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1、五、牙周病与免疫,The oral cavity harbors more than 700 bacterial species,coexisting with probably millions of viral genomic copies.口腔定居的细菌有700多种与数百万病毒基因组复制物共存（A Tsuo Amano,2010,Periodontology 2000）,Oral bacteria 口腔中的细菌：-Free to saliva 在唾液中-Attachment in biofilm 附着在生物膜 Between closely related,Saliva as a car
2、rier,is conducive to horizontal and vertical transmission of bacteria,In United States,75 per cent of adult populations suffer from periodontal disease.美国占75%成年人群体不同程度患有牙周病1/3 children of 611years old,and 2/3 of adolescent population have some degree of periodontal problems.1/3的611岁儿童，2/3青春期人群也有某种程度
3、的牙周问题,Over 200 kinds of bacterial form dental plaque,adhere to the surface of the teeth and gums,and cause periodontal infections.牙周感染细菌达200余种Periodontitis Gingivitis bleeding，Deep gingival Pocket 3mm Periodontitis bleeding，swelling，initial bone loss,Deep periodontal Pocket=5mm major stage bleeding，
4、swelling，major bone loss，Deep periodontal Pocket 6mm,Periodontal Pocket:a unique micro-environment牙周袋是独特的微环境escape the physical separation force 逃逸物理分离力hard tissue surface 不剥脱更新的硬组织表面junctional epithelialization,basically not differentiation有结合上皮，基本上不分化non-keratinizing epithelium 无角化facultative anae
5、robic anaerobic 兼性厌氧厌氧nutrition,humidity,pH,Eh 营养、湿度、pH、Eh,龈下细菌附着和聚集模式图,Subgingival biofilm formation龈下生物膜形成 Initial colonization早期定居者：actinomyces,streptococci succeeded colonization 微生物交替后：periodontal pathogens 致病微生物定植 Pg，AA,forsythia,T.denticole Fusobacterium nucleatum,1996 confirmed three bacteri
6、a for periodontal pathogens:Actinobacillus actinomycetemcomitans(AA)Tannerella forsythia(TF)Porphyromonas gingivalis(Pg)1996,牙周致病菌 AA，TF，PgRecent views change,pathogenic capacity of AA and other culturable or non-culturable bacteria should be confirmed.近期：AA待证实,50%oral microbial cannot be cultivated
7、 and can be identified through extra methods:口腔中有50%微生物不能培养，可通过下述方法鉴定：quantitative RT-PCR 定量PCRphylogenetic 16s-rRNA gene clone library analysis 用基因组或16s rRNA探针checkerboard hybridization 棋盘杂交high-throughput fingerprint technology 高通量指纹技术pyrophosphate sequencing 454技术（焦磷酸盐测序）metagenome technology 宏基因
8、组技术,General view:Periodontitis is caused by endogenous G-periodontal bacteria.目前普遍认为：牙周炎是由内源性G-牙周细菌所致 Red complex:Porphyromonas gingivalis 牙龈卟啉菌Tannerella forsythia 弗赛菌Treponema denticola 齿密螺旋体Potential virulence factors 潜在毒力因子Neutralization for local host defense mechanisms中和局部宿主防御机制Destruction of
9、periodontal tissue 破坏牙周组织,P.Gingivalis 牙龈卟啉菌G-厌氧、杆状、繖附着、与红色菌群共同构成生物膜adhere to host cells（integrins）通过整合素附着Secretory proteinase 分泌蛋白溶解酶、破坏牙龈附着After invasion,association with the change of intracellular signaling pathways 入侵后改变信号通路分泌脂多糖，是细菌内毒素的主要成分畸形血管生成,Tannerella forsythia 弗赛菌厌氧G-菌，cytophaga-Bactero
10、idetes familyNew pathogens through 16s rRNA detection 16s rRNA检测分泌富含亮氨酸的重复蛋白（leucine-rich-repeat protein,BSPA）,使细菌容易附着，是重要的毒力因子启动单核细胞释放炎症细胞因子，成骨细胞释放趋化因子，导致炎症和骨吸收,G-口腔螺旋体家族，绝对厌氧，纤细、螺旋、能动、可弯曲Virulence factors 毒力因子内毒素Accumulation in gingival pocket,using a variety of nutrition ingredients 聚集于牙周袋Degrada
11、tion of cytokines，inhibition of fibroblast migration,and prevention of healing 降解细胞因子,Treponema denticola 齿密螺旋体,Because subgingival microbial between periodontal health and disease individuals are significant differences,simple pathogens mode can not explain the etiology of periodontitis.Current the
12、ories tend to apply microorganism succession to explain the etiology of periodontitis,i.e.benign bacteria reducing results in the increase of pathogen bacteria.In some degree,the whole microbial community is its pathogen.单一致病源不能解释牙周病模式微生物交替可解释牙周病病因,Host-microorganisms interactions has established th
13、e basic framework,which can form a periodontal inflammation,but also offers the possibility of treatment.宿主寄生物相互作用已建立一种基本性框架，可形成牙周炎症，也提供了治疗的可能性,Subgingival infection 龈下感染 Bacteria adhesion-growth-biofilm formation-intrusion of host tissues-invasion of host immune system interface 细菌附着粘附细胞生长生物膜形成致病源入
14、侵宿主细胞/组织侵犯宿主免疫系统界面,Periodontal disease&host immunity牙周病与宿主免疫,46%people can be detected periodontal pathogens.However,many individuals may limit the occurrence of periodontal disease.Many scholars have proposed the multiple etiology of periodontal disease:microbes,host immune response,environmental f
15、actors46%检测到牙周致病菌，但许多人不发病牙周病病因涉及 微生物、宿主、环境,Although periodontal disease is causeal by bacterial infection,the resulting tissue damage is due to the immune response.牙周病损伤来自免疫反应,Individual immune responses to a large extent determine the severity of periodontal disease.个体反应决定牙周损害程度Twin study confirms
16、genetic hereditary effects on periodontal disease clinical sensitivity up to 50%.遗传因素占50%,First is the innate immune response Bacterial uptake by macrophages cytoken release by macrophages 巨噬细胞释放细胞因子 causing periodontal diseases related to inflammation 炎症 causing blood vessels to dilate,permeability
17、 increases 血管渗 透性增加 local blood flow increases,creating inflammation 血流量增加,Innate immune response 固有免疫反应,Acquired immune responses获得性免疫反应Pg is the most of bacteria related to periodontal inflammation,can sensitized and activate DC Pg 致敏并激活 DCDendritic cells(DC)play a role in antigen presentation Nai
18、ve T cells stimulatedDC 刺激幼稚T细胞 reaches the nearest lymph node activate T cells到达附近淋巴结，激活T细胞,Immune escape 免疫逃逸Pathogenic bacteria of periodontitis may enter cells,escape immune surveillance,and form ecological balance with host.Once balance damage,periodontal disease can happen.牙周致病菌进入细胞逃逸免疫监视；病毒的作
19、用Synergism 协同作用:Oral herpes virus,EB virus and bacterial,CD4+T cells appearance is the main cause of periodontal bone loss.CD4+T细胞Th2 cells activate B cells to produce antibodies.Th2 激活B细胞Epithelial cells in periodontitis patients contain high levels IgA and IgG,and IgM can be found in deep periodon
20、tal pocket.上皮细胞含IgA、G、M,Bone loss 骨丧失,Periodontal disease-related systemic diseases including cardiovascular disease and,preterm birth and other issuesPeriodontal inflammation enables individuals more sensitive to periodontal diseases and vascular sclerosis.血管硬化Inflammatory Cytokines,particularly IL-1 beta,PGE2 and TNF-alpha,can affect the cardiovascular and placenta.心血管和胚胎,Systemic reaction 全身反应,
