T-cells is explained with a emphasis with humoral and adaptive immunity . And the diffrent subsets of t cells are well explained by Dr Harshavardhan Patwal here .
T-cells is explained with a emphasis with humoral and adaptive immunity . And the diffrent subsets of t cells are well explained by Dr Harshavardhan Patwal here .
Platelet Rich Fibrin (PRF) is an autologous fibrin based biomaterial derived from human blood discovered by Choukroun and coworkers in the year 2006. The future of PRF has enormous therapeutic implications. Therefore, more clinicians should adopt this technology for the benefit of the patients.
Inflammation and Immunity in periodontitis pptPerio Files
Local destruction of periodontium occurs mostly by activation of immune and inflammatory response, initiated by plaque. First innate immune response is activated followed by specific immune response.
Useful for BDS and MDS students
”Contemporary Biomarkers In Periodontitis”- Guest lecture as a part of Dr NTRUHS Zonal CDE programme at Government Dental College and Hospital, Hyderabad, India on 281/1/2011, SIBAR Institute of Dental Sciences, Guntur, India on 29/12/12 and at Meghna Institute of Dental Sciences, Nizamabad, India on 31/7/2013.
Periodontitis is a chronic infectious inflammatory disease caused by microbes; however the presence of microbes is not enough for the cause of its complex nature of disease. Inflammation is the prime cause of periodontal disease. It commences with the aggregation of pathogenic microbes that induce the host to stimulate a cascade of inflammatory response reactions which in-turn leads to the destruction of the host tissues itself. There is a complex interplay of innate and adaptive immune responses which fights against the pathogens by direct interaction or by release of certain molecules including cytokines.
Cytokines are cell signalling molecules that aid cell to cell communication in immune responses and stimulate the movement of cells towards sites of inflammation, infection and trauma. Cytokine biology reveals that there are some subsets of cytokines which are pro-inflammatory cytokines which stimulate the inflammatory responses and cause tissue destruction.
A periodontist is expected to have a sound basis of the cytokine profile to understand the pathogenesis of periodontitis and also to discover the new treatment modality of anti-cytokine therapy.
HOST MICROBIAL INTERACTIONS
CONTENTS
MICROBIAL ASPECTS OF HOST MICROBIAL INTERACTIONS
1. Bacterial Colonization and Survival in the Periodontal Region
2. Microbial Mechanisms of Host Tissue Damage
MOLECULAR ASPECTS OF HOST MICROBIAL INTERACTIONS
1. Microbe-Associated Molecular Patterns (MAMPs)
2. Pattern Recognition Receptors (PRRs)
Toll-Like Receptors (TLRs)
NOD-Like Receptors (NLRs)
3. Complement System
Antimicrobial peptides
MICROBIAL ASPECTS OF HOST MICROBIAL INTERACTIONS
Gingivitis and periodontitis are chronic infectious diseases.
The interaction of the microorganism with the host determines the course and extent of the resulting disease.
Microorganisms may exert pathogenic effects directly by causing tissue destruction or indirectly by stimulating and modulating host responses.
The host response is mediated by the microbial interaction and inherent characteristics of the host, including genetic factors that vary among individuals.
In general, the host response functions in a protective capacity by preventing the local infection from progressing to a systemic, life-threatening infection. However, local alteration and destruction of host tissues as a result of the microbial-host interactions may manifest as periodontal disease.
The varying balance between locally harmful and beneficial effects of the pathogenic microorganisms and the host accounts for the wide variety of patterns of tissue changes observed among patients.
In periodontitis, the initial step in the disease process is the colonization of the periodontal tissues by pathogenic species.
Entry of the bacterium itself (invasion) or of bacterial products into the periodontal tissues may be important in the disease process.
Furthermore, inherent in successful colonization of host tissues is the ability of the bacterium to evade host defense mechanisms aimed at eliminating the bacterium from the periodontal environment.
BACTERIAL COLONIZATION AND SURVIVAL IN THE PERIODONTAL REGION
Bacterial Adherence in the Periodontal Environment
The gingival sulcus and periodontal pocket are bathed in gingival crevicular fluid, which flows outward from the base of the pocket.
Bacterial species that colonize this region must attach to available surfaces to avoid displacement by the fluid flow. Therefore, adherence represents a virulence factor for periodontal pathogens.
Bacteria may enter host tissues through ulcerations in the epithelium of the gingival sulcus or pocket and/ or direct penetration of bacteria into host epithelial or connective tissue cells.
Laboratory investigations have demonstrated the ability of A. actinomycetemcomitans, P. gingivalis, F. nucleatum, and Treponema denticola to invade host tissue cells directly.
COMPLEMENT SYSTEM
The periodontal host immune response is dependent on a functional complement system, which notably coordinates the recruitment and activation of immune cells, bacterial opsonization, phagocytosis, and lysis.
Platelet Rich Fibrin (PRF) is an autologous fibrin based biomaterial derived from human blood discovered by Choukroun and coworkers in the year 2006. The future of PRF has enormous therapeutic implications. Therefore, more clinicians should adopt this technology for the benefit of the patients.
Inflammation and Immunity in periodontitis pptPerio Files
Local destruction of periodontium occurs mostly by activation of immune and inflammatory response, initiated by plaque. First innate immune response is activated followed by specific immune response.
Useful for BDS and MDS students
”Contemporary Biomarkers In Periodontitis”- Guest lecture as a part of Dr NTRUHS Zonal CDE programme at Government Dental College and Hospital, Hyderabad, India on 281/1/2011, SIBAR Institute of Dental Sciences, Guntur, India on 29/12/12 and at Meghna Institute of Dental Sciences, Nizamabad, India on 31/7/2013.
Periodontitis is a chronic infectious inflammatory disease caused by microbes; however the presence of microbes is not enough for the cause of its complex nature of disease. Inflammation is the prime cause of periodontal disease. It commences with the aggregation of pathogenic microbes that induce the host to stimulate a cascade of inflammatory response reactions which in-turn leads to the destruction of the host tissues itself. There is a complex interplay of innate and adaptive immune responses which fights against the pathogens by direct interaction or by release of certain molecules including cytokines.
Cytokines are cell signalling molecules that aid cell to cell communication in immune responses and stimulate the movement of cells towards sites of inflammation, infection and trauma. Cytokine biology reveals that there are some subsets of cytokines which are pro-inflammatory cytokines which stimulate the inflammatory responses and cause tissue destruction.
A periodontist is expected to have a sound basis of the cytokine profile to understand the pathogenesis of periodontitis and also to discover the new treatment modality of anti-cytokine therapy.
HOST MICROBIAL INTERACTIONS
CONTENTS
MICROBIAL ASPECTS OF HOST MICROBIAL INTERACTIONS
1. Bacterial Colonization and Survival in the Periodontal Region
2. Microbial Mechanisms of Host Tissue Damage
MOLECULAR ASPECTS OF HOST MICROBIAL INTERACTIONS
1. Microbe-Associated Molecular Patterns (MAMPs)
2. Pattern Recognition Receptors (PRRs)
Toll-Like Receptors (TLRs)
NOD-Like Receptors (NLRs)
3. Complement System
Antimicrobial peptides
MICROBIAL ASPECTS OF HOST MICROBIAL INTERACTIONS
Gingivitis and periodontitis are chronic infectious diseases.
The interaction of the microorganism with the host determines the course and extent of the resulting disease.
Microorganisms may exert pathogenic effects directly by causing tissue destruction or indirectly by stimulating and modulating host responses.
The host response is mediated by the microbial interaction and inherent characteristics of the host, including genetic factors that vary among individuals.
In general, the host response functions in a protective capacity by preventing the local infection from progressing to a systemic, life-threatening infection. However, local alteration and destruction of host tissues as a result of the microbial-host interactions may manifest as periodontal disease.
The varying balance between locally harmful and beneficial effects of the pathogenic microorganisms and the host accounts for the wide variety of patterns of tissue changes observed among patients.
In periodontitis, the initial step in the disease process is the colonization of the periodontal tissues by pathogenic species.
Entry of the bacterium itself (invasion) or of bacterial products into the periodontal tissues may be important in the disease process.
Furthermore, inherent in successful colonization of host tissues is the ability of the bacterium to evade host defense mechanisms aimed at eliminating the bacterium from the periodontal environment.
BACTERIAL COLONIZATION AND SURVIVAL IN THE PERIODONTAL REGION
Bacterial Adherence in the Periodontal Environment
The gingival sulcus and periodontal pocket are bathed in gingival crevicular fluid, which flows outward from the base of the pocket.
Bacterial species that colonize this region must attach to available surfaces to avoid displacement by the fluid flow. Therefore, adherence represents a virulence factor for periodontal pathogens.
Bacteria may enter host tissues through ulcerations in the epithelium of the gingival sulcus or pocket and/ or direct penetration of bacteria into host epithelial or connective tissue cells.
Laboratory investigations have demonstrated the ability of A. actinomycetemcomitans, P. gingivalis, F. nucleatum, and Treponema denticola to invade host tissue cells directly.
COMPLEMENT SYSTEM
The periodontal host immune response is dependent on a functional complement system, which notably coordinates the recruitment and activation of immune cells, bacterial opsonization, phagocytosis, and lysis.
The fate and importance of Toll like receptors in a mammalian system . The slides include the signaling cascade after the activation of TLRS and the consequences on the intracellular signaling pathways that it follows
Book Chapter published at may 2021
From the Edited Volume "Innate Immunity in Health and Disease" by Prof. Shailendra K. Saxena
Via IntechOpen
DOI: http://dx.doi.org/10.5772/intechopen.97502
Immunity is the ability of the body to defend itself against disease-causing organisms.
The immune system refers to a collection of cells, chemicals and processes that function to protect the body from foreign antigens, such as microbes (organisms, such as bacteria, fungi, and parasites), viruses, cancer cells, and toxins.
The structural and chemical barriers which protect us from infection, the immune system can be classified into two “lines of defense”: innate immunity and adaptive immunity
Toll-like receptors (TLRs) are a class of proteins that play a key role in the innate immune system. They are single-spanning receptors usually expressed on sentinel cells such as macrophages and that recognize structurally conserved molecules derived from microbes. TLRs are pattern recognition receptors (PRRs) that recognize pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs). PAMPs are molecular structures associated with pathogens, such as bacteria, viruses, and fungi, that are recognized by the innate immune system. DAMPs are molecules that are released into the extracellular space when cells are injured or damaged. TLRs play a crucial role in the recognition of PAMPs and DAMPs and the initiation of immune responses, such as the production of pro-inflammatory cytokines, type I interferons, and other molecules that enhance the immune response. TLRs are a bridge between the innate and adaptive immune systems by regulating the activation of antigen-presenting cells and key cytokines. Upon recognition of their specific ligands, TLRs initiate downstream signaling cascades, leading to the production of pro-inflammatory and antiviral factors and the upregulation of co-stimulatory molecules, promoting the maturation of antigen-presenting cells and linking innate immunity to adaptive immunity. TLRs are widely distributed in both immune and other body cells and are a critical target for the development of immunotherapies and vaccines. Further research is needed to fully understand the .mechanisms underlying TLR signaling and its potential applications in the field of immunology.Toll-like receptors (TLRs) are a bridge between the innate and adaptive immune systems. TLRs are expressed on all innate immune cells and a large majority of non-hematopoietic cells, such as macrophages, neutrophils, dendritic cells, natural killer cells, mast cells, basophils, eosinophils, and epithelial cells. Importantly, TLRs can also be detected on adaptive immune cells, including T and B cells. Adaptive immunity consists of humoral immunity and cell-mediated immunity, which are mainly mediated by B lymphocytes and T lymphocytes, respectively. TLRs critically link innate immunity to adaptive immunity by regulating the activation of antigen-presenting cells and key cytokines. Upon recognition of pathogen-associated molecular patterns (PAMPs) or damage-associated molecular patterns (DAMPs) by TLRs, downstream signaling cascades are initiated, leading to the production of pro-inflammatory cytokines, such as IL-6 and INF-α, and the upregulation of co-stimulatory molecules, promoting the maturation of antigen-presenting cells and linking innate immunity to adaptive immunity. TLR signaling is also being studied for its direct regulatory roles in effector T cells and regulatory T cells, as well as its involvement in various diseases, including infectious diseases, autoimmune conditions, and cancer.
Evaluation and importance of innate & adaptive immunity Dr. ihsan edan ab...dr.Ihsan alsaimary
Dr. ihsan edan abdulkareem alsaimary
PROFESSOR IN MEDICAL MICROBIOLOGY AND MOLECULAR IMMUNOLOGY
ihsanalsaimary@gmail.com
mobile : 009647801410838
university of basrah - college of medicine - basrah -IRAQ
THIS SEMINAR HAS BRIEF ABOUT T CELLS , TYPES, FUNCTIONS, CLUSTER OF DIFFERENTIATION, MHC MOLECULE, TOLERANCE , ROLE OF T CELLS IN PROGRESSION AND PREVENTION, T CELL IMMUNODEFICIENCY DISORDERS
Telomere structure stability, function in plant breedingSachin Dharwad
TELOMERE, TELOMERE STRUCTURE, ITS FUNCTION AND USE IN PLANT BREEDING. Telomere in plant breeding perspective. Case studies related to telomere in case of plant breeding. telomeres can be made use as markers in plant breeding.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. CONTENTS
• Introduction
• Definition
• Origin and Discovery
• Structure of TLR
• Toll receptor superfamily
• Classification of TLR
• TLR Ligands
• Localization of TLR’s
• Regulation by TLR’s on APC
• TLR signalling ellicts inflammation
• TLR Signalling mechanism
• Role of TLR in Innate and Adaptive immunity
• Role of TLR in Periodontics
• Double edge Sword
• Role of virus in TLRS
• Recent studies
• Conclusion
• Reference
5. PAMPs Vs Virulence factors
PAMPs Virulence factors
Perform essential physiological functions
Detect the presence of infection
DID NOT evolve to interact with the host immune
system
A microbial adaptation to the unique environment
within the host.
Interact with the host
Invade host cells
Colony formation
Avoid host immune responses
Adjust to new nutrient sources.
Incapable of sustaining mutations
Conserved within a class of microbes
Multiple virulence factors that can vary between
different strains and species of pathogens.
Genes encoding PAMPs are expressed constitutively. Genes encoding virulence factors are turned on and
off depending on the stage of the infection cycle
6. DEFINITION
• A family of pattern-recognition receptors used as a tool to trigger an inflammatory response
to microbial invasion. They are single, membrane-spanning, non-catalytic receptors usually
expressed on sentinal cells such as macrophages and dentritic cells , that recognize structurally
conserved molecules derived from microbes. - Christiane Nüsslein-Volhard - 1995
• The ability of immune system to recognize molecules that are broadly shared by pathogens is, in
part, due to the presence of Immune receptors called toll-like receptors.
• Act as a bridge between Innate and Adaptive immunity by mediating dendritic cell maturation and
activation of pathogen-specific T lymphocytes.
• On interaction with PAMPs, TLRs transmit this information through intracellular signaling pathways,
resulting in activation of innate immune cells.
7. ORIGIN AND DISCOVERY
The gene in question, when mutated, makes the Drosophila (fruit fly) embryo look unusual.
The researchers were so surprised that they spontaneously shouted out in German "Das ist ja toll!"
which translates as "That's great!".
[The Nobel Prize in Physiology or Medicine 1995: Edward B. Lewis, Christiane
Nüsslein-Volhard, Eric F.Wieschaus]
Toll: Origin of the word (1985)
9. Structure of toll-like receptor(TLR)
TLRs are type I transmembrane proteins having:
• Ecto domain :amino terminal domain composed of repeated
motifs rich in leucine and known as lecine rich repeats(LRRs).
Leucine rich repeats has 1 to 2 cysteine residues.
• Transmembrane region
• Cytosolic domain: called as Toll/Interleukin I
receptor (TIR) domain.
TIR domain has 3 regions, highly conserved
among all family members, called boxes 1,2 in
and 3. These serve as binding site for intra
cellular proteins that participate in signalling
Pathway – Signalling box
10. • TLRs, together with the IL-1 receptors, form a receptor superfamily known as the “Interleukin-1
Receptor/TLR Superfamily”; all the members of this family have in common a so-called TIR-1 domain.
• Three subgroups of TIR domains exist.
• Proteins with subgroup 1 TIR domains are receptors for ILs that are produced by macrophages, monocytes and
dendritic cells, and all have extracellular immunoglobulin (Ig) domains.
• Proteins with subgroup 2 TIR domains are classical TLRs and bind directly or indirectly to molecules of microbial
origin.
• A third subgroup of proteins containing TIR domains consists of adaptor proteins that are exclusively cytosolic
and mediate signaling from proteins of subgroups 1 and 2.
The toll-like receptor superfamily
11. Types Of TLRs
• TLR can be classified as
- cell surface TLRs
- intracellular TLRs
• Cell surface TLRs seem to recognize microbial
products whereas intracellular TLRs recognize nucleic
acids.
• Include TLR1, TLR2, TLR3, TLR4, TLR5, TLR6, TLR
7, TLR8, TLR9, TLR10, TLR11, TLR12, and TLR13,
though the latter three are not found in humans.
12. RECEPTOR CELL TYPE REGULATION
TLR1 Ubiquitous No significant
regulation
TLR2 PMN,
Dentritic cells
& monocytes
Induced by LPS
Lipoarabinomanan
lipoteichoic acid
TLR3 Dentritic
cells&
Natural killer
cells
Recognises RNA
TLR4
Macrophages,
Dentritic cells
Proinflammatory
cytokines
and bacterial
products
TLR5 Monocytes,
Dentritic cells
epithelial
cells, T cells
Bacterial flagella
Types Of TLRs
12
TLR6 Bcells,Monocy
tes
Proinflammato
ry cytokines
TLR7 Bcells.
Dentritic cells
Synthetic
analogues
TLR8 Monocytes,
Tcells
gamma
interferon
,LPS
TLR9 Bcells,PMN,
Macrophages
and
Microglial cells
CpG MOTIF
of bacterial
DNA
TLR10 Bcells ,
Dentritic cells
NO significant
modulation
13. TLR LIGANDS
Those TLRs (i.e. TLRs 1, 2, 4, 5 and 6) that recognize extracellular
microbial structures are expressed on the host cell surface.
TLR2, in cooperation with its signaling partners, TLR1 or TLR6, detect
mostly microbial cell wall components, such as lipoproteins, lipoteichoic
acid (LTA), fimbriae, or yeast zymosan .
TLR4 and TLR5 recognize lipopolysaccharide (LPS) and bacterial
flagellin, respectively, whereas no ligand has been identified for TLR10.
Those TLRs (i.e. TLRs 3, 7, 8 and 9) specializing in detecting viral or
bacterial nucleic acids are expressed intracellularly on endocytic vesicles.
TLR3 recognizes double-stranded viral RNA, TLR7 and TLR8 recognize
single-stranded viral RNA and TLR9 detects microbial CpG DNA.
15. • TLRs are expressed on cell surface and within intracellular
vesicles( ER, endosomes, lysosomes etc.)
• TLRs on cell surface recognize components of microbial
membrane while those expressed within intracellular
vesicles recognize foreign nucleic acids.
• Protein PRAT4A regulates exit of TLR1,TLR2,TLR4,
TLR7 and TLR9 from ER to respective places.
• Gp96 – ER resident heat shock protein 90 family
acts as chaperone for most TLRs .
LOCALIZATION OF TLRS
16. Regulation of Th Cell development by TLR’s on APC
Recognition of pathogens - TLRs - cytokines - IL-12 and IL-18 in APCs –
”Instructive cytokines “ – drive Naïve T cells – TH 1 cells.
Pathogens - captured - phagocytosis, endocytosis or via TLRs themselves
Captured pathogens - processed - presented to T cells – MHC antigen.
For expansion of antigen-specific T cell clones - up-regulated expression
of costimulatory molecules on the cell surface of APCs.
This up-regulation is also triggered by TLR signaling.TLR-stimulated APCs
mainly induce TH1 development.
It remains unclear at present whether TLRs in APCs are involved in TH2
development
17. TLR signalling ellicts inflammation
Pathogens - enter host - breached epithelial barrier, leads - activation of
macrophage - TLRs by pathogen-derived molecules, including LPS.
TLR signaling - inflammatory cytokines, - near the site of infection to
recruit neutrophils and induce neutrophil production of antimicrobial
molecules, including peptides, reactive oxygen species (e.g. H2O2 and
superoxide anion), and leukotrienes.
Cytokines also travel throughout the body and induce systemic effects.
Both macrophages and neutrophils act to limit infection by phagocytosis
of pathogens.
18. TLR Signaling
- TLR signaling cascades are separated into two groups:
- The myeloid differentiation primary-response protein 88-dependent pathway
- The myeloid differentiation primary-response protein 88-independent pathway
- The myeloid differentiation primary-response protein 88-dependent pathway is essential for
most TLR-mediated cell activations.
- The molecules that are structurally related to myeloid differentiation primary-response protein
88 led to identification of other adaptor proteins which includes :
19. 5 cytoplasmic adaptor proteins have been identified for TLR signalling cascades (Beutler et al 2004)
MyD88 (Myleoid differentiation factor 88)
TRIF (Toll/interlukin-1R domain containing adaptor-inducing interferon β)
TIRAP (or Mal) (MyD88 adaptor-like) (Toll interlukin-1 receptor containing adaptor protein)
TRAM (TRIF-related adaptor molecule)
SARM (sterile alpha and HEAT/ Armadilo motif protein)
21. TLR 4
MAL / MyD88 TRAM / TIRAF
MAPK
Interferon regulatory
factor -3
NF - kβ
Proinflammatory cytokines and
TYPE I Interferons
A fifth known adaptor, designated sterile alpha and HEAT / Armadilo motif protein-1,
functions as a negative regulator of TLR signalling.
22. The MyD88 dependent pathway leads to subsequent activation of IRAK (IL-1R-associated kinase),
TRAF6, and ultimately NF-kB and it is essential for cytokine induction.
MyD88-independent pathway does not activate IRAK and leads to activation of NF-kB with delayed
kinetics.
This independent pathway requires different adaptor proteins, such as TIRAP, TRIF, and TRAM,
and probably does not lead to cytokine induction.
Another interesting aspect of MyD88-independent signaling is that it can induce dendritic cell
maturation.
Rather, it is related to interferon-β secretion and indirect upregulation of IFN-dependent genes.
23.
24. Role of TLR in Innate and Adaptive immunity
It is predominantly expressed on cells of the innate immune system, including neutrophils,
monocytes/macrophages, and dendritic cells.
Neutrophils are the first innate immune cells to migrate to sites of infection and utilize TLRs to
recognize and respond to microbial challenge.
Macrophages/monocytes, also the first line of defense, bind to microbial pathogens through TLRs.
They play a key role in host defense by recognizing, engulfing and killing microorganisms.
The binding of PAMPs to monocyte TLRs can influence the type of adaptive immune response
25. Development of adaptive immunity is controlled through activation of innate immune cells antigen
presenting dendritic cells.
TLRs of resident immature dendritic cells
detect the PAMPs
Transmit the information through signaling
pathways
Activation of dendritic cells
Production of cytokines and chemokines
critical for T-cell priming and differentiation
Two subpopulations of dendritic cell precursors have beenidentified in human blood: myeloid dendritic
cells and plasmacytoid dendritic cells expressing different TLRs
MDC – TLR – 1 - 6,8,10
PDC – TLR - 1,6,7,9 but not 2,5,8.
26. • TLRs are also expressed on the cells responsible for adaptive immunity, i.e. B and T lymphocytes
• T cells predominate in stable periodontal lesions . Proportion of B cells and plasma cells is increased in
progressive lesions
• The TLRs expressed on T lymphocytes and their respective ligands can directly modulate T cell function.
• These TLRs act as co-stimulatory receptors to enhance proliferation and/or cytokine production of T-cell
receptor-stimulated T lymphocytes.
• Different TLR ligands instruct dendritic cells to stimulate distinct T helper cell responses.
• E. coli lipopolysaccharide and flagellin, which trigger TLR 4 and TLR 5, respectively, cause human dendritic cells
to induce a Th1 response via IL-12 production.
• In contrast, the TLR 2 ligand and P. gingivalis lipopolysaccharide cause induction of a Th 2 response.
31. Gingival Epithelial cells
• TLR 2, 3, 4, 5, 6, 9
• Increased attachment and migration of leucocytes towards antigen on lumen of the
pocket, also induces production of Interleukin-8 (IL-8) as well as Matrix
metalloproteinases.
Gingival fibroblasts
• TLR 2, 4, 9
• Increased production of Interleukin-8 as well as other pro-inflammatory
cytokines.
32. Endothelium
• TLR 1, 3, 4, 5
• Production of pro-inflammatory cytokines and chemokines, migration of immune cells
towards gingival sulcus.
Osteoclasts
• TLR 2, 4
• Enhanced survival of osteoblasts and increased osteoclastic activities.
33. Cementoblasts
• TLR 2, 4
• Down regulation of RANKL
Periodontal ligament fibroblasts
• TLR 2, 4
• Enhanced production of pro-inflammatory cytokines, release of proteases causing
direct destruction of surrounding tissues.
34. • TLR signaling results in innate immune responses involving the release of the antibacterial β-
defensins cathelicidin and calprotectin, neutrophil chemoattractant (interleukin-8)
• TLR signaling limits microbial invasion and prevents commensal organisms from breaching the
epithelial barrier, thereby maintaining gingival health.
• TLR2, 4, 7 and 9 is upregulated in periodontitis lesions (Kajita K et al Oral Microbiol
Immunol 2007)
• TLR2 is detectable in gingival epithelia in the spinous epithelial layer (Kusumoto Y et al J
Periodontol 2004)
35. • Gingival fibroblasts express TLR-2 and 4 and their levels of expression are elevated in
periodontitis. ( Wang PL et al Biochem Biophys Res Commun 2003)
• TLR activation influences osteoclastogenesis (Aoki M et al Biochem Biophys Res Commun
2006), (Kikuchi T et al J Immunol 2001).
• TLRs (like 2, 4 and 9) enhance the survival rates of mature osteoclasts.(Takami M et al j
Immunol 2002)
37. • The periodontium is continually exposed to dental plaque, which harbors many commensal and
pathogenic oral microorganisms.
• Periodontal tissues express different types of TLRs, allowing them to actively participate in the
innate immune response against these oral microorganisms.
• Thus, these TLRs provide a first line of defense in maintaining periodontal health.
• It has been suggested recently that the oral mucosa develops tolerance after repeated exposure
to bacterial products.
POSITIVE EDGE
38. • Down-regulation of TLR expression and inhibition of intracellular signaling may be the
underlying mechanisms of tolerance.
• However, recent research has indicated that under steady-state conditions, activation of TLRs
by commensal bacteria is critical for the maintenance of oral health.
• Gingival epithelial cells express TLR 2, 3, 4, 5, 6 and 9 and recognize various microorganisms
with the help of these receptors.
• These TLRs expressed on the gingival epithelium continually interact with oral microorganisms
that form biofilms on tooth surfaces.
39. • This TLR signaling results in innate immune responses involving the release of the antibacterial
β-defensins , cathelicidin and calprotectin, as well as neutrophil chemoattractant (IL-8).
• Therefore, TLR signaling limits microbial invasion and prevents commensal organisms from breaching
the epithelial barrier, thereby maintaining gingival health.
• Periodontal health represents a dynamic state in which pro-inflammatory and anti-microbial activities
for control of infection are optimally balanced by anti-inflammatory mechanisms to prevent
unwarranted inflammation.
• This homeostasis is disrupted when pathogens present in dental plaque undermine the host defense
mechanism.
40. Disruption and penetration of the gingival
epithelial barrier by invasive bacteria or their cytotoxic
products
Invasion into deeper tissues
TLRs in cells such as macrophages, fibroblasts,
osteoblasts, osteoclasts and antigen-presenting cells
become activated
Various pro-inflammatory cytokines produced
Inflammation and immune cell infiltration
Infiltrated cells
(Eg:memory T-
cells)
Produce cytokines
Amplify the
inflammatory
reaction
Destruction of
connective tissue
and bone
41. Chronic stimulation of TLRs in periodontal tissues by bacterial PAMPs
Excessive production of pro-inflammatory mediators
Tissue destruction
42. • First cells to respond to PAMPs are the epithelial cells lining the sulcus.
Epithelial Cells
Intercellular adhesion molecule-1 (ICAM-1)
Lymphocyte function-associated antigen-1 (LFA-1)
Direct the attachment and migration of leucocytes towards the gingival sulcus.
Epithelial cells produce matrix metalloproteinases (MMPs) in response to PAMPs, causing direct
damage to periodontal tissues.
When stimulated via TLRs, neutrophils exhibit increased chemotaxis production of pro-inflammatory
cytokines [interleukin-1 (IL-1); interleukin-6 (IL-6); tumor necrosis factor-α (TNF-α)]
NEGATIVE EDGE
44. • IL-8 secreted by epithelial cells stimulates the endothelial cells lining the blood vessels through
TLR-4 increased adhesion of monocytes
• exposed to PAMPs monocytes produce proinflammatory cytokines and differentiate into osteoclasts
upon direct stimulation with bacterial lipopolysaccharides with the help of RANKL.
• TLRs present on dendritic cells stimulated with PAMPs induce their maturation act as antigen-
presenting cells produce cytokines and co-stimulatory molecules activate T-lymphocytes to
produce Th1 or Th2 immune response
46. • Once stimulated by PAMPs, gingival fibroblasts produce pro-inflammatory cytokines leading to
tissue destruction and bone resorption.
• Periodontal ligament fibroblasts, produce proteinases on TLR stimulation, resulting in direct
degradation of periodontal tissues.
• PAMPs entering the circulation via blood vessels in connective tissue lymphocytes move toward the
site of infection.
• In the presence of biological mediators, naïve T-cells differentiate and initiate a Th1 or Th2
immune response.
47. • TLRs on T cells act as type of co-stimulatory molecule.
• B lymphocytes are transformed into plasma cells, which produce antibodies against bacterial
antigens.
• Osteoblasts react to PAMPs through TLRs and produce biological mediators (MMPs, prostaglandin
E2) responsible for bone resorption.
• Osteoblasts, marrow stromal cells, and T and B cells express RANKL, which is essential for
activation of osteoclasts.
• RANKL in the presence of macrophage colony-stimulating factor (M-CSF) attaches to RANK
present on osteoclasts and osteoclast precursors, and activates them.
48.
49. Evasion or subversion of Toll-like receptor (TLR)
activation by Porphyromonas gingivalis
P. gingivalis - lipid A phosphatase and deacylase activities - modify the lipid
A structure LPS.
These modifications - lipopolysaccharide molecules that can either evade or
actively antagonize TLR4 activation
Although the activation of the TLR2 ⁄ TLR1 - not antagonized at the TLR
receptor level, P. gingivalis instigates a molecular crosstalk between the
CXC-chemokine receptor 4 and TLR2 ⁄ 1.
Unlike CD14, which facilitates TLR2 ⁄ 1 activation by the pathogen -
suppresses TLR2 signaling.
Mechanistically, P. gingivalis uses its fimbriae to bind CXCR4 and induce
cyclic AMP-dependent protein kinase A (PKA) signaling, which in turn inhibits
the activation of nuclear factor-kappaB (NF-jB) activation.
50. Crosstalk pathways between (TLRs) and complement in Porphyromonas gingivalis
activated macrophages.
- TLR recognition of P. gingivalis is predominantly mediated by the TLR2 ⁄ TLR1
heterodimer (TLR2 ⁄ 1), aided by the CD14 co-receptor.
- This interaction induces phosphatidylinositol 3-kinase (PI3K)- dependent inside-out
signaling, which transactivates the high-affinity state of complement receptor-3 (CR3).
-Interestingly, P. gingivalis interacts with activated CR3 and induces (ERK1 ⁄ 2) signaling,
which in turn downregulates the expression of messenger RNA for cytokines of the
interleukin- 12 family .
-Moreover, P. gingivalis uses its gingipains to attack C5 and release biologically active
C5a.
Through its receptor (C5aR), C5a can activate PI3K and ERK1 ⁄ 2, which in turn
suppress critical transcription factors (the interferon regulatory factors 1 and 8; IRF-1
and -8), required for expression of cytokines of the interleukin-12 family.
- Intriguingly, inhibition of bioactive interleukin-12 though these mechanisms results in
impaired immune clearance of P. gingivalis in vivo suggesting that the pathogen exploits
TLR ⁄ complement
51. Role of virus in TLR’S
- Several lines of evidence link herpesviruses, especially human cytomegalovirus and Epstein-Barr virus to the
severity of periodontitis.
These evidences include:
• The detection of viral DNA in gingival tissue .
• The presence of higher frequency of viral DNA in periodontitis tissue than in healthy periodontal tissue .
• The detection of active human cytomegalovirus replication in periodontal tissue .
- Several studies demonstrate that the presence of subgingival human cytomegalovirus or Epstein-Barr virus-1
DNA is associated with an increased presence periodontopathic bacteria .
- The findings suggest that local immune responses against oral plaque bacteria could be suppressed as a
result of herpesvirus infection.
52. - More specifically, Toll-like receptors 2 and 9 have been demonstrated to sense herpesvirus-associated
molecules and initiate antiviral responses.
- A study done by Compton et al 2003 revealed that Recognition of human cytomegalovirus virions
by Toll-like receptor 2 and CD14 leads to cytokine production.
- Krug et al 2004 in his study model done on mouse revealed that recognition of DNA viruses
by Toll-like receptor 9 is required for interferon-a Production
- In a study done by Alexopoulou et al – 2004 showed that Toll-like receptor 3 has been shown to recognize
dsRNA , a product of viral replication.
- Yoneyama et al 2004 showed that Host cells also express cytoplasmic RNA helicases
that can recognize dsRNA via Toll-like receptor- independent mechanisms.
- The presence of mRNA expression of Toll-like receptors 2, 3 and 9 in human gingival epithelial cells and
fibroblasts may suggest the role of periodontal tissue in antiviral responses.
53. Subjects TLR Ligands Reference
CP patients TLR 8 & 9 upregulated Sahiingur et al (2013)
CP patients TLR4 Ozturk and Yildiz(2011)
CP patients
TLR2 & TLR4
Becerik et al(2011),
Ribeiro et al(2012)
Li et al (2014b),
Beklen et al (2014),
Duarte et al (2012)
CP patients TLR9 Chen et al(2014)
CP patients
TLR4 no change, TLR2 & TLR9 Wara-aswapati et al (2013)
Studies related to chronic periodontitis
56. TLR in CP with systemic diseases
objects stimulus effects Refs
RA mice and mice
with CP
Cathepsin K KO TLR4, TLR5,
TLR9 reduced;
bone loss
inhibited
Hao ei al(2015)
APCs withTLR2
deficiency.
P.gingivalis Th 17 induction
inhibited.
de aquino et
al(2014)
CP patientswith
DM
TLR2 and TLR4 in
periodontal tissue
dysregulated
Promsudthi et al
(2014)
Patients with both
CP and DM
TLR2, TLR4, TLR9
elevated than CP
alone
Rojo-Botello et al
(2012)
TLR2 has been suggested as a potential therapeutic target in
the treatment of Periodontal disease,RA,,DM
57. • Prathahini Parthiban, 2015 Studied the role of TLR in periodontal disease and relationship with
pre term labour.
60. Conclusion
• Toll-like receptor signaling at the dento-epithelial junction is critical in maintaining periodontal
health as well as in the progression of periodontitis.
• There are still gaps in our knowledge of the mechanisms by which TLRs maintain periodontal health
and what leads to bacterial immune evasion and disease progression.
• It is uncertain which specific signaling pathways need to be blocked to attenuate the pathology or
enhanced to promote host defense.
• Further investigations are required in this field to understand the initiation and progression of
periodontal disease and develop therapeutic interventions to control it.
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Editor's Notes
Regulation of Th Cell development by TLR’s on APC
Immunity is the balanced state of having adequate biological defenses to fight infection, disease, or other unwanted biological invasion, while having adequate tolerance to avoid allergy, and autoimmune diseases.
It is the capability of the body to resist harmful microorganisms or viruses from entering it. Immunity involves both specific and nonspecific components. The nonspecific components act either as barriers or as eliminators of wide range of pathogens irrespective of antigenic specificity. Other components of the immune system adapt themselves to each new disease encountered and are able to generate pathogen-specific immunity.
The basic premise for the division of the immune system into innate and adaptive components comes down to the innate system being composed of primitive bone marrow cells that are programmed to recognise foreign substances and react, versus the adaptive system being composed of more advanced lymphatic cells that are programmed to recognise self substances and don't react. The reaction to foreign substances is etymologically described as inflammation, meaning to set on fire, while the non-reaction to self substances is etymologically described as immunity, meaning to exempt. The interaction of these two components of the immune system creates a dynamic biological environment where "Health" can be seen as an active physical state where what is self is immunologically spared, and what is foreign is inflammatorily and immunologically eliminated. Extending this concept, "Disease" then can arise when what is foreign cannot be eliminated, or what is self is not spared.
Innate immunity - Innate immunity refers to nonspecific defense mechanisms that come into play immediately or within hours of an antigen's appearance in the body. These mechanisms include physical barriers such as skin, chemicals in the blood, and immune system cells that attack foreign cells in the body. The innate immune response is activated by chemical properties of the antigen.
Adaptive immunityAdaptive immunity refers to antigen-specific immune response. The adaptive immune response is more complex than the innate. The antigen first must be processed and recognized. Once an antigen has been recognized, the adaptive immune system creates an army of immune cells specifically designed to attack that antigen. Adaptive immunity also includes a "memory" that makes future responses against a specific antigen more efficient.
the innate immune system is immediately available to combat threats.
There is no complicated method of selecting cells that react to foreign substances
from those that react to self.
There is no memory to change how the system
responds to the same threat upon the second or third exposure.
Instead, the
innate immune system responds to common structures shared by a vast majority
of threats. These common structures are called pathogen associated molecular
patterns, or PAMPs, and are recognized by the toll-like receptors, or TLRs. In
addition to the cellular TLRs, an important part of the innate immune system is the
humoral complement system that opsonizes and kills pathogens through the PAMP
recognition mechanism.
These highly conserved soluble and membrane bound proteins are collectively
called Pattern-Recognition Receptors (PRRs), and it is the PAMP/PRR interaction
that triggers the innate immune system.
Pattern recognition receptors (PRRs)[1] play a crucial role in the proper function of the innate immune system. PRRs are germline-encoded host sensors, which detect molecules typical for the pathogens[2]. They are proteins expressed, mainly, by cells of the innate immune system, such as dendritic cells, macrophages, monocytes, neutrophils and epithelial cells[3][4], to identify two classes of molecules: pathogen-associated molecular patterns (PAMPs), which are associated with microbial pathogens, and damage-associated molecular patterns (DAMPs), which are associated with components of host's cells that are released during cell damage or death. They are also called primitive pattern recognition receptors because they evolved before other parts of the immune system, particularly before adaptive immunity. PRRs also mediate the initiation of antigen-specific adaptive immune response and release of inflammatory cytokines
There are several subgroups of PRRs. They are classified according to their ligand specificity, function, localization and/or evolutionary relationships. Based on their localization, PRRs may be divided into membrane-bound PRRs and cytoplasmic PRRs.
Membrane-bound PRRs include Toll like receptors (TLRs) and C-type lectin receptors (CLRs).
Cytoplasmic PRRs include NOD-like receptors (NLRs) and RIG-I-like receptors (RLRs)
Tlr - Act as a bridge between Innate and Adaptive immunity by
mediating dendritic cell maturation and activation of
pathogen-specific T lymphocytes.
Activation and differentiation of naive T cells into Th1, Th2,
Th3 and Th17 cells or T-regs, facilitating cell mediated
immune responses.
Pathogen-associated molecular patterns (PAMPs) and virulence factors are not
equivalent.PAMPs did not evolve to interact with the host immune system; they evolved
to perform essential physiological functions.Pattern-recognition receptors evolved to
recognize PAMPs, and therefore to detect the presence of infection.Virulence factors, by
contrast, developed as a microbial adaptation to the unique environment within the host.
As PAMPs are essential for microbial survival, they are incapable of sustaining mutations.
As a result, they are conserved within a class of microbes.Virulence factors are produced
by pathogens in order to interact with the host: to invade host cells, to form colonies, to
avoid host immune responses, or to adjust to new nutrient sources.Because each group of
pathogens has developed a unique strategy for survival within the host, there are multiple
virulence factors that can vary between different strains and species of pathogens.
Virulence factors are typically encoded by ‘pathogenicity islands’,which are associated
with several features characteristic of mobile DNA and can be acquired by, or deleted
from, the microbial genome. Furthermore, unlike PAMPs,which in most cases are
expressed constitutively, the genes encoding virulence factors are turned on and off
depending on the stage of the infection cycle.
The TLR‑mediated innate immune response is also critical for the development and direction of the adaptive immune system.
Thus, TLRs act as a double‑edged sword, not only maintaining periodontal health (a positive edge) but also contributing to periodontal tissue destruction (a negative edge).
The TLRs are the major molecular mechanism by which the host recognizes that there is an invading microorganism present.
Periodontitis is a chronic bacterial infection that affects the tooth‑supporting structure. Bacterial plaque stimulates the host inflammatory response, leading to tissue damage.
The immune response applies a family of pattern‑recognition receptors (PRRs) called toll‑like receptors (TLRs)
This crucial information (i.e., a microbe is present in the body) is transmitted across the cell membrane, and the resulting signal is eventually transmitted into the nucleus so that specific gene sets can be activated to initiate an appropriate response.
LRRs are found in a diverse set of proteins in which they are involved in ligand recognition and signal transduction.
Toll-like receptors are primarily expressed by first-line professional phagocytes, i.e. neutrophils, macrophages and dendritic cells.
These receptors sense and respond to distinct microbial structures
Toll-like receptors and their ligands
Toll-like receptors are primarily expressed by first-line
professional phagocytes, i.e. neutrophils, macrophages
and dendritic cells. These receptors sense and respond to
distinct microbial structures. Toll-like receptors (TLRs 1,
2, 4, 5 and 6) that recognize extracellular microbial structures
are expressed on the host cell surface; for example,
TLR 5 responds to bacterial flagellin. TLR 2 is unique in
that it heterodimerizes with the signaling partner TLR1
or TLR6 for detecting and responding to microbial cell
wall components. Toll-like receptors (TLRs 3, 7, 8 and
9) specifically detecting viral or bacterial nucleic acids
are expressed intracellularly on endocytic vesicles; for
example, TLR 3 recognizes double-stranded viral DNA
(11). The ligands for human TLRs are enumerated in
Table 1.
These cytokines function as “instructive” cytokines and drive naïve T cells to differentiate into TH1 cells.
.
Stimulation of TLR 3 or TLR 4, however, results in induction of type I interferon through interferon‑regulatory factor‑3 in a myeloid differentiation primary‑response protein 88‑independent manner.
TLR: toll-like receptor; MyD88: myeloid differentiation
primary response protein 88;
TIRAP: toll-IL-1 receptor domain-containing adaptor protein; IRAK-1: interleukin 1
receptor-associated kinase-1; IRAK-4: interleukin 1 receptor-associated kinase-4; TRAF6:
tumor necrosis factor receptor-associated factor 6; MAK: mitogen-activated protein kinase;
AP-1: activator protein 1; TAK1: transforming growth factor-β-activated kinase 1; NF-κB:
nuclear factor- κB; IRF-3: interferon-regulatory factor-3; IRF-7: interferon-regulatory
factor-7; TRIF: Toll-IL-1 receptor domain-containing adaptor inducing interferon-β;
TRAM: TRIF-related adaptor molecules, ● phosphorylation
All TLRs except TLR3, use MyD88 for downstream signalling.
TLR1, 2, 6 uses MyD88 and TIRAF
TLR3 uses TRIF.
TLR4 uses MyD88, TIRAF & TRIF.
TLR7 & 9 use MyD88 only, without TIRAF or TRIF.
Only TLR2 & 4 utilize the MyD88 adaptor like (MAL) which serves to recruit MyD88 to the TLR2 or 4 cytoplasmic domains.
Development of adaptive immunity
is controlled through activation of innate immune cells,
especially antigen-presenting dendritic cells. TLRs of
resident immature dendritic cells detect the PAMPs and
transmit the information through signaling pathways,
resulting in activation of dendritic cells. This activation
results in production of cytokines and chemokines
critical for T-cell priming and differentiation (14). Two
subpopulations of dendritic cell precursors have beenidentified in human blood: myeloid dendritic cells and
plasmacytoid dendritic cells expressing different TLRs.
It is evident that both B and T lymphocytes are present in
diseased periodontal tissue. It has been hypothesized that
T cells predominate in stable periodontal lesions, while
the proportion of B cells and plasma cells is increased
in progressive lesions. More recently, it has been shown
that TLRs are also expressed on the cells responsible for
adaptive immunity, i.e. B and T lymphocytes. The TLRs
expressed on T lymphocytes and their respective ligands
can directly modulate T cell function. These TLRs act
as co-stimulatory receptors to enhance proliferation and/
or cytokine production of T-cell receptor-stimulated T
lymphocytes. Also, TLRs on CD25+CD4+ regulatory T
cells are thought to modulate their suppressive activity
(15). TLRs expressed by all of these immune cells are
listed in Table 2.
Chronic stimulation of TLRs in periodontal tissues by bacterial PAMPs
can lead to excessive production of pro‑inflammatory
mediators, resulting in tissue destruction. Also, periodontitis
induced by bacterial plaque may start with disruption and
penetration of the gingival epithelial barrier by invasive
bacteria or their cytotoxic products. Through this invasion
into deeper tissues, TLRs in other cells such as macrophages,
fibroblasts, osteoblasts, osteoclasts and antigen‑presenting cells become activated. These cells, when stimulated,
produce various pro‑inflammatory cytokines that lead to
inflammation and immune cell infiltration. The infiltrated
cells, such as memory T‑cells, further produce cytokines and
amplify the inflammatory reaction, leading to destruction
of connective tissue and bone.
Thus, TLRs act as
a double-edged sword, not only maintaining periodontal
health but also contributing to periodontal tissue destruction.
These cells express
intercellular adhesion molecule-1 (ICAM-1) and the
ligand for lymphocyte function-associated antigen-1
(LFA-1), which interact with and direct the attachment
and migration of leucocytes towards the gingival sulcus.
Dendritic cells are resident immune cells present
in both epithelium and connective tissue. TLRs present
on these cells induce their maturation when stimulated
with PAMPs. When activated, these cells not only act as
antigen-presenting cells but also produce cytokines and
co-stimulatory molecules that activate T-lymphocytes to
produce a Th1 or Th2 immune response
epithelial barrier is breached, microorganisms
and their products access gain to the underlying connective
tissue and directly activate the cells present there.
Once stimulated by PAMPs, gingival fibroblasts produce
pro-inflammatory cytokines leading to tissue destruction
and bone resorption. Periodontal ligament fibroblasts, on
the other hand, produce proteinases on TLR stimulation,
resulting in direct degradation of periodontal tissues
Osteoblasts also react to PAMPs through TLRs
and produce biological mediators (MMPs, prostaglandin
E2) responsible for bone resorption (40). Osteoblasts,
marrow stromal cells, and T and B cells express RANKL,
which is essential for activation of osteoclasts. RANKL
in the presence of macrophage colony-stimulating factor
(M-CSF) attaches to receptor activator of nuclear factor
κB (RANK) present on osteoclasts and osteoclast precursors,
and activates them
Oral plaque bacteria play a key role in causing
periodontitis.During the past decade, it has become
apparent that viral infection may also be involved in
the development of periodontitis.
Viral components such as envelope protein(s), genomic DNA and RNA or double-stranded RNA (dsRNA)
produced in infected host cells can be recognized by host Toll-like receptors.
There is still much work ahead
not only to firmly establish the role of viruses in
periodontitis, but also to understand the crucial role
of periodontal tissue in innate immune recognition of
viral infection.
TLR-dependent inflammatory mechanisms of P. gingivalis fimbriae (FimA). FimA interacts with CD14 and ß2 integrins (CD11/CD18), which serve as coreceptors in a TLR/CD14/ß2 integrin multireceptor complex. Subsequent TLR intracellular signaling leads to NF-kB activation and induction of proinflammatory cytokines (TNF-a and IL- 1ß) and upregulation of costimulatory molecules (CD40, CD80, CD86) required for costimulation of T cells.These mechanisms have been implicated in periodontal disease pathogenesis and may similarly operate in atherosclerotic lesions where the presence of P. gingivalis has been inferred by the detection of DNA specific for this pathogen.