Pocket Tissues Research Articles

Expression of miRNAs (146a and 155) in human peri-implant tissue affected by peri-implantitis: a case control study

BackgroundIn literature, the levels of miRNA-146a and miRNA-155 are increased in periodontitis. Limited data are available regarding the expression of miRNA-146a and miR-NA-155 in diseased human peri-implant tissue. Therefore, the objective of this study was to explore the expression of miRNA-146a and miRNA-155 in human gingival peri-implant tissue affected by peri-implantitis.MethodsAfter recording the clinical parameters, human peri-implant pocket tissues were harvested from sites diagnosed with peri-implantitis (n = 15 cases) in addition to healthy peri-implant sulcus tissues (n = 15 controls). The levels of miRNA-146a and miRNA-155 were assessed using real-time qPCR.ResultsCases exhibited a significantly higher mean expression of miRNA-155 (5.2-fold increase) and miRNA-146a (2.8-fold increase) than controls. MiRNA-155 and miRNA-146a demonstrated an appropriate sensitivity (87.5% and 87.5%, respectively) and specificity (73.3% and 66.7%, respectively) in discriminating cases from controls. A moderate correlation (r = 0.544, p = 0.029) was found between miRNA-155 and miRNA-146a levels in the case group.ConclusionsThe expressions of miRNA-146a and miR-NA-155 are different between healthy and peri-implantitis affected tissues. Both miRNAs might potentially able to discriminate healthy from peri-implantitis affected tissues.

Cytokine levels in gingival tissues as an indicator to understand periodontal disease severity

Cytokine levels in gingival tissues as an indicator to understand periodontal disease severity

The Use of Alloderm® Coverage to Reinforce Tissues in Two-Stage Tissue Expansion Placement in the Subcutaneous (Prepectoral) Plane: A Prospective Pilot Study.

Purpose: Two-stage tissue expander (TE) to implant breast reconstruction is commonly performed by plastic surgeons. Prepectoral implant placement with acellular dermal matrix (ADM, e.g., AlloDerm®) reinforcement is evidenced by minimal postoperative pain. However, the same is not known for TE-based reconstruction. We performed this study to explore the use of complete AlloDerm® reinforcement of breast pocket tissues in women undergoing unilateral or bilateral mastectomies followed by immediate, two-stage tissue expansion in the prepectoral plane.Methods: Patients (n = 20) aged 18-75 years were followed prospectively from their preoperative consult to 60 days post-TE insertion. The pain visual analog scale (VAS), Patient Pain Assessment Questionnaire, Subjective Pain Survey, Brief Pain Inventory-Short Form (BPI-SF), postoperative nausea and vomiting (PONV) survey, BREAST-Q Reconstruction Module, and short-form 36 (SF-36) questionnaires were administered. Demographic, intraoperative, and 30- and 60-day complications data were abstracted from medical records. After TE-to-implant exchange, patients were followed until 60 days postoperatively to assess for complications.Results: Pain VAS and BPI-SF pain interference scores returned to preoperative values by 30 days post-TE insertion. Static and moving pain scores from the Patient Pain Assessment Questionnaire returned to preoperative baseline values by day 60. The mean subjective pain score was 3.0 (0.5 standard deviation) with seven patients scoring outside the standard deviation; none of these seven patients had a history of anxiety or depression. Median PONV scores remained at 0 from postoperative day 0 to day 7. Patient-reported opioid use dropped from 89.5% to 10.5% by postoperative day 30. BREAST-Q: Sexual well-being scores significantly increased from preoperative baseline to day 60 post-TE insertion. Changes in SF-36 physical functioning, physician limitations, emotional well-being, social functioning, and pain scores were significantly different from preoperative baseline to day 60 post-TE insertion. Five participants had complications within 60 days post-TE insertion. One participant experienced a complication within 60 days after TE-to-implant exchange.Conclusions: We describe pain scores, opioid usage, patient-reported outcomes data, and complication profiles of 20 consecutive patients undergoing mastectomy followed by immediate, two-stage tissue expansion in the prepectoral plane. We hope this study serves as a baseline for future research.

Effects of aloe-emodin on alveolar bone in Porphyromonas gingivalis-induced periodontitis rat model: a pilot study.

Aloe-emodin (AE), a natural anthraquinone abundant in aloe plants and rhubarb (Rheum rhabarbarum), has long been used to treat chronic inflammatory diseases. However, AE's underlying mechanisms in periodontal inflammation have not been fully elucidated. Acidic mammalian chitinase (AMCase) is a potential biomarker involved in bone remodeling. This study aimed to evaluate AE's effect on periodontitis in rats and investigate AMCase expression. Eighteen Sprague-Dawley rats were separated into the following groups: healthy (group 1), disease (group 2), vehicle (group 3), AE high-dose (group 4), and AE low-dose (group 5). Porphyromonas gingivalis ligatures were placed in rats (groups 2-5) for 7 days. Groups 4 and 5 were then treated with AE for an additional 14 days. Saliva was collected from all groups, and probing pocket depth was measured in succession. Periodontal pocket tissues were subjected to histomorphometric analysis after the rats were sacrificed. Bone marrow-derived macrophages and murine macrophages were stimulated with receptor activator of nuclear factor-κB ligand (RANKL) and treated with different concentrations of AE. AMCase expression was detected from the analysis of saliva, periodontal pocket tissues, and differentiated osteoclasts. Among rats with P. gingivalis-induced periodontitis, the alveolar bone resorption levels and periodontal pocket depth were significantly reduced after treatment with AE. AMCase protein expression was significantly higher in the disease group than in the healthy control (P<0.05). However, AE inhibited periodontal inflammation by downregulating AMCase expression in saliva and periodontal pocket tissue. AE significantly reduced RANKL-stimulated osteoclastogenesis by modulating AMCase (P<0.05). AE decreases alveolar bone loss and periodontal inflammation, suggesting that this natural anthraquinone has potential value as a novel therapeutic agent against periodontal disease.

Risk Stratifying and Prognostic Analysis of Subclinical Cardiac Implantable Electronic Devices Infection: Insight From Traditional Bacterial Culture.

BackgroundSubclinical infection of cardiac implantable electronic devices (CIEDs) is a common condition and increases the risk of clinical infection. However, there are limited studies focused on risk stratifying and prognostic analysis of subclinical CIED infection.Methods and ResultsData from 418 consecutive patients undergoing CIED replacement or upgrade between January 2011 and December 2019 were used in the analysis. Among the patients included, 50 (12.0%) were detected as positive by bacterial culture of pocket tissues. The most frequently isolated bacteria were coagulase‐negative staphylococci (76.9%). Compared with the noninfection group, more patients in the subclinical infection group were taking immunosuppressive agents, received electrode replacement, or received CIED upgrade and temporary pacing. Patients in the subclinical infection group had a higher PADIT (Prevention of Arrhythmia Device Infection Trial) score. Univariable and multivariable logistic regression analysis found that use of immunosuppressive agents (odds ratio [OR], 6.95 [95% CI, 1.44–33.51]; P=0.02) and electrode replacement or CIED upgrade (OR, 6.73 [95% CI, 2.23–20.38]; P=0.001) were significantly associated with subclinical CIED infection. Meanwhile, compared with the low‐risk group, patients in the intermediate/high‐risk group had a higher risk of subclinical CIED infection (OR, 3.43 [95% CI, 1.58–7.41]; P=0.002). After a median follow‐up time of 36.5 months, the end points between the subclinical infection group and noninfection group were as follows: composite events (58.0% versus 41.8%, P=0.03), rehospitalization (54.0% versus 32.1%, P=0.002), cardiovascular rehospitalization (32.0% versus 13.9%, P=0.001), CIED infection (2.0% versus 0.5%, P=0.32), all‐cause mortality (28.0% versus 21.5%, P=0.30), and cardiovascular mortality (10.0% versus 7.6%, P=0.57).ConclusionsSubclinical CIED infection was a common phenomenon. The PADIT score had significant value for stratifying patients at high risk of subclinical CIED infection. Subclinical CIED infection was associated with increased risks of composite events, rehospitalization, and cardiovascular rehospitalization.

Antibiotic-Eluting Envelopes to Prevent Cardiac-Implantable Electronic Device Infection: Past, Present, and Future.

Objective: Cardiac-implantable electronic device (CIED) infections are associated with significant morbidity and mortality. In this review, we describe the risk factors and pathogenesis of CIED infections and review the rationale and the evidence for the use of antibiotic-eluting envelopes (ABEs) in patients at increased risk for CIED infections.Findings: The majority of CIED infections are caused by staphylococci that involve generator pocket and occur due to contamination of the device or the pocket tissues at the time of implantation. Clinical trials have shown that extending the duration of post-operative systemic antibacterial therapy is not beneficial in reducing CIED infection rate. However, ABEs that reduce device migration after implantation and provide sustained local delivery of prophylactic antibiotics at the pocket site, may provide benefit in reducing infection. Currently, there are two types of commercially available CIED envelope devices in the United States. The first ABE device (TYRX™, Medtronic Inc., Monmouth Junction, NJ) is composed of a synthetic absorbable mesh envelope that elutes minocycline and rifampin and has been shown to reduce CIED pocket infections in a large multi-center randomized clinical trial. The second ABE device (CanGaroo-G™, Aziyo Biologics, Silver Spring, MD) is composed of decellularized extracellular matrix (ECM) and was originally designed to stabilize the device within the pocket, limiting risk for migration or erosion, and providing a substrate for tissue ingrowth in a preclinical study. This device has shown promising results in a preclinical study with local delivery of gentamicin. Compared with artificial materials, such as synthetic surgical mesh, biologic ECM has been shown to foster greater tissue integration and vascular ingrowth, a reduced inflammatory response, and more rapid clearance of bacteria.Conclusions and Relevance: ABE devices provide sustained local delivery of antibiotics at the generator pocket site and appear beneficial in reducing CIED pocket infections. Given the continued increase in the use of CIED therapy and resultant infectious complications, innovative approaches to infection prevention are critical.

Microbiological Characteristics and Clinical Features of Cardiac Implantable Electronic Device Infections at a Tertiary Hospital in China.

The incidence of cardiac implantable electronic device (CIED) infections is rapidly increasing worldwide. However, the microbiological characteristics and clinical features of symptomatic CIED infections are not well described. The present study included patients with CIED infections in China, and their pocket tissues were collected for clinical microbiological determination. A total of 219 patients with CIED infections were investigated; of these patients, 145 (66.2%) were positive for CIED infection in pocket tissue cultures and 24 (11.0%) were positive in both blood and pocket tissue cultures. Patients with recurrent infections and patients with systemic infections tended to have higher rates of positive cultures from pocket tissue. In addition, patients with lung diseases were more likely to have early CIED infections than late CIED infections, while patients with liver diseases were more susceptible to systemic infections than local infections. Staphylococcus species were the most common cause of CIED infections; coagulase-negative staphylococci was the predominant type (accounting for 45.2% in all cases and 68.3% in culture-positive cases). None of the Staphylococcus isolates were resistant to gentamicin, linezolid or vancomycin. Gram-negative bacilli accounted for 9.1% of all cases and 13.8% of culture-positive cases. Significant differences in the distribution of different pathogens were identified between primary infections and recurrent infections, between local infections and systemic infections, and between early infections and late infections. Our data describe the microbiological characteristics and clinical features of CIED infections, and provide evidence for advisory guidelines on the management of CIED infections in China.

Identification of bacteriology and risk factor analysis of asymptomatic bacterial colonization in pacemaker replacement patients.

BackgroundRecent researches revealed that asymptomatic bacterial colonization on PMs might be ubiquitous and increase the risk of clinical PM infection. Early diagnosis of patients with asymptomatic bacterial colonization could provide opportunity for targeted preventive measures.ObjectiveThe present study explores the incidence of bacterial colonization of generator pockets in pacemaker replacement patients without signs of infection, and to analyze risk factors for asymptomatic bacterial colonization.MethodsFrom June 2011 to December 2013, 118 patients underwent pacemaker replacement or upgrade. Identification of bacteria was carried out by bacterial culture and 16S rRNA sequencing. Clinical risk characteristics were analyzed.ResultsThe total bacterial positive rate was 37.3% (44 cases), and the coagulase-negative Staphylococcus aureus detection rate was the highest. Twenty two (18.6%) patients had positive bacterial culture results, of which 50% had coagulase-negative staphylococcus. The bacterial DNA detection rate was 36.4 % (43 cases). Positive bacterial DNA results from pocket tissues and the surface of the devices were 22.0% and 29.7%, respectively. During follow-up (median, 27.0 months), three patients (6.8%, 3/44) became symptomatic with the same genus of microorganism, S. aureus (n=2) and S. epidermidis (n=1). Multivariable logistic regression analysis showed that history of bacterial infection, use of antibiotics, application of antiplatelet drugs, replacement frequency were independent risk factors for asymptomatic bacterial colonization.ConclusionThere was a high incidence of asymptomatic bacterial colonization in pacemaker patients with independent risk factors. Bacterial culture combined genetic testing could improve the detection rate.

외국인 이주노동자의 구강건강수준과 치과 의료이용 관련요인

Objectives: The purpose of the study is to investigate the related factors to dental care utilization, oral health behaviors, and oral health status in immigrant workers in Korea. Methods: The subjects were 504 foreign immigrant male workers over 20 years old who visited Daegu labor consultation center for oral health survey and oral examination. The questionnaire included 5 questions of socioeconomic characteristics, 8 questions of oral health practice behavior, 6 questions of dental clinic visit, 8 questions of social relations and Korean language proficiency. The question for health behavior was measure by body mass index(BMI). Social relations and Korean language proficiency instrument was modified by Seol from "Family welfare survey in Korean international marriage" and scored by Liker 5 scale. Results: The oral health examination of the immigrant workers was as follows: decayed teeth - 76.6%, filling teeth - 27.4%, missing teeth - 69.8%, dental caries experience above five or more - 60.2%, periodontal pocket tissues - 58.9%. Simplified Oral Hygiene Index was very poor and accounted for 49.0%. Dental care utilization experience was closely associated with social relation indexes including attendance in family events, household stuff help, financial help and counseling for hard work(p<0.01). Dental care utilization experience proportionally increased with proficiency in Korean literacy including speaking, listening, and writing abilities of Korean language(p<0.01). Conclusions: In order to improve the oral health condition of the immigrant workers, it is important to provide social network, Korean language proficiency support, and health insurance coverage through economic burden reduction by the Korean government.

Non‐bacterial protein expression in periodontal pockets by proteome analysis

To compare the proteomic profile of inter-proximal pocket tissues with inter-proximal healthy tissues in the same subject to reveal proteins associated with periodontal disease in sites where periodontopathogenic bacteria were not detectable. Twenty-five healthy patients, with moderate-to-advanced chronic periodontitis and presenting with at least one intra-bony defect next to a healthy inter-proximal site were enrolled. The periodontal defects were treated with osseous resective surgery, and the flap design included both the periodontal pockets and the neighbouring inter-proximal healthy sites. Pocket-associated and healthy tissues were harvested for proteomic analyses. Fifteen proteins were differently expressed between pathological and healthy tissues. In particular, annexin A2, actin cytoplasmic 1, carbonic anhydrase 1 & 2; Ig kappa chain C region (two spots) and flavinreductase were overexpressed, whereas 14-3-3 protein sigma and zeta/delta, heat-shock protein beta -1 (two spots), triosephosphateisomerase, peroxiredoxin-1, fatty acid-binding protein-epidermal, and galectin-7 were underexpressed in pathological tissue. The unbalanced functional network of proteins involved could hinder adequate tissue response to pathogenic noxa. The study of periodontal pocket tissue proteomic profile would be crucial to better understand the pathogenesis of and the therapeutic strategies for periodontitis.

Herpes Simplex I virus impairs regenerative outcomes of periodontal regenerative therapy in intrabony defects. A pilot study

To evaluate the impact of herpesvirus type-1 and -2 on the clinical outcomes of periodontal regenerative procedures in isolated deep intrabony pockets, in an experimental population with no detectable periodontal pathogens. Seventeen periodontal intraosseous defects in 17 moderate-to-advanced periodontitis patients were treated with regenerative therapy and amelogenins. Microbiological evaluation was performed at baseline (after the completion of initial therapy) and at 1year to exclude the presence of periodontal pathogens. Herpesviruses-1 and -2 DNA were quantified in the pocket tissues associated to the intrabony defect using molecular assays. Clinical attachment level (CAL), probing pocket depth (PPD) and gingival recession (REC) were recorded at baseline and at 1year. After 1year, the 17 defects resulted in significant CAL gain, PPD reduction and REC increase. HSV-1 was detected in five patients. Herpesvirus-2 was never found. The two subpopulations positive or negative to herpesvirus-1 were homogeneous at baseline. At 1year, the five herpesvirus-1 positive patients resulted in lower amounts of CAL-gain and PPD reduction and greater amount of REC with respect to the 12 herpesvirus-1 negative patients. The presence of herpesvirus-1 at baseline is associated with poor clinical outcomes following regenerative therapy.

Human gingiva is another site of C‐reactive protein formation

C-reactive protein (CRP) is primarily synthesized in the liver. It is hypothesized that human gingiva per se may produce CRP and its expression could be associated with IL-6. This study elucidated the CRP expression profile in human gingiva and its possible association with IL-6. Ninety-four gingival biopsies were collected from 44 subjects with chronic periodontitis and 18 periodontally healthy subjects. CRP protein was detected by immunohistochemistry and Western blotting, while CRP and IL-6 mRNAs were examined by reverse transcriptase-polymerase chain reaction (RT-PCR) and real-time PCR. CRP protein expression in the reconstituted human gingival epithelia (RHGE) was examined by the particle-enhanced immunoturbidimetric assay and Western blotting. CRP protein was detected in gingival tissues from patients and healthy subjects by immunohistochemistry and confirmed by Western blotting. Its expression pattern and level at 16 pairs of periodontal pocket tissues and the adjacent clinically healthy tissues from 16 patients were significantly interrelated (r(s)=0.693, p<0.01). CRP mRNA expression was strongly correlated with IL-6 (r=0.694, p<0.001). Both CRP protein and mRNA were detected in the RHGE. The present study shows for the first time that human gingiva is able to produce CRP in situ that may be associated with IL-6 activity.

The Expression Profile of Lipopolysaccharide‐Binding Protein, Membrane‐Bound CD14, and Toll‐Like Receptors 2 and 4 in Chronic Periodontitis

This study aimed to investigate the interrelationship of in vivo expression of lipopolysaccharide-binding protein (LBP) and membrane-bound CD14 (mCD14) in human gingival tissues as well as the coexpression of Toll-like receptors (TLR) 2 and 4 in association with periodontal conditions. Gingival biopsies were collected from 43 subjects with chronic periodontitis, including periodontal pocket tissues (PoTs) and clinically healthy gingival tissues (HT-Ps), and from 15 periodontally healthy subjects as controls (HT-Cs). The expression of LBP, CD14, TLR 2, and TLR 4 was detected by immunohistochemistry and reverse transcription-polymerase chain reaction (RT-PCR). LBP and mCD14 peptides were simultaneously detected in 91% of PoTs, 85% of HT-Ps, and 100% of HT-Cs. LBP and mCD14 mRNAs were simultaneously detected in 55% of PoTs, 55% of HT-Ps, and 75% of HT-Cs. The expression of LBP was confined to the gingival epithelium, whereas mCD14 was observed around the epithelium-connective tissue interface. A positive correlation existed between LBP and mCD14 peptides in both detection expression (r(s) = 0.608; P <0.001) and expression levels (r = 0.304; P <0.05) of these two molecules. In PoTs, TLR 2 was detected in both pocket epithelia and macrophage-like cells in connective tissues, whereas TLR 4 was predominantly detected in connective tissues. In HT-Ps and HT-Cs, a weak expression of TLR 2 was found in gingival epithelia, and no TLR 4 expression was detected. In PoTs, mCD14 was codetected on CD68-labeled macrophages in the underlying connective tissues of pocket epithelium as well as on CD1a-labeled dendritic cells in the pocket epithelium and connective tissues interface. No similar expression profile was detected in HT-Ps and HT-Cs. This study suggests that the in vivo expression of LBP and mCD14 may be interrelated. Altered cellular expression profiles of mCD14 and TLR 2 and 4 in periodontal pocket tissues imply that these pattern recognition receptors may play a role in periodontal pathogenesis.

Expression of human β‐defensin‐3 in gingival epithelia

This study aimed to investigate the expression patterns of the newly discovered human beta-defensin-3 (hBD-3) in human gingiva. Human beta-defensins (hBDs) are a group of small, broad-spectrum, cationic antimicrobial peptides. Our recent study showed that the expression levels of hBD-1 and 2 peptides were associated with periodontal conditions. A total of 49 gingival biopsies were collected, including 33 samples from 21 patients with chronic periodontitis and 16 samples from 16 periodontally healthy subjects. The expression of hBD-3 was detected by immunohistochemistry and in situ hybridization. Double staining was undertaken to identify hBD-3 peptide-positive cells, using CD-1a and cytokeratin 20 as markers for Langerhans cells and Merkel cells, respectively. hBD-3 peptide was detected in 88% of the samples, which was confined to the gingival epithelia. In healthy control subjects, hBD-3 peptide was more frequently detected in the basal layer as compared to the patients (53% vs. 18%, p < 0.05). In patients, hBD-3 expression extended from the basal layer to the spinous layers (82%), in which hBD-3 was confined to the basal and deep spinous layers in clinically healthy tissues from patients, whereas it extended to the superficial spinous layers in pocket tissues from patients (0% vs. 50%, p < 0.05). In both groups, hBD-3 peptide was expressed not only in gingival keratinocytes, but also in Langerhans cells and Merkel cells. hBD-3 transcripts were detected in 90% of the samples and they were confined to the basal and/or suprabasal layers of gingival epithelia. This study shows that hBD-3 is frequently expressed in gingival epithelia. The appropriate expression of hBD-3 peptide may contribute to the maintenance of periodontal homeostasis, possibly through its antimicrobial effect and promotion of adaptive immune responses.

Local expression of lipopolysaccharide-binding protein in human gingival tissues.

Lipopolysaccharide-binding protein (LBP) functions as a crucial molecule in innate host defense responses to bacterial challenge through neutralization of bacterial lipopolysaccharide (LPS) and activation of cellular responses. This study was to investigate the expression profile and levels of LBP in gingival tissues and their associations with periodontal health and disease. Gingival biopsies were collected from 44 chronic periodontitis patients, including periodontal pocket tissues (PoTs) and the adjacent healthy gingival tissues (HT-Ps), as well as from 15 periodontally healthy subjects as controls (HT-Cs). The peptide and mRNA of LBP were detected by semi-quantitative immunohistochemistry and reverse transcription-polymerase chain reaction (RT-PCR), respectively. LBP peptide was detected in 90.9% of PoTs (20/22), 84.6% of HT-Ps (11/13) and all HT-Cs (7/7). The expression of LBP was mainly confined to the cytoplasm of granular and keratinized layers of gingival epithelium, spreading from the oral sulcular epithelium to oral epithelium with the expression density decreasing gradually from coronal to apical portion. LBP peptide was also found on endothelial surfaces and/or inside the lumens of blood vessels in connective tissues. The mean LBP expression levels in HT-Cs were significantly higher than those in HT-Ps and PoTs. LBP mRNA was detected in 55% of PoTs (11/20), 55% of HT-Ps (11/20) and 75% of HT-Cs (6/8). We for the first time found the expression of LBP peptide and mRNA in human gingival tissues. Local expression of LBP in gingival tissues might contribute to periodontal homeostasis.

The in vivo expression of membrane-bound CD14 in periodontal health and disease.

Membrane-bound CD14 (mCD14) is a myeloid differentiation antigen expressed on monocytes/macrophages and neutrophils. It is a key molecule responsible for the innate recognition of bacteria by host cells and functions as an important receptor for bacterial lipopolysaccharide. This study investigated the in vivo expression profile and levels of mCD14 in healthy and diseased gingival tissues. Gingival biopsies were obtained from 24 patients with chronic periodontitis, including 22 periodontal pocket tissues, 13 clinically healthy tissues, and 18 inflamed connective tissues (i.e., granulation tissues). Gingival biopsies from seven periodontally healthy subjects were used as controls. mCD14 was detected by immunohistochemistry. mCD14 was detected in 21 of 22 periodontal pocket tissues and all other categories of tissues. The mCD14-positive cells were mainly confined to the gingival epithelium-connective tissue interface. The expression levels in periodontally healthy subjects were significantly higher than in the patients. Within the patients, clinically healthy tissues showed greater levels of mCD14 than periodontal pocket tissues and granulation tissues. mCD14 was commonly expressed in both healthy and diseased gingival tissues and was predominantly confined to the epithelium-connective tissue interface. The positive relationship observed between mCD14 expression levels and periodontal health may imply that mCD14 is associated with favorable host responses to bacterial challenge and contributes to maintaining periodontal homeostasis.

Expression of human beta-defensins-1 and -2 peptides in unresolved chronic periodontitis.

Human beta-defensins (hBDs) are antimicrobial peptides which contribute to host innate immunity by disrupting the membrane integrity of a broad spectrum of microorganisms. This study aimed to determine the expression profiles of hBD-1 and -2 peptides in gingiva and to assess the possible relations of these antimicrobial peptides with periodontal health and disease. Seven periodontally healthy subjects and 22 patients with unresolved chronic periodontitis were recruited and the gingival biopsies collected consisted of healthy tissues from the healthy subjects (HT-C); periodontal pocket tissues (PoT) and inflamed connective tissues (ICT) from the base of pocket, i.e. granulation tissues, as well as clinically healthy tissues (HT-P) from the adjacent clinically healthy sites from the patients. The expression of hBD-1 and -2 peptides was detected by immunohistochemistry and quantitatively analyzed with a computerized image processing system. Both hBD-1 and -2 peptides were detected in all periodontally healthy subjects, while hBD-1 was detected in all patients and hBD-2 was found in most of the patients. Their expression was mainly confined to the granular and spinous layers of gingival epithelium, in which hBD-1 was detected in both intercellular spaces and cytoplasm, whereas hBD-2 was mainly observed in the cytoplasm. HT-C expressed significantly higher levels of hBD-2 than HT-P (p < 0.05). Within the patients, both defensins were up-regulated significantly in PoT as compared with the adjacent HT-P (p < 0.05). The present study showed that hBD-1 and -2 were frequently expressed in the granular and spinous layers of gingival epithelia and their expression may be associated with periodontal health and disease.

Oral contraceptives do not alter the course of experimentally induced chlamydial salpingitis in monkeys.

The effects of oral contraceptive use on chlamydial infections and ensuing PID are not well understood. In this study, the effects of oral contraceptives on the clinical course of acute chlamydial salpingitis were investigated. Monkeys (n = 4) in which salpingeal auto-transplants had been established were given oral contraceptive pills consisting of a combination of estrogen and progesterone (Norlestrin 1/50, Parke-Davis, Ann Arbor, MI). After one complete cycle of hormone treatment, monkeys were inoculated with C. trachomatis serovar E in the subcutaneous salpingeal pockets while under continuous hormone treatment. Inoculated pockets were biopsied serially for isolation of organisms and histopathological evaluation. Two monkeys not given oral contraceptives were studied in parallel. The duration of infection as evidenced by recovery of organisms was not appreciably different between the treated and untreated monkeys. Chlamydia could be recovered from pocket tissues through day 10 post-infection in control and treated animals, and on day 14 post-infection in one of two control animals. Thereafter all isolation became negative. The inflammatory infiltrate consisted primarily of mononuclear cells (50-100 cells per 40 x field). Our results indicate that administration of oral contraceptives did not affect the duration of shedding of organisms nor the histopathology of acute chlamydial infection of the reproductive tract.

Bacterial Penetration of the Pocket Tissues in Juvenile/ Postjuvenile Periodontitis after the Presurgical Oral Hygiene Phase

Previous ultrastructural investigations of untreated sites of both adult and juvenile periodontitis have shown bacteria within the periodontal soft tissues. In the present study biopsies of the soft tissue walls of deep pockets from seven patients with juvenile (JP) or postjuvenile periodontitis (PJP) were removed at the end of the presurgical oral hygiene phase of treatment and examined in the transmission electron microscope. Bacteria were sparse, regardless of the level of tissue breakdown, both on the surface and within the superficial layers of the epithelium, deep to the basement membrane and throughout the underlying connective tissue. Of the 140 blocks from 20 biopsies, only two revealed intratissue accumulations of microorganisms. The organisms observed were gram-positive or gram-negative and appeared to be exclusively coccoid or rod-shaped. It is suggested that the reduced tissue content of bacteria reflects the establishment of adequate oral hygiene. Evidently either the tissue content of bacteria is less than has been reported previously or the host response is able to cope with residual bacteria that have penetrated the soft tissue.

Bacterial penetration of pocket soft tissues in chronic adult and juvenile periodontitis cases. An ultrastructural study.

This study investigates bacterial invasion of the soft tissue walls of deep pockets from cases with adult (AP) and juvenile periodontitis (JP). Transmission electron microscopy was used to examine pocket soft tissue walls removed from extracted teeth from 5 patients with AP and 2 patients with JP. Bacteria were sparse throughout the epithelium and connective tissue, regardless of the level of tissue breakdown. However many inflammatory cells were seen, and these did appear to be located in regions of marked collagen loss. Accumulations of large numbers of bacteria were extremely rare and found only on the epithelial surface or in artefactual spaces within the deeper tissues. The findings indicate that the tissue destruction associated with periodontitis is not directly related to bacterial invasion. The sparse organisms within the pocket tissues probably result from passive entry rather than an invasive action. Under these circumstances, it would seem reasonable to suggest that bacterial metabolic products rather than the micro-organisms themselves penetrate the tissues in periodontitis.