Immunomodulatory and superantigen activities of bacteria associated with adult periodontitis

Circulating inflammatory cell profiling and periodontitis: A systematic review and meta-analysis

Inflammation is a key driver of common noncommunicable diseases. Among common triggers of inflammation, chronic gingival inflammation (periodontitis) triggers a consistent humoral host inflammatory response, but little is known on its impact on circulating inflammatory cell profiles. We aimed to systematically appraise all the evidence linking periodontitis and its treatment to circulating inflammatory cell profiles. From 6 databases, 157 studies were eligible for qualitative synthesis and 29 studies for meta-analysis. Our meta-analysis showed that participants with periodontitis exhibited a significant mean increase in circulating CD4⁺ , CD4⁺ CD45RO⁺ , IFNγ-expressing CD4⁺ and CD8⁺ T cells, CD19⁺ CD27⁺ and CD5⁺ B cells, CD14⁺ CD16⁺ monocytes, and CD16⁺ neutrophils but decrease in CD8⁺ T and CD14⁺⁺ CD16^- monocytes. Our qualitative synthesis revealed that peripheral blood neutrophils of patients with periodontitis consistently showed elevated production of reactive oxygen species (ROS) when compared with those of healthy controls. Some evidence suggested that the treatment of periodontitis reversed the exaggerated ROS production, but limited and inconclusive data were found on several circulating inflammatory cell profiling. We conclude that periodontitis and its treatment are associated with minor but consistent alterations in circulating inflammatory cell profiles. These changes could represent key mechanisms explaining the association of periodontitis with other comorbidities such as cardiovascular disease, diabetes, and rheumatoid arthritis.

Detection of heat shock proteins but not superantigen by isolated oral bacteria from patients with Behcet's disease

We isolated bacteria from periodontal sites and mixed saliva in eight patients with Behcet's disease and surveyed them to determine whether they produced heat shock proteins (HSPs) and superantigen. Cultivable bacterial compositions from periodontal sites and saliva were examined by anaerobic culture using blood agar plates. Gram-negative anaerobic rods such as Prevotella intermedia, Fusobacterium nucleatum, and Capnocytophaga species were predominant in the isolates from the subgingival plaque samples. The Streptococcus mitis group was the most common type isolated from the saliva samples. To detect the production of HSPs, Western blot analyses were performed using a polyclonal rabbit antibody to Escherichia coli DnaK and a monoclonal antibody to Helicobacter pylori Gro-EL. Sonic extracts of 27 of the strains (79.4%) reacted with the antibody against E. coli DnaK. Nine of these 34 strains (26.5%) were found to produce HSPs that reacted with antibody to H. pylori Gro-EL. A total of 54 isolates were examined for superantigen activity against human peripheral leukocytes. Twenty-five gram-negative clinical strains isolated from chronic periodontitis lesions and 20 ATCC strains of microorganisms were also examined. We could not detect any superantigen activity in 500x diluted supernatant of the strains isolated from the eight patients with Behcet's disease. The present study indicates that the anaerobic strains isolated from the oral cavity of these patients produce HSPs, the production being related to Bechet's disease.

Antiproliferative activity of Actinobacillus (Haemophilus) actinomycetemcomitans and Fusobacterium nucleatum in peripheral blood mononuclear cells

Several studies indicate Actinobacillus (Haemophilus) actinomycetemcomitans and Fusobacterium nucleatum as etiologic agents of periodontal disease. Immunosuppressive factors produced by microorganisms probably contribute to the initiation and evolution of this disease. This study evaluated the antiproliferative activity of ammonium precipitate fractions of A. (H.) actinomycetemcomitans and F. nucleatum isolates from humans and marmosets both with and without periodontal disease. All A. (H.) actinomycetemcomitans and most F. nucleatum strains inhibited PBMC proliferation in a dose-dependent manner. The degree of cell proliferative inhibition of each bacterial species differed among the strains and was independent of host clinical status. The in vitro inhibition of stimulated lymphocyte proliferation induced by different A. (H.) actinomycetemcomitans and F. nucleatum isolates demonstrated the importance of this phenomenon in bacterial virulence, playing a possible suppressor role in host defense mechanisms in vivo. Moreover, our findings pointed out a marked difference between A. (H.) actinomycetemcomitans and F. nucleatum cytoplasmic extracts in their antiproliferative activity, regarding the antigen concentration required for maximum inhibition and their vulnerability to heating and proteolytic treatment.

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

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

A novel factor isolated from Actinobacillus actinomycetemcomitans stimulates mouse B cells and human peripheral blood mononuclear cells

A novel immunostimulating factor (ISTF) of Actinobacillus actinomycetemcomitans ATCC 29522 was isolated and characterized as inducing proliferation of mouse B cells and human peripheral blood mononuclear cells. This factor was isolated from the bacterial culture medium and purified by size exclusion chromatography, dye-ligand affinity chromatography, immunoaffinity chromatography using monoclonal antibodies, and preparative electrophoresis. Analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed that the purified ISTF migrated as a single band corresponding to a molecular mass of 13 kDa. ISTF was a proteinaceous material distinct from lipopolysaccharide; it directly induced the proliferation of B lymphocytes but had no effect on the proliferation of T lymphocytes, even in the presence of antigen-presenting cells. A B-lymphocyte-mitogenic activity of ISTF was also shown by flow cytometric analysis of responding cell subpopulations. Immunoblot analysis revealed that ISTF was a component of the outer membranes of bacteria, could exist as a soluble form, and was released by growing and/or lysed bacteria. These results suggest that ISTF produced by A. actinomycetemcomitans may play an important role in immunopathologic changes associated with A. actinomycetemcomitans infections.

Paradoxical role of PGE2 and cAMP in Actinobacillus actinomycetemcomitants strain Y4-induced lymphocyte proliferation

An immune mechanism has been suggested in the pathogenesis of periodontal disease. Actinobacillus actinomycetemcomitants (Aa) has been implicated as one of the etiological agents that induces the major immune response together with a dense infiltrate of inflammatory cells. But the exact role of these immune cells in periodontal disease has not yet been clarified. In this study the T lymphocyte (TL) proliferative response was evaluated after having being exposed to free cell supernatant (SN) from Aa. Aa SN increased TL proliferation. This mitogenic effect of Aa SN was attenuated by pretreating TL with indomethacin (INDO) or acetylsalicylic acid (ASA) but not by polymyxin B. The inhibitory effect of INDO on cell proliferation was reversed by the addition of prostaglandin E2 (PGE2) to the culture assay. Moreover, when immune cells were exposed to Aa SN they were able to generate PGE2 at the same time as intracellular levels of cAMP decreased. Both, PGE2 release and decrease accumulation of cAMP in TL were blunted by treated lymphocytes with INDO. In this paper we demonstrate that cell free SN from Aa induces a mitogenic effect on murine lymphocytes. The mechanism involves the host's immunecompetent cells and the release of PGE2 and appears not to be induced by capsular-like polysaccharide antigen. Results show a paradoxical mitogenic effect of Aa SN accompanied by increased generation of PGE2 and decreased production of cAMP by lymphocytes.

Interactions between non-immune host cells and the immune system during periodontal disease: role of the gingival keratinocyte

Periodontal disease and inflammatory dermatoses, such as psoriasis, are characterized by the accumulation of dense inflammatory infiltrates immediately beneath the epithelial cell layer of the gingiva and skin, respectively. Dermatologists are increasingly aware that the epidermal keratinocyte probably contributes to inflammatory disease progression by secreting a number of pro-inflammatory cytokines and expressing various adhesion molecules. In psoriatic lesions, it is now believed that epidermal keratinocytes may also act as antigen-presenting cells and participate directly in the superantigenic activation of T-cell clones, some of which may initiate, contribute to, or maintain the disease process. Although the role of the host response in periodontal disease has been extensively studied over the years, very little is known about the contribution of the gingival keratinocyte to the inflammatory response. The available published information is discussed in this review, and we suggest that, like its epidermal counterpart, the gingival keratinocyte may participate actively in the pathogenesis of periodontal disease.

Cytokine production by cryopreserved human peripheral blood mononuclear cells in response to periodontal pathogens

Freezing techniques provide a way of repeating and extending immunological assays by using frozen portions of an individual's peripheral blood mononuclear cell fraction. Earlier work shows that the lymphocytes that are stored frozen retain their ability to respond to polyclonal B-cell activators, mitogens, superantigens and bacterial extracts of oral interest. These studies extend previous findings by determining cytokine production by lymphocytes following frozen storage for up to 24 weeks. Production of interleukin (IL)-1beta, IL-2, IL-6, and tumour necrosis factor (TNF)-beta by stimulated lymphocytes after cyropreservation was not significantly different from those responses before storage, with one exception: IL-6 production was negligible after 24 weeks' frozen storage when thawed cells were cocultured with pokeweed mitogen. After stimulation with extracts from Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans, the proliferative capacity of the frozen cells was maintained as well as the production of IL-1beta, IL-2, and IL-6. TNF-beta was not produced in response to bacterial antigen stimulation. The ability of peripheral blood mononuclear cells to retain functional activity after frozen storage should permit more effective monitoring during longitudinal clinical studies and a better evaluation of changes in cytokine production in patients with advanced periodontitis both during and after treatment.

Strain-dependent activation of monocytes and inflammatory macrophages by lipopolysaccharide of Porphyromonas gingivalis

Porphyromonas gingivalis is one of the pathogens associated with periodontal diseases, and its lipopolysaccharide (LPS) has been suggested as a possible virulence factor, acting by stimulation of host cells to secrete proinflammatory mediators. However, recent studies have shown that P. gingivalis LPS inhibited some components of the inflammatory response. The present study was designed to test the hypothesis that there are strain-dependent variations in the ability of P. gingivalis LPS to elicit the host inflammatory response. By using LPS preparations from two strains of P. gingivalis, W50 and A7346, the responses of mouse macrophages and human monocytes were evaluated by measuring the secretion of nitric oxide (NO) and tumor necrosis factor alpha (TNF-alpha). Both direct and indirect (priming) effects were investigated. LPS from Salmonella typhosa was used as a reference LPS. P. gingivalis A7436 LPS induced lower secreted levels of NO from the tested cells than S. typhosa LPS but induced similar levels of TNF-alpha. In contrast, LPS from P. gingivalis W50 did not induce NO or TNF-alpha secretion. Preincubation of macrophages with LPS from S. typhosa or P. gingivalis A7436 prior to stimulation with S. typhosa LPS upregulated NO secretion and downregulated TNF-alpha secretion, while preincubation with P. gingivalis W50 LPS enhanced both TNF-alpha and NO secretory responses. These results demonstrate that LPSs derived from different strains of P. gingivalis vary in their biological activities in vitro. The findings may have an impact on our understanding of the range of P. gingivalis virulence in vivo.

Antigen-presenting properties of gingival fibroblasts in chronic adult periodontitis

Chronic periodontitis is characterized by dense infiltrations of T lymphocytes in the connective tissue, which consists mainly of gingival fibroblasts. It is becoming increasingly clear that T lymphocytes and gingival fibroblasts are capable of influencing each other. For example, the T cell cytokine interferon-gamma (IFN-gamma) is able to induce MHC class II molecules on the surface of several cell types, including gingival fibroblasts. Histological sections of chronically inflamed gingival tissue showed a great number of CD4+ and CD8+ T cells that produced IFN-gamma, and in addition showed abundant expression of MHC class II molecules on gingival fibroblasts. Therefore, we investigated whether these gingival fibroblasts acquire the capacity to carry out MHC class II-restricted functions such as antigen presentation to local T cells. In this study, we show that IFN-gamma-treated gingival fibroblasts were able to function as antigen-presenting cells (APC) for superantigen-mediated T cell proliferation. However, these fibroblasts failed to present whole-cell antigens of periodontitis-associated bacteria. Moreover, gingival fibroblasts inhibited the presentation of the whole-cell antigens of these bacteria by professional APC. This inhibition could be overcome by the addition of IL-2. These results suggest that gingival fibroblasts play an important role in the local specific immune response in chronic inflammatory periodontal lesions by regulating the response of infiltrating T cells.

Studies of proliferative responses by long-term-cryopreserved peripheral blood mononuclear cells to bacterial components associated with periodontitis

Freezing techniques provide a means for repeating and extending immunological assays with frozen aliquots of an individual's peripheral blood mononuclear cell fraction. Lymphocytes which are stored frozen for a limited time retain their ability to respond to polyclonal B-cell activators, mitogens, and antigens of dental interest. Our studies extend these previous findings by determining lymphocyte functional activity following frozen storage for up to 100 weeks. In addition, the autologous immune response was measured by spontaneous lymphocyte proliferation following 0, 1, 40, and 60 weeks of frozen storage. Peak responses for all individuals occurred at day 7 of incubation. The lymphocyte proliferative response to the superantigens toxic shock syndrome toxin-1 (TSST-1) and Staphylococcus enterotoxin A (SEA) were not changed after 100 weeks of frozen storage. Maximum responses varied among the individuals but occurred at equivalent stimulator concentrations. However, slopes generated from data obtained following 0, 4, 13, 20, 30, 50, 88, and 100 weeks of frozen storage showed no significant deviation from zero (P > 0.05) for all individuals tested. After 100 weeks of storage, the total changes in proliferative activity (counts per minute per week) were -2.1% +/- 16.8% and -5.5% +/- 17.0% for TSST-1 and SEA, respectively. The lymphocyte proliferative responses to pokeweed mitogen, concanavalin A, and sonicates of two periodontal pathogens (Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans) following frozen storage were similar to those with TSST-1 and SEA. These results indicate that peripheral blood mononuclear cells stored frozen may serve as appropriate controls to monitor changes in the disease state long-term periodontal treatment.