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1、五、牙周病与免疫五、牙周病与免疫(miny)第一页，共三十一页。牙周病与免疫The oral cavity harbors more than 700 bacterial species, coexisting with probably millions of viral genomic copies.口腔定居的细菌有口腔定居的细菌有700多种多种与数百万病毒基因组复制与数百万病毒基因组复制(fzh)物共存物共存（A Tsuo Amano, 2010, Periodontology 2000）第二页，共三十一页。牙周病与免疫Oral bacteria 口腔中的细菌口腔中的细菌： - Free
2、 to saliva 在唾液在唾液(tuy)中中 - Attachment in biofilm 附着在生物膜附着在生物膜 Between closely relatedSaliva as a carrier, is conducive to horizontal and vertical transmission of bacteria 第三页，共三十一页。牙周病与免疫In United States, 75 per cent of adult populations suffer from periodontal disease. 美国占美国占75%成年人群体不同成年人群体不同(b tn)
3、程度患有牙周病程度患有牙周病1/3 children of 611years old, and 2/3 of adolescent population have some degree of periodontal problems. 1/3的的611岁儿童，岁儿童，2/3青春期人群也有某种程度的牙周问青春期人群也有某种程度的牙周问题题第四页，共三十一页。牙周病与免疫Over 200 kinds of bacterial form dental plaque, adhere to the surface of the teeth and gums, and cause periodontal
4、 infections. 牙周感染牙周感染(gnrn)细菌达细菌达200余种余种Periodontitis Gingivitis bleeding，Deep gingival Pocket 3mm Periodontitis bleeding，swelling，initial bone loss, Deep periodontal Pocket = 5mm major stage bleeding，swelling，major bone loss， Deep periodontal Pocket 6mm第五页，共三十一页。牙周病与免疫 Periodontal Pocket: a unique
5、micro-environment牙周袋是独特的微环境牙周袋是独特的微环境escape the physical separation force 逃逸物理分离力逃逸物理分离力hard tissue surface 不剥脱更新的硬组织表面不剥脱更新的硬组织表面junctional epithelialization, basically not differentiation有结合上皮，有结合上皮，基本上不分化基本上不分化(fnhu)non-keratinizing epithelium 无角化无角化facultative anaerobic anaerobic 兼性厌氧兼性厌氧厌氧厌氧nut
6、rition, humidity, pH, Eh 营养、湿度、营养、湿度、pH、Eh第六页，共三十一页。牙周病与免疫第七页，共三十一页。牙周病与免疫龈下细菌龈下细菌(xjn)附着和聚集模式图附着和聚集模式图RootsurfacePellicleP.gP.gP.gP.gP.g第八页，共三十一页。牙周病与免疫Subgingival biofilm formation龈下生物膜形成龈下生物膜形成 Initial colonization早期早期(zoq)定居者定居者： actinomyces, streptococci succeeded colonization 微生物交替后：微生物交替后： pe
7、riodontal pathogens 致病微生物定植致病微生物定植 Pg，AA, forsythia, T. denticole Fusobacterium nucleatum第九页，共三十一页。牙周病与免疫第十页，共三十一页。牙周病与免疫1996 confirmed three bacteria for periodontal pathogens : Actinobacillus actinomycetemcomitans (AA) Tannerella forsythia (TF) Porphyromonas gingivalis (Pg) 1996, 牙周致病菌牙周致病菌 AA，TF，
8、PgRecent views change, pathogenic capacity of AA and other culturable or non-culturable bacteria should be confirmed. 近期近期(jn q)：AA待证实待证实第十一页，共三十一页。牙周病与免疫50% oral microbial cannot be cultivated and can be identified through extra methods:口腔中有口腔中有50%微生物不能培养，可通过下述方法微生物不能培养，可通过下述方法(fngf)鉴定：鉴定：quantitat
9、ive RT-PCR 定量定量PCRphylogenetic 16s-rRNA gene clone library analysis 用基因组或用基因组或16s rRNA探针探针checkerboard hybridization 棋盘杂交棋盘杂交high-throughput fingerprint technology 高通量指纹技术高通量指纹技术pyrophosphate sequencing 454技术（焦磷酸盐测序）技术（焦磷酸盐测序）metagenome technology 宏基因组技术宏基因组技术第十二页，共三十一页。牙周病与免疫General view: Periodont
10、itis is caused by endogenous G- periodontal bacteria. 目前普遍认为：牙周炎是由内源性目前普遍认为：牙周炎是由内源性G-牙周细菌所致牙周细菌所致(su zh) Red complex:Porphyromonas gingivalis 牙龈卟啉菌牙龈卟啉菌Tannerella forsythia 弗赛菌弗赛菌Treponema denticola 齿密螺旋体齿密螺旋体Potential virulence factors 潜在毒力因子潜在毒力因子Neutralization for local host defense mechanisms中和
11、局部宿主防御机制中和局部宿主防御机制Destruction of periodontal tissue 破坏牙周组织破坏牙周组织第十三页，共三十一页。牙周病与免疫P. Gingivalis 牙龈卟啉菌牙龈卟啉菌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）通过整合素附着Secretory proteinase 分泌蛋白溶解酶、破坏牙龈附着分泌蛋白溶解酶、破坏牙龈附着After invasion, association with the change of intrace
12、llular signaling pathways 入侵后改变信号通路入侵后改变信号通路分泌脂多糖，是细菌分泌脂多糖，是细菌(xjn)内毒素的主要成分内毒素的主要成分畸形血管生成畸形血管生成第十四页，共三十一页。牙周病与免疫Tannerella forsythia 弗赛菌弗赛菌厌氧厌氧G-菌，菌，cytophaga-Bacteroidetes familyNew pathogens through 16s rRNA detection 16s rRNA检测检测分泌富含亮氨酸的重复蛋白（分泌富含亮氨酸的重复蛋白（leucine-rich-repeat protein, BSPA ）, 使细菌容易
13、使细菌容易(rngy)附着，是重要附着，是重要的毒力因子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，导致炎症和骨吸收化因子，导致炎症和骨吸收第十五页，共三十一页。牙周病与免疫G-口腔螺旋体家族，绝对厌氧，纤细口腔螺旋体家族，绝对厌氧，纤细(xinx)、螺旋、能、螺旋、能动、可弯曲动、可弯曲Virulence factors 毒力因子毒力因子内毒素内毒素Accumulation in gingival pocket, using a variety of nutrition ingredients 聚集于牙周袋聚集于牙周袋Degrad
14、ation of cytokines，inhibition of fibroblast migration, and prevention of healing 降解细胞因子降解细胞因子Treponema denticola 齿密螺旋体齿密螺旋体第十六页，共三十一页。牙周病与免疫Because subgingival microbial between periodontal health and disease individuals are significant differences, simple pathogens mode can not explain the etiology
15、 of periodontitis.Current theories 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单一致病源不能解释牙周病模式微生物交替微生物交替(jiot)可解
16、释牙周病病因可解释牙周病病因第十七页，共三十一页。牙周病与免疫Host - microorganisms interactions has established the basic framework, which can form a periodontal inflammation, but also offers the possibility of treatment.宿主宿主寄生物相互作用已建立一种寄生物相互作用已建立一种(y zhn)基本性框架，基本性框架，可形成牙周炎症，也提供了治疗的可能性可形成牙周炎症，也提供了治疗的可能性第十八页，共三十一页。牙周病与免疫Subgingiv
17、al infection 龈下感染龈下感染 Bacteria adhesion - growth - biofilm formation- intrusion of host tissues - invasion of host immune system interface 细菌附着细菌附着粘附粘附细胞生长细胞生长生物膜形成生物膜形成致病源致病源入侵入侵(rqn)宿主细胞宿主细胞/组织组织侵犯宿主免疫系统界面侵犯宿主免疫系统界面第十九页，共三十一页。牙周病与免疫Periodontal disease & host immunity牙周病与宿主牙周病与宿主(szh)免疫免疫第二十页，共三十一页
18、。牙周病与免疫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 factors46%检测到牙周致病菌，但许多人不发病检测到牙周致病菌，但许多人不发病牙周病病因涉
19、及牙周病病因涉及(shj) 微生物、宿主、环境微生物、宿主、环境第二十一页，共三十一页。牙周病与免疫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牙周病损伤来自免疫(miny)反应反应第二十二页，共三十一页。牙周病与免疫Individual immune responses to a large extent determine the severity of periodonta
20、l disease. 个体反应决定牙周损害程度个体反应决定牙周损害程度Twin study confirms genetic hereditary effects on periodontal disease clinical sensitivity up to 50%. 遗传遗传(ychun)因素占因素占50%第二十三页，共三十一页。牙周病与免疫 First is the innate immune response Bacterial uptake by macrophages cytoken release by macrophages 巨噬细胞释放细胞因子巨噬细胞释放细胞因子 caus
21、ing periodontal diseases related to inflammation 炎症炎症(ynzhng) causing blood vessels to dilate, permeability increases 血管渗血管渗 透性增加透性增加 local blood flow increases, creating inflammation 血流量增加血流量增加Innate immune response 固有固有(gyu)免疫反应免疫反应第二十四页，共三十一页。牙周病与免疫Acquired immune responses获得性免疫反应获得性免疫反应Pg is the
22、 most of bacteria related to periodontal inflammation, can sensitized and activate DC Pg 致敏并激活致敏并激活(j hu) DCDendritic cells (DC) play a role in antigen presentation Naive T cells stimulatedDC 刺激幼稚刺激幼稚T细胞细胞 reaches the nearest lymph node activate T cells到达附近淋巴结，激活到达附近淋巴结，激活T细胞细胞第二十五页，共三十一页。牙周病与免疫Immu
23、ne escape 免疫逃逸免疫逃逸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；病毒牙周致病菌进入细胞逃逸免疫监视；病毒(bngd)的作用的作用Synergism 协同作用协同作用: Oral herpes virus, EB virus and bacteria
24、l 第二十六页，共三十一页。牙周病与免疫第二十七页，共三十一页。牙周病与免疫CD4+ T cells appearance is the main cause of periodontal bone loss. CD4+ T细胞细胞(xbo)Th2 cells activate B cells to produce antibodies. Th2 激活激活B细胞细胞Epithelial cells in periodontitis patients contain high levels IgA and IgG, and IgM can be found in deep periodontal
25、 pocket. 上皮细胞含上皮细胞含IgA、G、MBone loss 骨丧失骨丧失(sngsh)第二十八页，共三十一页。牙周病与免疫第二十九页，共三十一页。牙周病与免疫 Periodontal disease - related systemic diseases including cardiovascular disease and, preterm birth and other issuesPeriodontal inflammation enables individuals more sensitive to periodontal diseases and vascular s
26、clerosis. 血管硬化血管硬化Inflammatory Cytokines, particularly IL-1 beta, PGE2 and TNF-alpha, can affect the cardiovascular and placenta. 心血管和胚胎心血管和胚胎(piti)Systemic reaction 全身全身(qun shn)反应反应第三十页，共三十一页。牙周病与免疫内容(nirng)总结五、牙周病与免疫。G-厌氧、杆状、繖附着、与红色菌群共同构成生物膜。厌氧G-菌，cytophaga-Bacteroidetes family。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(zhlio)的可能性。Synergism 协同作用:第三十一页，共三十一页。牙周病与免疫
