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

Actinobacillus actinomycetemcomitans is present in elevated proportions and numbers in dental bacterial biofilms of patients with localized aggressive periodontitis. This variant of periodontal disease, occurring in adolescents and young adults, is characterized by rapid and severe destruction of the connective tissues and bone supporting the teeth, eventually culminating in tooth loss. The cytolethal distending toxin (Cdt) is a newly discovered bacterial protein toxin, uniquely present in A. actinomycetemcomitans among all known to-date oral bacterial species. The Cdt has the capacity to inhibit mammalian cell growth, but its putative role in the pathogenesis of the disease is unclear. The aim of this in vitro work has been to study the effects of A. actinomycetemcomitans on periodontal connective tissue cell cultures, and to evaluate the possible involvement of its Cdt. A. actinomycetemcomitans inhibited the proliferation of gingival and periodontal ligament fibroblasts, as a result of a combined arrest at the G1 and G2/M phases of the cell cycle. This growth inhibition was non-lethal and the cells remained metabolically active, although their DNA synthesis was reduced. The intoxicated cells exhibited increased size and irregular structure, characterized by distension and elongation. This cellular enlargement occurred in both G1 and G2/M phase arrested cells. The Cdt of A. actinomycetemcomitans was responsible for the observed growth inhibition, as well as the concomitant morphological alterations. The possible induction of inflammatory cytokines related to bone resorption was investigated in response to A. actinomycetemcomitans, and the involvement of Cdt was evaluated. Extensive focus was given to the study of receptor activator of NF-κB ligand (RANKL) expression, a membrane-bound ligand that signals osteoclast progenitors to differentiate and fuse into mature osteoclasts, activating bone resorption. It was demonstrated that A. actinomycetemcomitans induced RANKL mRNA and protein expression in the cells studied, but did not affect the expression of its decoy receptor, osteoprotegerin. This induction was solely attributed to its Cdt, as demonstrated by the use of a cdt-knockout A. actinomycetemcomitans strain, purified recombinant Cdt, and antibodies blocking the Cdt. In addition, this event was not mediated by pro-inflammatory cytokines known to stimulate RANKL. Interleukin-6 mRNA and protein expression were also enhanced by A. actinomycetemcomitans, but Cdt had limited involvement in this enhancement. In conclusion, two distinct mechanisms by which A. actinomycetemcomitans Cdt may be involved in the pathogenesis of localized aggressive periodontitis are proposed. Firstly, the growth arrest of the resident fibroblasts may impair the physiological connective tissue remodelling equilibrium and lead to connective tissue attachment loss. Secondly, the induction of RANKL by these cells, residing in the proximity of the alveolar bone, may locally stimulate osteoclastogenesis and promote alveolar bone resorption. This work also provides further insights to the understanding of Cdt mechanisms of action, contributing to the global characterization of the toxin’s virulence.