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Juvenile Periodontitis: Demonstration of Local Immunoglobulin Synthesis


Steven J. SpindIer, D.D.S., James J. Thompson,PhD, Raymond A. Yukna,D.M.D. and Aymee D. Costales, D.D.S.
Journal of Periodontology 57:(5) 300-304.




The purpose of this investigation was to determine the presence and quantity of immunoglobulin G (lgG) and albumin (ALB) in specified periodontal tissues and serum from patients diagnosed as having juvenile periodontitis (JP), using an immunoelectrophoresis technique and to determine which portion of the lesion generated the greatest local immunoglobulin production.

Serum and tissue samples were obtained from 19 patients (ages 13-21 years) who were diagnosed as having JP: 18 were female: 16 were African-American. Normal, diseased, and granulomatous gingival/periodontal tissues were collected during full thickness flap surgery then minced, homogenized, and centrifuged.

Supernatants containing the gingival/periodontal protein and the serum were electrophoresed against rabbit antihuman lgG and ALB. The relative lgG/ALB ratios in each specimen were plotted against known concentrations of lgG using a least squares analysis to provide evidence for local synthesis.

In comparing mean lgG/ALB ratios for all tissue types, it was noted that normal gingiva did not differ significantly from serum. Diseased and granulomatous tissues, taken together or separately, had significantly higher lgG/ALB ratios than normal gingiva or serum demonstrating that 73.6% of the lgG present was due to local synthesis. However, the greatest amounts of locally produced IgG were found in the granulomatous tissue from the deepest areas of the defects.

DISCUSSION Simultaneous determination of albumin and lgG concentration in serum. normal gingiva. and lesion-associated diseased and granulomatous tissue extracts has indicated higher lgG concentrations in tissues adjacent to JP lesions. lgG concentrations were similar in serum and normal gingiva. These findings in JP are in concert with those reported for AP (24,25,26) and for JP (29) lgG/ALB ratios for serum and normal gingival extracts did not differ significantly in JP patients. However, multiple comparisons involving serum or normal gingiva with lesion-associated tissues (diseased and/or granulomatous) consistently differed significantly. indicating a heightened local antibody response isolated to specific JP lesions. The higher ratios noted in defect granulomatous tissues compared to marginal diseased tissues were not surprising. Histologically, there was a more intense inflammatory infiltrate, consisting primarily of lymphocytes and plasma cells. in granulomabus tissue than in marginal diseased tissues. Additionally, heavy plasma cell infiltrates have been consistent findings in JP (2-4,10,11) The presence in high numbers of these cells, noted for antibody production and the fact that local synthesis of IgG in JP has been demonstrated in our laboratories point to several interesting speculations regarding the etiology of the elevated antibodv response and treatment of JP. The highest antibody levels and therefore the greatest disease activity in the JP lesion. are found in the granulomatous tissues present at the base of the osseous defects. This finding may be clinically very significant with respect to the treatment of JP. Conservative therapy consisting of scaling and personal oral hygiene may not be sufficient to arrest the very deep lesions usually found in these patients. Treatment would be better aimed at surgical removal of the tissue with the highest disease activity. (30)

The higher antibody titers present in the gingival extracts are more likely directed at a specific antigen or group of antigens. Slots (19) has demonstrated positive cultures of Aa in a high percentage of JP patients. The patients also had elevated serum antibody titers that were specific for Aa . Current research at our institution is investigating the specificity of the antibody present in the gingival extracts from the three tissue types sampled (normal. diseased, and granulomatous) toward Aa.

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