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The arginine-deiminase enzymatic system on gingivitis: preliminary pediatric study
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The arginine-deiminase enzymatic system on gingivitis: preliminary pediatric study
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The arginine-deiminase enzymatic system on gingivitis: preliminary pediatric study
1. The arginine-deiminase enzymatic system on gingivitis: preliminary pediatric study i al on Gaetano Ierardo, DDS, PhD1 Introduction Maurizio Bossù, DDS, PhD1 Desirée Tarantino, DDS1 The lactic bacteria are Gram-positive microorganisms with coc- cus or stick shape, which share a number of physiological and Vincenzo Trinchieri, MD2 biochemical properties. They include some species of lacto- Gian Luca Sfasciotti, MD, DDS, PhD1 zi bacilli, lattococchi, streptococci, pediococchi. Several exper- Antonella Polimeni, MD, DDS1 imental evidences suggest the possibility of using lactic acid bacteria as a potential preventive or therapeutic approaches, “Sapienza” University of Rome, Rome, Italy alternative or complementary protocols prevention or treatment na 1 Department of Oral Sciences, Paediatric Dentistry Unit, currently followed in several pathological conditions (Offen- (A. Polimeni) bacher, 1993; Mombelli, 1998) Specific components of Lac- 2 Department of Infectious and Tropical Diseases tobacilli seem to have an intense effect on the modulation of (V. Vullo) immune response, on the activation of the reticuloendothe- lial system and on the regulating production of cytokines and er inflammatory response (Malin, 1996; Naidu, 1999). In this way Corresponding author: it is very important to the study conducted by Ulisse (Ulisse, Prof. Antonella Polimeni 2001) in which was found an inhibitory action of Lactobacil- lus brevis against iNOS, in rat’s peritoneal macrophages stim- Via A. Serranti, 49 - 00136 Rome, Italy Tel. +39 06 35453539 E-mail: email@example.com nt ulated in vitro with IFN-γ and lipopolysaccharide (LPS). In the light of these results, in this work, we have proposed to as- sess the anti inflammatory effects of Lactobacillus brevis in iI case of marginal gingivitis. The initial pathogenic event de- termines in guest’s organism tissues the production and syn- thesis of cytokines (Bucci, 2006). The excessive production of cytokines driving in a non-specific way the production of ni- on Summary The arginine-deiminase enzymatic system on gingivitis: tric oxide (NO). preliminary pediatric study. NO2, gaseous free radical, is fleeting and in the presence of oxygen is rapidly metabolized by nitrate to nitrite (NO). The Aim. The lactic bacteria are Gram-positive microorgan- increase of NO can not be seen as specific for a clinical con- isms with coccus or stick shape, which share a number dition, but rather as a reflection of an immuno-inflammatory i of physiological and biochemical properties. Several ex- activated state, in which cytokines, together with other me- iz perimental evidences suggest the possibility of using diators, led to a stimulation of NO-synthase in tissues and flu- lactic acid bacterial as a preventive or therapeutic po- ids (Ramberg, 1994; Persson, 1990). tential approaches, alternative or complementary to pre- It is clear that excessive levels of NO are harmful and dan- Ed vention or treatment protocols currently followed in gerous for the tissues and promote the progression of the in- several pathological conditions. flammatory phenomena (De Luca, 1999). The plaque bacte- Lactobacillus brevis is able, through the arginine-deim- ria that have arginina-deiminase enzyme are: Streptococcus inase activity, to subtract the substrate (arginine) to ni- sanguinis, Streptococcus milleri, Streptococcus rattus, Lac- tric oxide synthase, and to inhibit in vitro generation of tobacillus fermentum, Streptococcus faecalis, Streptococcus nitric oxide from rat’s peritoneal macrophages. These faecium, Eubacterium nodatum species. Some strains of Lac- data led us to study the in vivo L. brevis anti-inflamma- tobacillus brevis species (CD2) are surprisingly rich in “argin-IC tory effect choosing as experimental model the gingivi- ina-deiminasi” enzymatic system. It is believed that the enzyme tis. may play an important role in the ecology of the mouth prob- Materials and methods. In our study were examined 21 ably protecting oral bacteria that are less tolerant against acid subjects, 16 males and 5 females, aged between 5 and environment, by the pH decrease (4.0) caused by aci-C 12 years, with marginal gingivitis problems who have dophilous bacteria glycolysis (Lindhe, 1998; Page, 1996; Poli- been given chewing gum containing the principle to test meni, 1995). This defense is expressed through an increase in measure of three per day. in pH associated with the production of ammonia. The action Results. At the time T1, after treatment, 18 patients no pad done by ammonia can be positive not only for the same longer showed inflammation; 2 of them had a slight in- plaque bacteria, but also for tooth and tissues of the guest.© flammation and only 1 patient still showed a moderate This enzyme uses the same iNOS substrate, inhibiting its ac- inflammation. tion, and pursuing anti-inflammatory effects (Chambers, Conclusions. From our research, as confirmed by clini- 1991; Lamster, 1987; Wong, 1999; Mizuho, 1996). cal and laboratory investigation, results an effective anti- The goal of the study has been to identify the possible med- inflammatory action of arginine-deiminase system that ical applications, both preventively and therapeutically, of the some bacteria possessing. lactic acid bacteria strains selected on the basis of specific Key words: gingivitis, lactobacillus brevis, arginine-deimi- chemical, physical and/or biological characteristics. nase. In particular, objectives of this work were: 8 Annali di Stomatologia 2010; LIX (1): 8-13
The arginine-deiminase enzymatic system on gingivitis: preliminary pediatric study • To analyze the in vivo effects of the tablets containing L. bre- vis on clinical signs in patients with primitive and applicant marginal gingivitis. • To analyze the in vivo effects of the tablets containing L. bre- vis on the salivary IgA levels and on the nitric oxide syn- thase (NOS) activity (Fig. 1). i al Materials and Methods on In our study were examined 21 subjects, 16 males (76%) and 5 females (24%), aged between 5 and 12 years, with marginal gingivitis problems, 16 volunteers as controls, 10 males (62.5%) and 6 females (37.5%), examined at the U.O.C. of Paediatric Dentistry of “ Sapienza”, University of Rome. The zi controls were used only for the evaluation of laboratory data, Figure 3 - Marginal gingivitis. and not in clinical investigations. To patients were administered gums containing the active ingredient (Fig. 2) for a period of subjects with systemic diseases or subjects under drug pro- na 60 days.The procedures were carried out in accordance with longed treatments. the Helsinki Declaration of 1975, and the 1983 revision of the • Personal behavior including the possible presence of or- same. For the study a medical bill in different sections was thodontic appliances. drawn up. They were selected subjects suffering from marginal gingivi- tis (Fig. 3) (T0) who have been given chewing gums containing er the principle to test in three per day. The gums, taken at reg- Section 1 ular intervals, were chewed by patient for a period longer than 20 minutes. The checks were made at the time T1 (30 days) • Personal data. and T2 (60 days). During each control has been made a levy • Accurate family history, physiological and pathological re- mote and next. • Possible presence of underlying conditions; excluding nt saliva. The saliva samples of patients and controls, collect- ed in tubes before and after treatment and immediately frozen at -20°C until use, were analyzed for the activity of NOS (this was determined as levels of nitrites/nitrates in the hamlet of iI salivary fluid), and the levels of IgA (Giuca, 2007; Grbic, 1995; Haffajee, 1983; Heskens, 1996; Riccia, 2007). on Section 2 The clinical evaluation was performed referring on 6 dental elements (upper arch: earlier sector 1.1 or 1.2, medium-rear sector 1.6 and 2.6; lower arch: earlier sector 3.1 or 4.1, medi- i um-rear sector 3.6 and 4.6), with symptoms (thermal sensi- iz tivity and bleeding) and objectivity (plaque, scale, gingival in- flammation) recorded at the time T0, T1 and T2 above reported with a gradual scale (Tables 1 and 2). Ed Section 3 Registration at T1 and T2 of possible side effects resulting from Figure 1 - Inhibition of NO-synthase by arginine-deiminase en- the administration of the principle tested. zyme.IC Section 4 Final evaluation including clinical and laboratory data. With re-C gard to clinical aspects on the basis of results obtained has given judgment: • healing; • improvement; • failure;© • relapse; • do not assessable. Results The clinical signs and symptoms (gingival inflammation, Figure 2 - Gums containing the active ingredients. plaque, scale, sensitivity to temperature and bleeding after Annali di Stomatologia 2010; LIX (1): 8-13 9
G. Ierardo et al. pressure), given before and after treatment with the gums of mation and only 1 patient still showed a moderate inflam- L. brevis, are shown in Table 3 and Table 4. At the time T0, mation. The tolerance to the treatment was considered very before treatment, gingival inflammation was evaluated mod- good in all patients. Overall dentist and patients opinion co- erate/diffused in 20 patients and slight in 1 patient (Table 3 incided and the results confirmed regression in 18 patients and Figure 4). At the time T1, after treatment, 18 patients no and improved in the remaining 3 of them. The effects of treat- i longer showed inflammation; 2 of them had a slight inflam- ment on the levels of plaque and scale are shown in Table al Table 1 - Symptoms with gradual scale shown in Section 2. on zi na er Table 2 - Signs objectives shown in Section 2. nt iI i on iz Ed Table 3 - Effect of gums with L. brevis on gingival inﬂammation, plaque and scale.ICC© 10 Annali di Stomatologia 2010; LIX (1): 8-13
The arginine-deiminase enzymatic system on gingivitis: preliminary pediatric study tients compared to the control samples, while treatment with tablets not producing a significant change. Evaluation of nitrite/nitrate levels i Levels of nitrites/nitrates are often indicative of NOS activity. al In our study we proposed to detect the activity of this enzyme. The results of determining the levels of nitrites and nitrates in the saliva of healthy subjects and subjects with gingivitis on before (T0) and after (T1) treatment with the gums are reported in Tables 5 and 6 and in Figure 5. As it is possible to see lev- els of nitrites/nitrates in patients with gum disease were sig- nificantly higher (P<0.01) compared to those of controls. It seems clear that in all patients, treatment with the gums with zi L. brevis was associated with a significant reduction in the lev- els of nitrites and nitrates (P <0.01). na Conclusions Lactobacillus brevis is able, through the arginine-deiminase activity, subtract the substrate (arginine) to nitric oxide syn- er thase and to inhibit in vitro the generation of nitric oxide from rat’s peritoneal macrophages stimulated with LPS and IFN- γ. These data led us to study in vivo the L. brevis anti-in- Figure 4 - Effect of gums with L. brevis on gingival inﬂammation, flammatory effect choosing as experimental model the gin- plaque and scale. 3, which notes the improvement in the levels of plaque in al- nt givitis. The choice was dictated by some observations and needs: L. brevis, like other lactic bacteria, is part of the nor- mal flora of the oral cavity, is present in dental plaque and in literature is not reported as pathogen for periodontium; the iI most all patients. In Table 4 (Figure 5) are shown the bene- method of collection of samples was not painful for patients and the inflammatory state and evolution of the disease were ficial effects of treatment on sensitivity to temperature and on evaluated using an objective examination and with the use of bleeding after pressure. on a simple equipment. Overall, our results allow us to hypoth- esize that L. brevis has anti-inflammatory activity due to its abil- ity to inhibit, in particular on macrophagic cells, the activity of Evaluation of secretory IgA iNOS, indirectly causing a reduction in levels of inflammato- ry cytokines. They were analyzed levels of secretory IgA in saliva fluid frac- i It was described the ability of some so-called protective mi- tion of control subjects and in patients with gingivitis before iz croorganisms present in dental plaque, (for example Strep- (T0) and after (T1) treatment with the gums. In Tables 5 and tococcus sanguinis, Gram-positive, Veillonella parvula, Gram- 6 and in Figure 6 are showed the data about antibody. A sig- negative, and Eubacteria), to suppress the growth of patho- nificant reduction in IgA levels was founded in saliva of the pa- genic bacteria. Therefore it would be advantageous to elim- Ed Table 4 - Effect of gums with L. brevis on sensitivity to temperature and bleeding.ICC© Annali di Stomatologia 2010; LIX (1): 8-13 11
G. Ierardo et al. Table 6 - Levels of nitrites/ nitrates and IgA s in patients with gingivitis before (T0) and after (T1) treatment with L. brevis gums. i al on Data displayed as ± STD. *P < 0.05 mean. abling an efficient competition with the same bacteria zi pathogens for periodontium for membership of adhesion sites on dental and epithelial surfaces. From our research, as confirmed by clinical and laboratory in- na vestigation, results an effective anti-inflammatory action of arginina-deiminasi system, that some bacteria possessing. It is conceivable that the anti-inflammatory action of arginina- deiminasi system can also act in other inflammatory conditions, Figure 5 - Effect of gums with L. brevis on sensitivity to temper- not necessarily where there is a bacterial component at the er ature and bleeding. base, acting mainly through iNOS inhibition. This is the case for example of recurring aphthosus stomatitis, multifactorial etiology disease, for which there isn’t still a valid treatment with- Table 5 - Levels of nitrites/ nitrates, PGE2, cytokine and IgAs out side effects. in controls and patients with periodontitis before (T0) treat- ment with L. brevis gums. nt Precisely for this inflammatory condition, we are implement- ing a therapeutic and research protocol, which aims to assess the efficacy of “arginine-deiminase” enzymatic system. iI References 1. Bucci P, Bucci M, Scutellà M, Giannone N, Santarelli A. Mi- on crobiological agents associated with IL-1 polymorphisms in periodontal disease. A pilot study Annali di Stomatologia 2006;LV(1):23-29. 2. Chambers DA, Imrey PB, Cohen RL. A cross-selectional Data displayed as ± STD. *P < 0.05 mean. analysis of aspartate aminotransferase in gingival crevicu- lar fluid. J Periodontal Res. 1991; 26: 75-84. i 3. Chambers DA, Imrey PB, Cohen RL. A longitudinal study of iz aspartate aminotransferase in human gingival crevicular flu- id. J Periodontal Res. 1991; 26:65-74. 4. De Luca M, Dolci G, Passariello C. Gli anaerobi e la malat- Ed tia parodontale. Bologna: Martina Ed; 1999. 5. Giuca MR, Saracino S, Giannotti E, Ceccarini A. Oral clearance of NaF from chewing gum and tablets in children and adults. Eur J Paediatr Dent. 2007; Mar;8(1):19-24. 6. Grbic JT, Singer RE, Jans HH, Celenti RS, Lamster BI. Im- munoglobulin Isotypes in gingival crevicular fluid: possible protective role of IgA. J Periodontol. 1995; 66:55-61. 7. Haffajee AD, Socransky SS, Goodson JM. Clinical param-IC eters as predictors of destructive periodontal disease activ- ity. J Clin Periodontol. 1983; 10: 257-265. 8. Henskens YMC, Van den Keijbus PAM, Veerman ECI, Van der Weijden GA, Timmermann MF, Snoek CM, Van der Velden U. Nieuw Amerongen A.V.: Protein composition ofC whole and parotid saliva in healthy and periodontitis subjects. J Periodontal Res. 1996; 31:57-65. 9. Lamster JB, Harper DS, Fiorello LA. Lisosomial and cyto- plasmic enzime activity, crevicular fluid volume, and clinical parameters characterizing gingival sites with shallow to in-© Figure 6 - Salivary IgA level of controls and patients with gingivi- termediate probing depths. J Periodontol. 1987; 58: 614-62. tis marginalis, before (T0) and after (T1) treatment with L. brevis 10. Lindhe J, Karring T, Lang NP. Parodontologia e Implantolo- gums. gia Dentale. Milano: Ermes Ed; 1998. 11. Malin M, Souomalainen H, Saxelin M, Isolauri E. Promotion of IgA immune. Response in patients with Crohn’s disease by oral bacteriotherapy with Lactobacillus GG. Ann Nutr inate harmful bacteria, encouraging the growth of beneficial Metab. 1996; 40:137-45. microorganisms. We can not exclude that the administration 12. Mizuho F, Mori H, Deguchi S. Aspartate aminotransferase of L. brevis, normally present in the oral flora and plaque, en- levels in human periodontum derived cells. J Periodontol. 12 Annali di Stomatologia 2010; LIX (1): 8-13
The arginine-deiminase enzymatic system on gingivitis: preliminary pediatric study 1996; 67: 733-736. sue alterazioni. Roma: Universitaria Ed; 1995. 13. Mombelli AW, Lang PN, Attström R, Löe H. The role of den- 19. Ramberg PW, Lindhe J, Gaffar A. Plaque and gingivitis in the tal plaque in the initiation and progression of periodontal dis- deciduos and permanent dentition. J Clin Periodontol. eases. Proceedings of the European Workshop on Me- 1994; 21:490-496. chanical Plaque Control. Berlin: Quintessence Publishing Co. 20. Riccia DN, Bizzini F, Perilli MG, Polimeni A, Trinchieri V, Ami- 1998; 85-97. cosante G, Cifone MG. Anti-inflammatory effects of Lacto- i 14. Naidu AS, Bidlack WR, Clemens RA. Probiotic spectra of lac- bacillus brevis (CD2) on periodontal disease. Oral Dis. 2007 al tic acid bacteria (LAB). Crit Rev Food Sci Nutr. 1999 Jul;13(4):376-85. Jan;39(1):13-126. 21. Ulisse S, Giochetti P, D’Alò S, Russo FP, Pesce I, Ricci G, 15. Offenbacher S, Collins JG, Heasman PA. Diagnostic potential Rizzello F, Helwig U, Cifone MG, Campirei M, De Simone C. of host response mediators. Adv Dent Res. 1993; 7: 175-181. Expression of cytokines,inducible nitric oxide synthase and on 16. Page RC . Gingivitis. J Clin Periodontol 1986; 13: 345-355. matrix metalloproteinases in pouchitis: effects of probiotic tre- 17. Persson RG, DeRouen TA, Page RC. Relationship betwe- atment. Am J Gastroenterol. 2001 Sep; 96(9):2691-9. en levels of aspartate aminotransferase in gingival crevicu- 22. Wong MY, Lu CL, Liu CM, Hou LT, Chang WK. Relationship lar fluid and gingival inflammation. J Periodontal Res. 1990; of the subgingival microbiota to a chairside test for aspartate 25: 17-24. aminotransferase in gingival crevicular fluid. J Periodontol. 18. Polimeni A, Gallottini L, Dolci M. La secrezione salivare e le 1999; 70: 57-62. zi na er nt iI i on iz EdICC© Annali di Stomatologia 2010; LIX (1): 8-13 13
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