Anticardiolipin antibodies (aCL), which are commonly present in autoimmune diseases such as systemic lupus erythematosus and the antiphospholipid syndrome (APS), are also present in 15-20% of serum samples from patients with chronic or generalized aggressive periodontitis. In APS, these antibodies are associated with thrombus formation, fetal loss and fetal growth restriction, preeclampsia, and atherosclerosis. In periodontitis, it is likely that these antibodies are produced in response to oal bacterial pathogens such as Porphyromonas gingivalis and others, which have peptide sequences that are homologous to a key sequence on beta-2 glycoprotein-I (?2GPI) the target antigen of aCL. aCL is thought to affect pregnancy in women with APS due to a variety of biological mechanisms with effects on placentation (impacting the decidua and trophoblast), thrombosis, and systemic and local inflammation. Our data indicate that aCL levels in periodontitis are associated with elevated markers of vascular inflammation, and that periodontal treatment decreases IgM aCL antibody levels (but not IgG levels), implicating the oral microflora as a source of antigen. aCL antibodies from periodontitis patients also induce inflammatory responses in cultured vascular endothelial cells (HUVEC). In addition, these antibodies promote competition of ?2GPI with Annexin V for binding sites on phosphatidylserine. Annexin V binding to PS on trophoblasts is thought to be an important protective mechanism during fetal development, so the data indicate that such antibodies could cause trophoblast inflammatory responses and fibrin deposition leading to inflammation and defective cell migration. We further found that antibody raised against P. gingivalis contains aCL which causes fetal loss in a mouse pregnancy model. We therefore hypothesize that cross-reactive anticardiolipin antibodies induced by P. gingivalis promote inflammatory responses in endothelial cells and trophoblasts that are consistent with their ability to cause complement-dependent fetal loss in mice. We propose to further study the mechanisms by which aCL in anti- P. gingivalis interacts with receptors such as TLR2, TLR4, and TLR8, and with Annexin A2 on HUVEC to induce inflammatory cytokine production. We further propose to examine the interactions of aCL induced by P. gingivalis with trophoblastic cell lines. These studies will examine disruption of the Annexin V protective shield and examine effects on complement activation, cytokine production, human chorionic gonadotropin production, and cell migration. We will also examine the dependence of fetal loss due to anti- P. gingivalis on complement activation and on C5a-C5a receptor interaction in the mouse pregnancy model. We will integrate studies examining human aCL derived from periodontitis patients, evaluating their in vitro and in vivo effects in parallel experiments. Results of these studies, if consistent with our hypothesis, would implicate molecular mimicry of ?2GPI by P. gingivalis as a likely mechanism linking periodontitis with adverse pregnancy outcomes in both the mouse pregnancy model and in human pregnancy.

Public Health Relevance

Periodontitis is associated with systemic conditions such as adverse pregnancy outcomes, cardiovascular diseases, and diabetes, but whether existing periodontal diseases increase risk for future development of these systemic conditions is unproven and a subject of considerable debate. We have found that many patients with periodontal diseases have serum antibodies, termed anticardiolipin, that can be induced by infection with periodontal pathogens and are themselves associated with thrombosis, adverse pregnancy outcomes, and atherosclerosis. Understanding how these antibodies may affect a person's health by examining their effects on models of pregnancy loss may suggest diagnostic tests and interventions that could reverse these potentially harmful effects.

Agency
National Institute of Health (NIH)
Institute
National Institute of Dental & Craniofacial Research (NIDCR)
Type
Research Project (R01)
Project #
5R01DE018125-06
Application #
9232123
Study Section
Oral, Dental and Craniofacial Sciences Study Section (ODCS)
Program Officer
Lunsford, Dwayne
Project Start
2006-12-01
Project End
2021-02-28
Budget Start
2017-03-01
Budget End
2018-02-28
Support Year
6
Fiscal Year
2017
Total Cost
$343,125
Indirect Cost
$118,125
Name
Virginia Commonwealth University
Department
Dentistry
Type
Schools of Dentistry
DUNS #
105300446
City
Richmond
State
VA
Country
United States
Zip Code
23298
Strauss 3rd, Jerome F; Romero, Roberto; Gomez-Lopez, Nardhy et al. (2018) Spontaneous preterm birth: advances toward the discovery of genetic predisposition. Am J Obstet Gynecol 218:294-314.e2
Schenkein, Harvey A; Thomas, Ravindar R (2018) Anticardiolipin (aCL) in sera from periodontitis subjects activate Toll-like receptor 4 (TLR4). PLoS One 13:e0203494
Chaston, Reve; Sabatini, Robert; Koertge, Thomas E et al. (2014) Serum anticardiolipin concentrations in patients with chronic periodontitis following scaling and root planing. J Periodontol 85:683-7
Schenkein, Harvey A; Loos, Bruno G (2013) Inflammatory mechanisms linking periodontal diseases to cardiovascular diseases. J Clin Periodontol 40 Suppl 14:S51-69
Schenkein, H A; Bradley, J L; Purkall, D B (2013) Anticardiolipin in porphyromonas gingivalis antisera causes fetal loss in mice. J Dent Res 92:814-8
Schenkein, Harvey A; Sabatini, Robert; Koertge, Thomas E et al. (2013) Anti-cardiolipin from periodontitis patients induces MCP-1 production by human umbilical vein endothelial cells. J Clin Periodontol 40:212-7
Sahingur, Sinem Esra; Xia, Xia-Juan; Schifferle, Robert E (2012) Oral bacterial DNA differ in their ability to induce inflammatory responses in human monocytic cell lines. J Periodontol 83:1069-77
Schenkein, Harvey A; Koertge, Thomas E; Sabatini, Robert et al. (2012) Birth weight of infants of mothers with aggressive periodontitis. J Periodontol 83:279-86
Tew, J G; El Shikh, M E; El Sayed, R M et al. (2012) Dendritic cells, antibodies reactive with oxLDL, and inflammation. J Dent Res 91:8-16
Sahingur, S E; Xia, X-J; Alamgir, S et al. (2010) DNA from Porphyromonas gingivalis and Tannerella forsythia induce cytokine production in human monocytic cell lines. Mol Oral Microbiol 25:123-35

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