Interleukin-1 gene polymorphism and periodontal status. A case-control study.

OBJECTIVES: This case-control study examined polymorphisms at the interleukin-1 gene in relation to periodontal status, subgingival bacteria and systemic antibodies to periodontal microbiota. METHODS: 132 periodontitis patients were age- and gender-matched with 73 periodontally intact controls. Full-mouth clinical assessments of the periodontal tissues were performed. Subgingival plaque samples (2440 in total) were analyzed by genomic DNA probes, and serum IgG antibodies to periodontal microbiota were assessed by an immunoassay. Polymorphisms in the IL-1A gene at position +4845 and the IL-1B gene at position +3953 were studied by PCR. A composite positive genotype was defined as at least one rare (#2) allele present at each locus. RESULTS: No skewed distribution of the composite genotype was observed between cases and controls (45.2% vs 41.7%). In cases, both the composite genotype and the number of #2 alleles were positively correlated with the severity of attachment loss. No relationship between genotype and subgingival microbial profiles was observed. Genotype positive patients revealed both overall lower serum antibody levels and specific titers against selected bacteria. CONCLUSIONS: The composite genotype failed to distinguish between periodontitis patients and controls but correlated in patients with the severity of the disease and the antibody responses to periodontal microbiota.

Checkerboard assessments of serum antibodies to oral microbiota as surrogate markers of clinical periodontal status.

BACKGROUND: This study addresses whether checkerboard assessments of serum IgG antibodies to oral bacteria may serve as surrogate markers of clinical periodontal status in epidemiologic studies. METHOD: The analysis involved data from 205 subjects, 132 periodontitis patients and 73 periodontally-intact controls, from whom full-mouth clinical periodontal data and serum IgG titers against 19 periodontal bacterial species were available. RESULTS: A logistic regression model involving titers against 6 species (Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Eubacterium nodatum, Eikenella corrodens, Capnocytophaga ochracea and Actinomyces naeslundii genospecies 2) classified correctly 74.5% of the subjects examined, with 84% sensitivity, 57.5% specificity, 78% positive predictive value and 66.7% negative predictive value. CONCLUSIONS: Checkerboard serology may be useful in providing surrogate markers for clinical periodontal status when such data are not readily available and, thus may serve as a valuable complement in the armamentarium of epidemiologic tools suited for the study of periodontal diseases.

Cytokine responses of oral epithelial cells to Porphyromonas gingivalis infection.

Accumulating evidence indicates that epithelia are not merely mechanical barriers but also important elements of the innate immune system. The present study was performed to examine cytokine responses of oral epithelial cells after infection with the periodontal pathogen Porphyromonas gingivalis. The KB-cell line and primary cultures of periodontal pocket epithelium were infected with P. gingivalis for assessment of bacterial invasion by an antibiotic protection assay, and examination of expression of interleukin-1 beta, interleukin-6, interleukin-8, and tumor necrosis factor-alpha by in situ hybridization and immunohistochemistry. We observed that P. gingivalis induces a strong cytokine response, positively correlated with the adhesive/invasive potential of the infecting strain, in both KB cells and primary cultures. These findings indicate that the epithelial cells of the periodontal pocket are an integral part of the immune system, eliciting cytokine responses to a bacterial challenge. In this context, the adhesive/invasive phenotype of P. gingivalis appears to contribute to pathogenicity.

"Checkerboard" assessments of periodontal microbiota and serum antibody responses: a case-control study.

BACKGROUND: We explored the association between subgingival microbial profiles and serum IgG responses to periodontal microbiota in relation to clinical periodontal status. METHODS: One hundred thirty-one (131) periodontitis patients aged 29 to 74 years (mean 51.8) were age- and gender-matched with 74 periodontally intact controls (range 26 to 77, mean 49.3). Smoking habits and health history were recorded and assessments of plaque, bleeding on probing, probing depth, and attachment level were performed at 6 sites per tooth on all present teeth, excluding third molars. Subgingival plaque samples were obtained from each tooth in one upper and one lower quadrant (maximum 14 samples/subject; 2,440 samples total) and analyzed with respect to 19 species by means of whole genomic DNA probes. Serum IgG antibodies against the same 19 species were assessed by an immunoassay. RESULTS: Cases displayed an average of 22.7 teeth, 20.3 sites with probing depth > or =6 mm, and 18.9 sites with attachment loss > or =6 mm. Corresponding figures for controls were 27.1, 0.1, and 1.0, respectively. Heavy smoking was 3 times more frequent among cases than controls (32.1% versus 9.6%). Higher levels of Porphyromonas gingivalis, Porphyromonas endodontalis, Prevotella intermedia, Prevotella nigrescens, Prevotella melaninogenica, Bacteroides forsythus, Fusobacterium nucleatum, Treponema denticola, Eubacterium nodatum, Peptostreptococcus micros, and Campylobacter rectus were found in cases and higher levels of Eikenella corrodens, Veillonella parvula, and Actinomyces naeslundii in controls. Cases displayed higher IgG levels against P. gingivalis and Actinobacillus actinomycetemcomitans, while controls displayed higher levels against F. nucleatum, T. denticola, E. nodatum, and Capnocytophaga ochracea. Positive correlations between bacterial colonization and antibody responses were identified for 9 species in controls. In cases, however, statistically significant correlations were observed for only 3 species out of which only one was positive (V. parvula). Both bacterial levels and antibody responses declined in ages over 55 years. A logistic regression employing selected elements of bacterial colonization and antibody responses as independent variables resulted in 81.1% correct diagnosis, with sensitivity of 83.1%, specificity of 77.8%, positive predictability of 86%, and negative predictability of 73.7%. Smoking did not reach statistical significance in this model. CONCLUSION: A combined microbial colonization/antibody response profile can effectively discriminate between periodontitis patients and periodontally intact controls.

"Checkerboard" versus culture: a comparison between two methods for identification of subgingival microbiota.

The present study compared the "checkerboard" DNA-DNA hybridization methodology with culture techniques for the analysis of the composition of the subgingival microbiota. 70 subjects, presenting with a variety of periodontal conditions, contributed with a total of 283 subgingival plaque samples analyzed with respect to the following species: Porphyromonas gingivalis, Prevotella intermedia/Prevotella nigrescens, Fusobacterium nucleatum, Campylobacter rectus, Eikenella corrodens, Bacteroides forsythus, Actinobacillus actinomycetemcomitans, Streptococcus sanguis and Streptococcus mutans. Species identification and quantification was performed by (i) the checkerboard method, using whole genomic, digoxigenin labeled DNA probes; and (ii) culture, including non-selective and selective media in combination with routine biochemical testing using commercial test panels. We found that the checkerboard technology resulted in higher prevalence figures for half of the species tested when compared to culture data. If the latter were used as the reference, checkerboard detection sensitivities ranged from 0.17 to 0.86, specificities from 0.17 to 1.0, and diagnostic accuracies from 0.51 to 0.81, depending on bacterial species. The use of the checkerboard data as the reference resulted in detection sensitivities for the culture procedures between 0.24 and 1.0 and specificities between 0.21 and 0.87. The checkerboard methodology resulted in statistically significant higher bacterial counts for the majority of the species. It was further observed that, for most species, the higher the total number colony-forming units in the sample, the higher the discrepancy between the results obtained by the two techniques.

Porphyromonas gingivalis infection of oral epithelium inhibits neutrophil transepithelial migration.

Periodontal diseases are inflammatory disorders caused by microorganisms of dental plaque that colonize the gingival sulcus and, subsequently, the periodontal pocket. As in other mucosal infections, the host response to plaque bacteria is characterized by an influx of polymorphonuclear leukocytes (PMNs) to the gingival crevice. Neutrophil migration through the epithelial lining of the gingival pocket is thought to be the first line of defense against plaque bacteria. In order to model this phenomenon in vitro, we used the oral epithelial cell line KB and human PMNs in the Transwell system and examined the impact of Porphyromonas gingivalis-epithelial cell interactions on subsequent PMN transepithelial migration. We demonstrate here that P. gingivalis infection of oral epithelial cells failed to trigger transmigration of PMNs. Furthermore, it significantly inhibited neutrophil transmigration actively induced by stimuli such as N-formylmethionyl leucyl phenylalanine, interleukin-8 (IL-8), and the intestinal pathogen enterotoxigenic Escherichia coli. The ability of P. gingivalis to block PMN transmigration was strongly positively correlated with the ability to adhere to and invade epithelial cells. In addition, P. gingivalis attenuated the production of IL-8 and the expression of intercellular adhesion molecule 1 by epithelial cells. The ability of P. gingivalis to block neutrophil migration across an intact epithelial barrier may critically impair the potential of the host to confront the bacterial challenge and thus may play an important role in the pathogenesis of periodontal disease.

Cellular events concurrent with Porphyromonas gingivalis invasion of oral epithelium in vitro.

The aim of the present study was to elucidate events related to receptor function, signal transmission and cytoskeletal rearrangements concurrent with Porphyromonas gingivalis invasion of oral epithelial cells in vitro. Porphyromonas gingivalis strain FDC 381 and the KB cell line (ATCC CCL 17) were used in a previously described antibiotic protection assay. The involvement of a receptor-mediated endocytosis pathway in the internalization process was demonstrated after treatment of the epithelial cells with monodansylcadaverine and ouabain, substances that inhibit formation of coated pits, resulting in reduction in the number of invading P. gingivalis: Treatment of the epithelial cells with the protein kinase (PK) inhibitor staurosporine and the tyrosine-specific PK inhibitor genistein was also found to significantly decrease the number of invading bacteria, suggesting involvement of tyrosine phosphorylation in signal transduction during invasion. This was further supported by the identification of a 43 kD protein acting as a substrate for tyrosine phosphorylation subsequent to the microbial-host cell interaction. Tyrosine phosphorylation of the 43 kD protein was strongly reduced by treatment with PK inhibitors. The decrease in invasion observed after treatment of epithelial cells with colchicine and nocodazole, inhibitors of microtubuli polymerization, suggested that the bacterial-receptor interaction and the phosphotyrosine-dependent intracellular signalling trigger an internalization process involving rearrangements of cytoskeletal microtubuli.

Porphyromonas gingivalis FDC381 multiplies and persists within human oral epithelial cells in vitro.

Porphyromonas gingivalis FDC381 replication and persistence within KB epithelial cells in vitro were studied by means of an antibiotic protection assay and electron microscopy. Intracellular counts decreased during the first 24 h; showed a threefold increase during the second day, indicating intracellular multiplication; and after 8 days declined to levels approximating 40% of the initial invasion. The ability of P. gingivalis to persist and multiply within epithelial cells may constitute a pathogenic mechanism in periodontal disease.

Pyruvate oxidase, as a determinant of virulence in Streptococcus pneumoniae.

Pneumococcus has been shown to bind to epithelial cells of the nasopharynx and lung, and to endothelial cells of the peripheral vasculature. To characterize bacterial elements required for attachment to these cell types, a library of genetically altered pneumococci with defects in exported proteins was screened for the loss of attachment to glycoconjugates representative of the nasopharyngeal cell receptor, type II lung cells (LC) and human endothelial cells (EC). A mutant was identified which showed a greater than 70% loss in the ability to attach to all cell types. This mutant also showed decreased adherence to the glycoconjugates containing the terminal sugar residues GalNAcbeta1-3Gal, GalNAcbeta1-4Gal and the carbohydrate GlcNAc, which are proposed components of the pneumococcal receptors specific to the surfaces of LC and EC. Analysis of the locus altered in this mutant revealed a gene, spxB, that encodes a member of the family of bacterial pyruvate oxidases which decarboxylates pyruvate to acetyl phosphate plus H2O2 and CO2. This mutant produced decreased concentrations of H2O2 and failed to grow aerobically in a chemically defined medium, unless supplemented with acetate which presumably restores acetyl phosphate levels by the action of acetate kinase, further suggesting that spxB encodes a pyruvate oxidase. The addition of acetate to the growth medium restored the adherence properties of the mutant indicating a link between the enzyme and the expression of bacterial adhesins. A defect in spxB corresponded to impaired virulence of the mutant in vivo. Compared to the parent strain, an spxB mutant showed reduced virulence in animal models for nasopharyngeal colonization, pneumonia, and sepsis. We propose that a mutation in spxB leads to down-regulation of the multiple adhesive properties of pneumococcus which, in turn, may correlate to diminished virulence in vivo.

Peptide permeases from Streptococcus pneumoniae affect adherence to eucaryotic cells.

To gain access to tissues within the human host, Streptococcus pneumoniae initially colonizes the nasopharynx and then interacts with glycoconjugates on the surfaces of target cells at various sites of infection. Although pneumococcal adhesins are currently unknown, exported proteins on the bacterial surface are potential candidates. To identify bacterial elements involved in this process, mutants of S. pneumoniae with defects in exported proteins were screened for the inability to adhere to cells representative of three in vivo niches: (i) agglutination of bovine erythrocytes, which reflects adherence to cells which reside in the nasopharynx; (ii) human type II pneumocytes (lung cells [LC]), representing the alveolar site of infection; and (iii) human vascular endothelial cells (EC), representing the endovascular site. The capacity of the mutants to adhere during the course of pneumococcal disease was also assessed by using cytokine-activated LC and EC. All of the 30 mutants analyzed produced hemagglutination values comparable with those of the parent strain. Four independent mutants demonstrated a greater than 50% decrease in adherence to both LC and EC. Sequence analysis of the altered alleles from these strains showed that mutations had occurred in two previously identified loci, plpA and ami, which belong to the family of genes encoding protein-dependent peptide permeases. Mutations in the ami locus resulted in an inability to recognize the GalNAc beta 1-4Gal glycoconjugate receptor present on resting LC and EC, whereas mutations in plpA resulted in a failure to recognize a GalNAc beta 1-3Gal glycoconjugate receptor also present on resting cells. Mutations in neither allele affected recognition of GlcNAc receptors present on cytokine-activated LC and EC. These results suggest that peptide permeases modulate pneumococcal adherence to epithelial and endothelial cells either by acting directly as adhesins or by modulating the expression of adhesins on the pneumococcal surface during the initial stages of colonization of the lung or the vascular endothelium.

Inhibition of leukocyte-endothelial cell interactions and inflammation by peptides from a bacterial adhesin which mimic coagulation factor X.

Factor X (factor ten) of the coagulation cascade binds to the integrin CD11b/CD18 during inflammation, initiating procoagulant activity on the surface of leukocytes (Altieri, D.C., O.R. Etingin, D.S. Fair, T.K. Brunk, J.E. Geltosky, D.P. Hajjar, and T. S. Edgington. 1991. Science [Wash.DC]. 254:1200-1202). Filamentous hemagglutinin (FHA), an adhesin of Bordetella pertussis also binds to the CD11b/CD18 integrin (Relman D., E. Tuomanen, S. Falkow, D.T. Golenbock, K. Saukkonen, and S.D. Wright. 1990. Cell. 61:1375-1382). FHA and the CD11b/CD18 binding loops of Factor X share amino acid sequence similarity. FHA peptides similar to Factor X binding loops inhibited 125I-Factor X binding to human neutrophils and prolonged clotting time. In addition, ETKEVDG and its Factor X analogue prevented transendothelial migration of leukocytes in vitro and reduced leukocytosis and blood brain barrier disruption in vivo. Interference with leukocyte migration by a coagulation-based peptide suggests a novel strategy for antiinflammatory therapy.

Lectin domains in the toxin of Bordetella pertussis: selectin mimicry linked to microbial pathogenesis.

The pathogenesis of many infectious diseases is critically determined by prokaryotic lectins which enable differential recognition and activation of targeted eukaryotic cells. Some bacterial adhesins mimic and co-opt eukaryotic cell-cell adhesion motifs. This is illustrated by the toxin of Bordetella pertussis. Pertussis toxin mediates intoxication of eukaryotic cells by elevation of cAMP and it serves as an adhesin binding the bacteria to ciliated cells and respiratory macrophages. These activities are mediated by the lectin-like properties of the binding oligomer of the toxin. A comparison of pertussis toxin and the selectins involved in leukocyte trafficking indicates that these prokaryotic and eukaryotic C-type lectins share some element of primary sequence similarity, three dimensional structure, and biological activities. Such mimicry suggests a link between eukaryotic cell-cell adhesion motifs and microbial pathogenesis.

Host-related genotypic heterogeneity of Porphyromonas gingivalis strains in the beagle dog.

The present investigation explored the genotypic heterogeneity of Porphyromonas gingivalis using restriction endonuclease analysis and ribotyping of 64 P. gingivalis isolates, recovered from the periodontal pockets of 3 beagle dogs, 2 of which were reared together. The isolates originated from both healthy and periodontal disease affected sites and thereby enabled the study of bacterial genotype with respect to (i) individual host, (ii) ecological niche (site within host) and (iii) level of periodontal health. Whole genomic DNA was extracted from each isolate and digested by the restriction endonuclease KpnI. Digestion fragments were separated by electrophoresis and transferred onto nylon membranes. The blots were hybridized with a digoxigenin-labeled 16S rDNA probe, and hybridization bands were detected using an anti-digoxigenin antibody conjugated with alkaline phosphatase and enhanced chemiluminescence. Fourteen genomic fingerprints and 13 ribotypes were observed among the 64 isolates. As many as 8 distinct fingerprints were detected within a single host and up to 4 fingerprints within a single periodontal pocket. The dogs reared together shared 2 common clonal types but also exhibited clonal types unique to each dog. No clear association between clonal type and periodontal health status could be made. The results revealed an extensive intra-host genotypic heterogeneity of P. gingivalis strains in the beagle dog and indicated that ribotyping was a sensitive method for differentiating clonal types within species.

Peptides from pertussis toxin interfere with neutrophil adherence in vitro and counteract inflammation in vivo.

Selectins on the surface of endothelial cells initiate leukocyte rolling along the capillary walls during inflammation. The amino acid sequence 19-52 of pertussis toxin subunit S3 is strikingly similar to the sequence 15-46 of the selectins. The S3 subunit inhibits the binding of neutrophils to selectin-coated surfaces and a peptide spanning the 28-45 sequence of S3 reduces leukocyte binding to endothelial cells in vitro and inhibits leukocyte recruitment to the subarachnoid space in vivo. To identify sequences within the 28-45 S3 peptide responsible for these activities, 27 peptides derived by successive truncation of amino acids from either the amino or the carboxyl terminus were tested for anti-inflammatory activity. Truncation at five residues ablated the ability to inhibit neutrophil adherence to endothelial monolayers: valine32, alanine33, arginine36, asparagine38, and threonine43. The most active peptides were either full-length molecules (28-44, 30-45) or short peptides from both ends of the full sequence (39-45, 40-45, 41-45, 28-32). Three peptides with the strongest ability to prevent neutrophil adherence in vitro (28-44, 30-45, 40-45) reduced the cerebrospinal fluid leukocytosis in a pneumococcal meningitis model when administered intravenously. We conclude that peptides derived from a prokaryotic lectin have anti-inflammatory properties consistent with inhibition of selectin participation in leukocyte recruitment during inflammation.

Porphyromonas gingivalis invades human pocket epithelium in vitro.

The present study examined the adhesive and invasive potential of Porphyromonas gingivalis interacting with human pocket epithelium in vitro. Pocket epithelial tissue, obtained during periodontal surgery of patients with advanced periodontal disease, generated a stratified epithelium in culture. P. gingivalis strains W50 and FDC 381 (laboratory strains), OMGS 712, 1439, 1738, 1739 and 1743 (clinical isolates) as well as Escherichia coli strain HB101 (non-adhering control) were tested with respect to epithelial adhesion and invasion. Adhesion was quantitated by scintillation spectrometry after incubation of radiolabeled bacteria with epithelial cells. The invasive ability of P. gingivalis was measured by means of an antibiotic protection assay. The epithelial multilayers were infected with the test and control strains and subsequently incubated with an antibiotic mixture (metronidazole 0.1 mg/ml and gentamicin 0.5 mg/ml). The number of internalized bacteria surviving the antibiotic treatment was assessed after plating lyzed epithelial cells on culture media. All tested P. gingivalis strains adhered to and entered pocket epithelial cells. However, considerable variation in their adhesive and invasive potential was observed. E. coli strain HB101 did not adhere or invade. Transmission electron microscopy revealed that internalization of P. gingivalis was preceded by formation of microvilli and coated pits on the epithelial cell surfaces. Intracellular bacteria were most frequently surrounded by endosomal membranes; however, bacteria devoid of such membranes were also seen. Release of outer membrane vesicles (blebs) by internalized P. gingivalis was observed. These results support and extend previous work from this laboratory which demonstrated invasion of a human oral epithelial cell-line (KB) by P. gingivalis.

Attachment factors of Bordetella pertussis: mimicry of eukaryotic cell recognition molecules.

Bacteria localize to specific target organs during infection by recognizing eukaryotic cell surface addresses. This address system exists to facilitate normal trafficking of host cells such as leukocytes. The mechanisms by which bacteria subvert host targeting codes provide a unique link between microbial pathogenesis and eukaryotic cell trafficking, and can point to a new array of antibodies and peptides of potential therapeutic value.

Porphyromonas gingivalis invades oral epithelial cells in vitro.

The aim of the present study was to analyze the adhesive and invasive potential of a number of P. gingivalis strains, in an in vitro system utilizing cultures of human oral epithelial cells (KB cell line, ATCC CCL 17). P. gingivalis strains W50 and FDC 381 (laboratory strains) and OMGS 1738, 1743 and 1439 (clinical isolates) as well as E. coli strain HB 101 (non-adhering, non-invasive control) were used. Adherence was assessed by means of scintillation counting and light microscopy, after incubation of radiolabelled bacteria with epithelial cells. In the invasion assay, monolayers were infected with the P. gingivalis and E. coli strains and further incubated with an antibiotic mixture (metronidazole 0.1 mg/ml and gentamicin 0.5 mg/ml). Invasion was evaluated by (i) assessing presence of bacteria surviving the antibiotic treatment, and (ii) electron microscopy. All P. gingivalis strains adhered to and entered into the oral epithelial cells. After 3 hours of incubation, bacteria were frequently identified intracellularly by means of electron microscopy. The cellular membranes, encapsulating the microorganisms in early stages of the invasive process, appeared later to disintegrate. The presence of coated pits on the epithelial cell surfaces suggested that internalization of P. gingivalis was associated with receptor-mediated endocytosis (RME). Formation of outer membrane vesicles (blebs) by intracellular bacteria indicated that internalized P. gingivalis was able to retain its viability. E. coli strain HB 101 neither adhered to nor invaded epithelial cells.

Non-random chromosome rearrangements in herpes simplex virus type 1 transformed diploid CHEF cells.

The effects of Herpes simplex virus type 1 (HSV-1) on diploid, non-tumourigenic Chinese hamster embryo fibroblasts (CHEF/18-1D-3) were studied. Six independent lines transformed by HSV-1 alone or by HSV-1 in combination with acyclovir or aqueous tobacco extract were isolated. In contrast to uninfected CHEF/18-1D-3 cells, all transformants grew in soft agar and were tumourigenic in nude mice. Neither infectious virus nor viral antigens could be detected in any of the lines. Cytogenetic analysis revealed clonal chromosome abnormalities in all lines including trisomy for the long arm of chromosome 3 in five lines. In three of these the extra 3q was translocated onto 6p. All lines showed loss of the corresponding 3p arm. The remaining line had a hypodiploid stemline with loss of one chromosome 7. This line also showed a pronounced chromosomal instability with a multitude of mainly sporadic rearrangements. These results show that HSV-1 induced transformation and tumourigenesis in CHEF cells is associated with the induction of chromosome rearrangements, in particular trisomy for 3q.