Aggregation of human platelets by gingipain-R from Porphyromonas gingivalis cells and membrane vesicles.

The hypothesis that there is an association between periodontitis and cardiovascular disease suggests new lines of research on the mechanism whereby oral bacteria might exert systemic effects. This study was conducted to ascertain and quantitate the effect of Porphyromonas gingivalis on human platelets in vitro. A second related objective was to purify and identify the aggregating vector. Aggregation was measured by platelet turbidometry and gingipain-R was purified from P. gingivalis membrane vesicles by Sepharose 2B and hydroxyapatite chromatography. The in vitro aggregation of platelets requires that at least 1.0 x 10(4) cells be stirred with 1.35 x 10(8) platelets. The specific activity is substantially increased in the membrane vesicles that are shed by this bacterium. Aggregability was due to gingipain-R activity, a potent cysteine protease that was found to be highly concentrated in the membrane vesicle fraction. The enzyme was purified 18-fold in high yield from the membrane vesicles, and consists of two noncovalently linked proteins that migrate at 49 and 44 kDa on SDS-PAGE. Aggregation of platelets by gingipain-R was shown to be dose-dependent, and inhibited by leupeptin and arginine, but not by anti-thrombin III. This is the first report enumerating the specific number of cells and lowest concentration of membrane vesicles necessary to evoke a full human platelet response, and the first report to assign this activity to gingipain-R.

Clinical use of antibiotics in dental practice.

Inappropriate use of antibiotics by clinicians leads to development of antibiotic resistance. For the most part, antibiotics are prescribed in dental practice for prophylactic and therapeutic reasons. Prophylactic antibiotics are prescribed to prevent diseases caused by members of the oral flora introduced to distant sites in a host at risk or introduced to a local compromised site in a host at risk. In most cases, prophylaxis is used for prevention of endocarditis. Therapeutic antibiotics are prescribed, in most cases, to treat diseases of hard and soft tissues in the oral cavity after local debridement has failed. Antibiotics used for prophylaxis must: (1) be active against the major pathogens; and (2) achieve a tissue loading dose before the bacteria are introduced. Antibiotics used for therapy are required in cases where the infection is already present and thus the agent must reach the site of infection at a high enough level for a long enough time to produce the desired effect. For an exogenous agent the goal is to eliminate the agent from the site of infection. In the case of an endogenous agent the antibiotic must suppress the organism at the site of infection. Recent evidence underscores the important role of antibiotics in the treatment and prevention of diseases initiated in the oral cavity that have the potential to spread to distant organs in the body.

Purification and characterization of a potent 70-kDa thiol lysyl-proteinase (Lys-gingivain) from Porphyromonas gingivalis that cleaves kininogens and fibrinogen.

We isolated an enzyme from a major periodontal pathogen, Porphyromonas gingivalis (also called Bacteroides gingivalis), that is capable of initially increasing the coagulant activity of high molecular weight kininogen (HK), releasing bradykinin from HK and low molecular weight kininogen (LK), and destroying the light chain (coagulant portion) of HK. This enzyme, a membrane-bound thiol proteinase that preferentially cleaves the P1-Lys position of tripeptide substrates, is also able to rapidly render fibrinogen nonclottable. We will refer to this enzyme as lys-gingivain because of its origin from P. gingivalis, its classification as a thiol proteinase, and its action as a lysyl-amidase. The activity of lys-gingivain is enhanced by beta-mercaptoethanol, and the enzyme has a molecular mass of 68-70 kDa, a pH optimum of 7.4, and is not inactivated by plasma protease inhibitors. The second-order rate constant for the destruction of the coagulant activity of the HK light chain (surface-binding domain) at 23 degrees C is 2.3 x 10(7) M-1 s-1, and, for cleavages that render fibrinogen unclottable, is 2.05 x 10(6) M-1 s-1. These data suggest that lys-gingivain is a very potent proteinase that would be fully functional in anaerobic periodontal crevices and might participate in the pathogenesis of periodontitis. Lys-gingivain appears to be the most potent kininogenase and fibrase to be described to date.

Routine anaerobic bacterial culture and systemic antibiotic usage in the treatment of adult periodontitis: a 6-year longitudinal study.

This investigation evaluated the efficacy of obtaining baseline culture and sensitivity data on a routine basis from the patient with adult periodontitis. Patients diagnosed with chronic adult periodontitis, rapidly progressive periodontitis, or refractory periodontitis were followed for up to 6 years. More than 95% of patients with chronic adult periodontitis were successfully treated with mechanical therapy alone. Approximately one half of the patients with rapidly progressive periodontitis were treated successfully without antibiotics. All of the patients with refractory periodontitis required systemic antibiotics as part of treatment. Most patients with chronic adult periodontitis exhibited one or two species of organisms at baseline, and these organisms were eliminated or reduced to low levels by mechanical therapy. In contrast, patients with rapidly progressive or refractory periodontitis consistently demonstrated multiple species and required systemic antibiotics in conjunction with mechanical therapy to alter the subgingival microbial milieu. Routine culturing and antibiotic therapy is contraindicated in patients with chronic adult periodontitis, but may be beneficial for successful treatment of patients with rapidly progressive or refractory periodontitis.

Enterococci in human periodontitis.

Enterococci are potential pathogens in many human body sites. This study determined the subgingival occurrence and the in vitro antimicrobial susceptibility of enterococci in 100 persons with early-onset periodontitis and 545 persons with advanced adult periodontitis. Subgingival microbial samples were collected with paper points, transported in VMGA III and plated onto anaerobic enriched brucella blood agar or selective Enterococcosel agar (BBL Microbiology Systems). Enterococcal speciation was performed using commercial micromethod kit systems. In vitro sensitivity was determined using a commercial kit system and an agar dilution assay. Subgingival enterococci occurred in 1% of early-onset periodontitis patients and in approximately 5% of adult periodontitis patients. Enterococcus faecalis was the only enterococcal species recovered, and all but one isolate belonged to the same biotype. In vitro antimicrobial sensitivity testing revealed subgingival enterococci resistant to therapeutic levels of penicillin G, tetracycline, clindamycin and metronidazole, but relatively sensitive to ciprofloxacin and amoxicillin/potassium clavulanate (Augmentin). Enterococci may populate periodontal pockets as superinfecting organisms and, in heavily infected patients, may contribute to periodontal breakdown.

Antimicrobial activity of flurbiprofen and ibuprofen in vitro against six common periodontal pathogens.

Nonsteroidal antiinflammatory drugs (NSAIDs) such as flurbiprofen and ibuprofen, have been shown to inhibit the inflammation and alveolar bone loss associated with chronic destructive periodontal disease. However, the direct effect of NSAIDs on the gingival crevice microflora has not been studied. The purpose of this investigation was to evaluate the antimicrobial activity of ibuprofen and flurbiprofen in vitro on six commonly isolated periodontal pathogens. The bacterial strains evaluated were Actinobacillus actinomycetemcomitans, Bacteroides gingivalis, Bacteroides intermedius, Eikenella corrodens, Fusobacterium nucleatum and Wolinella recta. Pure cultures of these organisms were inoculated into broth, allowed to grow and inoculated again into sheep blood agar plates. For preliminary dose-response studies, antibiotic sensitivity blank disks loaded with 10 microliters of flurbiprofen 250 micrograms, 50 micrograms and 5 micrograms, or ibuprofen 500 micrograms, 50 micrograms and 5 micrograms were placed on the seeded agar plates. Clindamycin 2 micrograms disks were used as positive controls and discs loaded with only drug vehicle served as negative controls. In an attempt to estimate the minimal inhibitory concentrations of these NSAIDs on specific microorganisms, additional experiments employing intermediate drug dosages were also performed. Clindamycin produced large zones of inhibition for all bacterial strains except for Eikenella corrodens which is known to be resistant to the antibiotic and Actinobacillus actinomycetemcomitans which appeared to be only moderately sensitive to the antibiotic. Zones of inhibition were not produced by any of the negative control disks or by the 5 micrograms or 50 micrograms doses of either NSAID.(ABSTRACT TRUNCATED AT 250 WORDS)

Structural proteins of the Actinobacillus actinomycetemcomitans bacteriophage phi Aa.

øAa is an A1 morphotype bacteriophage which infects certain strains of Actinobacillus actinomycetemcomitans. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analysis of dissociated, purified phi Aa particles revealed 7 major structural proteins (P1-P7) ranging in size from 17.5 to 52.7 kilodaltons (Kd). Treatment of the intact phage particles with 67% dimethyl sulfoxide (DMSO) resulted in the separation of the virion head and tail subunits. Purification of the head subunits was accomplished by sucrose density gradient centrifugation of the DMSO-treated phage particles. The purified head subunits were composed of a single protein having an electrophoretic mobility which corresponded to a 39.5 Kd protein (P3) of the intact virus. Raising the pH of a purified phi Aa suspension to 12.7 disrupted the head subunits, as well as the tail tube and tail fibers, releasing intact contractile tail sheaths. The tail sheaths were collected by centrifugation. The purified tail sheaths were analyzed by SDS-PAGE and were found to be composed of two proteins (P1 and P2) having molecular weights of 52.7 and 41.2 Kd respectively. The location of each of the 4 remaining major structural proteins in the phi Aa virion remains to be determined.

The comparative cytotoxicity of periodontal bacteria.

The direct cytotoxicity of sonic extracts (SE) from nine periodontal bacteria for human gingival fibroblasts (HGF) was compared. Equivalent dosages (in terms of protein concentration) of SE were used to challenge HGF cultures. The cytotoxic potential of each SE was assessed by its ability to (1) inhibit HGF proliferation, as measured by direct cell counts; (2) inhibit 3H-thymidine incorporation in HGF cultures; or (3) cause morphological alterations of the cells in challenged cultures. The highest concentration (500 micrograms SE protein/ml) of any of the SEs used to challenge the cells was found to be markedly inhibitory to the HGFs by all three of the criteria of cytotoxicity. At the lowest dosage tested (50 micrograms SE protein/ml); only SE from Actinobacillus actinomycetemcomitans, Bacteroides gingivalis, and Fusobacterium nucleatum caused a significant effect (greater than 90% inhibition or overt morphological abnormalities) in the HGFs as determined by any of the criteria employed. SE from Capnocytophaga sputigena, Eikenella corrodens, or Wolinella recta also inhibited cell proliferation and thymidine incorporation at this dosage; however, the degree of inhibition (5-50%) was consistently, clearly less than that of the first group of three organisms named above. The SE of the three other organisms tested (Actinomyces odontolyticus, Bacteroides intermedius, and Streptococcus sanguis) had little or no effect (0-10% inhibition) at this concentration. The data suggest that the outcome of the interaction between bacterial components and normal resident cells of the periodontium is, at least in part, a function of the bacterial species.

Bacteriology of periodontal disease in the cat.

Subgingival plaque samples were obtained from 32 cats showing different stages of periodontal disease. Correlations were sought between gingival index scores and the prevalence of various microbial groups, and between microbial populations found in sites designated as most-affected and least-affected within individual cats. The tendency with higher gingival index scores, and with the most-affected sites, was toward a microbial population composed to a greater extent of anaerobic Gram-negative rods. The most common organism was an anaerobic Gram-negative rod in the black-pigmented Bacteroides group that was biochemically similar to B. gingivalis but had catalase activity. The black-pigmented Bacteroides group and Peptostreptococcus anaerobius were found in increasing numbers with increasingly severe periodontal disease. Pasteurella multocida was isolated from most samples and appeared to decrease in numbers with increasing periodontal disease.

A bacteriocin of Actinobacillus actinomycetemcomitans.

An inhibitory factor from Actinobacillus actinomycetemcomitans Y4 was isolated, and its properties indicated that it was a bacteriocin (actinobacillicin). The bacteriocin was active against Streptococcus sanguis strains, Streptococcus uberis (FDC1), and Actinomyces viscosus T14 as well as other strains of A. actinomycetemcomitans, but not against other crevicular bacteria, including other streptococci and actinomycetes. The activity of this bacteriocin was inhibited by pronase, trypsin, and heat (45 min at 56 degrees C) but not by DNase, RNase, phospholipase, exposure to UV light, or low pH (1.0 to 6.5). Although actinobacillicin markedly inhibited glycolysis in S. sanguis, the primary mechanism of its bactericidal action appears to be alterations in cell permeability, with the resultant leakage of RNA, DNA, and other essential intracellular macromolecules. These findings provide an ecologic explanation for the reciprocal growth relationship between A. actinomycetemcomitans and S. sanguis/Actinomyces viscosus observed in localized juvenile periodontitis.

Purification and biochemical properties of a bacteriocin from Actinobacillus actinomycetemcomitans.

Extracts of certain strains of Actinobacillus actinomycetemcomitans are inhibitory to strains of Streptococcus sanguis such as S. sanguis ATCC 10556. The isolation of a protein from an A. actinomycetemcomitans sonic extract which copurified with the inhibitory activity was accomplished by preparative isoelectric focusing, Sephadex G-100 gel filtration chromatography, and preparative polyacrylamide gel electrophoresis (PAGE). The resulting isolated protein, which focused at a pH of 6.1 to 6.3, appeared as a single band in anionic nondissociating PAGE analysis. This protein could be dissociated into two subunits with molecular weights of 50,000 and 70,000, which were resolvable by PAGE analysis. A 1,758-fold increase in specific activity was seen in the purified inhibitory protein compared with the crude sonic extract starting material. The properties of the inhibitory activity in the A. actinomycetemcomitans extract are characteristic of a bacteriocin. Accordingly, we propose the name actinobacillicin for the inhibitory protein.

Human immune responses to oral microorganisms. II. Serum antibody responses to antigens from Actinobacillus actinomycetemcomitans and the correlation with localized juvenile periodontitis.

Human serum antibody responses to antigens from a suspected oral pathogen, Actinobacillus actinomycetemcomitans (Aa), were studied. IgG and IgM isotype antibodies to four antigen preparations, sonicate antigen (SA), leukotoxin (LT), group carbohydrate (LG), and lipopolysaccharide (LPS), were determined using an ELISA. An ELISA inhibition technique was developed to show that human serum antibodies reacting with the LT, LG, or LPS materials were binding to different antigenic moieties in each preparation. Cross-sectional studies of serum IgG antibodies showed that patients with localized juvenile periodontitis (LJP) had a greater frequency of occurrence and a higher level of antibodies to the SA (82%), LT (70%), and LG (62%) antigens compared to all other diseased (11-46%) or normal (4-13%) groups. Serum IgM antibodies to LPS were increased in LJP, generalized juvenile periodontitis, and adult periodontitis patients compared to all other groups. Therefore, while both IgG and IgM antibodies were found against various Aa antigens, the detection of IgG antibodies was most clearly associated with the specific disease classification of LJP. Blocking studies suggested that the human serum responses were specific for the Aa antigens and that the LT, LG, and LPS comprise major antigenic determinants on the organisms to which human serum antibody reacts.

Cytotoxicity of the bacterium Actinobacillus actinomycetemcomitans extracts in human gingival fibroblasts.

Filter-sterilized sonic extracts (SE) of strains of Actinobacillus actinomycetemcomitans were shown to inhibit the proliferation of human gingival fibroblasts in vitro. The inhibition was dose-dependent: a 50 per cent inhibitory dose of 2 micrograms protein/ml was found for A. actinomycetemcomitans strain Y4. The inhibitory activity could be neutralized by homologous antiserum and was heat inactivated by temperatures of 80 degrees C or greater. The fibroblast-inhibitory activity was present in SEs of both leukotoxic-producing and non-leukotoxic strains of A. actinomycetemcomitans, suggesting that a separate agent is responsible for leukotoxicity and fibroblast inhibition. A short (10 min) exposure of the fibroblasts to the A. actinomycetemcomitans SE was sufficient to inhibit irreversibly cell proliferation, provided that serum was present at the time that the cells were exposed to the SE. SE-challenged fibroblasts exhibited a marked decrease in the rate of DNA synthesis, but no inhibition of RNA or protein synthesis. Although the SE-treated cells did not proliferate, they appeared to remain intact and viable; and displayed no gross morphological alterations.

Characterization of an inducible bacteriophage from a leukotoxic strain of Actinobacillus actinomycetemcomitans.

A bacteriophage, designated phi Aa17, was isolated by mitomycin C induction from leukotoxic Actinobacillus actinomycetemcomitans strains 651. Electron microscopy of the virus revealed particles with regular, nonelongated, polyhedral heads, and tails consisting of a contractile sheath and core. Spikes emanated from the base of the tail. The head had a diameter of 70 nm. The fully extended tail sheath had a length of 127 nm and a diameter of 22 nm. In its contracted form, the tail sheath measured 47 nm in length and 25 nm in diameter. The phage had a buoyant density of 1.370 in CsCl, and its genome was found to be double-stranded DNA. A single-cycle growth curve revealed that the phage had a latent period of 30 min and a burst size of 435 PFU per cell. The host range of the phage was examined, and A. actinomycetemcomitans strains ATCC 29523 and ATCC 29524 were found to be phage sensitive, whereas strains Y4, ATCC 29522, 2043, 652, 651, 627, 2097, N27, 2112, and 511 were resistant. The host range of this virus does not suggest any association between the phage and leukotoxin production.