Abstract
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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