Este estudo visa determinar o efeito da infecção experimental por patógenos periodontais sobre a prenhez. Periodontite foi induzida com P.gingivalis seguindo acasalamento. Infecção por A.actinomycetemcomitans foi realizada iv em camundongos prenhes. No 16º dia da prenhez, os animais foram sacrificados. O grupo teste com Pg apresentou menor peso e menor peso fetal. Pg foi detectado no grupo teste em fetos(8/27), placentas(9/27) e líquido amniótico(1/9). Não houve diferença em citocinas na gengiva e soro. Os níveis placentários de IL-1β, INF- γ, IL-10, GMCSF e IL-12 foram maiores no teste do que no controle. O grupo com Aa apresentou a bactéria em fetos(11/14), placentas(11/14) e líquido amniótico(1/6). Não houve diferença em parâmetros relacionados à prenhez e citocinas séricas entre teste e controle, mas os níveis placentários de TNF-α, IL-4 e IL-6 foram maiores no grupo teste. Os dados sugerem a capacidade de patógenos periodontais ultrapassar a barreira placentária, colonizar e aumentar a produção de mediadores inflamatórios na unidade fetoplacentária. / This study aims to determine the effect of experimental infection by periodontal pathogens on pregnancy. Periodontitis was induced with P. gingivalis following mating. Infection was performed by A.actinomycetemcomitans IV in pregnant mice. On the 16th day of pregnancy, the animals were sacrificed. The test group Pg showed lower weight and reduced fetal weight. Pg was detected in the test group in fetuses (8/27), placentas (9/27) and amniotic fluid (1/9). There was no difference of cytokine in gum and serum. Placental IL-1β, INF-γ, IL-10, GM-CSF and IL-12 were higher in the test compared to the control. The Aa group presented bacteria fetuses (11/14), placenta (11/14) and amniotic fluid (1/6). There was no difference in parameters related to pregnancy and serum cytokines between test and control, but the placental levels of TNF-α, IL-4 and IL-6 were higher in the test group. The data suggest the ability of periodontal pathogens overcome the placental barrier, colonize and increase the production of inflammatory mediators in the fetoplacental unit.

Gingipaine sind Cysteinproteinasen des wohl in Ätiologie und Pathogenese der chronischen Erwachsenenparodontitis bedeutsamsten bakteriellen Erregers und zugleich die wichtigsten Virulenzfaktoren der Spezies Porphyromonas gingivalis. Die für diese extrazellulären Produkte kodierenden Gene sind rgpA, rgpB und kgp. Deren Produkte sind entsprechend HRgpA, RgpB und Kgp. HRgpA und RgpB verursachen eine Steigerung der Gefäßpermeabilität durch die Aktivierung des Kallikrein/Kinin-Systems und aktivieren die Blutgerinnung, welche potentiell mit der Synthese der Sulkusflüssigkeit und dem Fortschreiten der Entzündung bis hin zum Verlust des alveolären Knochens assoziiert sind. Offenbar wird dieses durch die Aktivierung von Matrixmetalloproteinasen begünstigt. Kgp ist von den dreien die potenteste fibrinogen-und fibrinabbauende Proteinase und bei der Blutungsneigung der erkrankten Stellen involviert. HRgpA aktiviert besonders Blutgerinnungsfaktoren. Gingipaine stören das Komplementsystem und manipulieren den Zytokinhaushalt der Entzündungskaskaden. Die Gingipaine unterstützen die Kolonisierung von P. gingivalis durch die Bindung zu anderen Bakterien des subgingivalen Biofilms und der Bindung zu epithelialen Zellen. Sie vermögen an Laminin, Fibrinogen, Fibronektin, Hämoglobin und an manchen Typen von Kollagen zu binden. Alle können den Rezeptor CD14 auf Makrophagen abbauen und so die Leukozytenaktivierung hemmen. Sie regulieren die Infektionsintensität, den Bakterienhaushalt, die Aminosäurenaufnahme aus Wirtsproteinen und die Fimbrienreifung. Die Genetik, die Chemie und die virulenzverursachenden Eigenschaften der Gingipaine stehen seit Mitte der 90iger Jahre des letzten Jahrhunderts im Blickpunkt des wissenschaftlichen Interesses. Aufgrund ihrer Schlüsselrolle bei der Pathogenese der Parodontitis und der mikrobiellen Infektion sind die Gingipaine Ziele für die mögliche Entwicklung von Hemmstoffen respektive für Immunisierungsstrategien gegen die chronische Parodontitis. / Gingipains are cysteine proteases of the probably most important bacterial pathogen of the adult periodontitis in the field of etiology as well as pathology. At the time, they are the most important virulence factors of the species Porphyromonas gingivalis. The encoding genes of this extracellular products are rgpA, rgpB and kgp. Their products are corresponding HRgpA, RgpB and Kgp. HRgpA and RgpB induce vascular permeability enhancement through activation of the kallikrein/kinin system and activate the blood coagulation, processes potentially associated with gingival crevicular fluid synthesis and progression of inflammation which ultimately can lead to alveolar bone loss. Obviously, this will be favoured by matrix metalloproteinases. Kgp is the most potent fibrinogen/fibrin degrading enzyme of the three gingipains involved in the bleeding tendency at the diseased sites. HRgpA especially activates coagulation factors. Gingipains disturb the complement system and manipulate the cytokine network of the inflammation cascades. Gingipains support colonizing of P. gingivalis due to their connection to other bacteria of the subgingival biofilm and to epithelial cells. They are able to bind to laminin, fibrinogen, fibronectin, hemoglobin and some types of collagen. All of them are able to degrade macrophage CD14 receptor, thus preventing activation of the leukocytes. They regulate the intensity of infection and the bacterial housekeeping, including amino acid uptake from host proteins and fimbriae maturation. Genetics, chemistry and the virulence inducing properties of gingipains are the focus of scientific attention since the middle of the nineties of the last century. Due to their key role in pathogenesis of periodontitis and microbial infection the gingipains are targets for the possible development of inhibitory substances, respectively for immunization strategies against chronic periodontitis.

Depuis plusieurs années, l’influence des pathologies parodontales sur certaines pathologies systémiques, notamment les maladies cardio-vasculaires et l’athérosclérose apparait de plus en plus évidente. Dans notre étude, nous nous sommes intéressés à l’évaluation des effets induits par Porphyromonas gingivalis, une des principales bactéries parodontopathogènes, et son lipopolysaccharide sur les cellules endothéliales, qui forment une interface entre le flux sanguin et la paroi vasculaire, d’où un rôle important dans l’initiation et le développement de la plaque d’athérome. Nous avons surtout ciblé les effets induits sur la cathepsine B, une protéase impliquée dans le développement de la plaque d’athérome, et sur l’inflammasome, un complexe impliqué dans la production d’IL-1beta. Les résultats de nos travaux montrent que l’infection par Porphyromonas gingivalis et la stimulation par son LPS sont capables d’induire une augmentation de l’activité enzymatique de la cathepsine B, ceci suivant différentes cinétiques. Dans les deux cas, ces augmentations d’activité se font sans modifications de la synthèse d’ARNm, ni de la concentration protéique de l’enzyme. Nos résultats démontrent également que l’infection par Porphyromonas gingivalis entraine une augmentation de l’expression ARN de l’inflammasome NLRP3, mais celle ci n’est pas observée au niveau protéique du fait d’un processus de protéolyse de la protéine NLRP3 suite à l’infection. Dans un deuxième temps, nous avons développé un modèle de parodontite expérimentale, fiable et reproductible, nous permettant d’envisager une expérimentation in vivo afin d’observer les interactions à distance entre maladies parodontales et athérosclérose sur dessouris apolipoprotéine-E -/-. / Periodontal diseases have been linked to systemic diseases especially cardiovascular diseases and atherosclerosis. In our study, we investigated the effects induced by an infection with Porphyromonas gingivalis, a major periodontal pathogen, and stimulation by its lipopolysaccharide on endothelial cells at the interface between the inner part of arteries and blood flow. We focused on the effects induced on cathepsin B, a protease involved in atherosclerosis and on the activation of inflammasome, an intracellular complex linked to secretion of IL-1beta. Results showed that infection with Porphyromonas gingivalis and stimulation by its lipopolysaccharide increase enzymatic activity of cathepsin B with different kinetics. These modifications are observed without any modifications of RNAm expression and protein concentration. We also showed that infection with Porphyromonas gingivalis increases RNAm expression of NLRP3 but this increase at the RNAm level is not associated with an increase of the protein concentration due to an induced proteolysis. Furthermore, we developed a reliable model of experimental periodontitis that will be used to analyze interactions between periodontitis and systemic diseases in vivo, especially in apolipoprotein-E -/- mice.

Porphyromonas gingivalis é um dos principais organismos associados à periodontite crônica e apresenta intensa diversidade, que poderia refletir em sua virulência. A maioria dos estudos sobre a virulência de P. gingivalis foi realizada com cepas de referência, e pouco se conhece sobre este aspecto em isolados clínicos. A capacidade de indução de abscessos difusos em modelos animais experimentais parece estar associada a cepas capsuladas, enquanto a expressão de fímbrias e a capacidade de internalização em células epiteliais não fagocíticas, foram relacionadas à cepa não capsulada. Em P. gingivalis, o lócus de biossíntese do polissacarídeo capsular (BPC) apresenta características de ter sido adquirido por transferência horizontal de genes. O objetivo do presente estudo foi testar a hipótese de que a estrutura populacional de P. gingivalis relaciona-se com a variabilidade do lócus BPC e características fenotípicas como produção de cápsula e hidrofobicidade. Foram analisadas 28 cepas de P. gingivalis pertencentes aos 5 genótipos fimA quanto a, presença da cápsula por microscopia óptica, hidrofobicidade e detecção de genes do lócus BPC por PCR. A análise filogenética foi realizada por tipagem através de seqüenciamento de genes housekeeping (multilocus sequence typing, MLST). Dezesseis entre 28 amostras estudadas apresentaram cápsula, e não foram detectadas diferenças na hidrofobicidade dos isolados clínicos capsulados e não capsulados. O gene pg0106 foi detectado por PCR em 78% das amostras capsuladas e em 80% das amostras não capsuladas, enquanto pg0111 foi detectado em apenas 25% de amostras capsuladas. Apenas um isolado clínico e a amostra padrão W83 foram classificados como K1, por apresentarem o gene pg0118. Através do MLST foi possível identificar grande variabilidade entre as amostras de P.gingivalis. Foi observada relação entre STs e o tipo fimA ou hidrofobicidade, mas nenhum cluster foi associado à presença da cápsula ou aos genes do lócus de biossíntese do polissacarídeo capsular. Os dados indicam associação entre o lócus BPC e produção de cápsula, porém a diversidade deste lócus parece ser maior do que a relatada na literatura. O lócus BPC e a produção de cápsula não se relacionam com a origem filogenética da cepa, indicando a intensa recombinação que ocorre em P. gingivalis. / Porphyromonas gingivalis is one of main organisms associated with chronic periodontitis and is largely diverse, which could reflect in its virulence. Most studies on the virulence of P.gingivalis were performed with reference strains, and little is known about this aspect in clinical isolates. The ability to induce diffuse abscesses in experimental animal models seems to be associated with encapsulated strains, while expression of fimbriae and the ability to internalize into non phagocytic epithelial cells were related to noncapsulated strains. In P.gingivalis, the locus of biosynthesis of the capsular polysaccharide (GP) has characteristics of having been acquired by horizontal gene transfer. This study aimed to test the hypothesis that the structure population of P.gingivalis is related to the variability of the GPC locus and phenotypic characteristics such as capsule production and hydrophobicity. 28 P.gingivalis isolates representing fimA genotypes were screened for presence of capsule by light microscopy, hydrophobic properties and detection of genes in the GPC locus by PCR. The phylogenetic analysis was performed by sequencing of housekeeping genes typing (multilocus sequence typing, MLST). Sixteen of 28 studied samples had capsule, and there were no differences in the hydrophobic properties of capsulated and non capsulated clinical isolates. The pg0106 gene was detected by PCR in 78% of capsulated isolates and in 80% of not capsulated while pg011 was detected in only 25% of encapsulated isolates. One clinical isolate and reference strain W83 were classified as K1, due to the presence of pg0118 gene. MLST detected large variations within the P.gingivalis population. MLST clustering analysis revealed a relation between sequence type (STs) and fimA genotype or hydrophobic property, but there was no association of STs with the presence of capsule or the genes encoding for the biosynthesis of capsular polysaccharide. The data indicated an association between GPC locus and capsule production but the diversity of this locus appeared to be greater than that reported in the literature. The GPC locus and capsule production were not related to the phylogenetic origin of the strain, indicating intense recombination in P. gingivalis.

P. gingivalis é um dos principais patógenos da doença periodontal, é encontrado em biofilmes orais com S. gordonii e P. intermedia e em células endoteliais da artéria coronária in vivo. P. gingivalis necessita de ferro em seu metabolismo e pode usar certas proteínas do hospedeiro como fontes deste íon em ambientes limitantes. Assim, este estudo investigou o papel dos genes PGN0741/PG0637 (receptor dependente de TonB) e PGN0531/PG1380 (fvW) de P. gingivalis na formação de biofilme em diferentes concentrações de ferro, em biofilmes mistos com S. gordonii e P. intermedia, e na adesão e invasão de células endoteliais da artéria coronária. Os resultados mostraram divergências no papel dos genes TonB e fvW na formação dos monobiofilmes e mistos e em diferentes concentrações de ferro, demonstrando uma relação cepa-dependente. Na adesão, fvW se mostrou importante para ambas cepas, mas na persistência apenas para P. gingivalis W83. Este trabalho enfatiza, assim, a necessidade do uso de mais de uma cepa de P. gingivalis no estudo do papel de genes em ensaios experimentais. / P. gingivalis is one of the major pathogens of periodontal diseases. It is found in oral biofilms associated with S. gordonii and P. intermedia, and inside of coronary artery endothelial cells in vivo. P. gingivalis requires iron for growth and can exploit iron-carrying proteins of the host as sources in limiting environments. Thus, this work aimed to study the role of genes PGN0741/PG0637 (TonB-dependent receptor) and PGN0531/PG1380 (fvW) of P. gingivalis in biofilm formation under different iron concentrations, in mixed biofilms with S. gordonii and P. intermedia, and in the adhesion and invasion of coronary artery endothelial cells. Our data showed discordance for the role of TonB and fvW in homo- and heterotypic biofilm formation and in different iron concentrations. The relevance of both genes was strain-dependent. Gene fvW was relevant for adhesion to endothelial cells, but only for strain W83 during persistence. Therefore, our study emphasizes the importance of using different strains for a better understanding of the role of genes in experimental assays.

As doenças periodontais são infecções locais que apresentam morbidade e têm sido relacionadas com outras doenças ou complicações sistêmicas. Pacientes tabagistas apresentam taxas elevadas e maior predisposição às doenças periodontais severas e avançadas. A administração sistêmica de antibióticos, particularmente metronidazol (M) e amoxicilina (A), associados ao tratamento periodontal mecânico (raspagem e alisamento radiculares - RAR) tem sido amplamente estudada frente às doenças periodontais crônicas. Porém, pouco tem sido esclarecido referente aos efeitos desses tratamentos sobre Porphyromonas gingivalis e seus genótipos. Os objetivos deste trabalho foram: avaliar os efeitos clínicos (profundidade a sondagem - PS, nível de inserção clínica - NIC, índice de placa - IP, sangramento gengival - SG, sangramento à sondagem SS, e supuração - SUP) e microbiológicos (referente à presença de P. gingivalis e seus genótipos fimA II, fimA IV e ragB) após 180 dias do tratamento periodontal mecânico (RAR) associado à administração sistêmica de antibióticos (RAR+M+A), comparados ao tratamento periodontal mecânico (RAR), utilizando-se o PCR convencional (primers específicos para 16S rRNA); e relacionar a presença de P. gingivalis e seus genótipos fimA II, fimA IV e ragB com a profundidade de sondagem (PS) em pacientes fumantes com periodontite crônica. Foram avaliadas 167 amostras oriundas de sítios de 20 sujeitos tratados com RAR (n=11) e RAR + M + A (n=9), no exame inicial e 180 dias após a terapia. Parâmetros clínicos (PS, NIC, IP, SG, SS e SUP) e coletas microbiológicas foram mensuradas em ambos tempos. A detecção da freqüência de P. gingivalis foi realizada por PCR convencional, bem como para os genótipos fimA II, fimA IV e ragB. Não houve diferença estatisticamente significante entre o tratamento periodontal mecânico associado à administração sistêmica de antibióticos (RAR+M+A) e o tratamento periodontal mecânico (RAR), nos pacientes fumantes, em relação à detecção de P. gingivalis. O grupo RAR apresentou-se mais efetivo (estatisticamente significante) na redução de prevalência do genótipo ragB, em comparação ao grupo RAR+M+A, após 180 dias do tratamento. Não foi observada relação estatisticamente significante entre a prevalência de P. gingivalis e dos genótipos fimA II, fimA IV e ragB com a PS no exame inicial. / Periodontal diseases are local infections that present morbidity and have been relation with others systemic diseases or complications. Smoking patients present high levels and bigger predisposition to the severe and advanced periodontal diseases. The systemic administration of antibiotics, mainly metronidazole (M) and amoxicillin (A), associated to the mechanical periodontal treatment (scaling and root planing - SRP) has been largely researched referring to the chronic periodontal diseases. However, not much has been cleared up referring to the effects of those treatments about Porphyromonas gingivalis and its genotypes. The purpose of this research was to evaluate the clinical effects (depth probing - DP, clinical attachment level - CAL, plaque index - PI, gingival bleeding - GB, bleeding on probing - BOP, and supuration - SUP) and microbiological (referring to the presence of P. gingivalis and its genotypes fimA II, fimA IV and ragB) after 180 days of the mechanical periodontal treatment (SRP) associated to the systemic administration of antibiotic (SRP+M+A), compared to the mechanical periodontal treatment (SRP) in smoking patients with chronic periodontitis, by using the conventional PCR (specific primers to the 16S rRNA); to associate the P. gingivalis presence and its genotypes fimA II, fimA IV and ragB with depth probing (DP) of the researched population. 167 samples from the sites of 20 subjects treated with SRP (n=11) and SRP+M+A (n=9) have been evaluated, at the baseline and 180 days after the therapy. Clinical parameters (DP, CAL, PI, GB, BOP and SUP) and microbiological samples were evaluated in both moments. The detection of P. gingivalis frequence was made by using conventional PCR, and also to the genotypes fimA II, fimA IV and ragB. There was no statistically significative difference between the mechanical periodontal treatment associated to the systemic administration of antibiotics (SRP+M+A) and the mechanical periodontal treatment (SRP), in the smoking patients, related to the detection of the P. gingivalis. The SRP group showed more effective (statiscally significative) on the reduction of the genotype ragB prevalence, comparing to the SRP+M+A group, after 180 days of therapy. No statistically significative relation between the prevalence of P. gingivalis and its genotypes fimA II, fimA IV e ragB with DP at the baseline have been observed.

Gingipaine sind Cysteinproteinasen des wohl in Ätiologie und Pathogenese der chronischen Erwachsenenparodontitis bedeutsamsten bakteriellen Erregers und zugleich die wichtigsten Virulenzfaktoren der Spezies Porphyromonas gingivalis. Die für diese extrazellulären Produkte kodierenden Gene sind rgpA, rgpB und kgp. Deren Produkte sind entsprechend HRgpA, RgpB und Kgp. HRgpA und RgpB verursachen eine Steigerung der Gefäßpermeabilität durch die Aktivierung des Kallikrein/Kinin-Systems und aktivieren die Blutgerinnung, welche potentiell mit der Synthese der Sulkusflüssigkeit und dem Fortschreiten der Entzündung bis hin zum Verlust des alveolären Knochens assoziiert sind. Offenbar wird dieses durch die Aktivierung von Matrixmetalloproteinasen begünstigt. Kgp ist von den dreien die potenteste fibrinogen-und fibrinabbauende Proteinase und bei der Blutungsneigung der erkrankten Stellen involviert. HRgpA aktiviert besonders Blutgerinnungsfaktoren. Gingipaine stören das Komplementsystem und manipulieren den Zytokinhaushalt der Entzündungskaskaden. Die Gingipaine unterstützen die Kolonisierung von P. gingivalis durch die Bindung zu anderen Bakterien des subgingivalen Biofilms und der Bindung zu epithelialen Zellen. Sie vermögen an Laminin, Fibrinogen, Fibronektin, Hämoglobin und an manchen Typen von Kollagen zu binden. Alle können den Rezeptor CD14 auf Makrophagen abbauen und so die Leukozytenaktivierung hemmen. Sie regulieren die Infektionsintensität, den Bakterienhaushalt, die Aminosäurenaufnahme aus Wirtsproteinen und die Fimbrienreifung. Die Genetik, die Chemie und die virulenzverursachenden Eigenschaften der Gingipaine stehen seit Mitte der 90iger Jahre des letzten Jahrhunderts im Blickpunkt des wissenschaftlichen Interesses. Aufgrund ihrer Schlüsselrolle bei der Pathogenese der Parodontitis und der mikrobiellen Infektion sind die Gingipaine Ziele für die mögliche Entwicklung von Hemmstoffen respektive für Immunisierungsstrategien gegen die chronische Parodontitis.:Erklärungen I Genehmigungsvermerk II Inhaltsverzeichnis III 1. Einleitung und Fragestellung 4 1.1 Parodontitis 4 1.1.1 Epidemiologie 4 1.1.2 Klassifikation 4 1.1.3 Ätiologie und Pathogenese 5 1.1.4 Mikrobiologie 7 1.1.5 Biofilm 8 1.2 Porphyromonas gingivalis 10 1.3 Verwandtschaftsverhältnisse von P. gingivalis 12 1.4 Mit P. gingivalis assoziierte Proteinasen 15 1.5 Fragestellung 16 2. Material und Methoden 17 3. Ergebnisse und Diskussion 18 3.1 Einführung – Gingipaine als Enzyme von P. gingivalis 18 3.1.1 Definition der Gingipaine 18 3.1.2 RgpA- und RgpB-Gen-Gingipaine 19 3.1.3 Kgp-Gen-Gingipain 20 3.2 Bedeutung der Gingipaine für die Pathogenität von P. gingivalis 21 3.2.1 Gingipaine und fimbrienvermittelte Adhäsion, intrazelluläre Invasion und parazellulärer Pfad von P. gingivalis 21 3.2.2 Effekte auf die Integrität des Bindegewebes 24 3.2.3 Aktivierung des Kallikrein-Kinin-Systems 25 3.2.4 Aktivierende Einflüsse auf das Gerinnungssystem 27 3.2.5 Hemmende Einflüsse auf das Fibrinogen-Fibrin-System 28 3.2.6 Beeinträchtigung der Immunabwehr des Wirts 28 3.3 Gingipaine im biochemischen Regulationsmechanismus von P. gingivalis 35 3.3.1 Die Rolle des proteolytischen Systems von P. gingivalis beim Nährstofferwerb 35 3.3.2 Gingipainreifung und die Steuerung des intrazellulären Haushalts von P. gingivalis 39 3.3.3 Regulation der Proteinaseexpression von P. gingivalis 40 3.3.4 Gingipaine als bakterielle Hämagglutinine, Adhäsine und hämoglobinbindende Proteine 42 3.3.5 Proteinasegenmutationen bei P. gingivalis und ihre enzymatische Aktivität 42 3.4 Gingipaine und systemische Effekte 44 3.5 Synergismen mit anderen Spezies und quorum sensing 45 3.6 Hemmstoffe der Gingipaine 46 3.7 Immunisierung gegen Gingipaine 48 4. Zusammenfassung / Summary 52 5. Literaturverzeichnis 53 Anhang 87 Abbildungsverzeichnis 87 Tabellenverzeichnis 87 Danksagung 88 Lebenslauf 89 / Gingipains are cysteine proteases of the probably most important bacterial pathogen of the adult periodontitis in the field of etiology as well as pathology. At the time, they are the most important virulence factors of the species Porphyromonas gingivalis. The encoding genes of this extracellular products are rgpA, rgpB and kgp. Their products are corresponding HRgpA, RgpB and Kgp. HRgpA and RgpB induce vascular permeability enhancement through activation of the kallikrein/kinin system and activate the blood coagulation, processes potentially associated with gingival crevicular fluid synthesis and progression of inflammation which ultimately can lead to alveolar bone loss. Obviously, this will be favoured by matrix metalloproteinases. Kgp is the most potent fibrinogen/fibrin degrading enzyme of the three gingipains involved in the bleeding tendency at the diseased sites. HRgpA especially activates coagulation factors. Gingipains disturb the complement system and manipulate the cytokine network of the inflammation cascades. Gingipains support colonizing of P. gingivalis due to their connection to other bacteria of the subgingival biofilm and to epithelial cells. They are able to bind to laminin, fibrinogen, fibronectin, hemoglobin and some types of collagen. All of them are able to degrade macrophage CD14 receptor, thus preventing activation of the leukocytes. They regulate the intensity of infection and the bacterial housekeeping, including amino acid uptake from host proteins and fimbriae maturation. Genetics, chemistry and the virulence inducing properties of gingipains are the focus of scientific attention since the middle of the nineties of the last century. Due to their key role in pathogenesis of periodontitis and microbial infection the gingipains are targets for the possible development of inhibitory substances, respectively for immunization strategies against chronic periodontitis.:Erklärungen I Genehmigungsvermerk II Inhaltsverzeichnis III 1. Einleitung und Fragestellung 4 1.1 Parodontitis 4 1.1.1 Epidemiologie 4 1.1.2 Klassifikation 4 1.1.3 Ätiologie und Pathogenese 5 1.1.4 Mikrobiologie 7 1.1.5 Biofilm 8 1.2 Porphyromonas gingivalis 10 1.3 Verwandtschaftsverhältnisse von P. gingivalis 12 1.4 Mit P. gingivalis assoziierte Proteinasen 15 1.5 Fragestellung 16 2. Material und Methoden 17 3. Ergebnisse und Diskussion 18 3.1 Einführung – Gingipaine als Enzyme von P. gingivalis 18 3.1.1 Definition der Gingipaine 18 3.1.2 RgpA- und RgpB-Gen-Gingipaine 19 3.1.3 Kgp-Gen-Gingipain 20 3.2 Bedeutung der Gingipaine für die Pathogenität von P. gingivalis 21 3.2.1 Gingipaine und fimbrienvermittelte Adhäsion, intrazelluläre Invasion und parazellulärer Pfad von P. gingivalis 21 3.2.2 Effekte auf die Integrität des Bindegewebes 24 3.2.3 Aktivierung des Kallikrein-Kinin-Systems 25 3.2.4 Aktivierende Einflüsse auf das Gerinnungssystem 27 3.2.5 Hemmende Einflüsse auf das Fibrinogen-Fibrin-System 28 3.2.6 Beeinträchtigung der Immunabwehr des Wirts 28 3.3 Gingipaine im biochemischen Regulationsmechanismus von P. gingivalis 35 3.3.1 Die Rolle des proteolytischen Systems von P. gingivalis beim Nährstofferwerb 35 3.3.2 Gingipainreifung und die Steuerung des intrazellulären Haushalts von P. gingivalis 39 3.3.3 Regulation der Proteinaseexpression von P. gingivalis 40 3.3.4 Gingipaine als bakterielle Hämagglutinine, Adhäsine und hämoglobinbindende Proteine 42 3.3.5 Proteinasegenmutationen bei P. gingivalis und ihre enzymatische Aktivität 42 3.4 Gingipaine und systemische Effekte 44 3.5 Synergismen mit anderen Spezies und quorum sensing 45 3.6 Hemmstoffe der Gingipaine 46 3.7 Immunisierung gegen Gingipaine 48 4. Zusammenfassung / Summary 52 5. Literaturverzeichnis 53 Anhang 87 Abbildungsverzeichnis 87 Tabellenverzeichnis 87 Danksagung 88 Lebenslauf 89

Objectifs: Le but de cette étude clinique était de comparer un groupe d’adultes ayant un parodonte sain avec un groupe d’adultes atteints de parodontite chronique en terme de risque carieux et mesures cliniques et microbiologiques de la carie. Méthodes: Quatre-vingt-seize individus ont été divisés en deux groupes en fonction de leur état de santé parodontal et ont été appariés pour l'âge, le sexe et l'origine ethnique. Trente-huit sujets étaient atteints de parodontite chronique définie comme ayant au moins quatre dents avec ≥ 1 site avec une profondeur de sondage ≥ 4 mm et une perte d'attache clinique ≥ 2 mm, et 58 sujets présentaient un parodonte sain. Par la suite, les groupes ont été subdivisés en deux groupes en fonction de leur statut carieux : les participants ayant au moins une lésion carieuse non traitée sur une surface dentaire et ceux n’ayant pas de lésion carieuse non traitée. Les données ont été recueillies par le biais d’un questionnaire, un examen clinique et des échantillons de plaque supra- et sous-gingivale. L’évaluation de la charge buccale de Streptococcus mutans et de six agents pathogènes parodontaux a été réalisée par la technique d'amplification de la réaction en chaine de la polymérase (PCR). Les données ont été analysées à l'aide d’analyses statistiques descriptives et bivariées. Résultats: Les individus atteints de parodontite chronique étaient 3,5 fois plus susceptibles d'avoir des caries que les individus en bonne santé (OR 3,5 ; IC: 1,5 - 8,3 ; P = 0,006). Les sujets à la fois atteints de parodontite chronique et de caries dentaires ont eu un niveau d’éducation significativement plus faible que les sujets ayant un parodonte sain et sans caries dentaires (OR 6,0 ; IC: 1,7 à 21,7 ; P = 0,04). La proportion de sujets ayant une charge buccale élevée de Porphyromonas gingivalis (P. g.) et Treponema denticola (T. d.) était significativement plus élevée chez les patients atteints de parodontite chronique et de carie que chez les patients sains présentant des caries (P. g.: OR 8,6 ; IC: 2,4 - 30,3 ; P = 0,004 et T. d.: OR 10,0 ; CI: 2,6 - 38.1 ; P = 0,003). Conclusions: Les résultats de cette étude suggèrent que, chez les sujets adultes atteints de la parodontite chronique, la fréquence des caries est plus élevée que chez les sujets ayant un parodonte sain. De plus, le faible niveau d'éducation influence négativement le statut parodontal des individus. / Aim: The aim of this clinical study was to compare adults with a healthy periodontium and those with chronic periodontitis, in terms of caries’ risk and caries’ clinical and microbiological measures. Methods: Ninety-six healthy adults were divided into chronic periodontitis (n= 38) and healthy periodontium (n=58) based on their periodontal status, and matched for age, gender, and ethnic background. Chronic periodontitis was defined as having at least four teeth with ≥1 site with a pocket depth ≥4 mm and clinical attachment loss ≥2 mm. Each group were subsequently subdivided in 2 groups according to their caries status: participants having at least one untreated decayed surface and those with no untreated caries. Data were collected by means of self-administrated questionnaire, clinical examination, and supra- and subgingival plaque sampling. Assessments of oral levels of Streptococcus mutans and six periodontal pathogens were conducted by PCR amplification techniques. Data were analyzed using descriptive and bivariate statistical tests. Results: Individuals with chronic periodontitis were 3.5 times more likely to have caries than healthy individuals (OR 3.5; CI: 1.5 – 8.3; P = 0.006). Subjects with both chronic periodontitis and dental caries had a significantly lower level of education than periodontally healthy subjects without dental caries (OR 6.0; CI: 1.7 – 21.7; P = 0.04). A significant higher proportion of subjects with high oral levels of Porphyromonas gingivalis (P. g.) and Treponema denticola (T. d.) was found among subjects with chronic periodontitis and untreated caries compared to periodontally healthy subjects with untreated caries (P. g.: OR 8.6; CI: 2.4 – 30.3; P = 0.004 and T. d.: OR 10.0; CI: 2.6 – 38.1; P = 0.003). Conclusion: The results from this study suggest that, adults with chronic periodontitis are more prone to caries disease than those adults with a healthy periodontium. Furthermore, low educational level could have a negative impact on the periodontal status of individuals.

Microorganismos da cavidade oral têm sido admitidos como causadores de doenças sistêmicas com reconhecido mecanismo de disseminação via corrente sangüínea. Diferentes fatores, incluindo a presença da doença periodontal, têm influência no risco de bacteremia oral, podendo ocasionar endocardite infecciosa por Streptococcus viridans. Sendo assim, a manutenção da saúde bucal adquire elevado grau de importância em gestantes portadoras de doença valvar reumática, em que o risco de endocardite infecciosa é eminente. A escassez científica fez deste tema o objetivo deste estudo: investigar a condição clínica periodontal de gestantes portadoras de cardiopatia valvar, identificando agentes periodontopatógenos nas amostras coletadas de saliva, sulco/bolsa periodontal, Para tanto, foram estudadas 52 gestantes cardiopatas (GC) e 70 gestantes não-cardiopatas (GNC). A condição periodontal foi avaliada empregando-se profundidade clínica de sondagem (PCS), nível clínico de inserção (NCI), linha esmalte cemento/margem gengival (LEC/MG), índice de sangramento (IS) e índice de placa bacteriana (IP). As seguintes médias foram obtidas para os parâmetros periodontais avaliados: PCS: 1.52 (GC) e 1.45 (GNC); NCI: 1.13 (GC) e 1.02 (GNC); LEC/MG: 0.41 (GC) e 0.40 (GNC); IS: 7.34 (GC) e 6.27 (GNC) e IP: 12.19 (GC) e 13.48 (GNC). Não houve diferença entre os grupos para o NCI (p= 0,612). A presença da Porphyromonas gingivalis na saliva foi maior (p= 0,007) no GNC, porém não houve diferença nas amostras de sulco/bolsa periodontal. / Microorganisms of the oral cavity are known to cause systemic diseases, spread through sanguine current. Different factors, including the presence of periodontal disease, influencing the risk of oral bacteremia could cause infectious endocarditis for Streptococcus viridans. Nevertheless, the maintenance of the oral health is extremely important in pregnant women with rheumatic valvar disease, in which the risk of infectious endocarditis is eminent. The aim of this study was to investigate the clinical periodontal condition of pregnant women with valvar disease and to identify the presence of Porphyromonas gingivalis in saliva and subgingival samples. For these purposes, we studied 52 pregnant with valvar disease (GC) and 70 healthy pregnant women (GNC). The following periodontal parameters were evaluated: probing depth (PCS), clinical attachment level (NCI), gingival margin location (LEC/MG), bleeding on probing (IS) and plaque index (IP). The following mean periodontal parameters were obtained: PCS: 1.52 (GC) e 1.45 (GNC); NCI: 1.13 (GC) e 1.02 (GNC); LEC/MG: 0.41 (GC) e 0.40 (GNC); IS: 7.34 (GC) e 6.27 (GNC) e IP: 12.19 (GC) e 13.48 (GNC). There was no statistical difference for NCI among the groups. There was no difference between periodontal clinical conditions in pregnant women with valvar disease and healthy pregnant women. The presence of the Porphyromonas gingivalis in saliva samples of healthy pregnant women is statistically higher than in pregnant woman with valvar disease; however, there was no difference in periodontal samples

Dentro do contexto do novo paradigma da doença periodontal, alguns estudos têm sugerido que a doença periodontal poderia influenciar o desenvolvimento de doenças sistêmicas, incluindo os acidentes vasculares cerebrais. O objetivo deste estudo foi avaliar as condições periodontais de pacientes com acidente vascular cerebral (AVC), comparativamente à amostra populacional sem AVC, bem como identificar e quantificar o nível de bactérias periodontopatogênicas presentes nas áreas de bolsa periodontal com a finalidade de investigar a correlação da doença periodontal com acidente vascular cerebral. Para tanto, foram selecionados 80 pacientes de ambos os sexos, com idade entre 30-80 anos. O grupo experimental foi constituído por 20 pacientes internados em ambiente hospitalar devido à ocorrência de AVC. O grupo controle foi constituído de 60 pacientes provenientes da amostra populacional da cidade de Bauru que não apresentavam sinais e sintomas clínicos ou história familiar de AVC. Um questionário de saúde investigando as possíveis causas do AVC e outras condições sistêmicas foi aplicado a todos os pacientes. Os dois grupos foram avaliados periodontalmente quanto às medidas de profundidade de sondagem, nível de inserção, sangramento à sondagem e índice de placa. Para identificar e quantificar as bactérias periodontopatogênicas, Porphyromonas gingivalis e Aggregatibacter (Actinobacillus) actinomycetemcomitans, em ambos os grupos, foi coletada amostra de placa dentomicrobiana subgengival dos dois sítios com maior profundidade de sondagem de todos os pacientes, por meio da introdução de tira de papel esterilizada (PerioPaper) no sulco gengival. A análise qualitativa e quantitativa dessas bactérias foi realizada por meio de PCR convencional e em tempo real. Os dados obtidos foram analisados por meio de análise de variância (ANOVA) complementado pelo método de Tukey, teste de correlação de Spearman, teste \"t\" de Student, Mann-Whitney, Qui-Quadrado e \"Odds Ratio\" para avaliar a correlação entre os diferentes parâmetros clínicos periodontais com o AVC e os resultados obtidos pelo PCR convencional e PCR em tempo-real, com nível de confiança de 95%. Os resultados obtidos mostraram maior prevalência da doença periodontal no grupo teste (95%) do que no controle (28,3%). O nível de inserção à sondagem, índice de placa e índice gengival estavam significativamente aumentados nos pacientes com AVC (p<0,001). Entretanto, as medidas de profundidade de sondagem não mostraram diferenças significantes entre os grupos (p=0,051), embora estivessem aumentadas para o grupo teste. A presença e quantidade da P.gingivalis foi estatisticamente maior no grupo teste do que no controle (p<0,05). Não foi encontrado A.actinomycetemcomitans em nenhum dos grupos estudados. Do total de pacientes com AVC, 65% desenvolveram AVC-I e 35% AVC-H. Pacientes com AVC-H abrigavam maiores níveis de P.gingivalis do que pacientes com AVC-I. Entretanto, nesse grupo, houve correlação positiva entre bolsas mais profundas e contagem de bactérias (p<0,05), o que não foi observado para AVC-H. A análise de risco por \"odds ratio\" identificou que pacientes com doença periodontal apresentam risco elevado de desenvolvimento de AVC (OR=48,06, IC=95%). Esses achados indicam que a doença periodontal é mais prevalente e severa em pacientes com AVC-I ou AVC-H, com grande quantidade de bactérias, especialmente P. gingivalis, presente em bolsas periodontais mais profundas, sugerindo que a doença periodontal poderia atuar como fator de risco ao desenvolvimento de acidentes vasculares cerebrais. / Inside of the context of the new paradigm of the periodontal disease, some studies have suggested that the periodontal disease could influence the development of systemics diseases, including vascular cerebral accident. The aim of this study was to evaluate the periodontal conditions of patients with vascular cerebral accidents (VCAs), comparatively to the population sample without VCA, as well as identifying and quantifying the level of periodontopathic bacteria presents in the areas of periodontal pocket in order to investigate the correlation of the periodontal disease with vascular cerebral accident. For this study, it had been selected 80 patients of both genders, with age between 30-80 years. The experimental group consisted of 20 hospitalized patients presenting VCA. The control group was consisted of 60 patients proceeding from the population sample of Bauru who did not present clinical signs and symptoms or family history of VCA. A health questionnaire investigating the possible causes of the VCA and others systemics conditions was applied to all patients. The both groups were periodontally evaluated according to probing depth measures; bleed on probing and plaque index. In other to identify and quantify the periodontopathic bacteria Porphyromonas gingivalis and Aggregatibacter (Actinobacillus) actinomycetemcomitans, in both groups, a sample of subgengival plaque was collected from the two deepest sites of all patients by the introduction of sterilized paper strip (PerioPaper). The qualitative and quantitative analysis of these bacteria was performed by conventional PCR and Real Time PCR. Data were analyzed by variance analysis test (ANOVA) complemented by the Tukey test, Pearson correlation test, Student \"t\" test, Mann-Whitney test, Qui-Square test and Odds Ratio to evaluate the different correlations between the different periodontal clinical parameters VCA, and the results obtained from the Real Time PCR, with a 95% confidence level. The analysis of the results showed significantly bigger prevalence of the periodontal disease in the test group (95%) than the control group (28,3%). The level of insertion, plaque index and bleeding on probing were significantly increased in the patients with VCA (p<0,001). However, the probing depth measures had not shown significant differences between the groups (p=0,051), even so were increased for the test group. The presence and amount of the P.gingivalis were statistically bigger in the test group than the control group (p<0,05). A.actinomycetemcomitans was not found in any of the studied groups. Considering all patients with VCA, 65% developed VCA-I and 35% VCA-H. Patients with VCA-H showed greater levels of P.gingivalis than patient with VCA-I. However, in this group, it had positive correlation between deeper pockets and number of bacteria (p<0,05), what it was not observed for VCA-H. The analysis of risk for \"odds ratio\" identified that patient with periodontal disease present high risk of VCA development (OR=48,06, IC=95%). These findings show that the periodontal disease is more prevalent and severe in patients with VCA-I or VCA-H, with great amount of bacteria, especially P. gingivalis, present in deeper periodontal pockets, suggesting that the periodontal disease could play as risk factor on the development of vascular cerebral accident.