As doenças periodontais (DP) afetam os tecidos de suporte dos dentes e são desencadeadas por micro-organismos gram-negativos anaeróbios presentes no biofilme periodontal. A evolução da doença é influenciada pela resposta inflamatória e imunológica do hospedeiro e envolve a participação de diversos tipos celulares, que atuam no micro ambiente local modulando a resposta do hospedeiro em busca do controle da infecção. Acredita-se que citocinas inflamatórias, quimiocinas e seus receptores estão envolvidos na migração celular para os tecidos periodontais, contudo, pouco se sabe sobre os mecanismos de determinação de resistência ou susceptibilidade às DP; ou no desencadeamento do dano tecidual decorrente da resposta. Neste projeto, avaliou-se o papel das células CCR5+ na DP experimental induzida pela inoculação oral de Aggregatibacter actinomycetemcomitans em camundongos C57BL/6 wild type e camundongos CCR5-knockout. Os resultados mostram que a maioria das células CCR5+ possuem fenótipo compatível com células T do subtipo Th1, devido a co-expressão de CD3 e CXCR3; além de co-expressarem RANKL. Na ausência das células CCR5+, houve uma significativa diminuição da migração de células inflamatórias totais e RANKL+ para os tecidos periodontais, diminuição da reabsorção óssea alveolar, diminuição dos níveis de expressão de citocinas pró-inflamatórias TNFα-, IL-1β e IFN-γ, assim como diminuição na expressão de MMP-1, MMP-2 e MMP-13. Sua ausência não interferiu no controle da infecção periodontal apesar da diminuição dos níveis de iNOS. Estes resultados conduzem à conclusão de que a maioria das células CCR5+ são células T do subtipo Th1, que atuam como importantes moduladoras das citocinas TNFα-, IL-1β e IFN-γ, das metaloproteinases de matriz MMP-1, MMP-2 e MMP-13, e que também expressam e modulam a expressão de RANKL, tendo participação importante na imunopatogenese da DP experimental, sem interferir no controle da infecção periodontal. Estes fatos tornam as células CCR5+ potenciais alvos para intervenção terapêutica visando ao controle das doenças periodontais. / The periodontal diseases (PD) affect the supportive tissues of the teeth and are triggered by periodontopathogens present in the dental biofilm. The clinical outcome is highly influenced by the host inflammatory and immune response with participation of many cellular types, that act in the local microenvironment modulating the host response to control the infection. Inflammatory cytokines, chemokines and its receptors are thought to be involved in the cellular migration to the periodontal tissues, but there is little knowledge about the mechanisms of determination of resistance or susceptibility to the PD and in the triggering of tissue damage by immune response components. This study evaluated the role of CCR5+ cells in the experimental PD induced by oral inoculation of Aggregatibacter actinomycetemcomitans in C57BL/6 wild type mice and CCR5-knockout mice. The phenotypic analysis of inflammatory infiltrate demonstrated that the most of CCR5+ cells coexpress CD3 and CXCR3, suggesting a phenotype compatible with Th1-type cells, and also co-express RANKL. In the absence of CCR5+ cells there was a significant overall reduction of inflammatory cells and RANKL+ cells influx to the periodontal tissues, reduction in the alveolar bone resorption, reduction in the levels of pro-inflammatory cytokines TNFα-, IL-1β and IFN-γ expression, as a reduction in the expression of MMP-1, MMP-2 and MMP-13. The absence of CCR5+ cells did not impair the control of periodontal infection, despite the reduction of iNOS levels. In conclusion, these data demonstrate that the most of CCR5+ cells are Th1 cells, which act as important modulators of TNFα-, IL-1β and IFN-γ, MMP-1, MMP- 2 and MMP-13 levels, and which also express and modulate the expression of RANKL, playing an important role in the immunopathogenesis of experimental PD, without impairing the control of periodontal infection. These facts point to CCR5+ cells as potentials targets to therapeutic interventions aimed to control periodontal diseases.

Aggregatibacter actinomycetemcomitans está associado à periodontite agressiva, caracterizada pela intensa reabsorção do osso alveolar. Esta espécie produz a toxina distensora citoletal (AaCDT) que possui atividade de DNAse, e promove o bloqueio das células alvo na fase G2 ou G1/ G2. Por outro lado, CDT ativa a cascata apoptótica pela atividade de PIP3, regulando a proliferação e sobrevivência de linfócitos, pelo bloqueio de Akt. Em monócitos, AaCDT induz aumento da produção de citocinas pró-inflamatórias e inibe a produção de óxido nítrico e fagocitose. Células precursoras de osteoclastos têm origem hematopoiética e sofrem diferenciação em osteoclastos, mediada pelo RANKL, mas outros fatores co-estimulatórios estão envolvidos. A AaCDT induz a produção de RANKL por fibroblastos. Assim, formulamos a hipótese se CDT influenciaria a homeostase óssea por afetar a diferenciação de células precursoras de osteoclastos. O estudo visou determinar o efeito de AaCDT sobre a sobrevivência, diferenciação e atividade em RAW264.7 e BMC. Os dados sugerem que a CDT interfere na homeostase óssea, favorecendo a indução da diferenciação de células precursoras de osteoclastos e alterando o perfil de citocinas produzidas. / Aggregatibacter actinomycetemcomitans is associated with aggressive periodontitis, characterized by severe alveolar bone resorption. This species produces a distending toxin cytolethal (AaCDT) which has DNase activity, and promotes the blocking of target cells in G2 or G1 / G2 phase. On the other hand, CDT activates the apoptotic cascade by PIP3 activity, regulating lymphocyte proliferation and survival by blocking Akt. In monocytes, AaCDT enhances the production of proinflammatory cytokines and inhibits nitric oxide production and phagocytosis. Osteoclast precursor cells are of hematopoietic origin and must undergo differentiation into osteoclasts mediated by RANKL although other co-stimulatory factors are involved. AaCDT induces the production of RANKL by fibroblasts. Thus, CDT is hypothesized to influence bone homeostasis by affecting the differentiation of precursor cells into osteoclasts. This study aimed to determine the effect of AaCDT on survival, differentiation and activity of osteoclasts precursor cells. The data suggested that CDT interfere in bone homeostasis, favoring the differentiation of osteoclasts precursors cells and by altering their cytokines profile.

Aggregatibacter actinomycetemcomitans está associado à periodontite agressiva e produz CDT. Visando contribuir no entendimento do papel da CDT na regulação da resposta imune, foi determinada sua atividade sobre macrófagos e a resposta humoral contra a toxina. CDT inibiu a proliferação de células epiteliais OBA-9 e macrófagos Raw 264.7 e também a produção de NO por células Raw 264.7 e macrófagos peritoneais de camundongos C3H/HePas e C3H/HeJ, mas estimulou a produção de IL-12. Na imunidade humoral, 75% dos soros de indivíduos com PAgL e 81,8% dos PAgG foram reativos para A. actinomycetemcomitans. Não houve diferença na resposta contra CDTA e CDTB entre o soro de pacientes com diferentes condições periodontais. Todos os pacientes PAgG foram soropositivos para a CDTC, porém apenas 8,3% dos indivíduos com PAgL, nenhum dos PC e 25% dos saudáveis foram positivos. CDT tem atividade imunomodulatória e a resposta humoral difere entre indivíduos infectados pela bactéria. / Aggregatibacter actinomycetemcomitans is associated with aggressive periodontitis and produces CDT. Aiming to contribute in the understanding the CDT activity in the immune response regulation, its action on macrophages was determined and the response against the toxin analyzed. CDT inhibited the proliferation of OBA-9 epithelial cells and Raw 264.7 macrophages and also inhibited the NO production by Raw 264.7 cells and peritoneal macrophages of C3H/HePas and C3H/HeJ mice, however, stimulated the IL-12 production. In the humoral immunity, 75% of sera from LAgP subjects and 81.8% were reactive to A. actinomycetemcomitans. There was not difference in the response against CDTA and CDTB among sera of patients with different periodontal conditions. All GAgP subjects were sera-reactivity to CDTC, however only 8.3% LAgP subjects, none in CP and 25% of healthy subjects were positive. CDT has immunomodulatory activity and the humoral response differ among bacteria infected subjects.

Aggregatibacter actinomycetemcomitans (A.a) é associado a periodontite agressiva. Na infecção, pode ocorrer ativação de vias de sinalização do hospedeiro e bacterianas. Objetivos: determinar a transcrição de genes relacionados à virulência bacteriana e das vias de transdução de sinais da célula epitelial após interação bactéria-célula epitelial. Métodos: cepas de A.a foram co-cultivadas com células epiteliais OBA-9. A transcrição dos genes bacterianos e das células epiteliais foi determinada por RT-qPCR e a concentração de citocinas determinada por ELISA. Resultados: A regulação da transcrição de certos genes de virulência de A.a é cepa e tempo específica. Quinze genes foram regulados positivamente nas células OBA-9 infectadas. Altos níveis de GM-CSF, TNF-<font face=\"Symbol\">&#945 e ICAM-1 foram detectados em células OBA-9 infectadas e tecidos gengivais de pacientes com periodontite. Conclusão: a interação entre A. a e célula epitelial pode modular a resposta do hospedeiro com a indução da expressão de fatores que exacerbam o processo inflamatório. / Aggregatibacter actinomycetemcomitans (A.a) is associated with the etiology of aggressive periodontitis. The activation of signaling pathways by the host and bacterial cells occurs during infection. Objectives: to determine the transcription of genes related to bacterial virulence and epithelial cell after bacterial-epithelial cell interaction. Methods: A.a strains were co-cultured with epithelial cells OBA-9. The transcription of A.a virulence genes and genes belonging to signaling transduction pathway were determined by RT-qPCR and the concentration of cytokines was determined by ELISA. Results: the transcription of some virulence genes is strain and time specific. Fifteen genes were up-regulated in OBA-9 cells. High levels of GM-CSF, TNF-<font face=\"Symbol\">&#945 and ICAM-1 were detected in infected OBA-9 cells and tissues of patients with periodontitis. Conclusion: the interaction between A.a and epithelial cell can modulate the host response with induction of factors which exacerbate inflammatory process.

Aggregatibacter actinomycetemcomitans produz fatores de virulência que induzem destruição periodontal, porém a sua regulação é pouco conhecida. O sistema de dois componentes ArcAB é um regulador da transcrição gênica que percebe concentrações de oxigênio no ambiente. Este estudo tem como objetivo construir uma amostra de A. actinomycetemcomitans arcB deficiente e comparar características fenotípicas e de transcrição gênica em relação à amostra selvagem. As curvas de crescimento em condições de microaerofilia e anaerobiose foram similares. Foram observadas diferenças nas capacidades de adesão e invasão às células epiteliais, de formação de biofilme, de adesão à hidroxiapatita recoberta por saliva e na hidrofobicidade entre as amostras. A análise de transcrição gênica por RT-PCR em tempo real mostrou expressão diferenciada de apaH, vppA, vapA e omp29. Os dados indicam que em A. actinomycetemcomitans, ArcB é capaz de detectar condições redox, sendo associado a expressão de fatores de colonização da cavidade oral, regulando a transcrição de genes associados à virulência. / Aggregatibacter actinomycetemcomitans produces several virulence factors which induce periodontal destruction, but little is known about their regulation. The two components system ArcAB is a genetic transcription regulator that senses oxygen concentrations in the environment. This study aimed to construct an A. actinomycetemcomitans arcB deficient mutant and to compare phenotypic carachteristics and gene transcription with the wild type. The growth curves under microaerophilic and anaerobic conditions were similar. There were differences in abilities to adhere and invade epithelial cells, to form biofilm, to adhere to saliva-coated hydroxyapatite and in hydrophobicity between the strains. Gene transcription analysis by real time PCR showed differential expression of apaH, vppA, vapA and omp29. These data indicate that in A. actinomycetemcomitans, ArcB is able to detect redox conditions and is associated with colonization factors of the oral cavity, by regulating transcription of genes associated with virulence.

A Diabetes mellitus do tipo I (IDDM), doença metabólica caracterizada pela deficiência na produção de insulina, causa profundas alterações sistêmicas, incluindo a cavidade bucal. A doença periodontal, que se apresenta mais agressiva em pacientes diabéticos, até mesmo na infância, tem como agentes etiológicos microrganismos denominados periodontopatógenos, dentre eles o Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), anteriormente chamado Actinobacillus actinomycetemcomitans, que em associação às alterações na resposta imune e inflamatória decorrentes da diabetes, poderá causar maior reabsorção do osso alveolar precocemente em crianças. A identificação precoce destes agressores poderá ser extremamente útil para a instituição de medidas preventivas e terapêuticas que possam inibir ou minimizar os efeitos nocivos da IDDM e suas conseqüências para a cavidade bucal. Para este fim, métodos moleculares de investigação estão sendo cada vez mais utilizados, destacando-se a Reação em Cadeia da Polimerase em Tempo Real (Real-Time PCR) com alta especificidade e sensibilidade para detectar e quantificar microrganismos, mesmo em pequeno número e em meios, até então, pouco explorados como a saliva. Por fim, a utilização de um antimicrobiano seguro, que possa ser aplicado topicamente por meio da escovação dentária, como o metronidazol 25% na forma de gel, poderia reduzir ou eliminar o A. actinomycetemcomitans evitando a progressão da doença periodontal. Assim, este estudo foi realizado para observar a presença do A. actinomycetemcomitans antes e após o uso do gel de metronidazol 25% uma vez ao dia, em substituição a uma das escovações diárias. Avaliou também a influência deste protocolo de tratamento nos índices de placa, gengival e profundidade de sondagem em 32 crianças, na faixa etária de 3 a 12 anos de idade, divididas em dois grupos: diabéticos tipo I (D) e não diabéticos (ND). Para avaliação da presença do A. actinomycetemcomitans foi utilizado o método da Real-Time PCR. Os resultados obtidos sugerem que o gel de metronidazol 25%, aplicado segundo o protocolo estabelecido neste trabalho foi efetivo para a redução dos índices de placa, gengival e do A. actinomycetemcomitans, no entanto, pareceu não atuar sobre a profundidade de sondagem. Os dados obtidos sugerem que, ainda que a ocorrência da bactéria nos indivíduos avaliados tenha sido baixa e a diferença entre o grupo diabéticos e não diabéticos tenha restringido-se apenas à profundidade de sondagem, o gel estudado demonstrou ser promissor na prevenção da doença periodontal em crianças diabéticas, havendo necessidade da realização de mais estudos clínicos randomizados. / Type I Diabetes mellitus (IDDM) is a metabolic disease characterized by deficiency on the insulin production, causing great systemic alterations, including at the oral cavity. Periodontal disease is more aggressive in diabetic patients, even during the childhood, and presents as etiological microorganisms the Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), formerly Actinobacillus actinomycetemcomitans. This microorganisms in association to alterations in the immune and inflammatory answers caused by diabetes, can promote a larger and early alveolar bone resorption even in children. So, the early identification of these aggressors could be extremely useful for the institution of preventive and therapeutic measures in order to inhibit or minimize the noxious effects of IDDM and their consequences in the oral cavity. Aiming this early identification, molecular biology methods of investigation are being used more frequently, pointing out the Real Time Polymerase Chain Reaction (Real-Time PCR), which presents high specificity and sensibility to detect and to quantify microorganisms, even in small number and in different media little explored like saliva. The use of a safe topical antibiotic, such as metronidazole 25% gel, which used in association with dental brushing, could reduce or eliminate A. actinomycetemcomitans, avoiding the progression of the periodontal disease. This study evaluated the presence of A. actinomycetemcomitans before and after the use of metronidazole 25% gel once a day, in substitution to one of the daily teeth brushing. It also evaluated the influence of this treatment protocol on the plaque, gingival and probing depth indexes. Thirty-two children, aging from 3 to 12 years were included in this study and they were divided into two groups: type I diabetic (D) and no diabetic (ND). Real-Time PCR methods were used to evaluate the presence of A. actinomycetemcomitans. The obtained data suggest that metronidazole 25% gel, applied according to the established protocol in this study, effectively reduced plaque and gingival indexes and the number of A. actinomycetemcomitans. However, no influence was observed regarding the probing depth. The obtained data suggest that, although the number of bacteria has been small and the difference between the D and ND groups was not observed only regarding probing depth, the studied antibiotic gel demonstrated to be promising in preventing periodontal disease in diabetic children. More randomized clinical trials are necessary for a final conclusion.

The Gram-negative, motile bacterium Campylobacter jejuni is a causative agent of food-borne gastroenteritis. Cytolethal distending toxin (CDT) is one of the important virulence factors for C. jejuni pathogenesis. It was not previously known how CDT is released from C. jejuni into the surrounding environment. In our study, CDT proteins were observed in the periplasmic fraction and all CDT subunits from C. jejuni were released from the bacterial cells in association with OMVs. The OMV-associated toxin caused cytolethal distending effects on tissue culture cells. Our results strongly suggest that the release of OMV-associated CDT is a route by which C. jejuni delivers all CDT toxin subunits (CdtA, CdtB, and CdtC) to the surrounding environment, including infected host tissue.The Gram-negative, motile bacterium Vibrio cholerae is primarily known as the causal organism of the severe dehydrating diarrheal disease cholera. OMVs released from non-O1 non-O139 V. cholerae (NOVC) strain V:5/04 induced an inflammatory response in human host cells. The inflammatory potential is mediated by the nucleotide-binding domain, leucine-rich repeat containing family members NOD1 and NOD2. Physiochemical analysis in conjunction with NOD1/2 reporter assays in HEK293T cells confirmed the presence of the NOD1/2 active peptidoglycan (PGN) in OMVs. Deletion of the quorum sensing master regulator HapR specifically reduced the inflammatory potential of the V:5/04 OMVs and their ability to activate NOD1 and NOD2. These findings suggest that OMVs from a NOVC strain delivered PGN to the host cells, where they elicited an immune response mediated by NOD1 and NOD2.The Gram-negative, non-motile coccobacillus Aggregatibacter actinomycetemcomitans is a natural inhabitant of the oral cavity, but the bacterium can translocate from the oral cavity into the bloodstream and thereby be transported to other regions of the body. A. actinomycetemcomitans is implicated in aggressive forms of periodontitis. The mechanism behind this aggressive periodontitis was not fully known. In addition to several virulence factors, this organism also produces CDT. We have demonstrated that OMVs released by A. actinomycetemcomitans contain several virulence factors, including CDT. We showed that OMVs delivered CDT to the host cells and that CDT was localized inside the nucleus, which led to a cytolethal distending effect on two different cell lines tested: HeLa cells and human gingival fibroblasts (HGF). These results suggest that A. actinomycetemcomitans OMVs could deliver biologically active CDT toxin into the periodontal tissue and may contribute to periodontitis.In our earlier studies, we discovered that an M6 family metalloprotease PrtV was an essential factor for V. cholerae survival from predator grazing. Pure PrtV protein effectively degraded human blood plasma components. In addition, it also showed a dose-dependent cytotoxic effect in the human intestinal HCT8 cell line. V. cholerae produces a large amount of outer membrane vesicles (OMVs) during the normal course of cell growth. OMVs are composed of periplasmic proteins, membrane lipids, lipopolysaccharides and outer membrane proteins. We showed that OMVs can transport several biologically active toxins and enzymes to the surrounding environment and ultimately into the host cells. We have initiated analysis of OMV-associated secretion of virulence factors in V. cholerae. It was observed that PrtV is secreted from V. cholerae wild type strain C6706 into the culture supernatant in association with OMVs and OMV-associated PrtV protein is biologically active and more stable than the free, soluble PrtV protease.

Aggregatibacter (Actinobacillus) actinomycetemcomitans is a bacterium mainly associated with aggressive forms of periodontitis. Among its virulence factors, a leukotoxin is suggested to play an important role in the pathogenicity. Periodontal infections with strains producing high levels of the leukotoxin are strongly associated with severe disease. Leukotoxin selectively kills human leukocytes and can disrupt the local defense mechanisms. Previous studies examining the role of the leukotoxin in host-parasite interactions have mainly focused on polymorphonuclear leukocytes (PMNs). In the inflamed periodontium, macrophages play a significant role in the regulation of the inflammatory reactions and the tissue breakdown and remodeling. Thus, the aim of this dissertation was to investigate death mechanisms of human macrophages exposed to leukotoxin. Human lymphocytes, PMNs, and monocytes/macrophages isolated from venous blood were exposed to purified leukotoxin or live A. actinomycetemcomitans strains producing variable levels or no leukotoxin. Different target cells were characterized by their expression of cell surface molecules. Cell death and viability were studied by examining cell membrane integrity and morphological alterations. Further, processes and cellular markers involved in apoptosis and necrosis were investigated. The expression and activation of pro-inflammatory cytokines of the leukotoxin-challenged leukocytes were examined at the mRNA and protein level. The biological activity of the secreted cytokines was investigated by testing the culture supernatants in a bone resorption assay. Additionally, different intracellular signaling pathways involved in the pro-inflammatory response from the macrophages were examined. Monocytes/macrophages were the most sensitive leukocytes for A. actinomycetemcomitans leukotoxin-induced lysis. This process in monocytes/ macrophages involved caspase-1 activation, and in addition, leukotoxin triggered abundant activation and secretion of IL-1β from these cells. The secreted IL-1β was mainly the 17 kDa bioactive protein and stimulated bone resorption. This activity could be blocked by an IL-1 receptor antagonist. When live bacteria were used, the A. actinomycetemcomitans-induced IL-1β secretion from human macrophages was mainly caused by the leukotoxin. Closer examination of the macrophages exposed to leukotoxin revealed that the induced cell death proceeded through a process that differed from classical apoptosis and necrosis. Interestingly, this process resembled a newly discovered death mechanism termed pyroptosis. The extensive leukotoxin induced IL-1β secretion did not correlate to increased levels of mRNA for IL-1β. It was mainly mediated by caspase-1 activation, since blocking it by a specific inhibitor also abolished the secretion of IL-1β. A similar pattern, but at much lower level, was seen for IL-18. In conclusion, these results show that A. actinomycetemcomitans leukotoxin induces a death process in human macrophages leading to a specific and excessive pro-inflammatory response. Our results indicate that this novel virulence mechanism of leukotoxin may play an important role in the pathogenic potential of A. actinomycetemcomitans.

Aggregatibacter (Actinobacillus) actinomycetemcomitans is a Gram-negative coccobacillus of the Pasteurellaceae family. It is implicated in periodontitis, a common low-grade bacterial infection, but it can also cause non-oral infections. The main aim of this project was to identify and characterize in A. actinomycetemcomitans novel cell surface components bearing virulence potential that could contribute to systemic immunoinflammatory burden. We first established and evaluated a method for preparing homogeneous cell suspensions of autoaggregating clinical isolates of A. actinomycetemcomitans. The chosen method is based on a gradual dispersion of bacterial colonies into solution, which generated homogeneous suspensions without losing cell viability or fimbriation. When sera from two patients with A. actinomycetemcomitans-associated infections were used to probe A. actinomycetemcomitans outer membrane protein (OMP) preparations in western blot, strong reactions were found at 17 kDa. Interestingly, antiserum against CsgA, a major subunit of Eschirichia coli curli, also reacted with A. actinomycetemcomitans OMP preparations at 17 kDa size, that is the size of E. coli CsgA, suggesting antigenic crossreactivity. The 17 kDa A. actinomycetemcomitans OMP was subsequently identified as peptidoglycan-associated lipoprotein (PAL; AaPAL) by using immunoproteomics methods. Studies on the pal gene and its gene product showed that they were conserved among the clinical A. actinomycetemcomitans isolates representing all currently known serotypes. AaPAL expression was shown under different nutritional and atmospheric conditions that resembled those in periodontal pockets. PAL deficiency in turn led to pleiotropic effects on the phenotype of A. actinomycetemcomitans, such as cell elongation and decreased growth rate. To purify AaPAL we employed affinity chromatography using anti-AaPAL peptide antibodies. The extensive characterization of the purified AaPAL by SDS-PAGE gel staining and mass spectrometry demonstrated that the final purification product did not contain other bacterial proteins than AaPAL. The protein had not lost its antigenicity during purification, since it was recognized by sera from patients with A. actinomycetemcomitans-associated oral and nonoral infections. AaPAL also appeared to be a strongly immunoreactive antigen in patients with periodontitis whose serum IgG antibodies recognized in western blot a 17 kDa OMP in the parental strain but not in the pal-deficient mutant. In addition to its immunogenicity, AaPAL also induced proinflammatory cytokine and chemokine response from human whole blood as determined by a cytokine antibody array. A cell culture insert model was designed to study how bacterial components could be introduced to the host in infections. The experiments demonstrated that live bacteria released extracellularly free-soluble AaPAL, but also other components, via an unknown outer membrane vesicle-independent mechanism. The immunogenicity and proinflammatory potential of the previously uncharacterized outer membrane lipoprotein of A. actinomycetemcomitans, AaPAL, suggests that it contributes to the pathogenicity of this bacterium. That live A. actinomycetemcomitans cells released free-soluble cell components may represent a new pathogenic mechanism.

Periodontitis, the primary cause of tooth-loss worldwide, is a bacterially induced chronic inflammatory disease of the periodontium. It is associated with systemic conditions such as cardiovascular disease (CVD). However, pathogenic mechanisms of periodontitis-associated bacteria that may contribute to the CVD association are unclear. The aim of this doctoral thesis project was to characterize bacterial mechanisms that can originate from the periodontal pocket and expose the host to multiple effector proteins, thereby potentially contributing to periodontal tissue degradation and systemic stimulation. As our main model, we have used Aggregatibacter actinomycetemcomitans, a Gram-negative species associated with aggressive forms of periodontitis, and with non-oral infections, such as endocarditis. Since Gram-positive species might be more common in periodontitis than previously believed, we have also investigated mechanisms of the multipotent bacterium, Staphylococcus aureus. Using an ex vivo insert model we showed that free-soluble surface material, released during growth by A. actinomycetemcomitans independently of outer membrane vesicles (OMVs), enhanced the expression of several proinflammatory cytokines in human whole blood. A clear LPS-independent effect suggested the involvement of effector proteins in this cytokine stimulation. This was supported by MALDI-TOF-MS and immunoblotting, which confirmed the release of GroEL and peptidoglycan-associated lipoprotein (PAL), in free-soluble form. We next demonstrated that A. actinomycetemcomitans OMVs could deliver multiple proteins including biologically active cytolethal distending toxin (CDT), a major virulence factor, into human gingival fibroblasts and HeLa cells. Using confocal microscopy, the active toxin unit, CdtB, was localized inside the nucleus of the intoxicated cells, whereas OmpA and proteins detected using an antibody specific to whole A. actinomycetemcomitans serotype a cells had a perinuclear distribution. By using a fluorescent probe, B-R18, it was shown that the OMVs fused with lipid rafts in the plasma membrane. These findings suggest that OMVs can deliver biologically active virulence factors such as CDT into susceptible cells of the periodontium. Using A. actinomycetemcomitans vesicles labeled with the lipophilic dye, PKH26, it was shown that the OMVs can be internalized into the perinuclear region of human cells in a cholesterol-dependent manner. Co-localization analysis supported that the internalized OMVs carried A. actinomycetemcomitans antigens. Inhibition assays suggested that although OMV internalization appeared to have a major role in effector protein delivery, additional interactions such as vesicle membrane fusion may also contribute. The OMVs strongly induced activation of the cytosolic pathogen recognition receptors NOD1 and NOD2 in HEK293T-cells, consistent with a role in triggering innate immunity by carrying PAMPs such as peptidoglycan into host cells. Membrane vesicles (MVs) from S. aureus were found to carry biologically active alpha-toxin, a key virulence factor, which was delivered to host cells and required for full cytotoxicity of the vesicles. Confocal microscopy analysis revealed that these MVs, similar to A. actinomycetemcomitans OMVs, interacted with HeLa cells via membrane fusion. Thus, as S. aureus is frequently found in individuals with aggressive periodontitis, MV production could have potential to contribute to the severity of tissue destruction.