Development of Novel Tools for Prevention and Diagnosis of Porphyromonas Gingivalis Infection and Periodontitis I Dedicate This Thesis to My Beloved Parents
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Development of Novel Tools for Prevention And Diagnosis of Porphyromonas gingivalis Infection and Periodontitis I dedicate this thesis to my beloved parents ¨A small body of determined spirits fired by an unquenchable faith in their mission can alter the course of history¨ - Gandhi Örebro Studies in Medicine 151 SRAVYA SOWDAMINI NAKKA Development of Novel Tools for Prevention and Diagnosis of Porphyromonas gingivalis Infection and Periodontitis © Sravya Sowdamini Nakka, 2016 Title: Development of Novel Tools for Prevention and Diagnosis of Porphyromonas gingivalis Infection and Periodontitis Publisher: Örebro University 2016 www.publications.oru.se Print: Örebro University, Repro 09/2016 ISSN 1652-4063 ISBN 978-91-7668-162-8 Abstract Sravya Sowdamini Nakka (2016): Development of Novel Tools for Prevention and Diagnosis of Porphyromonas gingivalis Infection and Periodontitis. Örebro studies in Medicine 151. Periodontitis is a chronic inflammatory disease caused by exaggerated host im- mune responses to dysregulated microbiota in dental biofilms leading to degrada- tion of tissues and alveolar bone loss. Porphyromonas gingivalis is a major perio- dontal pathogen and expresses several potent virulence factors. Among these fac- tors, arginine and lysine gingipains are of special importance, both for the bacterial survival/proliferation and the pathological outcome. The major aim of this thesis was to develop and test novel methods for diagnosis and prevention of P. gingi- valis infection and periodontitis. In study I, anti-P. gingivalis antibodies were de- veloped in vitro for immunodetection of bacteria in clinical samples using a surface plasmon resonance (SPR)-based biosensor. Specific binding of the antibodies to P. gingivalis was demonstrated in samples of patients with periodontitis and the re- sults were validated using real-time PCR and DNA-DNA checkerboard analysis. In study II, we elucidated the properties and antimicrobial effects of different lac- tobacillus species and the two-peptide bacteriocin PLNC8 on P. gingivalis. L. plantarum NC8 and 44048 effectively inhibited P. gingivalis growth and pure PLNC8 induced bacterial lysis by damaging P. gingivalisαβ membrane. In study III, we demonstrated that PLNC8 dose-dependently induces proliferation and release ofαβ growth factors in gingival epithelial cells (GECs). Furthermore, PLNC8 decreased P. gingivalis-induced αβcytotoxic effects in GECs but did not alter the effect of gingipains on cytokine expression. In study IV, we elucidated the effects ofαβ anti-P. gingivalis antibodies and PLNC8 in regulating cellular responses dur- ing P. gingivalis infection. Both antibodies and PLNC8 modulated P. gingi- valis-induced expression of growth factorsαβ in GECs, however, their effects were diminished when used in combination. The results of thisαβ thesis demonstrate a possible role of anti-P. gingivalis antibodies and PLNC8 in prevention and treatment of P. gingivalis infection and periodontitis with no cytotoxic effects on human cells. αβ Keywords: Periodontitis, Porphyromonas gingivalis, anti-P. gingivalis antibodies, surface plasmon resonance, PLNC8 , proliferation, growth factors. Sravya Sowdamini Nakka, Örebro αβstudies in Medicine, Örebro University, SE-70182 Örebro, Sweden, Email: [email protected] Table of Contents LIST OF PAPERS ...................................................................................... 9 PUBLICATIONS NOT INCLUDED IN THIS STUDY ........................... 10 LIST OF ABBREVIATIONS ................................................................... 11 INTRODUCTION .................................................................................. 13 Periodontitis ............................................................................................ 13 Porphyromonas gingivalis ....................................................................... 14 Oral Biofilms ........................................................................................... 16 Periodontitis and P. gingivalis Associated Systemic Diseases ................... 16 Host Immune Responses ......................................................................... 17 Antibodies ............................................................................................... 20 Diagnosis, Treatment and Prevention of Periodontitis ............................ 21 Lactobacillus and Bacteriocins ................................................................ 22 Aims ........................................................................................................ 25 METHODS ............................................................................................. 26 Study Participants and Ethical Approval ................................................. 26 Bacterial Strains and Bacteriocins ............................................................ 26 Cell Culturing ......................................................................................... 27 Antibody Production ............................................................................... 27 Flow Cytometry ...................................................................................... 28 Transmission Electron Microscopy ......................................................... 28 Confocal Microscopy .............................................................................. 29 Surface Plasmon Resonance Analysis ...................................................... 29 DNA-DNA Hybridization Technique ..................................................... 30 Enzyme-linked Immunosorbent Assay ..................................................... 31 Growth Factor Array .............................................................................. 31 Liposome Model ..................................................................................... 32 Antibacterial Activity of PLNC8 ........................................................ 32 Circular Dichroism Spectroscopy ............................................................ 33 Western Blotting ................................αβ ..................................................... 33 Statistics .................................................................................................. 34 RESULTS AND DISCUSSION ................................................................ 35 Activation of Leukocytes and Induction of Secondary Immune Responses (Study I) .................................................................................................. 35 SRAVYA NAKKA Prevention and Diagnosis of Porphyromonas gingivalis Infection 7 Detection and Attenuation of P. gingivalis by Anti-P. gingivalis antibodies (Study I) ................................................................................................... 36 Antibacterial Activity of Lactobacillus spp. and PLNC8 αβ (Study II) .... 36 Effects of PLNC8 αβ per se on GECs and During P. gingivalis Infection (Studies III & IV) ..................................................................................... 37 Effects of Anti-P. gingivalis Antibodies on GECs and During P. gingivalis Infection (Study IV) ................................................................................. 39 Combined Effects of Anti-P. gingivalis Antibodies and PLNC8 αβ on P. gingivalis-infected GECs (Study IV) .................................................... 40 CONCLUSIONS ..................................................................................... 41 FUTURE PERSPECTIVES ....................................................................... 42 ACKNOWLEDGEMENTS ..................................................................... 43 REFERENCES ........................................................................................ 46 8 SRAVYA NAKKA Prevention and Diagnosis of Porphyromonas gingivalis Infection List of Papers This thesis is based on the following original papers and manuscripts, which are referred to in the text by their roman numerals: I. Sravya Sowdamini Nakka, Johanna Lönn, Carin Starkhammar Jo- hansson, Torbjörn Bengtsson and Fariba Nayeri. Antibodies pro- duced in vitro in the detection of periodontal bacteria by using sur- face plasmon resonance analysis. Clinical and experimental dental research 2015, 1:32. II. Hazem Khalaf, Sravya Sowdamini Nakka, Camilla Sandén, Anna Svärd, Kjell Hultenby, Nikolai Scherbak, Daniel Aili and Torbjörn Bengtsson. Antibacterial effects of Lactobacillus and bacteriocin PLNC8 αβ on the periodontal pathogen Porphyromonas gingi- valis. BMC Microbiology 2016, 16:188. III. Sravya Sowdamini Nakka, Eleonor Palm, Torbjörn Bengtsson, Hazem Khalaf. Bacteriocin plantaricin NC8 αβ antagonizes Por- phyromonas gingivalis infection and induces proliferation of gin- gival epithelial cells. (Manuscript). IV. Sravya Sowdamini Nakka, Eleonor Palm, Fariba Nayeri, Torbjörn Bengtsson, Hazem Khalaf. Effects of plantaricin NC8 αβ and an- tibodies on gingival epithelial cells infected by Porphyromonas gin- givalis. (Manuscript). SRAVYA NAKKA Prevention and Diagnosis of Porphyromonas gingivalis Infection 9 Publications not included in this study Chongcong Wu, Sravya Sowdamini Nakka, Sepahdar Mansouri, Tor- björn Bengtsson, Tayeb Nayeri and Fariba Nayeri. In vitro model of pro- duction of antibodies; a new approach to reveal the presence of key bacteria in polymicrobial environments. BMC Microbiology 2016 (in press). Johanna Lönn, Carin Starkhammar Johansson, Sravya Sowdamini Nakka, Eleonor Palm, Torbjörn Bengtsson, Fariba Nayeri F, Nils Ravald.