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.

Aggregatibacter actinomycetemcomitans is an oral bacterium that is mainly associated with aggressive forms of periodontitis, which most often starts at an early age. Amongst the virulence factors of A. actinomycetemcomitans, two exotoxins, the leukotoxin (LtxA) and the cytolethal distending toxin (Cdt), are suggested to play an important role in the pathogenicity of aggressive periodontitis. There is also a genetic diversity of the different strains of A. actinomycetemcomitans, and a variation in the ability of different strains to express and release exotoxins has been suggested. Of the different genotypes of A. actinomycetemcomitans, the highly leukotoxic JP2 genotype, which is prevalent in individuals of African origin, seems to be the genotype that is most strongly associated with localized aggressive periodontitis. This thesis is built upon studies of a West African adolescent population. The aim was to study the virulence characteristics of A. actinomycetemcomitans genotypes with a specific focus on the LtxA and the Cdt in relation to the progression of attachment loss (AL). The specific aim was first, to investigate cross-sectionally the presence of the JP2 and non-JP2 genotypes of A. actinomycetemcomitans in relation to the prevalence of AL and then prospectively to assess the progression of AL in a Ghanaian adolescent population. Second, in clinical isolates of A. actinomycetemcomitans obtained from the participants of the study, the serotypes and the virulence characteristics related to the two exotoxins were studied and associated with the progression of AL at the individual level. In Paper I, based on the study population consisting of 500 adolescents (mean age 13.2 years; SD ±1.5), it was shown that the overall carrier rate of A. actinomycetemcomitans was high (54.4%) and that the presence of this bacterium was associated with AL ≥ 3 mm. The JP2 genotype was prevalent (8.8%) in this population. In Paper II, 397 (79.4%) of the study participants were periodontally examined again at a 2-year follow-up. The presence of the JP2 genotype of A. actinomycetemcomitans in subgingival plaque was strongly associated with the progression of AL. This study also provided support for an enhanced estimated risk (odds ratio, OR=3.4), though less pronounced, for the progression of AL in individuals positive for the non-JP2 genotypes of A. actinomycetemcomitans. In Paper III, all three cdt genes (a, b and c) were detected in 79% of the examined A. actinomycetemcomitans isolates, all of which expressed an active toxin. The distribution of the cdt genes showed a serotype-dependent pattern. In particular, the presence of the b serotypes (both JP2 and non-JP2 genotypes) was associated with the disease progression, whereas the expression of Cdt was not particularly related to the disease progression.  In Paper IV, it was shown that the presence of of A. actinomycetemcomitans isolates with high leukotoxicity, also those of the non-JP2 genotypes of A. actinomycetemcomitans, were associated with an increased risk of the progression of AL in relation to the reference group. The main proportion of the serotype b isolates was distributed in the category of highly leukotoxic isolates. The analyses of the non-JP2 genotypes of serotype b indicated a diversity linked to the level of leukotoxicity. In conclusion, A. actinomycetemcomitans in general was associated with the progression of AL. Individuals with an increased risk of developing progression of AL mainly harboured isolates of A. actinomycetemcomitans with a high leukotoxicity, which suggests that the LtxA is an important virulence factor. Of the two exotoxins, the pathogenic potential was mainly associated with the LtxA, while the role of the Cdt is unclear.

Orientador: Carlos Rossa Junior / Banca: Shannon Margaret Wallet / Banca: Karina Gonzales Silvério Ruiz / Banca: Alexandra Ivo de Medeiros / Banca: Paulo Sérgio Cerri / Resumo: Inflammasomes are multi-protein complexes that can amplify the inflammatory signal in situations involving host-microbial interactions and host tissue destruction, such as chronic periodontal disease. There is a relative scarcity of information on the role of NLRC4 and NLRP3 inflammasomes in periodontal disease. In this study, we used a model of bacteria-initiated periodontal disease in WT, Ipaf-knockout (Ipaf-KO), Caspase 1-knockout (Casp1-KO) and NLRP3-knockout (NLRP3-KO) mice to describe the effect of those inflammasomes on inflammation and alveolar bone resorption. Heat-killed Aggregatibacter actinomycetemcomitans (Aa) were injected in the gingival tissues on the palatal aspect adjacent to first molars of wild-type (WT), Ipaf-KO, Casp1-KO and NLRP3-KO mice, and control animals received the suspension vehicle (PBS). Severity of bone resorption was quantitated by μCT analysis. Inflammation was assessed by immunofluorescence, verifying the presence and intensity of a pan-leukocyte (CD45) and a neutrophil (Ly6G) markers. Osteoclast number was determined by TRAP and gene expression of RANKL, MMP-13, TNF-a, IL-6 and IL-10 in the gingival tissues was evaluated by RT-qPCR. In the first publication, μCT analysis showed a significantly greater inflammatory bone resorption in Ipaf-KO mice; however there was no difference between WT and Ipaf-KO on osteoclast numbers of inflammatory infiltrate. Expression of candidate genes was also similarly increased by the induction of experimental... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Inflamassomos são complexos multi protéicos capazes de amplificar o sinal inflamatório em condições de interações microbiota-hospedeiro e destruição tecidual, como a doença periodontal crônica. Devido à escassez de informações sobre o papel dos inflamassomos NLRC4 e NLRP3 na doença periodontal, utilizamos neste estudo um modelo de doença periodontal induzida por bactérias em camundongos WT, Ipafknockout (Ipaf-KO), Caspase 1-knockout (Casp1-KO) e NLRP3-knockout (NLRP3-KO) para descrever o efeito destes na inflamação e reabsorção óssea alveolar. Aggregatibacter actinomycetemcomitans (Aa) inativadas pelo calor foram injetadas nos tecidos gengivais palatais adjacentes aos primeiros molares dos camundongos normais e knockout, e os grupos controle receberam o mesmo volume do veículo de suspensão (PBS). A severidade da reabsorção óssea foi quantificada por análise de μCT. A inflamação foi avaliada por imunofluorescência, verificando-se presença e intensidade da coloração por marcadores de leucócitos (CD45) e neutrófilos (Ly6G). O número de osteoclastos foi determinado por TRAP e a expressão gênica de RANKL, MMP-13, TNF-a, IL-6 e IL-10 nos tecidos gengivais avaliada por RT-qPCR. A publicação 1 mostra uma reabsorção óssea inflamatória significativamente maior nos camundongos Ipaf-KO, sem diferenças, porém, no número de osteoclastos entre WT e Ipaf-KO. A expressão dos genes-alvo aumentou com a indução da doença periodontal, exceto de TNFa e IL-10, que foram altas n... (Complete abstract click electronic access below) / Doutor

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / Aggregatibacter actinomycetemcomitans à um patÃgeno intensamente relacionado com a etiologia da periodontite agressiva. O objetivo deste estudo foi avaliar, via reaÃÃo em cadeia da polimerase, a presenÃa de clones de A. actinomycetemcomitans que exibem alta ou mÃnima leucotoxicidade em indivÃduos portadores de periodontite agressiva (PAG) e em seus membros familiares (FAM). Trinta e cinco indivÃduos com PAG (33,9  7,1 anos), 33 FAM (22,8  11,4 anos) e 41 portadores de periodontite crÃnica (PC) (44,1  9,4 anos) foram analisados clinicamente pelo Ãndice de placa (IP), Ãndice gengival (IG), profundidade de sondagem (PS) e nÃvel de inserÃÃo clÃnico (NIC). Amostras de biofilme subgengival foram coletadas de todos os indivÃduos do sÃtio interproximal com maior PS e maior NIC e analisadas microbiologicamente por meio de PCR, quanto à presenÃa de A. actinomycetemcomitans e de seus clones leucotÃxicos. MÃdias de PS e NIC desses sÃtios foram: PAG â 9,8 mm e 10,7 mm, FAM â 5,3 mm e 4,6 mm e PC â 8,2 mm e 9,4 mm, tendo sido observadas diferenÃas estatisticamente significantes entre os grupos. A presenÃa de A. actinomycetemcomitans foi observada em 23 (51,1%) portadores de periodontite agressiva e em 16 (30,1%) portadores de periodontite crÃnica. Dentre eles, 37 (94,8%) exibiram clones de mÃnima leucotoxicidade e 2 (5,1%) clones de alta leucotoxicidade, um do grupo PAG e outro do grupo FAM, tambÃm com doenÃa agressiva. Quanto à condiÃÃo periodontal do grupo FAM, 30,3% apresentaram periodontite agressiva, 36,3% periodontite crÃnica e 33,3% estavam periodontalmente saudÃveis ou mostravam gengivite. Dentre eles, 12,2% estavam positivos para a presenÃa de A. actinomycetemcomitans. Maiores valores de PS e NIC foram observados nos pacientes com periodontite agressiva positivos para A. actinomycetemcomitans quando comparados Ãqueles pacientes negativos, com diferenÃa estatisticamente significante. A presenÃa de A. actinomycetemcomitans foi associada à condiÃÃo clinica de periodontite agressiva (odds ratio=3,1; intervalo de confianÃa: 1,4-7,0; p=0,009). A maioria destes indivÃduos exibiu uma forma generalizada de doenÃa e estavam positivos para clones de mÃnima leucotoxicidade de A. actinomycetemcomitans. Os familiares externaram em sua maioria algum tipo de doenÃa periodontal crÃnica ou agressiva. / Aggregatibacter actinomycetemcomitans is a pathogen strongly associated with the etiology of aggressive periodontitis. The purpose of this study was to evaluate by polymerase chain reaction (PCR) the presence of highly and minimally leukotoxic clones of A. actinomycetemcomitans in patients with aggressive periodontitis (AgP) and their family members (FM). Thirty five patients with AgP (33,9  7,1 years), 33 FM (22,8  11,4 years) and 41 patients with chronic periodontitis (CP) (44,1  9,4 years) were clinical analyzed through plaque index (PI), gingival index (GI), probing depth (PD) and clinical attachment level (CAL). Subgingival biofilm samples were collected from the interproximal periodontal sites (> PD and > CAL) of each patient and their microbiological analysis were taken by PCR, concerning A. actinomycetemcomitans was observed and its leukotoxic clones. The PD and CAL average of this sites were: AgP â 9,8 mm e 10,7 mm, FM â 5,3 mm e 4,6 mm e CP â 8,2 mm e 9,4 mm. Statistically significant difference was observed among the groups. The presence of A. actinomycetemcomitans was observed in 23 (51,1%) patients with aggressive periodontitis and in others ones, 16 (30,1%) with chronic periodontitis. Among them 37 (94,8%) showed minimally leukotoxic clones and 2 (5,1%) highly leukotoxic clone, one was AgP group, the other was FM group, also with aggressive disease. Concerning to periodontal status of the FM group, 30,3% had aggressive periodontitis, 36,3% chronic periodontitis and 33,3% were periodontally normal or had gingivitis. Among them 12,2% were A. actinomycetemcomitans positive. The higher values of PD and CAL were observed in aggressive periodontitis patients that were A. actinomycetemcomitans positive when compared with A. actinomycetemcomitans negative patients (p<0.05). The presence of A. actinomycetemcomitans was correlated with aggressive periodontitis clinical status (Odds ratio=3,1; CI: 1,4-7,0; p=0,009). The majority of the patients with aggressive periodontitis exhibited a generalized form of disease and were positives to minimally leukotoxic A. actinomycetemcomitans clones. The family members had any type of chronic or aggressive periodontal disease.

Made available in DSpace on 2014-06-12T23:02:15Z (GMT). No. of bitstreams: 2 arquivo969_1.pdf: 1672515 bytes, checksum: 57a925ef24be8c7dd06dd31514a160d4 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2009 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / O presente trabalho teve por objetivo avaliar a presença dos periodontopatógenos que formam o complexo vermelho (Tannerella forsythia (Tf), Porphyromonas gingivalis (Pg) e Treponema denticola (Td)) e o Aggregatibacter actinomycetemcomitans (Aa) em pacientes portadores de periodontite crônica. A amostra foi constituída de 29 pacientes com diagnóstico clínico e radiográfico de periodontite crônica de acordo com os critérios da AAP (2000). Todos os dentes foram sondados em seis sítios para registro de profundidade, perda de inserção clínica e sangramento após sondagem. As amostras para análise microbiológica foram coletadas dos 4 sítios com maior profundidade de sondagem para cada paciente, totalizando 116 amostras. Estas amostras foram processadas através da técnica de PCR convencional e foram observados os seguintes resultados: 46,6% apresentaram resultado positivo para a bactéria Pg; 41,4% para Tf; 33,6% para Td e 27,6% para Aa. Não se verificou associação significante entre a presença dos periodontopatógenos e as variáveis faixa etária, sexo e sangramento à sondagem. Para a bactéria Pg verificou-se associação significante (p<0,05) com a variável placa visível, e a presença das bactérias Pg e Tf foi mais prevalente (p < 0,05) em bolsas periodontais &#8805; 8 mm. Nos sítios com profundidade &#61619; 8 mm foram observadas com maior freqüência as combinações Pg + Tf (23,2%) e Pg + Tf + Td (20,0%). Foram estatisticamente significantes (p < 0,05) as associações entre a presença simultânea das bactérias Aa + Pg, Aa+ Tf, Pg + Tf e entre Tf + Td. Concluiu-se que as bactérias analisadas, principalmente as do complexo vermelho, estiveram fortemente relacionadas com a periodontite crônica, e que as bactérias Pg e Tf foram mais frequentes em bolsas periodontais profundas

Das parodontopathogene Bakterium Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) exprimiert zahlreiche Virulenzfaktoren. In dieser Studie wurden die Gene für die Virulenzfaktoren Leukotoxin (LtxA), Cytolethal Distending Toxin (CDT) und Fimbriae-assoziiertes Protein (Flp1) in 99 A. actinomycetemcomitans-Isolaten aus der Plaque von Parodontitispatienten aus vier deutschen Universitätskliniken untersucht. Die Proben wurden serotypisiert. Die Entnahme erfolgte mit sterilen Papierspitzen aus der jeweils tiefsten Tasche jedes Quadranten. Es wurden von den Patienten Sondierungstiefe (PD) und Attachmentlevel (AL) an sechs Stellen pro Zahn gemessen und ebenfalls die Tiefen an den vier Entnahmestellen notiert. Außerdem wurden ethnische Herkunft der Eltern, Geschlecht und Raucherstatus erfragt. Lediglich zwei A. actinomycetemcomitans-Isolate aus Frankfurt/Main wiesen das ltx-Gen mit Deletion auf. Diese zeigten signifikant höhere PD an den vier Entnahmestellen. Die übrigen 97 Proben hatten das ltx-Gen ohne Deletion in der DNA-Promotorregion ihrer A. actinomycetemcomitans-Stämme. Probanden mit Genlokus für das cdtB-Gen, mit drei cdt-Genen oder insgesamt fünf Genen für Virulenzfaktoren litten signifikant häufiger an aggressiver Parodontitis. A. actinomycetemcomitans-Isolate mit cdtA-Gen, cdtB-Gen, cdtCGen, drei cdt-Gene oder flp-1-Gen wiesen signifikant häufiger Serotyp b oder c auf. Probanden ohne cdtC-Gen oder flp-1-Gen in der DNA ihrer isolierten A. actinomycetemcomitans-Stämme zeigten am häufigsten Serotyp e. Probanden mit Genlokus für das cdtB-Gen oder drei cdt-Gene in den isolierten A. actinomycetemcomitans-Proben oder mit aggressiver Parodontitis stammten signifikant häufiger aus dem Ausland. Es wurde kein signifikanter Zusammenhang zwischen Vorkommen der Gene für Virulenzfaktoren und PD bzw. AL im gesamten Gebiss gefunden.

Objectives: Microbial infection and the host response to the infection play a significant role in the etiology of periodontal diseases. Previous studies reported a relatively high prevalence of periodontitis among adolescents in Morocco. The importance of the composition of subgingival plaque and the presence and proportion of Aggregatibacter actinomycetemcomitans to the total plaque bacteria in the pathogenesis of periodontitis is not well understood. The purpose of this study is to compare the relative abundance of A. actinomycetemcomitans in subgingival dental plaque from young Moroccans with aggressive periodontitis, chronic periodontitis, and those without periodontitis, and to construct a multivariable model to investigate the effect of demographic attributes of age, gender and relative ratio of A. actinomycetemcomitans in dental plaque with periodontal disease status. Methods: Sample population includes 984 subjects, aging from 12-20 years old, who were surveyed and examined for periodontal disease status. 82 subjects were selected consisting of 26% aggressive periodontitis, 12% chronic periodontitis, and 62% without periodontitis. Subgingival plaque was collected from these 82 subjects. Whole DNA was extracted and purified, and real-time PCR was used employing a primer for eubacteria, and specific primer for A. actinomycetemcomitans. PCR assays confirmed the amplification and quantification of DNA of total bacterial and A. actinomycetemcomitans. Results: 73% of the subjects harbored A. actinomycetemcomitans: 63% in aggressive periodontitis, 90% in chronic periodontitis, and 73% in controls. The percentage A. actinomycetemcomitans to total bacterial load increased with age, was similar among males and females, and was somewhat higher in persons with periodontitis than the controls. Using a logistic regression analysis that included age, gender and A. actinomycetemcomitans ratio showed that only age is significantly correlated with the diagnosis of periodontitis in this population. Conclusions: A. actinomycetemcomitans is prevalent among this young Moroccan group and is somewhat more prevalent in subjects with periodontitis than the controls. However, the presence and ratio of this species to the total bacteria in subgingival plaque explained only a small proportion of the variance in periodontitis in this group. / Oral Biology

Aggregatibacter actinomycetemcomitans is a Gram negative bacterium found exclusively in the mammalian oral cavity where it resides in the gingival crevice, the space between the tooth and gum tissue. Though it has historically been considered a common commensal organism, it is now appreciated that A. actinomycetemcomitans is an opportunistic pathogen associated with the diseases periodontitis and endocarditis. To cause infection, A. actinomycetemcomitans must interact and compete with neighboring bacteria for space and nutrients, though little is known about the physiology it employs within the gingival crevice. Using A. actinomycetemcomitans grown in a chemically defined medium containing carbon sources found in vivo, I use transcriptome analyses and growth studies to show that A. actinomycetemcomitans preferentially utilizes lactate over the phosphotransferase system (PTS) sugars glucose and fructose. Additionally, the presence of lactate or pyruvate inhibits the transport and metabolism of these sugars in a post-transcriptionally controlled process I have termed PTS substrate exclusion. Since lactate is an energetically inferior carbon source, PTS substrate exclusion appears to be a carbon resource partitioning mechanism that allows A. actinomycetemcomitans to avoid competition for energetically favorable sugars with other species, and I propose a model to describe this phenomenon. To begin to understand the mechanism of PTS substrate exclusion, I examine the first step of the proposed model by purifying and characterizing the L-lactate dehydrogenase (LctD) from A. actinomycetemcomitans. I demonstrate that, unlike other studied lactate dehydrogenases, the LctD from A. actinomycetemcomitans does not exhibit feedback inhibition in the presence of physiologically relevant concentrations of pyruvate, which supports my hypothesis that elevated intracellular pyruvate levels inhibit the PTS. The results of my studies provide insight into a new regulatory mechanism governing carbon utilization in this bacterium. / text

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.