Inflammatory cells and their subsets in lesions of juvenile periodontitis. A family study

Immunologic burden links periodontitis to acute coronary syndrome: levels of CD4 + and CD8 + T cells in gingival granulation tissue

OBJECTIVE

To investigate the proportional variation of macrophage and T-lymphocytes subpopulations in acute coronary syndrome (ACS) patients, its association with periodontitis (P), and to compare with control individuals.

SUBJECTS AND METHODS

Three groups of subjects participated: one group consisted of 17 ACS patients with P (ACS + P), another group consisted of 22 no ACS + P patients, and a control group consisted of 23 participants with gingivitis (no ACS + G). Macrophage, CD4 + , and CD8 + T-lymphocytes and CD4 + /CD8 + ratio values in gingival tissue were determined histometrically.

RESULTS

Significant differences were found among three groups regarding the mean number of macrophage (no ACS + P > ACS + P > no ACS + G; p < 0.05) and CD8 + T-lymphocytes (no ACS + P > ACS + P > no ACS + G; p < 0.05). Significant variations were observed between the groups both CD4 + T-lymphocytes densities (ACS + P > no ACS + P and ACS + P > no ACS + G; p < 0.05) and CD4 + / CD8 + ratio (no ACS + P < no ACS + G and ACS + P < no ACS + G; p < 0.05).

CONCLUSIONS

The increased number of CD8 + T-lymphocytes in both group ACS + P and group no ACS + P resulted in a reduction of the CD4 + /CD8 + ratio in gingival tissue when compared with no ACS + G group.

CLINICAL RELEVANCE

The decrease of CD4 + /CD8 + ratio in gingival tissue reflects periodontitis and may be associated with severe adverse outcomes in people with ACS.

Maintaining homeostatic control of periodontal bone tissue

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

The effects of age and gender on gingival tissue and peripheral blood T-lymphocyte subsets: a study in mice

The aim of this study is to investigate the effects of age and gender on relative number of CD4+ and CD8+ T lymphocyte and CD4+/CD8+ ratios in gingival tissue and peripheral blood of periodontally healthy BALB/c mice with flow cytometric analysis. The study was carried out on periodontally healthy 60 BALB/c mice. They were separated into five groups according to the life expectancy: Group I (newborn, 1-10 days old), Group II (age at weaning, 21-28 days old), Group III (age of sexual maturity, puberty, 7-8 weeks old), Group IV (adult, 8 months old), and Group V (the aged, 14 and over). Males and females were equally represented in each group. CD4+ and CD8+ T lymphocytes and CD4+/CD8+ ratio values in gingival tissue and peripheral blood were determined using flow cytometry in the biopsy samples. The relative number of CD8+ T lymphocyte in gingival tissue was higher in puberty (p < 0.05) and the aged (p < 0.05), with more significantly difference in males (p < 0.05). The CD4+/CD8+ ratios in gingival tissue were lower in puberty group and the-aged groups compared to the other groups (p < 0.05). The peripheral blood CD4+/CD8+ ratio increased in puberty and the aged groups. These differences were more significant in females than in males (p < 0.05). There were considerable negative correlations between CD4+/CD8+ T lymphocyte ratio in gingival tissue and CD4+/CD8+ T lymphocyte ratio in peripheral blood in puberty (r = 0.647, p < 0.01) and the aged ( r = 0.599, p < 0.05). In conclusion, our data suggest that CD4+/CD8+ T lymphocyte ratios in peripheral blood increase periodontally healthy mice in puberty and the old groups, while CD4+/CD8+ T lymphocyte ratios in gingival tissue decrease in the same groups. The relative number of CD8+ T lymphocytes increases in gingival tissue in puberty and the old groups when it decreases in peripheral blood. Results from this study indicated that periodontally healthy BALB/c mice may represent important information to determine the character of an immune response in the course of a lifetime.

The changes in T lymphocyte subsets following periodontal treatment in patients with chronic periodontitis

OBJECTIVE

The aim of this study was to determine whether there was any change in T-lymphocyte subsets in patients with chronic periodontitis after applying different periodontal treatment methods.

PATIENTS AND METHODS

Twenty-four patients with chronic periodontitis were included in the study. In every phase of the treatment (pretreatment, initial treatment, curettage and flap operations) the biopsy samples were taken from the gingival tissues at sites of chronic periodontitis. Then CD4(+) and CD8(+) lymphocyte and CD4(+)/CD8(+) ratio values were determined using flow cytometry in the biopsy samples. At the same time, gingival pocket depth, Löe-Silness gingival index, and Silness-Löe plaque index scores were recorded to assess the periodontal status in patients. To determine the correlation between the clinical measurements and the laboratory results obtained before the treatment, after initial treatment, after curettage and after flap operations, we conducted an analysis using a paired t-test.

RESULTS

Flow cytometry findings in the patients with chronic periodontitis showed that CD4(+) and CD8(+) lymphocyte values before treatment were under the normal value and the CD4(+)/CD8(+) ratio was within the normal distribution interval. The CD4(+)/CD8(+) ratio decreased postcurettage and postflap operation. This decrease was statistically significant (p < 0.001). The CD4(+) and CD8(+) lymphocyte values were increased postcurettage and postflap operation. This increase was also statistically significant (p < 0.001).

CONCLUSIONS

These findings suggest that local immune response was poor in the patients with chronic periodontitis. CD4(+) and CD8(+) T-lymphocytes could play a significant role in chronic periodontitis pathobiology.

Flow-cytometric analysis of T-lymphocyte subsets after different treatment methods in smokers and non-smokers with chronic periodontitis

AIM

To determine any change in T-lymphocyte subsets after applying different treatment methods in smokers and non-smokers with chronic periodontitis.

PARTICIPANTS

50 adults with chronic periodontitis.

METHOD

The subjects were divided into smokers and non-smokers. Biopsy samples were taken from the gingival pocket wall tissues at sites with chronic periodontitis before treatment, after initial treatment, after curettage and after flap operation and tested for CD4+, CD8+ lymphocyte and CD4/ CD8 ratio values. Gingival pocket depth, gingival index (GI-Löe-Silness) and plaque index (PI-Silness-Löe) scores were also recorded. Analysis aimed at determining the relation between the clinical measurements and the laboratory results.

RESULTS

Flow cytometry findings in both groups showed that CD4+ and CD8+ lymphocyte values before treatment were under the normal value while the CD4+/CD8+ ratio was within normal distribution interval. The lymphocyte values observed in the smokers were found to be lower than those in the non-smokers. After treatment the difference between the lymphocyte values in smokers and non-smokers was found to be statistically significant. However, the difference between the CD4/CD8 rate obtained in smokers and non-smokers was not found to be statistically significant.

CONCLUSIONS

The lymphocyte values observed in smokers were found to be lower than those in non-smokers after applying different treatment methods and the local immune response was poor in the smokers.

Flow-cytometric analysis of T-lymphocyte subsets after different treatment methods in patients with pericoronitis

PURPOSE

The aim of this study was to determine whether there was any change in T-lymphocyte subsets in patients with periocoronitis after the application of different treatment methods.

PATIENTS AND METHODS

Twenty-six patients with acute pericoronitis were included in the study. In every phase of the treatment (pretreatment, postcurettage, and postextraction), the biopsy samples were taken from the gingival tissues at sites of pericoronitis. Then, CD4(+) and CD8(+) lymphocyte and CD4(+)/CD8(+) ratio values were determined using flow cytometry in the biopsy samples. At the same time, gingival index (Löe-Silness) and plaque index (Silness-Löe) scores were recorded to assess the periodontal status in patients. To determine the correlation between the clinical measurements and the laboratory results obtained before the treatment, after curettage, and after extraction, we conducted an analysis using a paired t-test.

RESULTS

The normal values in peripheral blood of CD4(+) and CD8(+) lymphocytes are 25% to 29% and 19% to 48%, respectively. However, the CD4(+) and CD8(+) lymphocyte values in the patients with acute pericoronitis were found to be 22.12% +/- 6.15% and 7.69% +/- 4.12%, respectively. These values are lower than the normal values. The CD4(+) lymphocyte value increased to 31.06% +/- 7.09% postcurettage and to 32.24% +/- 3.11% postextraction. The CD8(+) lymphocyte value increased to 16.21% +/- 5.27% postcurettage and to 18.25% +/- 3.13% postextraction. The CD4/CD8 ratio increased postcurettage and postextraction. This increase was statistically significant (P <.001). Postcurettage, there was decrease in clinical indexes, which was statistically significant (P <.001). A significant correlation between CD4(+) lymphocyte and ginigival index values and also between CD8(+) lymphocyte and plaque index values was determined postcurettage (P <.05).

CONCLUSION

CD4(+) and CD8(+) T-lymphocytes could play a significant role in pericoronitis pathobiology.

High numbers of T cells in gingiva from patients with human immunodeficiency virus (HIV) infection

A quantitative, immunohistologic evaluation of CD3+, CD4+ and CD8+ cells was carried out on gingival biopsies from 25 HIV-infected persons with gingivitis or periodontitis and 13 HIV-seronegative persons with periodontitis. CD3+ T cells were found in all biopsies. CD8+ cells were significantly more numerous and the CD4+/CD8+ ratio was significantly decreased in the gingival connective tissue of the HIV+ patients (p < 0.05). The number of CD4+ lymphocytes subjacent to the pocket epithelium was moderately lower in the HIV+ patients as compared to the HIV patients (p < 0.05). HIV+ patients with a history of necrotizing periodontal disease had fewer CD4+ cells subjacent to the oral gingival epithelium than patients without such disease (p < 0.05). The general HIV-related changes in T lymphocyte numbers were therefore reflected in inflamed gingival tissues. HIV+ patients had, however, significantly higher CD4+/CD8+ ratios in gingiva than in peripheral blood (p < 0.05), indicating that CD4+ T cells are actively recruited to gingiva, even in cases of extreme CD4+ T lymphocytopenia.

The immunopathology of chronic inflammatory periodontal disease

Chronic inflammatory periodontal disease is known to be under the control of the immune response. However, the precise mechanism of the immunopathogenesis of this lesion has not yet been fully elucidated. In this review, the regulatory role of both lymphoid and non-lymphoid cells as well as cytokines and accessory molecules in the course of chronic inflammatory periodontal disease is discussed. Finally, based upon previous evidences, an attempt to establish a model of chronic inflammatory periodontal disease is made herein.

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

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

Subpopulations of lymphocytes in connective tissue from adolescents with periodontal disease

Mononuclear cell populations were studied in gingival biopsy specimens from adolescents (n = 10) with at least one periodontal pocket with an increased probing depth (greater than 5 mm). The marginal bone loss was measured on radiographs, subgingival plaque samples were collected from the lesions, and the microbial flora was identified. Specimens from gingivitis lesions (n = 5) were used as controls. The mononuclear cell populations in the specimens were detected by using monoclonal antibodies defining functional T-lymphocyte subpopulations, B lymphocytes, and monocytes. All gingival specimens from patients with increased probing depth showed large lymphocyte infiltrates, most of which were CD 3-antigen-positive cells (T lymphocytes). Few (2%) infiltrating T cells expressed receptors for interleukin-2. B cells were detected in most specimens from the periodontitis group and varied from less than 1% to 21%. This study indicates that lesions in adolescents with early signs of periodontitis are characterized predominantly by T-cell lesions with relatively few cell aggregates of B cells present.

In situ lymphocyte subpopulations from active versus stable periodontal sites

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

Immunocytochemical examination of immune cells in periapical granulomata and odontogenic cysts

Monoclonal antibodies (mAbs) were used to determine the presence and distribution of immune cells including lymphocytes, macrophages and Langerhans cells, in normal periodontal ligament, periapical granulomata, periapical cysts and dental developmental cysts. Isolated T-lymphocytes, but not B-lymphocytes, were detected in specimens of non-inflamed periodontal ligament. Increased numbers of T and B lymphocytes were found in all of the lesions examined. Monocytes/macrophages were associated with most periapical granulomata, dental developmental cysts and all periapical cysts. Langerhans cells, intraepithelial lymphocytes, and monocytes/macrophages were not detected in the rests of Malassez but were found in some epithelia within periapical granulomata and in most epithelial linings of odontogenic cysts. Increased numbers of immune cells were seen around proliferative epithelia and adjacent to the epithelial linings of cysts. Epithelium, particularly that of odontogenic cysts, showed positive reactions for HLA-Dr, lysozyme and for alpha-1 antitrypsin. The presence of immune cells in periapical granulomata and odontogenic cysts, suggests that cell-mediated and humoral immunoreactions occur in these lesions and may be associated with the epithelial proliferation within the periapical lesions.

Gingival beta 2-microglobulin in juvenile and chronic periodontitis

The beta 2-microglobulin (beta 2-m) pattern in gingival biopsy specimen from 24 patients with chronic severe periodontitis (P), from 11 patients with juvenile periodontitis (JP), and from 24 periodontally healthy subjects (CO) was studied with an indirect immunoperoxidase method. No reactivity for beta 2-m was found in 71% of specimens in the P and CO groups, whereas 82% of the JP specimens showed positive beta 2-m staining in the epithelium. The reactivity was detected mostly in the upper layers of the epithelium. In all the three groups the beta 2-m reactivity was less frequent in the subepithelial connective tissue than in the epithelium proper, and it seemed to be confined to the inflammatory cells. In the JP group, prominent reactivity for beta 2-m was also located in intercellular bridges of the squamous cells. The significance of the results is discussed in terms of the cell differentiation in these diseases, including the function of beta 2-m related to the function of the classical HLA antigens (HLA-A, HLA-B, HLA-C).