Медицина 7 (клиническая медицина)

Malezhik M.S.

Chita State Medical Academy, Russia

The role of autoantibodies to heat shock proteins (HSP-70) in immune reactions in old-aged patients with chronic generalized periodontitis and coronary heart disease

Introduction: Autoimunne process is accompanied by any chronic inflammation and chronic generalized periodontitis is no exception. Sources of antigenic material in chronic periodontitis may be of different origin, but we were interested in heat shock proteins, isolated bacteria inhabiting the oral cavity and periodontal tissues degraded.

Heat shock proteins, microbial stressfull annoying pattern-recognition receptors (PRR) epithelial cells gums and start a chain of immune responses that trigger inflammation [1]. HSP immunogenic, they develop antibodies. Recent targeted transported to the periodontium and form immune complexes that are having a cytolytic effect, destroys not only bacteria, but also affected by periodontal cells. We believe that one of the reasons supporting the chronic inflammation of the periodontium are autoimmune processes associated with the expression of HSP in the destruction.

Aim: To investigate the intensity of formation of autoantibodies to heat shock proteins (HSP-70), and some immunological parameters in peripheral blood and saliva of the elderly before and after treatment of chronic generalized periodontitis and coronary heart disease.

Materials and methods: 96 patients with chronic generalized periodontitis of moderate severity (age 64-75 years) and 25 controls aged 64-75 years with no signs of periodontal inflammation. Patients with chronic generalized periodontitis and controls enrolled in Veterans Hospital of war with clinical manifestations of coronary heart disease, and received on this occasion cardiovascular therapy. Patients with inflammatory periodontal received additional local anti-inflammatory therapy. Blood samples and saliva was performed before and after treatment. In the blood and saliva studied concentration of autoantibodies to HSP-70 content of interleukin and immunoglobulins (s. IgA, IgA, IgM, IgG) by ELISA.

Statistical analysis was performed using the software package Biostat statistical analysis and program Microsoft Exel. When comparing the performance of immunoglobulins and interleukins have used the method of nonparametric statistics using the Mann-Whitney test. The content of autoantibodies to HSP expressed as mean values with standard deviation (M± SD).

Results and discussion: Our studies have shown that autoantibodies to HSP-70 in older people not suffering from chronic periodontitis, in saliva exist, but not at high concentrations (66, 6 ± 7,1 ng / ml) in human blood of the control group required significantly more autoantibodies (164 ± 13,6 ng / ml), which is associated with concomitant organ pathologies (atherosclerosis, hypertension, ischemic heart disease). [2]

When inflammation of the periodontal maintenance of autoantibodies to HSP-70 increased (212,2 ± 16, 3 ng / ml), indicating that enhanced secretion

HSP-70 from cells involved in inflammation. In the mouth it can be not only stressirovannye microorganisms and damaged cells of periodontal.

Developed antibodies to the respective HSP epytops form immune complexes that exhibit complement-dependent cytotoxicity and antibody to cells producing these proteins. The target can be any somatic cells expressing surface membrane proteins that are similar in structure to the pathogen HSP (molecular mimicry). Due to the cross-reaction antibodies to the bacteria settle on the chaperone proteins of somatic cells, thus developing an autoimmune process with organ failure. Perhaps, therefore, chronic periodontitis is not a local disease. He always has a related disease, and most of all, the defeat of the cardiovascular system. [3]

HSP act on antigen-presenting cells, mainly through toll-signaling receptors that cause release of proinflammatory cytokines and chemokines that attract cells to the periodontal performing an immune response - macrophages, lymphocytes, neutrophils, eosinophils, basophils, mast cells. [4]

Our studies have shown that in chronic periodontitis concentration of Il-8 in saliva compared with control values increased by 10 times, the content of Il-a - 3 times the level of IgG and IgA 2-fold, Ig M - 4 times and s.IgA 1.5-fold, which confirms the presence of local inflammation. In the blood of patients noted a significant increase in the level of Il-1a (140 ± 12 pg / ml, control 27,5 ± 6,1 pg / ml), Il-8 (34 ± 2,3 pg / ml, control - 17 ± 0,8 pg / ml) and IL-4 (29,6 ± 3,2 pg / ml, control 17 ± 1,1 pg / ml). At the same time there is polyclonal activation of adaptive immunity to the increase in blood concentrations of IgG, IgM, IgA, and autoantibodies to HSP-70 (349 ± 12,2 ng / ml).

Following the local anti-inflammatory therapy and concomitant coronary artery disease symptoms, correction of immune parameters occurs in part. The level of IgG in saliva and blood is not changed, indicating a preserved because of their synthesis. The concentration of autoantibodies to HSP is somewhat reduced in the saliva and blood, but does not reach the reference values.

High levels of autoantibodies to HSP-70 in saliva and blood suggests about pathogenetic role of protein-сhaperones in the development of periodontal inflammation and chronicity of the process.

References: 1. Lebedev K.F. Immunology obrazraspoznayuschih receptor / K.A.Lebedev, I.D.Ponyakina / / Librokom, 2009. - P.116-143

2. Nagornev V.A. Chaperones and their role in atherogenesis. / V.A.Nagornev, V.A.Pigarevsky, S.V.Maltsev / / Vest.RAMN - 2008. - N 1. - P.41-45.

3. Poltorak N.A. The relationship of degree of inflammation in the periodontium and some clinico-functional and laboratory parameters.

4. Yasuyuki A. Oral trepones and their ounter membrane extracts activate human gingival epithelial cell though toll-like receptor-2 / A. Yasuyuki, J.Tarayoshi, O.Tomohiko // Invest. and immun. - 2009. - Vol. 71, N 2. - P. 717 - 725