Persistent bacterial colonization of Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans in periodontitis and its association with alveolar bone loss after 6 months of therapy.

BACKGROUND, AIMS: The purpose of this study was to determine whether the presence of bacterial antigens for Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), and Actinobacillus actinomycetemcomitans (Aa) in subgingival plaque of periodontitis patients after periodontal treatment was associated with progressive alveolar bone loss. METHOD: 39 (39) subjects in good general health previously diagnosed with adult periodontitis within the last 2 years, and still presenting with probing depth >5 mm in 2 to 6 teeth, were studied. All subjects were treated with scaling and root planing. Half of the subjects were randomly assigned to receive adjunctive systemic doxycycline (200 mg the 1st day, then 100 mg per day for 21 days). Subgingival plaque samples were taken at baseline, 1, 3 and 6 months after therapy. A modified ELISA test (Evalusite, Periodontal Test Kit, Eastman Kodak Co., Rochester, NY) was used to test for plaque antigens associated with P. gingivalis, P. intermedia and A. actinomycetemcomitans. Progressive alveolar bone loss was determined using digital subtraction radiography with standardized radiographs taken at baseline and 6 months after treatment. RESULTS: The presence of P. gingivalis in plaque after treatment was significantly associated with progressive bone loss (positive predictive value 84%, negative predictive value 85%, odds ratio 31.9, p<0.0001). In contrast, the presence of P. intermedia in plaque after treatment was not indicative of progressive loss (positive predictive value 39%, negative predictive value 82%). Too few sites had evidence of A. actinomycetemcomitans to be amenable to statistical analysis. No significant difference in bone loss was attributable to the systemic antibiotic therapy. CONCLUSION: These data indicated that, in this population, the presence of P. gingivalis in plaque after treatment might be indicative of progressive alveolar bone loss.

Analytical performance of an immunologic-based periodontal bacterial test for simultaneous detection and differentiation of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia.

The analytical performance of a membrane-based immunoassay for the simultaneous detection and differentiation of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia (including Prevotella nigrescens) was investigated. Positive reactions were observed for 71 of 71 reference strains and recent oral isolates of A. actinomycetemcomitans, P. gingivalis, and P. intermedia. No cross-reactivity was observed with 39 other common oral and environmental species. The specificity of the test was unaffected by the presence of potential oral interferents including whole blood, white blood cells, mucin, saliva, toothpastes, and oral rinses. A proficiency test by dental professionals using a standardized set of unknown simulated samples yielded a sensitivity of 97% (116/120) and a 100% specificity (240/ 240). An additional group including dental professionals and high school students was shown to be 99% proficient (1385/1397) in distinguishing proper from improper test function when processing control samples with normal test devices and devices with simulated error conditions. Comparisons to a culture standard for 104 subgingival plaque samples collected from 26 adult periodontitis patients yielded > 98% specificity for each of the test bacteria. In addition, the detection threshold for the test was determined to be equivalent to 10(4) cultivable test bacteria when compared to the culture standard. The data indicate that this membrane immunoassay is a valid and easy-to-use method for the detection of A. actinomycetemcomitans, P. gingivalis, and P. intermedia in subgingival plaque, at levels above the detection threshold of the test.

Colonization by Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia in adult periodontitis patients as detected by the antibody-based Evalusite Test.

Studies were performed to evaluate the detection of disease-associated bacterial colonization in adult periodontitis patients by the antibody-based Evalusite TestTM (Eastman Kodak Company). The association of test results with disease was assessed by collecting 104 duplicate subgingival plaque samples from 26 patients. Samples were tested for Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia using both microbiological culture and the immunoassay test. The sensitivity and specificity of the 2 methods was calculated using %s of positive results in deep periodontal pockets and negative results in shallow subgingival sites. A cutoff >10(4) cultivable counts yielded the greatest discrimination between health and disease on a cross-sectional basis and established this threshold as clinically relevant for the detection of disease-associated levels of bacterial colonization by these three microorganisms. The clinical detection limit of the immunoassay test was observed to coincide with this threshold of >10(4) cultivable counts. Microbiological testing of the 4 deepest pockets using the immunoassay test was determined to be sufficient to yield a 90% confidence of detecting positive patients in a study with 59 adult subjects. The immunoassay test method was also demonstrated to be effective at detecting bacterial colonization in sets of paper point samples that were pooled for analysis. An overall agreement of 94% (288 of 306) was observed when comparing test results for duplicate sets of pooled and individual samples collected from 51 patients. These studies demonstrate that the Evalusite Test is an effective method for detecting clinically relevant colonization by the test bacteria in patients at risk for periodontal disease.

Mechanistic studies on cyclohexanone oxygenase.

The bacterial flavoprotein monooxygenase carries out an oxygen insertion reaction on cyclohexanone, with ring expansion to form the seven-membered cyclic product epsilon-caprolactone, a transformation quite distinct from the phenol leads to catechol transformation carried out by the bacterial flavoprotein aromatic hydroxylases. Cyclohexanone oxygenase catalysis involves the four-electron of O2 at the expense of a two-electron oxidation of NADPH, concomitant with a two-electron oxidation of cyclohexanone to epsilon-caprolactone. NADPH oxidase activity is fully coupled with oxygen transfer to substrate. Steady-state kinetic assays demonstrate a ter-ter mechanism for this enzyme. Pre-steady-state kinetic assays demonstrate the participation of a 4a-hydroperoxyflavin intermediate during catalysis. In addition to its ketolactonizing activity, cyclohexanone oxygenase carries out S-oxygenation of thiane to thiane 1-oxide, a reaction which represents a nucleophilic displacement by the sulfur upon the terminal oxygen of the hydroperoxide. This is in contrast to cyclohexanone oxygenations where the flavin hydroperoxide acts as a nucleophile. In addition, a stable apoenzyme form is accessible and can be reconstituted with various FAD analogues with up to 100% recovery of enzyme activity. The accumulated results presented here support a Baeyer-Villiger rearrangement mechanism for the enzymatic oxygenation of cyclohexanone.

Kinetic isotope effects in the oxidation of isotopically labeled NAD(P)H by bacterial flavoprotein monooxygenases.

Three bacterial flavoprotein monooxygenases, p-hydroxybenzoate hydroxylase, orcinol hydroxylase, and salicylate hydroxylase, have been examined for steady-state kinetic isotope effects with (4R)-[4-2H]NAD(P)H and (4R)-[4-3H]NAD(P)H. The observed isotope selections are for deuterium, DV = 1.8-3.5 and D(V/K) = 1.7-5.1, and for tritium, T(V/K) = 5-19. For both orcinol hydroxylase and p-hydroxybenzoate hydroxylase, reduction of enzyme-bound FAD by (4R)-[4-2H]NAD(P)H in pre-steady-state assays reveals intrinsic deuterium isotope effects of 10 +/- 2 on this redox step. These values are at the upper end of substrate deuterium effects seen in enzymatic reactions. Suppression of approximately 83% of the intrinsic isotope effects in the overall reaction rate (e.g., kH/kD = 10 down to DV = 2.5) corroborates earlier kinetic data on p-hydroxybenzoate hydroxylase [Husain, M., & Massey. V. (1979) J. Biol. Chem. 254, 6657] and suggests that these bacterial phenolic monooxygenases balance out internal transition states such that no single barrier is fully rate limiting.

The stereochemistry of NADH utilization by the flavoenzyme monooxygenase orcinol hydroxylase.

Ribbons et al. (Ribbons, D.W., Ohta, Y., and Higgins, I.J. (1972) in Molecular Basis of Electron Transport, Miami Winter Symposic Series (Schultz, J., and Cameron, B.F., eds) Vol. 4, pp. 251-274, Academic Press, New York) presented a preliminary report that the flavoenzyme monooxygenase orcinol hydroxylase shows mixed type 4R, 4S stereospecificity with respect to dihydronicotinamide oxidation when resorcinol and m-cresol were used as substrate analogs. With the natural substrate orcinol, 4R chirality was maintained. In kinetic isotope experiments reported here, we demonstrate in fact that orcinol hydroxylase maintains 4R stereospecificity with respect to dihydronicotinamide oxidation with all three substrates, orcinol, resorcinol, and m-cresol. Deuterium and tritium kinetic isotope effects were detected under Vmax conditions with (4R)-[4-2H]-, and (4R)-[4-3H]NADH for all three substrates. No isotope effect was observed with (4S)-[4-2H]NADH and tritium labilization from assays with (4S)-[4-3H]-NADH was negligible in all cases.