Ontogeny and senescence of salivary immunity

Immune System Dysfunction in the Elderly

Human aging is characterized by both physical and physiological frailty that profoundly affects the immune system. In this context aging is associated with declines in adaptive and innate immunity established as immunosenescence. Immunosenescence is a new concept that reflects the age-associated restructuring changes of innate and adaptive immune functions. Thus elderly individuals usually present chronic low-level inflammation, higher infection rates and chronic diseases. A study of alterations in the immune system during aging could provide a potentially useful biomarker for the evaluation of immune senescence treatment. The immune system is the result of the interplay between innate and adaptive immunity, yet the impact of aging on this function is unclear. In this article the function of the immune system during aging is explored.

An Organic Field-effect Transistor with an Extended-gate Electrode Capable of Detecting Human Immunoglobulin A

We herein report on the development of an extended-gate type organic field-effect transistor (OFET)-based immunosensor for the detection of human immunoglobulin A (IgA). The titration results of IgA exhibited shifts in the transfer characteristics of the OFET sensor device with increasing IgA concentration. A linear detection range from 0 to 10 μg/mL was realized with a detection limit of 2.1 μg/mL, indicating that the OFET-based immunosensor can be potentially applied to the monitoring of infectious diseases and psychological stress in daily life.

Developmental profiles of mucosal immunity in pre-school children

This study investigated the effect of attending pre-school on mucosal immunity. Children 3.5 to 5 years of age who attended pre-school were observed for a 10 month period. Demographic information was collected on previous childcare experiences, the home environment and clinical information relating to the child and the family. A daily illness log was kept for each child. A multivariate longitudinal analysis of the relation between immunoglobulins in saliva and age, gender, childcare experience, pre-school exposure, number of siblings, environmental tobacco smoke (ETS), atopy and hospitalisation was conducted. There was a positive association of higher IgA levels with the winter season and with children being older than 4 years (P < .001), having attended childcare prior to commencing pre-school (P < .05), and having been exposed to ETS at home (P < .05). Lower IgA levels were associated with being atopic (P < .05). Higher IgG levels were associated with exposure to ETS (P < .001), while lower levels were associated to having atopy. Higher IgM levels were associated with previous childcare experience (P < .01) whilst having been hospitalised was associated with having low salivary IgM levels (P < .01). Lagged analyses demonstrated that immunological parameters were affected by the number of respiratory infections in the preceding 2 months.

A Single-Bead Analysis on a Disk-shaped Microfluidic Device Using an Antigen-immobilized Bead

A disk-shaped microfluidic device (lab-on-a-Disk) was developed to allow the evaluation of mental stress. As a standard sample, secretory immunoglobulin A (sIgA), which is a candidate marker of mental stress, was measured by a heterogeneous enzyme immunoassay (EIA) on the lab-on-a-Disk. Centrifugal force provided a microfluidic control on the lab-on-a-Disk. We examined the relationship between the rotational speed, the channel profile, and the position of the microfluidic chambers from the center of rotation to manipulate sample solutions into each reaction reservoir through microchannels sequentially, i.e., retain in a reservoir or flow into a subsequent reservoir. A single glass bead with immobilized sIgA on its surface was injected into a reservoir for a competitive antigen-antibody reaction, and applied to a specific surface in a heterogeneous assay. It is expected that the lab-on-a-Disk would be suitable for miniaturization and automation of the processes in EIA compared with a conventional EIA using a titer plate.

Immune response in humans to a nasal boost with Streptococcus mutans antigens

We previously reported that a Streptococcus mutans enriched-glucosytransferase (E-GTF) preparation induces an immune response following intranasal, but not tonsillar, immunization of humans. In this study, we determined whether intranasal immunization of these subjects 2 years later resulted in augmented immune responses compared to those seen in control subjects. Subjects previously immunized via the intranasal (IN, n = 7) or tonsillar (IT, n = 7) route and control (n = 12) subjects were immunized via the intranasal route with E-GTF. Nasal wash, saliva, and serum were collected before immunization and then weekly for 3 months after immunization. Significant (P < 0.05) mucosal and serum immunoglobulin A (IgA) anti-E-GTF responses were observed in all three groups. Nasal and serum IgA anti-E-GTF responses were significantly higher (P < 0.05) in the IN group. The salivary responses in the three groups were, in general, similar. These results indicate that intranasal immunization primes the immune system for a localized secondary response to S. mutans antigens.

Salivary sIgA and cortisol: markers for functional dependence in older adults

Elderly persons with health problems and physical limitations have reduced independence. Since poor functional ability is a known risk factor for disease among older populations, including oral disease, this study was undertaken to assess whether salivary defense factors and the stress hormone cortisol are significant markers for functional dependence. Oral examinations; salivary and microbial analyses; and interviews using the Activities of Daily Living (ADD index, the Mini Nutritional Assessment (MNA) and the Perceived Life Stress Questionnaire (PLSQ) were conducted for 123 dentate subjects. Of the subjects, 80 lived independently in the community or in apartments at the Baycrest Centre for Geriatric Care in Toronto, Canada, and 43 resided in the Baycrest nursing home or the Baycrest Hospital. Whole saliva samples were assayed for total secretory immunoglobulin A (sIgA), sIgA1, sIgA2, total protein and cortisol using ELISA. Dependent residents in the nursing home/hospital scored significantly lower in the nutritional assessment, had higher mean PLSQ scores, increased total protein and cortisol concentrations, and reduced salivary flow rates in comparison to ambulatory residents in the community/apartments. In multivariable logistic regression, factors associated with functional dependence were: being male, perceiving income as inadequate, having low salivary flow rate and drinking less than 5 cups of water per day. These results indicate that salivary flow and cortisol may be useful markers of functional dependence; however, the ability of these markers to predict functional decline cannot be confirmed until longitudinal studies are conducted.

Effect of age on immunoglobulin A subclass distribution in human parotid saliva

Two subclasses of immunoglobulin A (IgA) antibodies are produced in humans, IgA1 and IgA2, IgA2 being more resistant to digestion by bacterial proteases than IgA1. The amount of IgA in saliva has been shown to vary with age; however, little is known about the correlation between IgA subclass distribution in saliva and age. The purpose of this study was to determine whether differences exist in the levels and ratio of IgA subclasses in parotid saliva of children and adults. Parotid saliva was obtained from healthy children (age range 6-12 years, n = 14) and adults (age range 22-51 years, n = 20) using Schaefer cups. Samples were analyzed for levels of total IgA, IgA1, and IgA2 by ELISA. IgA and IgA1 levels were significantly higher in adults than in children. However, no differences were seen in the ratio of IgA1 and IgA2 in the two groups of subjects. These findings indicate that levels of IgA increase with age, whereas the IgA subclass ratio is established early in life.

Analysis of secretory immunoglobulin A in human saliva by laser-induced fluorescence capillary electrophoresis

The utility of capillary electrophoresis (CE) has been demonstrated for the analysis of secretory immunoglobulin A (sIgA) in human saliva. The amount of sIgA in saliva correlates with immune status. For detecting salivary sIgA, laser-induced fluorescence was conducted in this report for signal amplification. sIgA and anti-sIgA antibody were labeled with cyanine fluorescence (Cy5) for competitive immunoassay and non-competitive analysis, respectively. Cy5 was excited by He-Ne laser with a wavelength of 635 nm, with maximum emission at 670 nm. Migration time during electrophoresis depended on whether sIgA-Cy5 was mixed with antibody or anti-sIgA-Cy5 mixed with sIgA to form Ag-Ab complex. The results indicated that CE competitive immunoassay was effective for analyzing serum sIgA, but not for salivary sIgA. However, salivary sIgA can be analyzed by complex formation assay. The peak area of the complex was proportional to the amount of sIgA added. A standard linear regression curve was generated using purified sIgA. From this standard curve, the amount of sIgA from saliva of either normal or immunocompromised patients can be calculated from the Ag-Ab complex peak area.

Oral health, taste, and olfaction

Oral health, taste, and smell are critical components to an older person's overall sense of well-being and quality of life. Oral health problems can cause pain and discomfort and can hinder the maintenance of a satisfying and nutritious diet. Loss of taste and smell interferes with pleasure derived from food and food-related activities. Attention should be given to preserving teeth and optimizing oral function. Likewise, close evaluation of older adults' medications may identify the causes of taste and smell disorders. In instances in which nutrient intake is inadequate and chemosensory perception is considered a likely contributor, a trial of flavor enhancers or monosodium glutamate may improve both quality and quantity of intake. Much more information is needed to understand the interrelationship between chemosensory perception, food intake regulatory mechanisms, and nutritional status. Multidisciplinary studies will be required to understand how to improve nutrition through manipulation of oral characteristics, taste, and smell.

Effect of donor age on the concentrations of histatins in human parotid and submandibular/sublingual saliva

Histatins are small proteins of human glandular saliva that have antifungal properties. Recent studies show that oral candidal infections increase with age, suggesting an age-associated compromise in oral host defence. Here, the effect of age and of physiological gland stimulation on the concentration and secretion of salivary histatins was investigated. Parotid and submandibular/sublingual salivas were collected from six young adults under unstimulated, mechanical (chewing) and gustatory (0.025 M and 0.1 M citric acid) stimulation, and the concentration and secretion of histatins was measured by cationic polyacrylamide gel electrophoresis with subsequent densitometric scanning of the stained gels. With gland stimulation, parotid saliva showed no significant increase in histatin concentration (microg/ml); however, histatin secretion (microg/min) increased up to 26-fold (p<0.005; ANOVA). Stimulation of submandibular/sublingual saliva resulted in significant increases in both histatin concentration (p<0.005) and secretion (p<0.0005). Ageing effects on salivary histatins were determined in citric acid (0.1 M)-stimulated parotid and submandibular/sublingual saliva samples collected from 80 individuals (divided into four age groups having approximately equal numbers of males and females: 35-44 years; 45-54 years; 55-64 years and 65-76 years). None of the patients was taking medications or wore dentures. ANOVA showed no sex differences in histatins. Regression analysis showed significant age-associated decreases for parotid saliva histatin concentration (p<0.002) and secretion (p<0. 002) as well as for submandibular/sublingual saliva histatin concentration (p<0.0001) and secretion (p<0.0001). Both saliva types showed significant (p<0.0001) decreases in the histatin concentration per mg of total protein, suggesting a preferential decrease in salivary histatins compared to total salivary protein. These results suggest that the salivary histatin component of the oral host defence system is compromised with increasing age.

Saliva, salivary micro-organisms, and oral health in the home-dwelling old elderly--a five-year longitudinal study

High scores of chair-side salivary microbial tests have been found to be related to an increased prevalence and incidence of coronal and root caries. Many elderly face an increased risk of the growth of oral microbes, and previous studies have reported high salivary microbial counts in elderly populations. The aim of this follow-up study was to compare, at five-year intervals, stimulated salivary flow rates with the numbers of selected salivary micro-organisms (mutans streptococci, lactobacilli, and yeasts) in a group of home-dwelling elderly in Helsinki. A further aim was to study the influence of baseline microbial counts on five-year root caries increments and rates of tooth loss. The baseline study population was comprised of 270 subjects who were all participants in the population-based Helsinki Aging Study. Salivary flow rates and microbial conditions were determined as part of their dental examination at the Institute of Dentistry, University of Helsinki, in 1990-1991. Of these subjects, 110 underwent a follow-up examination in 1995-1996. Commercially available kits (Dentocult SM strip mutans for mutans streptococci, Dentocult LB for lactobacilli, and Oricult N for yeasts) were used for the enumeration of micro-organisms, after the collection of paraffin-wax-stimulated whole saliva. The stimulated whole saliva flow rates of the subjects were significantly lower at the follow-up than at baseline (paired t test, difference -0.16 mL/min; p < 0.05), whereas buffer capacity was higher (paired t test, difference 0.19 on a three-unit scale; p < 0.05). Apart from lower salivary lactobacilli counts at follow-up (paired t test, difference -0.44 CFUs/mL of saliva; p < 0.001), no changes were found in salivary microbial levels. Salivary microbial counts were clearly associated with the subjects' dentition types: More denture-wearers had high microbial counts than persons with natural dentitions. None of the salivary factors correlated with the root caries incidence or the number of teeth lost during the five-year follow-up.

Xerostomia and hyposalivation: causes, consequences and treatment in the elderly

Xerostomia and salivary gland hypofunction (SGH) are prevalent in elderly populations, causing much discomfort and even difficulties in eating. SGH also increases the occurrence and severity of oral diseases and makes the patient susceptible to candidiasis. The principal causes of SGH and xerostomia are systemic diseases and drugs used daily. The diagnosis of SGH and xerostomia is based on simple methods, of which measuring both unstimulated and stimulated salivary flow rate is the most important. Treatment calls for proper management of underlying disease, avoidance of all unnecessary medications, and topical remedies such as artificial saliva substitutes. However, good hydration is essential in the elderly with SGH and xerostomia, and water is the drink of choice. In extremely difficult cases, for instance in patients receiving radiotherapy for cancer of the head and neck regions, parasympathomimetic drugs may be administered if no contraindications exist.

Longitudinal analysis of the association of human salivary antimicrobial agents with caries increment and cariogenic micro-organisms: a two-year cohort study

Previous studies of the possible associations of salivary antimicrobial agents with dental caries have given controversial results, obviously mainly because almost all studies have been cross-sectional. Our aim was to find out, in a two-year longitudinal follow-up study, the associations among selected salivary non-immune and immune antimicrobial variables, cariogenic bacteria, and caries increment. The study population was comprised of 63 subjects, all of whom had their 13th birthday during the first study year. In addition to a comprehensive dental examination at baseline and after 2 yrs, paraffin-stimulated whole saliva samples were collected in a standardized way at six-month intervals. Saliva samples were analyzed for flow rate, buffer effect, lysozyme, lactoferrin, total peroxidase activity, hypothiocyanite, thiocyanate, agglutination rate, and total and specific anti-S. mutans IgA and IgG, as well as for numbers of total and mutans streptococci, lactobacilli, and total anaerobic bacteria. Cluster analysis and Spearman-Rank correlation coefficients were used to explore possible associations between and among the studied variables. During the two-year period, a statistically significant increase was observed in flow rate, thiocyanate, agglutination rate, anti-S. mutans IgA antibodies, lactobacilli, and total anaerobes, whereas lysozyme, lactoferrin, and total and anti-S. mutans IgG antibodies declined significantly. Based on various analyses, it can be concluded that, at baseline, total IgG and hypothiocyanite had an inverse relationship with subsequent two-year caries increment, anti-S. mutans IgG antibodies increased with caries development, and mutans streptococci and lactobacilli correlated positively with both baseline caries and caries increment. Total anaerobic microflora was consistently more abundant among caries-free individuals. In spite of the above associations, we conclude that none of the single antimicrobial agents as such has sufficiently strong power to have diagnostic significance in vivo with respect to future caries.

Age-related changes in salivary antibodies to commensal oral and gut biota

The prevalence of mucosally derived infections appears to increase with age, suggesting dysfunction at the mucosal surfaces. The present investigation was undertaken to examine any age-related changes in secretion rates and concentrations of secretory antibodies in whole and parotid saliva in a healthy adult population. A total of 116 subjects were subdivided into the following age groups: 20-39 years, 40-59 years, 60-79 years and 80 years and over. Specific immunoglobulin A (IgA), IgG and IgM antibodies in whole and parotid saliva to Streptococcus mutans (serotype c), Actinomyces viscosus NCTC 10951, and Escherichia coli NCTC 10418 were quantified by enzyme-linked immunosorbent assay. IgA antibodies to all three organisms examined increased with age in both whole and parotid saliva, whereas IgG antibody levels to S. mutans in whole saliva were significantly decreased with age. IgG antibodies to E. coli in parotid saliva were reduced in older age groups. IgM antibody levels to S. mutans were reduced with age in both secretions, whereas IgM antibodies to A. viscosus were greatest in the oldest age groups. No significant changes with age were observed in salivary IgM antibody levels to E. coli. No significant reduction in the secretion rates of IgA antibodies were observed in parotid or whole saliva, whereas IgG and IgM antibody secretion rates to all three microorganisms were reduced in most age groups in both whole and parotid saliva. The results of this investigation have demonstrated age-related changes with salivary antibodies, but, whereas salivary IgG and IgM antibodies showed decreases, salivary IgA levels generally increased with age. This suggests that the ability to form IgA antibody responses is not impaired with increased age, and that secretion rates and functional properties of antibodies may be as important as concentrations in protection against mucosal infective diseases.

Does variability in salivary protein concentrations influence oral microbial ecology and oral health?

Salivary protein interactions with oral microbes in vitro include aggregation, adherence, cell-killing, inhibition of metabolism, and nutrition. Such interactions might be expected to influence oral ecology. However, inconsistent results have been obtained from in vivo tests of the hypothesis that quantitative variation in salivary protein concentrations will affect oral disease prevalence. Results may have been influenced by choices made during study design, including saliva source, stimulation status, control for flow rate, and assay methods. Salivary protein concentrations also may be subject to circadian variation. Values for saliva collected at the same time of day tend to remain consistent within subjects, but events such as stress, inflammation, infection, menstruation, or pregnancy may induce short-term changes. Long-term factors such as aging, systemic disease, or medication likewise may influence salivary protein concentrations. Such sources of variation may increase the sample size needed to find statistically significant differences. Clinical studies also must consider factors such as human population variation, strain and species differences in protein-microbe interactions, protein polymorphism, and synergistic or antagonistic interaction between proteins. Salivary proteins may form heterotypic complexes with unique effects, and different proteins may exert redundant effects. Patterns of protein-microbe interaction also may differ between oral sites. Future clinical studies must take those factors into account. Promising approaches might involve meta-analysis or multi-center studies, retrospective and prospective longitudinal designs, short-term measurement of salivary protein effects, and consideration of individual variation in multiple protein effects such as aggregation, adherence, and cell-killing.

Age-related changes in immunoglobulin isotypes in whole and parotid saliva and serum in healthy individuals

Mucosal infections account for the majority of infections seen in elderly people, but little is known of whether mucosal immunity decreases with age. The objective of this study was to investigate the effect of age on the levels of salivary and serum immunoglobulins and the salivary immunoglobulin secretion rates in a healthy adult population. Healthy subjects (116 total) were divided into the following age groups: 20-39; 40-59; 60-79 and >80 years. Unstimulated (resting) whole and stimulated parotid saliva and serum were collected from all participants. Salivary and serum immunoglobulins were quantified by enzyme-linked immunosorbent capture assays. The levels of serum immunoglobulin G (IgG) and IgM were significantly reduced in the oldest age group, whereas no significant reduction in the level of IgA with age was observed. The IgG and IgA levels in whole saliva increased significantly in the oldest age group D, but no changes were detected in IgM levels. No significant changes in any immunoglobulin levels with age were found in parotid saliva. However, significant reductions in the secretion rates of IgA and IgM, but not IgG, in whole saliva were detected in the oldest age group. No significant changes in the secretion rates in parotid saliva were found with age. Our results demonstrate a decline in immunoglobulin concentrations with increased age, which may contribute to the increased susceptibility of elderly individuals to infectious diseases.

Pioneer oral streptococci produce immunoglobulin A1 protease

As part of a longitudinal study of the relationship between bacterial colonization and the secretory immune response, 367 isolates of pioneer viridans streptococci collected from 40 breast- and bottle-fed neonates within the first month postpartum were tested for the production of immunoglobulin A1 (IgA1) protease and glycosidases. Fifty percent of the streptococci isolated produced IgA1 protease, including all isolates of Streptococcus oralis and S. sanguis, 60.7% of S. mitis biovar 1 isolates, and some isolates that could not be identified. Three cleavage patterns of alpha 1 heavy chains were observed. Six isolates of S. mitis biovar 1 that did not produce IgA1 protease attacked the alpha 1 chain. Incubation of IgA1 protease-negative S. mitis biovar 1 isolates with IgA1, either prior to or together with S. sanguis, rendered the IgA1 paraprotein resistant to cleavage by the IgA1 protease of S. sanguis. The ability of some pioneer streptococci in the human oral cavity to produce IgA1 protease and of others to modify the susceptibility of IgA1 to cleavage by IgA1 protease perhaps enhances their ability to survive in this habitat.

Immunoglobulin A subclasses in infants' saliva and in saliva and milk from their mothers

We sought to determine (1) the ontogeny of secretory IgA subclasses in saliva of breast- and formula-fed infants and (2) the influence of breast-feeding on the maturation of secretory salivary IgA subclasses. Secretory IgA and subclasses 1 and 2 concentrations were determined in saliva from 40 healthy, term infants from birth to age 18 months, and in parallel milk samples from the infants' mothers who were breast-feeding during the first 6 months after birth. Secretory IgA was detected in the neonates' saliva as early as 3 days after birth, increased rapidly during the next 6 months, but then stabilized at a level approximately one-sixth that of the mothers' salivary secretory IgA. Secretory IgA2 represented less than 15% of secretory IgA in saliva collected 2 weeks after birth but by 6 months represented 24.4% of secretory IgA, a value approaching that of the mothers' salivary secretory IgA2 (30.4%). This increase in the proportion of secretory IgA2 was temporally related to a reduction in the proportion of secretory IgA2 in milk throughout lactation. The secretory IgA concentration increased more rapidly during the first 6 months after birth in infants exclusively breast fed than in those exclusively bottle fed. We conclude that although secretory immunity is immature in infants, breast-feeding may aid in protection against pathogenic microorganisms by increasing the rate of mucosal IgA maturation.

Effect of age on immunoglobulin content and volume of human labial gland saliva

Stimulated lower labial (LLGF) and parotid salivary volumes and IgG, IgA, and IgM concentrations were measured in 264 subjects whose ages ranged from 17 to 76 years. A significant (p < 0.001) age-related decline in LLGF output was observed for subjects over this age range. Sixty-three percent of the subjects in the 18-20-year-old group (n = 46) secreted at least 10 microL of labial saliva in a 7-10-minute period, while approximately 70% of the subjects in the two oldest groups (61-70 and 71-76 years old) secreted less than 1 microL of LLGF during this time period (n = 64). No significant gender-based differences occurred in the volumes of labial saliva secreted. Stimulated parotid salivary flow showed no age-related trend in these subjects. Lower labial gland salivary IgA concentrations in an older population (mean age +/- SD = 55.6 yr +/- 1.3) were significantly lower (p < 0.025) than IgA concentrations in a younger population (20.7 yr +/- 0.8), when IgA was expressed as microgram/mL LLGF collected. Immunoglobulin A concentrations in parotid saliva and IgG and IgM concentrations in labial and parotid saliva were not significantly different when the two age populations were compared. These data suggest that the physiological and immunological potential of labial gland saliva may decrease with age.

Oral defense factors in the elderly

Continuously increasing proportion of elderly people in the human population creates new challenges for the dental care. Because the microbial etiology of the most common oral diseases, dental caries, endodontal and periodontal diseases, is not substantially different in different age groups, the altered host response during aging may modify the progression of these diseases. Most prevalent and severe change in the oral defense is hyposalivation or xerostomia but aging as such does not seem to reduce neither parotid nor whole salivary flow rate. However, submandibular and minor salivary glands produce less saliva at old age which may be the reason for the frequently reported symptoms of oral dryness even if the stimulated flow rate is normal. Concomitantly to the changes in the flow rate the daily output of many saliva-mediated defense factors declines but age-related impairment has been described only for specific IgA response to external antigens, for salivary opsonic activity, and for T-lymphocyte function. The non-immunoglobulin defense factors seem to act with full capacity over the entire life-span. Therefore, elderly people with normal salivary flow rate possess no special risk group for the development of oral diseases.

Ontogenesis of the secretory immune system and innate defence factors in human parotid glands

Immunoglobulin-producing cells and epithelial expression of secretory component (SC), amylase, lysozyme (Ly) and lactoferrin (Lf) were studied by immunohistochemistry to obtain information about the development of mucosal immunity. Tissue specimens were obtained from 20 fetal and 40 postnatal parotid glands. (1) Fetal specimens. Occasional IgM- and IgA- but no IgD-, IgG- or IgE- producing cells were seen (ratios, IgM:IgA:IgD:IgG:IgE approximately 4:1:0:0:0). The IgAl subclass dominated (median 90%, range 50-95%) and these cells were mostly J-chain-positive (median 97%, range 94-98%). Only few IgA2-producing cells were seen (median 10%, range 5-50%) and they were also mostly J-chain-positive (median 99%, range 98-100%). Amylase, Ly and Lf were most prominent in early fetal life, while only small amounts of SC were present. (2) Postnatal specimens. Secretory component increased markedly along with a growing number of IgA- and IgD-producing cells (IgA:IgM:IgD:IgG:IgE approximately 4:2:1:1:0). The IgAl subclass remained predominant (median 65%, range 50-90%) although the proportion of IgA2-positive cells tended to be raised (median 35%, range 10-50%). Most IgAl (median 97%, range 67-100%) and IgA2 (median 94%, range 75-100%) cells were J-chain-positive. These features probably reflected local activation of the immune system in response to environmental factors. The amount of amylase, Ly and Lf decreased shortly after delivery, perhaps because the cellular stores were emptied by postnatal increase in secretory activity.

The specific pathogen-free human: a new frontier in oral infectious disease research

The indigenous flora acts as a deterrent to the establishment of some pathogenic species. We propose that advances in oral health research will lead to control of oral infections by altering the indigenous microflora to create a specific pathogen-free human. Investigations of important endogenous and exogenous factors which affect the oral flora and the interactions among these parameters, in health and disease, will have to be undertaken for this goal to be achieved. Several approaches to produce a specific pathogen-free human include: (1) introduction of individual or collective moieties which inhibit detrimental interactions on a genetic and molecular level; (2) genetic modification of salivary flow and protein composition by use of transgenic techniques; (3) therapeutic replacement with altered bacterial strains; (4) alteration of host immune responses to produce specific isotype immunity at the most appropriate time in the ontogeny of the oral environment; (5) production of isotype and/or antigen-specific regulatory molecules at the most appropriate time in development; (6) use of synthetic vaccines; (7) genetic alteration or replacement of cells with defective protective capabilities; and (8) use of anti-idiotype vaccines.