Takafumi Okui

Balance of inflammatory response in stable gingivitis and progressive periodontitis lesions

The balance between inflammatory mediators and their counter‐regulatory molecules may be crucial for determining the outcome of immune pathology of periodontal diseases. Based on clinical and immunological findings, the immune response in stable gingivitis lesion is supposed to be in balance, whereas the response is skewed towards the predominance of proinflammatory reactivity in progressive periodontitis lesion. However, this hypothesis has not been verified. Therefore, the aim of this study was to compare the gene expression profile of inflammatory mediators including proinflammatory cytokines and other inflammatory molecules, and anti‐inflammatory cytokines by using quantitative real‐time polymerase chain reaction in gingivitis and periodontitis lesions showing distinct clinical entities. For inflammatory mediators, interleukin (IL)‐1β, interferon (IFN)‐γ and receptor activator of nuclear factor (NF)‐κB ligand tended to be higher in periodontitis, whereas tumour necrosis factor (TNF)‐α and IL‐12 p40 showed no difference. Heat‐shock protein 60 (HSP60) expression was up‐regulated significantly in periodontitis. For anti‐inflammatory cytokines, transforming growth factor (TGF)‐β1 expression tended to be higher in periodontitis compared with gingivitis, whereas no difference was observed for IL‐10 and IL‐4. These findings support further our previous finding that autoimmune response to HSP60 may exert in periodontitis lesion, and suggest that perhaps subtle differences in the balance of cytokines may result in different disease expression.

Relationship of periodontal infection to serum antibody levels to periodontopathic bacteria and inflammatory markers in periodontitis patients with coronary heart disease

Several reports have demonstrated a possible association of periodontal infections with coronary heart disease (CHD) by elevated antibody titre to periodontopathic bacteria in CHD patients compared with non‐diseased controls. Although each periodontopathic bacterium may vary in virulence for periodontitis and atherosclerosis, antibody response to multiple bacteria in CHD patients has not been understood fully. Therefore, serum levels of antibody to 12 periodontopathic bacteria together with other atherosclerotic risk markers were compared among 51 patients with CHD, 55 patients with moderate to severe chronic periodontitis and 37 healthy individuals. The antibody response was the most prevalent for Porphyromonas gingivalis, a major causative organism, in CHD as well as periodontitis patients. However, antibody positivity was different between CHD and periodontitis if the response was analysed for two different strains of P. gingivalis, namely FDC381 and Su63. While periodontitis patients were positive for both P. gingivalis FDC381 and Su63, a high frequency of antibody positivity for P. gingivalis Su63 but not for FDC381 was observed in CHD patients. The results indicate that the presence of particular periodontopathic bacteria with high virulence may affect atherogenesis. Identifying the virulence factors of P. gingivalis Su63 may gain insight into the new therapeutic modality for infection‐induced deterioration of atherosclerosis.

Elevated expression of IL-17 and IL-12 genes in chronic inflammatory periodontal disease

BACKGROUND A number of different theories have been postulated to explain the progression of gingivitis to periodontitis in the context of the Th1/Th2 paradigm. However, no consistent results have been obtained. Th17, a new T-cell subset producing IL-17, which is implicated in many aspect of inflammatory tissue destruction, overcomes many of the discrepant findings in the studies related to the Th1/Th2 hypothesis. We compared the gene expression profile of Th17-related molecules in gingivitis and periodontitis lesions showing distinct clinical entities. METHODS Gingival tissue samples were obtained from 23 gingivitis and 24 periodontitis tissues. The gene expression was measured by using quantitative real-time PCR for IL-17A, IL-17F, CCR4, CCR6, IL-12 p35 and IL-23 p19. The difference of gene expressions between gingivitis and periodontitis was analyzed by Mann-Whitney U-test. Correlations between each gene expression were also analyzed. RESULTS The expression level of IL-17A was higher than that of IL-17F and a significant difference in expression between gingivitis and periodontitis was observed only for IL-17A. CCR4 and CCR6 tended to be higher in periodontitis compared with gingivitis, although the differences were not statistically significant. Whereas the gene expression of IL-12 p35 was significantly higher in periodontitis compared with gingivitis, that of IL-23 p19 was not different between the two diseases. CONCLUSION This study demonstrates the elevated expression of IL-17 and IL-12 in periodontitis, i.e., the tissue destruction form of periodontal diseases, as compared with gingivitis, and provides new insight into the T-cell mediated immunopathogenesis of periodontal disease.

The Presence of IL-17+/FOXP3+ Double-positive Cells in Periodontitis

Increasing evidence suggests that distinct inflammatory cytokines convert forkhead box protein P3 (FOXP3+) regulatory T-cells (Tregs) into IL-17-producing cells (Th17 cells) in vitro. However, this functional plasticity has not been examined in the pathogenesis of periodontal disease. In this study, we analyzed the IL-17A+FOXP3+ cells present in periodontitis lesions to determine the association between Treg conversion and the pathogenesis of periodontitis. The immunohistochemical analysis of gingival tissues demonstrated that the numbers of Th17 cells (IL-17A+FOXP3−) and Tregs (IL-17A−FOXP3+) were greater in periodontitis lesions than in gingivitis lesions. We further identified a small number of IL-17A+FOXP3+ cells in periodontitis lesions but not in gingivitis lesions. The flow cytometry analysis of CD4+ T-cell lines established from gingival tissues and the peripheral blood of periodontitis patients showed that the proportion of Tregs was reduced and the proportion of IL-17A+FOXP3+ cells among all FOXP3+ cells was elevated in gingival tissue T-cell lines relative to the proportions in peripheral blood T-cell lines. Our findings indicate that Treg-Th17 conversion may occur in periodontitis lesions. Further studies addressing the role of Treg conversion during inflammatory responses against periodontopathic bacteria are needed.

Characterization of CD4+ FOXP3+ T-cell clones established from chronic inflammatory lesions.

INTRODUCTION Our previous study demonstrated that the gene expression of FOXP3, a characteristic marker for CD4(+) CD25(+) regulatory T cells in mice, is upregulated more in periodontitis than in gingivitis at the messenger RNA (mRNA) level. Furthermore, most of the T-cell clones established from periodontitis lesions expressed FOXP3 mRNA. However, role of the FOXP3(+) gingival T cells has not been elucidated. METHODS The phenotype of FOXP3-expressing cells in periodontitis lesions was determined immunohistochemically. CD4(+) FOXP3(+) gingival T-cell clones were established from three patients with advanced periodontitis by using immunomagnetic beads. Gene expression and phenotype analyses were performed by reverse-transcription polymerase chain reactions and flow cytometry, respectively. The effect of CD4(+) FOXP3(+) T-cell clones on the proliferative response of CD4(+) CD25(-) T cells was examined by [(3)H]thymidine incorporation. RESULTS FOXP3 expression was found in some CD4(+) T cells and CD25(+) cells but not in CD8(+) T cells by immunohistochemistry. In spite of a substantial expression of the CD25 gene, the expression level of membrane CD25 on the CD4(+) FOXP3(+) gingival T-cell clones was low. While peripheral blood CD4(+) CD25(+) FOXP3(+) cells suppressed the proliferation of CD4(+) CD25(-) T cells, the CD4(+) CD25(low) FOXP3(+) gingival T-cell clones enhanced the proliferation significantly. CONCLUSION Our study makes it evident that most, if not all, of the FOXP3(+) T cells in periodontitis lesions can be considered to be effector T cells. The effector activity of the gingival T-cell clones could be attributable to the low level of membrane CD25 expression. Further studies are clearly needed to clarify the role of these T cells and their unique characteristics in the pathogenesis of periodontal disease.

Porphyromonas gingivalis antigens and interleukin-6 stimulate the production of monocyte chemoattractant protein-1 via the upregulation of early growth response-1 transcription in human coronary artery endothelial cells.

Background: Individuals with periodontitis have elevated serum levels of IL-6 and C-reactive protein and have been reported to have a significantly increased risk of developing cardiovascular disease. The transcription factor early growth response factor 1 (Egr-1) has been shown to play an important role in the development and progression of atherosclerosis. However, it is not known whether periodontal infection affects the expression of Egr-1 and subsequent endothelial cells expression of monocyte chemoattractant protein (MCP)-1, a key molecule of leukocyte chemoattraction into vessels. Methods: Human coronary artery endothelial cells (HCAECs) were stimulated with either sonicated extracts from Porphyromonas gingivalis strains 381 or SU63, or a combination of IL-6 and soluble IL-6 receptor (IL-6/sIL-6R). The expression of Egr-1, and subsequently MCP-1, was then analyzed. The role of Egr-1 on MCP-1 expression was analyzed by siRNA transfection. Results: Both P. gingivalis antigens and IL-6/sIL-6R stimulations upregulated the expression of Egr-1, with a more robust effect by IL-6/sIL-6R. Increased expression of Egr-1 coincided with MCP-1 production, and Egr-1 downregulation by siRNA suppressed this effect. Conclusion: These results clearly suggest that periodontal infection has the potential to affect HCAECs and hence contribute to the development of subsequent atherosclerosis.

Effects of systemic sitafloxacin on periodontal infection control in elderly patients.

OBJECTIVE To evaluate the microbiological and clinical effects of the systemic administration of sitafloxacin (STFX) on periodontal pockets in elderly patients receiving supportive periodontal therapy (SPT). BACKGROUND Periodontitis is a risk factor for atherosclerosis. Better periodontal health contributes to reduce atherosclerosis-related diseases in elderly population. MATERIALS AND METHODS Forty-four patients undergoing SPT were randomly assigned to two groups: a test group took 100 mg/day of STFX for five consecutive days, or a control group received scaling and root planing (SRP) under local anaesthesia. Microbiological and clinical parameters were examined at baseline and at 1 and 3 months after therapy. RESULTS The presence of Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia was significantly reduced at 1 month after treatment in both groups. The median reductions of the bacteria between the baseline and 1 month were 3.08 and 2.54% in the STFX- and SRP-treated groups, respectively. Both treatments significantly decreased the probing depth at 1 and 3 months compared to the baseline. CONCLUSION The systemic administration of STFX is effective at improving periodontal health during SPT and could be an alternative to SRP for elderly patients who cannot undergo anaesthesia or are at risk of tissue injury.

Effect of interleukin-17 on the expression of chemokines in gingival epithelial cells.

The role of interleukin (IL)-17 in cellular communication in inflammation has been well described, and a positive correlation between the severity of periodontitis and the level of IL-17 was reported. Although epithelial cells are a major target of IL-17, little is known about the effect of IL-17 on the production of chemokines by human gingival epithelial cells (HGECs). We evaluated the effects of IL-17 on the expression of CXCL8 and CCL2 by HGECs using quantitative real-time PCR and ELISA. In addition, the role of the nuclear factor (NF)-κB signalling pathway in the IL-17-mediated expression of chemokines was assessed using a specific inhibitor. Stimulation with IL-17 up-regulated the expression of CXCL8 mRNA but not of CCL2 mRNA in HGECs, whereas tumour necrosis factor-α (TNF-α) elevated the expression of mRNA for both chemokines. Stimulation with IL-17 up-regulated the secretion of CXCL8 protein, but not the secretion of CCL2 protein. The effect of IL-17 on CXCL8 production was suppressed using an anti-IL-17R Ig, suggesting a role for a specific receptor-ligand interaction. Inhibition of the NF-κB signalling pathway demonstrated that NF-κB activation is required for the CXCL8 expression in HGECs. In conclusion, IL-17 is involved in the regulation of the innate immune response in HGECs by inducing CXCL8 production.

Microbiological and clinical effects of sitafloxacin and azithromycin in periodontitis patients receiving supportive periodontal therapy

ABSTRACT Sitafloxacin (STFX) is a newly developed quinolone that has robust antimicrobial activity against periodontopathic bacteria. We previously reported that oral administration of STFX during supportive periodontal therapy was as effective as conventional mechanical debridement under local anesthesia microbiologically and clinically for 3 months. The aim of the present study was to examine the short-term and long-term microbiological and clinical effects of systemic STFX and azithromycin (AZM) on active periodontal pockets during supportive periodontal therapy. Fifty-one patients receiving supportive periodontal therapy were randomly allocated to the STFX group (200 mg/day of STFX for 5 days) or the AZM group (500 mg/day of AZM for 3 days). The microbiological and clinical parameters were examined until 12 months after the systemic administration of each drug. The concentration of each drug in periodontal pockets and the antimicrobial susceptibility of clinical isolates were also analyzed. The proportions of red complex bacteria, i.e., Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, which are the representative periodontopathic bacteria, were significantly reduced at 1 month and remained lower at 12 months than those at baseline in both the STFX and AZM groups. Clinical parameters were significantly improved over the 12-month period in both groups. An increase in the MIC of AZM against clinical isolates was observed in the AZM group. These results indicate that monotherapy with systemic STFX and AZM might be an alternative treatment during supportive periodontal therapy in patients for whom invasive mechanical treatment is inappropriate. (This study has been registered with the University Hospital Medical Information Network-Clinical Trials Registry [UMIN-CTR] under registration number UMIN000007834.)

The Role of Distinct T Cell Subsets in Periodontitis—Studies from Humans and Rodent Models

Periodontal disease results from an interaction between the host’s defense mechanisms and the microorganisms that constitute the dental plaque biofilm, and penetrate gingival tissue. Therefore, the progression and severity of the disease are strongly modulated by the host immune response, particularly, T cell responses. Because T cells consist of a variety of subpopulations, numerous studies have attempted to associate an impaired balance between each T cell subset and periodontal tissue destruction in periodontitis patients. Here, we overview studies examining human specimens obtained from patients with periodontitis and experiments analyzing rodent models with age-related or pathogen-induced experimental periodontitis. Human research provides valuable insights but also inconsistent results, which may be attributed to the difference in experimental approaches and lack of evaluation of disease activity. Rodent models have shown that an optimal balance between functionally different T cells is essential in the protection against periodontal tissue destruction.