Este estudo longitudinal teve como objetivo avaliar o impacto da cirurgia bariátrica na condição periodontal e quantificar bactérias periodontopatogênicas em pacientes submetidos a esta cirurgia. Trata-se de um estudo prospectivo, composto por 50 pacientes submetidos à cirurgia bariátrica por derivação gastrojejunal em Y de Roux, em 3 hospitais do estado de São Paulo. A coleta de dados foi realizada em três períodos: pré-operatório, pós-operatório de 6 e de 12 meses e consistiu de: avaliação do fluxo salivar; exame clínico bucal para avaliar desgaste dentário e doença periodontal; coleta de amostras do fluido gengival para quantificação das bactérias periodontopatogênicas Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola ePrevotella intermédia por meio de Reação em Cadeia da Polimerase em Tempo Real (q-PCR); aplicação de questionário relacionado aos fatores para ocorrência de desgaste dentário e autopercepção da saúde bucal; avaliação do peso e altura para obtenção do índice de massa corporal (IMC) e coleta de dados complementares relacionados à saúde do indivíduo, por meio do prontuário médico. No baseline, 51 pacientes com IMC normal foram analisados e comparados aos obesos. ANOVA, teste de Tukey, correlação de Pearson e teste t de Student foram utilizados na análise estatística (p<0,050). No baseline, foi observado maior índice de sangramento gengival (ISG), presença de cálculo e sítios com bolsa 4-5 mm em obesos comparados ao grupo controle (p<0,050), que mostrou uma melhor autopercepção da saúde bucal do que os obesos (p=0,008). A média do IMC nos pacientes submetidos à cirurgia bariátrica diminuiu de 49,69±8,76 kg/m2 para 36,16±8,12 kg/m2 e para 32,26 kg/m2 após 6 e 12 meses da cirurgia (p<0,000), respectivamente. Antes da cirurgia, 67% dos pacientes apresentavam altos níveis séricos de proteína C-reativa (PCR) e 38% glicemia alta. Houve redução significativa nos níveis séricos de PCR e glicose após a cirurgia. O fluxo salivar foi similar nos três períodos variando de 0,86-0,96 mL/min. Após a cirurgia bariátrica, o percentual de faces dentárias com desgaste em dentina aumentou significativamente (p=0,002), enquanto que em esmalte diminuiu (p=0,019), indicando aumento na severidade do desgaste dentário nestes pacientes. A média da profundidade de sondagem (PS) e do nível de inserção clínica (NIC) aumentou significativamente no pós-operatório de 6 meses (p<0,000). No mesmo período a quantidade de P. gingivalis aumentou (p=0,028) e das outras bactérias diminuiu discretamente (p>0,050). Em presença das bactérias P. gingivalis, T. forsythia, T. denticola e P. intermédia a condição periodontal se mostrou pior. Concluiu-se que a cirurgia bariátrica promoveu impacto negativo nas condições de saúde bucal, especialmente doença periodontal e desgaste dentário. Foram observadas alterações na quantidade de bactérias periodontopatogênicas nos pacientes avaliados durante os três períodos, sendo que a P. gingivalis acompanhou o aumento da severidade da doença periodontal. / The aim of this longitudinal study was to evaluate the impact of bariatric surgery on periodontal condition and quantify periodontopathogenic bacteria in patients undergoing this surgery. This was a prospective study composed of 50 patients who underwent bariatric surgery for Roux-en-Y gastric bypass in three hospitals in the state of São Paulo. Data collection was performed in three periods: preoperative, postoperative of 6 and 12 months and consisted of: salivary flow evaluation; oral clinical examination to assess tooth wear and periodontal disease; gingival fluid sample collection for quantification of periodontopathogenic bacteria Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola and Prevotella intermedia using Real-time Polymerase Chain Reaction (q-PCR); questionnaire applied as regards factors related to occurrence of tooth wear and self-perceived oral health; weight and height evaluation to determine the body mass index (BMI), in addition to collection of individual\'s health-related data from medical files. At baseline, 51 patients with normal BMI were analyzed and compared with obese subjects. ANOVA, Tukey test, Pearson correlation and Students t-test were used for statistical analysis (p<0.050). At baseline, greater gingival bleeding index (GBI), presence of calculus and sites with 4-5 mm pocket depth were observed in obese compared with the control group (p<0.050), which showed better self-perceived oral health than the obese (p=0.008). Mean BMI decreased from 49.69±8.76 kg/m2 to 36.16±8.12 kg/m2 and to 32.26 kg/m2 after 6 and 12 months postoperatively (p <0.000), respectively. Before surgery 67% of patients had high C-reactive protein (CRP) serum levels and 38% high glucose level. There was significant reduction in serum CRP and glucose after surgery. Salivary flow was similar in all three periods, ranging from 0.86 to 0.96 mL / min. After bariatric surgery, the percentage of tooth surfaces with dentin wear increased significantly (p=0.002), while enamel wear decreased (p=0.019), indicating increase in the severity of tooth wear in these patients. The mean probing depth (PD) and clinical attachment level (CAL) increased significantly in the postoperative period of 6 months (p<0.000). In the same period the amount of P. gingivalis increased (p = 0.028) and of other bacteria decreased slightly (p> 0.050). In the presence of P. gingivalis, T. forsythia, T.denticola and P. intermedia, a worse periodontal condition was observed. It was concluded that bariatric surgery promoted negative impact on oral health conditions, especially periodontal disease and tooth wear. Changes were observed in the amount of periodontopathogenic bacteria in the patients evaluated during the three periods, and P. gingivalis accompanied the increased periodontal disease severity.

Este estudo longitudinal teve como objetivo avaliar o impacto da cirurgia bariátrica na condição periodontal e quantificar bactérias periodontopatogênicas em pacientes submetidos a esta cirurgia. Trata-se de um estudo prospectivo, composto por 50 pacientes submetidos à cirurgia bariátrica por derivação gastrojejunal em Y de Roux, em 3 hospitais do estado de São Paulo. A coleta de dados foi realizada em três períodos: pré-operatório, pós-operatório de 6 e de 12 meses e consistiu de: avaliação do fluxo salivar; exame clínico bucal para avaliar desgaste dentário e doença periodontal; coleta de amostras do fluido gengival para quantificação das bactérias periodontopatogênicas Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola ePrevotella intermédia por meio de Reação em Cadeia da Polimerase em Tempo Real (q-PCR); aplicação de questionário relacionado aos fatores para ocorrência de desgaste dentário e autopercepção da saúde bucal; avaliação do peso e altura para obtenção do índice de massa corporal (IMC) e coleta de dados complementares relacionados à saúde do indivíduo, por meio do prontuário médico. No baseline, 51 pacientes com IMC normal foram analisados e comparados aos obesos. ANOVA, teste de Tukey, correlação de Pearson e teste t de Student foram utilizados na análise estatística (p<0,050). No baseline, foi observado maior índice de sangramento gengival (ISG), presença de cálculo e sítios com bolsa 4-5 mm em obesos comparados ao grupo controle (p<0,050), que mostrou uma melhor autopercepção da saúde bucal do que os obesos (p=0,008). A média do IMC nos pacientes submetidos à cirurgia bariátrica diminuiu de 49,69±8,76 kg/m2 para 36,16±8,12 kg/m2 e para 32,26 kg/m2 após 6 e 12 meses da cirurgia (p<0,000), respectivamente. Antes da cirurgia, 67% dos pacientes apresentavam altos níveis séricos de proteína C-reativa (PCR) e 38% glicemia alta. Houve redução significativa nos níveis séricos de PCR e glicose após a cirurgia. O fluxo salivar foi similar nos três períodos variando de 0,86-0,96 mL/min. Após a cirurgia bariátrica, o percentual de faces dentárias com desgaste em dentina aumentou significativamente (p=0,002), enquanto que em esmalte diminuiu (p=0,019), indicando aumento na severidade do desgaste dentário nestes pacientes. A média da profundidade de sondagem (PS) e do nível de inserção clínica (NIC) aumentou significativamente no pós-operatório de 6 meses (p<0,000). No mesmo período a quantidade de P. gingivalis aumentou (p=0,028) e das outras bactérias diminuiu discretamente (p>0,050). Em presença das bactérias P. gingivalis, T. forsythia, T. denticola e P. intermédia a condição periodontal se mostrou pior. Concluiu-se que a cirurgia bariátrica promoveu impacto negativo nas condições de saúde bucal, especialmente doença periodontal e desgaste dentário. Foram observadas alterações na quantidade de bactérias periodontopatogênicas nos pacientes avaliados durante os três períodos, sendo que a P. gingivalis acompanhou o aumento da severidade da doença periodontal. / The aim of this longitudinal study was to evaluate the impact of bariatric surgery on periodontal condition and quantify periodontopathogenic bacteria in patients undergoing this surgery. This was a prospective study composed of 50 patients who underwent bariatric surgery for Roux-en-Y gastric bypass in three hospitals in the state of São Paulo. Data collection was performed in three periods: preoperative, postoperative of 6 and 12 months and consisted of: salivary flow evaluation; oral clinical examination to assess tooth wear and periodontal disease; gingival fluid sample collection for quantification of periodontopathogenic bacteria Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola and Prevotella intermedia using Real-time Polymerase Chain Reaction (q-PCR); questionnaire applied as regards factors related to occurrence of tooth wear and self-perceived oral health; weight and height evaluation to determine the body mass index (BMI), in addition to collection of individual\'s health-related data from medical files. At baseline, 51 patients with normal BMI were analyzed and compared with obese subjects. ANOVA, Tukey test, Pearson correlation and Students t-test were used for statistical analysis (p<0.050). At baseline, greater gingival bleeding index (GBI), presence of calculus and sites with 4-5 mm pocket depth were observed in obese compared with the control group (p<0.050), which showed better self-perceived oral health than the obese (p=0.008). Mean BMI decreased from 49.69±8.76 kg/m2 to 36.16±8.12 kg/m2 and to 32.26 kg/m2 after 6 and 12 months postoperatively (p <0.000), respectively. Before surgery 67% of patients had high C-reactive protein (CRP) serum levels and 38% high glucose level. There was significant reduction in serum CRP and glucose after surgery. Salivary flow was similar in all three periods, ranging from 0.86 to 0.96 mL / min. After bariatric surgery, the percentage of tooth surfaces with dentin wear increased significantly (p=0.002), while enamel wear decreased (p=0.019), indicating increase in the severity of tooth wear in these patients. The mean probing depth (PD) and clinical attachment level (CAL) increased significantly in the postoperative period of 6 months (p<0.000). In the same period the amount of P. gingivalis increased (p = 0.028) and of other bacteria decreased slightly (p> 0.050). In the presence of P. gingivalis, T. forsythia, T.denticola and P. intermedia, a worse periodontal condition was observed. It was concluded that bariatric surgery promoted negative impact on oral health conditions, especially periodontal disease and tooth wear. Changes were observed in the amount of periodontopathogenic bacteria in the patients evaluated during the three periods, and P. gingivalis accompanied the increased periodontal disease severity.

In der vorliegenden Arbeit sollten die in der veterinärmedizinischen Literatur bisher diskutierten Ursachen für LJD bei Makropoden hinsichtlich ihrer tatsächlichen Bedeutung abgeklärt und die Eignung einer formalininaktivierten, bestandsspezifischen Adsorbatvakzine zur Prophylaxe von LJD getestet werden. Da LJD eine parodontale Erkrankung darstellt, wurden auch die für Entstehung einer humanen Parodontitis prädisponierenden Faktoren mit in die Untersuchung einbezogen. Es wurden Tupferproben zur bakteriologischen Untersuchung von insgesamt 15 gesunden und 11 an LJD erkrankten Kängurus entnommen. Dabei konnten gramnegative Anaerobier bei allen Tieren isoliert werden. Fusobacterium nucleatum wurde in 82% der von an LJD erkrankten und nur in 33% der von gesunden Tieren entnommenen Tupferproben nachgewiesen, womit sich ein signifikanter Zusammenhang (P < 0,05) zwischen diesem Erreger und LJD ergab. Weitere überwiegend bei erkrankten Makropoden nachgewiesene Anaerobier stellten Prevotella oris/oralis (bei 73% der LJD-Fälle und bei 40% der gesunden Tiere) sowie Capnocytophaga spp. (45% vs. 13%) dar. Bacteroides spp. und Porphyromonas gingivalis wurden – wenn auch nur mit 3 bzw. 2 Nachweisen – ausschließlich bei kranken Tieren isoliert. Fusobacterium necrophorum wurde jeweils in 27% der Kängurus gefunden und spielte damit in dieser Studie keine Rolle für die Entstehung von LJD. In Übereinstimmung mit der Literatur konnten Moraxella spp. ausschließlich bei gesunden Makropoden isoliert werden. Vertreter dieser Gattung gehören damit offensichtlich zur normalen Maulflora der Kängurus. Für die Zoos in Halle und Leipzig wurde eine formalininaktivierte, bestandsspezifische Adsorbatvakzine gegen die bei einem an LJD erkrankten Känguru des jeweiligen Bestandes isolierten gramnegativen Anaerobier hergestellt. 7 Tiere (2 Rote Riesenkängurus, 5 Bennettwallabies) des Leipziger Zoos und 6 Bennettkängurus des Zoos in Halle wurden geimpft, wobei Auffrischungsimpfungen nach 4 bzw. 8 Wochen und nach 6 bzw. 12 Monaten erfolgten. Die spezifischen AK gegen das Prüfantigen Fusobacterium necrophorum wurden im SLA bestimmt. Es konnte keine Erhöhung der AK-Titer induziert werden und auch die Todesrate infolge von LJD senkte sich während des Untersuchungszeitraumes von 42 Monaten in den beiden Zoos nicht. Die höchsten AK-Level (1:512 bis 1:2048) ließen sich im Serum von natürlich infizierten und letztendlich tödlich erkrankten Bennettwallabies des Zoos in Hoyerswerda feststellen. Der Nachweis von AK-Titern im Serum von nicht geimpften Jungtieren lässt vermuten, dass AK via Kolostrum oder Dottersackplazenta auf die Jungtiere übertragen werden. Die Untersuchungen hinsichtlich der Fütterung zeigten, dass im Zoo Leipzig eine azidotische Stoffwechsellage induziert wurde, was sich bei den Leipziger Bennettkängurus in einem mit 7,53 signifikant niedrigeren Vormagen-pH-Wert im Vergleich zu den Hallenser und Auer Tieren (8,25 und 8,38) offenbarte. Dies schlug sich auch in erhöhten K-, Cholesterol- und &#61537;-Amylasewerten im Serum der Leipziger Wallabies nieder, womit gezeigt werden konnte, dass sich diese Parameter offenbar auch bei Makropoden zur Diagnostik einer chronischen Azidose eignen. Die Versorgung der Bennettkängurus in Magdeburg und Halle mit Ca und P war zwar nicht ausreichend, spiegelte sich aber nicht in veränderten Blutwerten dieser Mengenelemente wider. Die Aktivität der AP nimmt mit zunehmenden Alter ähnlich wie bei anderen Tierarten ab. Ihre negative Korrelation mit dem Alter der Tiere war dabei hochsignifikant (P < 0,001, r = 0,77 bzw. 0,62). Beim direkten Vergleich gesunder mit an LJD erkrankten Tieren konnte weder eine Störung im Ca/P-Stoffwechsel noch eine Azidose in Verbindung zu LJD gebracht werden. In allen Zoos erfolgte eine Überversorgung mit Vitamin A, wobei die Bedarfswerte für Schaflämmer um das 3,5fache bis 41fache übertroffen wurden. Den Bedarfswerten am nächsten lagen die Versorgungswerte der Bennettkängurus vom TP Aue und der Östlichen Grauen Riesenkängurus vom Zoo Magdeburg, beides Bestände ohne LJD. Die ermittelten Retinolplasmakonzentrationen standen in keiner Beziehung zu den Vitamin-A-Gehalten im Futter, was darauf hindeutet, dass sich Retinolbestimmungen im Blutplasma ebenso wie bei anderen Tierarten nur in extremsten defizitären Situationen zur Einschätzung des Vitamin-A-Status eignen. Ob eine Hypervitaminose A für die Entstehung von LJD tatsächlich eine Rolle spielt, muss in zukünftigen Arbeiten unter Einbeziehung von Retinolesterbestimmungen in der Leber abgeklärt werden. Die Glukosewerte lagen mit 8,57 mmol/l (M. rufus) bzw. 6,51 mmol/l (M. rufogriseus) über den bisher bekannten Werten aus der Literatur. Da die Werte bei an LJD erkrankten Kängurus niedriger waren als bei gesunden Tieren, kann ein Diabetes mellitus als Ursache für LJD ausgeschlossen werden. Weder die Durchsicht von 144 Sektionsprotokollen noch die Bestimmung der Kreatinin- und Harnstoffkonzentration im Serum von an LJD erkrankten Tieren ließen einen Zusammenhang zwischen Erkrankungen der Nieren und LJD erkennen. 30 Tiere verendeten an LJD, wovon 20% auch an den Nieren erkrankt waren. Allerdings wiesen auch 16,7% der anderweitig gestorbenen Kängurus eine Nierenerkrankung auf. Die Serumkonzentrationen von Harnstoff bzw. Kreatinin der an LJD erkrankten Makropoden unterschieden sich nicht von den für die gesunden Roten Riesenkängurus (7,40 mmol bzw. 114 mmol/l) und Bennettwallabies (7,81 mmol/l bzw. 86 mmol/l) ermittelten Werten. Insgesamt 184 Sera von 107 Kängurus wurden auf AK gegen MaHV-1 und MaHV-2 mittels Neutralisationtest geprüft. Während 94,4% bzw. 97,2% der Roten Riesenkängurus serologisch positiv für MaHV-1 bzw. MaHV-2 waren, reagierten von den 71 überprüften Bennettkängurus nur 4 bzw. 3 Tiere positiv. Unter den Wallabies befanden sich auch 21 an LJD erkrankte Tiere, wovon lediglich 2 Tiere gegen MaHV-1 und 1 Tier gegen MaHV-2 eine Serokonversion zeigten. Die AK-Titer der Roten Riesenkängurus ließen keine Unterschiede zwischen gesunden und an LJD leidenden Tieren zu und die entnommenen Serumpaarproben von 5 zum Zeitpunkt der Blutentnahme an LJD leidenden Riesenkängurus zeigten kein einheitliches Verhalten im Sinne einer Serokonversion. Somit ließ sich der Verdacht, dass die Reaktivierung latenter Herpesinfektionen die Ursache für LJD sein könnte, nicht bestätigen. Im Ergebnis der vorliegenden Studie und im Zusammenhang mit den Angaben aus der Literatur stellt sich LJD primär als eine Infektion mit gramnegativen Anaerobiern dar, wovon Fusobacterium nucleatum, Bacteroides spp., Prophyromonas gingivalis und Fusobacterium necrophorum, Biovar A die größte Bedeutung haben dürften. Den Abschluss der Arbeit bilden Empfehlungen für die Haltung von Kängurus in zoologischen Einrichtungen und für die Therapie von LJD. Im Anhang finden sich Röntgenaufnahmen und Photographien von erkrankten und gesunden Makropoden. / The aim of this thesis was the investigation of the aetiology of Lumpy Jaw Disease (LJD) in macropods concentrating specifically on the causes of the diseases in current veterinary medicine literature and to evaluate the use of a group-specific Al(OH)3-adjuvanted, formalin-inactivated whole-cell vaccine for the control of LJD in kangaroos kept in zoos. LJD is regarded as periodontal disease, therefore the risk factors for the development of human periodontitis were also included in this study. The oral flora from 15 healthy macropods and 11 animals suffering from LJD was isolated. At least one anaerobic gram-negative bacterial species was found in swabs of each macropod. The occurrence of Fusobacterium nucleatum was associated with LJD (P < 0.05) by detecting this bacterium in 82% of the kangaroos suffering from LJD compared to only in 33% of the healthy animals. Prevotella oris/oralis and Capnocytophaga spp. were also predominantly found in diseased animals in comparison with healthy macropods (73% vs. 40% and 45% vs. 13% respectively). Bacteroides spp. and Porphyromonas gingivalis were isolated in only 3 and 2 kangaroos suffering from LJD, respectively. Contrary to previously published studies about LJD Fusobacterium necrophorum was not associated with LJD, as this anaerobe was detected in only 27% of the diseased as well as healthy macropods. Moraxella spp. seem to be a part of the normal oral flora of macropods and was found exclusively in healthy animals. 11 Red-necked Wallabies (Macropus rufogriseus) and 2 Red Kangaroos (Macropus rufus) were immunized with a group-specific Al(OH)3-adjuvanted, formalin-inactivated whole-cell vaccine containing previously in a kangaroo suffering from LJD isolated gramnegative anaerobs. The kangaroos were re-vaccinated after 1, 2, 6 and 12 months. Blood was collected from each animal at the same time. Antibodies were titrated against Fusobacterium necrophorum in an agglutination assay. The vaccine failed to induce increased levels of antibodies as well as to protect wallabies and kangaroos against LJD. As the highest antibody titres were detected in most severely diseased wallabies kept in the Hoyerswerda zoo, the protective role of the humoral immune response in LJD seems to be doubtful. The finding of detectable levels of antibodies in unvaccinated joeys supports the theory, that there is a transmission of antibodies from the mother to the offspring via colostrum or yolk-sac placenta. The diet of the Red-necked Wallabies in one zoo has induced an acidosis: The pH of the forestomach fluid collected by probang was lower in the animals of this zoo (pH = 7.53) than in the wallabies of two other zoos (pH = 8.25 and 8.38, respectively). Potassium, cholesterol and &#61537;-amylase were also higher in the blood of the animals of this zoo in comparison to the wallabies of the two other ones, hence these blood values seem to be helpful for the diagnosis of chronic acidosis in macropods. There was a calcium and phosphor deficiency in the nutrition of the wallabies in two zoos, but the blood concentration of both of these minerals was not changed. The activity of the ALP correlated negative with the age of the Bennett`s Wallabies (P < 0.001, r = -.77 and r = -.62 respectively, depending on the instruments). All of the above mentioned blood values showed no differences between healthy and diseased animals and could so far not support the assumption, that an imbalance in Ca and P metabolism or an acidosis are important factors for LJD. The macropods of all investigated zoos were fed on a diet rich in vitamin A ranging from the 3.5 to the 41fold requirement for lambs. The vitamin A content of the diets for the 2 collections without a history of LJD was the lowest in this study. These results raised the point, that a hypervitaminosis A could be a more predisposing factor for LJD than a vitamin A deficiency. Due to the fact the plasma retinol concentration was independent from the vitamin A content of the diet and so not helpful in diagnosis of a vitamin A deficiency or toxicity, further investigations regarding the role of vitamin A in the aetiopathogenesis of LJD should include measurements of the liver tissue content of retinol esters. The glucose plasma concentration of the healthy Red Kangaroos (8.57 mmol/l) as well as the Red-necked Wallabies (6.51 mmol/l) was higher than previously published values for macropods, but also higher than the results of the diseased animals in this study. Therefore diabetes mellitus can be ruled out as an underlying factor for LJD. The analysis of 144 pathological records showed, that 30 animals died because of LJD, 20% of them and 16.7% of the other 114 macropods had a concurrent kidney disease. The urea and creatinin concentration in serum samples of healthy animals was not higher than the values of diseased animals. In conclusion, these results suggest kidney diseases are not important for the development of LJD. Altogether 184 sera collected from 107 kangaroos were tested for antibodies against MaHV-1 and MaHV-2 using a neutralisation assay. The prevalence of the MaHV-1- as well as MaHV-2-antibodies was high among the Red Kangaroos (94.4% and 97.2% respectively), but low among the Red-necked Wallabies (5.6% and 4.2% respectively). Seroconversion for MaHV-1 was seen in 2 out of 21 wallabies suffering from LJD, only 1 of these animals also had antibodies against MaHV-2. The antibody-titres against both of the macropodid herpes viruses also did not differ between Red Kangaroos with and without LJD, therefore a reactivation of a latent herpesvirus infection does not appear to be causative for LJD. In summary, considering the results of this study and previously published literature LJD is an infectious disease caused by gramnegative anaerobic bacteria with Fusobacterium nucleatum, Bacteroides spp., Porphyromonas gingivalis and Fusobacterium necrophorum subsp. necrophorum being of most significance. Recommendations concerning the keeping of kangaroos in captivity and the management of LJD are listed in the conclusion of this thesis. Some radiographs and photos of diseased and healthy kangaroos are attached.

In der vorliegenden Arbeit sollten die in der veterinärmedizinischen Literatur bisher diskutierten Ursachen für LJD bei Makropoden hinsichtlich ihrer tatsächlichen Bedeutung abgeklärt und die Eignung einer formalininaktivierten, bestandsspezifischen Adsorbatvakzine zur Prophylaxe von LJD getestet werden. Da LJD eine parodontale Erkrankung darstellt, wurden auch die für Entstehung einer humanen Parodontitis prädisponierenden Faktoren mit in die Untersuchung einbezogen. Es wurden Tupferproben zur bakteriologischen Untersuchung von insgesamt 15 gesunden und 11 an LJD erkrankten Kängurus entnommen. Dabei konnten gramnegative Anaerobier bei allen Tieren isoliert werden. Fusobacterium nucleatum wurde in 82% der von an LJD erkrankten und nur in 33% der von gesunden Tieren entnommenen Tupferproben nachgewiesen, womit sich ein signifikanter Zusammenhang (P < 0,05) zwischen diesem Erreger und LJD ergab. Weitere überwiegend bei erkrankten Makropoden nachgewiesene Anaerobier stellten Prevotella oris/oralis (bei 73% der LJD-Fälle und bei 40% der gesunden Tiere) sowie Capnocytophaga spp. (45% vs. 13%) dar. Bacteroides spp. und Porphyromonas gingivalis wurden – wenn auch nur mit 3 bzw. 2 Nachweisen – ausschließlich bei kranken Tieren isoliert. Fusobacterium necrophorum wurde jeweils in 27% der Kängurus gefunden und spielte damit in dieser Studie keine Rolle für die Entstehung von LJD. In Übereinstimmung mit der Literatur konnten Moraxella spp. ausschließlich bei gesunden Makropoden isoliert werden. Vertreter dieser Gattung gehören damit offensichtlich zur normalen Maulflora der Kängurus. Für die Zoos in Halle und Leipzig wurde eine formalininaktivierte, bestandsspezifische Adsorbatvakzine gegen die bei einem an LJD erkrankten Känguru des jeweiligen Bestandes isolierten gramnegativen Anaerobier hergestellt. 7 Tiere (2 Rote Riesenkängurus, 5 Bennettwallabies) des Leipziger Zoos und 6 Bennettkängurus des Zoos in Halle wurden geimpft, wobei Auffrischungsimpfungen nach 4 bzw. 8 Wochen und nach 6 bzw. 12 Monaten erfolgten. Die spezifischen AK gegen das Prüfantigen Fusobacterium necrophorum wurden im SLA bestimmt. Es konnte keine Erhöhung der AK-Titer induziert werden und auch die Todesrate infolge von LJD senkte sich während des Untersuchungszeitraumes von 42 Monaten in den beiden Zoos nicht. Die höchsten AK-Level (1:512 bis 1:2048) ließen sich im Serum von natürlich infizierten und letztendlich tödlich erkrankten Bennettwallabies des Zoos in Hoyerswerda feststellen. Der Nachweis von AK-Titern im Serum von nicht geimpften Jungtieren lässt vermuten, dass AK via Kolostrum oder Dottersackplazenta auf die Jungtiere übertragen werden. Die Untersuchungen hinsichtlich der Fütterung zeigten, dass im Zoo Leipzig eine azidotische Stoffwechsellage induziert wurde, was sich bei den Leipziger Bennettkängurus in einem mit 7,53 signifikant niedrigeren Vormagen-pH-Wert im Vergleich zu den Hallenser und Auer Tieren (8,25 und 8,38) offenbarte. Dies schlug sich auch in erhöhten K-, Cholesterol- und &#61537;-Amylasewerten im Serum der Leipziger Wallabies nieder, womit gezeigt werden konnte, dass sich diese Parameter offenbar auch bei Makropoden zur Diagnostik einer chronischen Azidose eignen. Die Versorgung der Bennettkängurus in Magdeburg und Halle mit Ca und P war zwar nicht ausreichend, spiegelte sich aber nicht in veränderten Blutwerten dieser Mengenelemente wider. Die Aktivität der AP nimmt mit zunehmenden Alter ähnlich wie bei anderen Tierarten ab. Ihre negative Korrelation mit dem Alter der Tiere war dabei hochsignifikant (P < 0,001, r = 0,77 bzw. 0,62). Beim direkten Vergleich gesunder mit an LJD erkrankten Tieren konnte weder eine Störung im Ca/P-Stoffwechsel noch eine Azidose in Verbindung zu LJD gebracht werden. In allen Zoos erfolgte eine Überversorgung mit Vitamin A, wobei die Bedarfswerte für Schaflämmer um das 3,5fache bis 41fache übertroffen wurden. Den Bedarfswerten am nächsten lagen die Versorgungswerte der Bennettkängurus vom TP Aue und der Östlichen Grauen Riesenkängurus vom Zoo Magdeburg, beides Bestände ohne LJD. Die ermittelten Retinolplasmakonzentrationen standen in keiner Beziehung zu den Vitamin-A-Gehalten im Futter, was darauf hindeutet, dass sich Retinolbestimmungen im Blutplasma ebenso wie bei anderen Tierarten nur in extremsten defizitären Situationen zur Einschätzung des Vitamin-A-Status eignen. Ob eine Hypervitaminose A für die Entstehung von LJD tatsächlich eine Rolle spielt, muss in zukünftigen Arbeiten unter Einbeziehung von Retinolesterbestimmungen in der Leber abgeklärt werden. Die Glukosewerte lagen mit 8,57 mmol/l (M. rufus) bzw. 6,51 mmol/l (M. rufogriseus) über den bisher bekannten Werten aus der Literatur. Da die Werte bei an LJD erkrankten Kängurus niedriger waren als bei gesunden Tieren, kann ein Diabetes mellitus als Ursache für LJD ausgeschlossen werden. Weder die Durchsicht von 144 Sektionsprotokollen noch die Bestimmung der Kreatinin- und Harnstoffkonzentration im Serum von an LJD erkrankten Tieren ließen einen Zusammenhang zwischen Erkrankungen der Nieren und LJD erkennen. 30 Tiere verendeten an LJD, wovon 20% auch an den Nieren erkrankt waren. Allerdings wiesen auch 16,7% der anderweitig gestorbenen Kängurus eine Nierenerkrankung auf. Die Serumkonzentrationen von Harnstoff bzw. Kreatinin der an LJD erkrankten Makropoden unterschieden sich nicht von den für die gesunden Roten Riesenkängurus (7,40 mmol bzw. 114 mmol/l) und Bennettwallabies (7,81 mmol/l bzw. 86 mmol/l) ermittelten Werten. Insgesamt 184 Sera von 107 Kängurus wurden auf AK gegen MaHV-1 und MaHV-2 mittels Neutralisationtest geprüft. Während 94,4% bzw. 97,2% der Roten Riesenkängurus serologisch positiv für MaHV-1 bzw. MaHV-2 waren, reagierten von den 71 überprüften Bennettkängurus nur 4 bzw. 3 Tiere positiv. Unter den Wallabies befanden sich auch 21 an LJD erkrankte Tiere, wovon lediglich 2 Tiere gegen MaHV-1 und 1 Tier gegen MaHV-2 eine Serokonversion zeigten. Die AK-Titer der Roten Riesenkängurus ließen keine Unterschiede zwischen gesunden und an LJD leidenden Tieren zu und die entnommenen Serumpaarproben von 5 zum Zeitpunkt der Blutentnahme an LJD leidenden Riesenkängurus zeigten kein einheitliches Verhalten im Sinne einer Serokonversion. Somit ließ sich der Verdacht, dass die Reaktivierung latenter Herpesinfektionen die Ursache für LJD sein könnte, nicht bestätigen. Im Ergebnis der vorliegenden Studie und im Zusammenhang mit den Angaben aus der Literatur stellt sich LJD primär als eine Infektion mit gramnegativen Anaerobiern dar, wovon Fusobacterium nucleatum, Bacteroides spp., Prophyromonas gingivalis und Fusobacterium necrophorum, Biovar A die größte Bedeutung haben dürften. Den Abschluss der Arbeit bilden Empfehlungen für die Haltung von Kängurus in zoologischen Einrichtungen und für die Therapie von LJD. Im Anhang finden sich Röntgenaufnahmen und Photographien von erkrankten und gesunden Makropoden. / The aim of this thesis was the investigation of the aetiology of Lumpy Jaw Disease (LJD) in macropods concentrating specifically on the causes of the diseases in current veterinary medicine literature and to evaluate the use of a group-specific Al(OH)3-adjuvanted, formalin-inactivated whole-cell vaccine for the control of LJD in kangaroos kept in zoos. LJD is regarded as periodontal disease, therefore the risk factors for the development of human periodontitis were also included in this study. The oral flora from 15 healthy macropods and 11 animals suffering from LJD was isolated. At least one anaerobic gram-negative bacterial species was found in swabs of each macropod. The occurrence of Fusobacterium nucleatum was associated with LJD (P < 0.05) by detecting this bacterium in 82% of the kangaroos suffering from LJD compared to only in 33% of the healthy animals. Prevotella oris/oralis and Capnocytophaga spp. were also predominantly found in diseased animals in comparison with healthy macropods (73% vs. 40% and 45% vs. 13% respectively). Bacteroides spp. and Porphyromonas gingivalis were isolated in only 3 and 2 kangaroos suffering from LJD, respectively. Contrary to previously published studies about LJD Fusobacterium necrophorum was not associated with LJD, as this anaerobe was detected in only 27% of the diseased as well as healthy macropods. Moraxella spp. seem to be a part of the normal oral flora of macropods and was found exclusively in healthy animals. 11 Red-necked Wallabies (Macropus rufogriseus) and 2 Red Kangaroos (Macropus rufus) were immunized with a group-specific Al(OH)3-adjuvanted, formalin-inactivated whole-cell vaccine containing previously in a kangaroo suffering from LJD isolated gramnegative anaerobs. The kangaroos were re-vaccinated after 1, 2, 6 and 12 months. Blood was collected from each animal at the same time. Antibodies were titrated against Fusobacterium necrophorum in an agglutination assay. The vaccine failed to induce increased levels of antibodies as well as to protect wallabies and kangaroos against LJD. As the highest antibody titres were detected in most severely diseased wallabies kept in the Hoyerswerda zoo, the protective role of the humoral immune response in LJD seems to be doubtful. The finding of detectable levels of antibodies in unvaccinated joeys supports the theory, that there is a transmission of antibodies from the mother to the offspring via colostrum or yolk-sac placenta. The diet of the Red-necked Wallabies in one zoo has induced an acidosis: The pH of the forestomach fluid collected by probang was lower in the animals of this zoo (pH = 7.53) than in the wallabies of two other zoos (pH = 8.25 and 8.38, respectively). Potassium, cholesterol and &#61537;-amylase were also higher in the blood of the animals of this zoo in comparison to the wallabies of the two other ones, hence these blood values seem to be helpful for the diagnosis of chronic acidosis in macropods. There was a calcium and phosphor deficiency in the nutrition of the wallabies in two zoos, but the blood concentration of both of these minerals was not changed. The activity of the ALP correlated negative with the age of the Bennett`s Wallabies (P < 0.001, r = -.77 and r = -.62 respectively, depending on the instruments). All of the above mentioned blood values showed no differences between healthy and diseased animals and could so far not support the assumption, that an imbalance in Ca and P metabolism or an acidosis are important factors for LJD. The macropods of all investigated zoos were fed on a diet rich in vitamin A ranging from the 3.5 to the 41fold requirement for lambs. The vitamin A content of the diets for the 2 collections without a history of LJD was the lowest in this study. These results raised the point, that a hypervitaminosis A could be a more predisposing factor for LJD than a vitamin A deficiency. Due to the fact the plasma retinol concentration was independent from the vitamin A content of the diet and so not helpful in diagnosis of a vitamin A deficiency or toxicity, further investigations regarding the role of vitamin A in the aetiopathogenesis of LJD should include measurements of the liver tissue content of retinol esters. The glucose plasma concentration of the healthy Red Kangaroos (8.57 mmol/l) as well as the Red-necked Wallabies (6.51 mmol/l) was higher than previously published values for macropods, but also higher than the results of the diseased animals in this study. Therefore diabetes mellitus can be ruled out as an underlying factor for LJD. The analysis of 144 pathological records showed, that 30 animals died because of LJD, 20% of them and 16.7% of the other 114 macropods had a concurrent kidney disease. The urea and creatinin concentration in serum samples of healthy animals was not higher than the values of diseased animals. In conclusion, these results suggest kidney diseases are not important for the development of LJD. Altogether 184 sera collected from 107 kangaroos were tested for antibodies against MaHV-1 and MaHV-2 using a neutralisation assay. The prevalence of the MaHV-1- as well as MaHV-2-antibodies was high among the Red Kangaroos (94.4% and 97.2% respectively), but low among the Red-necked Wallabies (5.6% and 4.2% respectively). Seroconversion for MaHV-1 was seen in 2 out of 21 wallabies suffering from LJD, only 1 of these animals also had antibodies against MaHV-2. The antibody-titres against both of the macropodid herpes viruses also did not differ between Red Kangaroos with and without LJD, therefore a reactivation of a latent herpesvirus infection does not appear to be causative for LJD. In summary, considering the results of this study and previously published literature LJD is an infectious disease caused by gramnegative anaerobic bacteria with Fusobacterium nucleatum, Bacteroides spp., Porphyromonas gingivalis and Fusobacterium necrophorum subsp. necrophorum being of most significance. Recommendations concerning the keeping of kangaroos in captivity and the management of LJD are listed in the conclusion of this thesis. Some radiographs and photos of diseased and healthy kangaroos are attached.

Indiana University-Purdue University Indianapolis (IUPUI) / Tobacco smoking is considered a major modifiable risk factor for periodontal disease. Tobacco contains about 6700 compounds and almost 4000 compounds of these have been identified in tobacco smoke. Nicotine is the addictive ingredient in tobacco and has been shown to affect multiple cellular processes. Cigarette smoke condensate (CSC) is the particulate matter of smoke. It is believed to be a powerful inducer of inflammatory responses. Neutrophils are the first line of host defense and are critical cells in the maintenance of periodontal health through their role in the control of bacteria, but they can also contribute to the progression of periodontal disease by the production and release of reactive oxygen species (ROS). Virulence factors from periodontal pathogens, such as Porphyromonas gingivalis (P. gingivalis), stimulate the respiratory burst of neutrophils. In this dissertation, three studies aimed at understanding the oxidative activity of neutrophils when stimulated with either nicotine, cigarette smoke condensate (CSC) or four other components of tobacco smoke (2-naphthylamine, hydroquinone, acrolein, and acetaldehyde) with or without P. gingivalis supernatant. The release of matrix metalloproteinase-9 (MMP-9) was also examined. ROS production increased significantly when the neutrophils were stimulated with nicotine. P. gingivalis induced the maximum ROS production when compared to all the other components examined. The combination of nicotine and P. gingivalis did not have an additive effect on ROS production. Nicotine significantly increased the MMP-9 release from the neutrophils. On the contrary, CSC inhibited ROS production at all the concentrations examined. The combination of CSC and P. gingivalis resulted in the inhibition of ROS production. MMP-9 release was also increased from the CSC-treated neutrophils. The four other tobacco smoke components examined affected ROS production and MMP-9 release differently. These projects demonstrated that CSC inhibited the ROS production from neutrophils, which can be attributed to several components in tobacco smoke that may include acrolein and hydroquinone. More research is needed to determine the mechanisms of inhibition and if other tobacco components are involved in ROS inhibition

Indiana University-Purdue University Indianapolis (IUPUI) / The negative heath consequences of smoking are widely recognized, but there are still about 20% of the people in United States using tobacco products. Cigarette smoke condensate (CSC), the particulate matter of cigarette smoke, is comprised of thousands of chemicals (e.g., nicotine). Secondary only to bacterial plaque, cigarette smoking is a major risk factor for periodontal disease. Human gingival fibroblasts (HGFs) are the main cellular component of periodontal connective tissues. During the development of periodontal disease, collagen degradation occurs. Collagen is the major extracellular matrix component of the gingiva. The major extracellular matrix degrading enzymes produced by the HGFs are the matrix metalloproteinases (MMPs). The MMPs are mainly modulated by the tissue inhibitors of metalloproteinases (TIMPs). In this dissertation, three studies aimed at understanding the effects of tobacco on human gingival fibroblasts and their mechanisms have been conducted: the effects of CSC on HGF-mediated collagen degradation; comparison of the effects of CSC on HGFs with that of nicotine; and the combined effects of CSC and bacteria on HGFs. The cell proliferation of HGFs decreased and cytotoxicity increased in HGFs treated with increasing concentrations of CSC. CSC increased the collagen degrading ability of the HGFs by altering the production and localization of MMPs and TIMPs. Nicotine is one of the major components and the most pharmacologically active agent in tobacco. The percentage of nicotine in the CSC was 2.4%. CSC (100 µg/ml) increased the collagen degrading ability of the HGFs by affecting membrane associated MMP-2, MMP-14, and TIMP-2, but the level of nicotine in the CSC may only play a limited role in this process. Porphyromonas gingivalis (P. gingivalis) is an opportunistic pathogen involved in periodontal disease. The combined effects of CSC and P. gingivalis supernatant increased HGF-mediated collagen degradation by destroying the balance between the MMPs and TIMPs at the protein and mRNA levels. This project demonstrated that tobacco (with or without P. gingivalis) increased HGF mediated collagen degradation, as seen in the periodontal disease, through altering the MMPs and TIMPs.