inflamed shallow and deep sites in subjects with periodontitis and shallow sites in age- and sex-matched controls. A total of 308 clones were sequenced and found to belong to one of six Porphyromonas or Tannerella species or phylotypes, one of which, Porphyromonas P3, was novel. Tannerella forsythensis was found in significantly higher proportions in patients than in controls. Porphyromonas catoniae and Tannerella phylotype BU063 appeared to be associated with shallow sites. Targeted culture-independent molecular ecology studies have a valuable role to play in the identification of bacterial targets for further investigations of the pathogenesis of bacterial infections.
Collapse
Affiliation(s)
- A de Lillo
- Infection Research Group, Dental Institute, King's College London, United Kingdom
| | | | | | | | | |
Collapse
|