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Kamikawa Y, Fujisaki J, Nagayama T, Kawasaki K, Hirabayashi D, Hamada T, Sakamoto R, Mukai H, Sugihara K. Use of Candida-specific chicken egg yolk antibodies to inhibit the adhering of Candida to denture base materials: prevention of denture stomatitis. Gerodontology 2014; 33:342-7. [PMID: 25393605 DOI: 10.1111/ger.12163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Polyclonal anti-Candida chicken egg yolk antibodies (anti-IgY) were used to investigate the prevention of adherence of Candida species to denture base material in vitro. BACKGROUND Candida is a potential virulence factor that can cause systemic infection and even death in immunocompromised individuals. Because long-term antifungal treatment may lead to the emergence of drug-resistant strains, it is necessary to develop novel preventive measures and treatments for candidiasis. MATERIALS AND METHODS Three types of chicken egg yolk antibodies were used in this study: non-specific antibody (control IgY), Candida albicans-specific antibody (anti-C.a.IgY) and Candida glabrata-specific antibody (anti-C.g.IgY). A mixture of different dilutions of each antibody with a suspension of Candida species and denture base material was incubated for 3 h, and then the colony-forming units of Candida on the denture base material were counted. RESULTS Compared with control IgY, anti-C.a.IgY and anti-C.g.IgY significantly inhibited the adherence of C. albicans, but anti-C.a.IgY tended to be more potent than anti-C.g.IgY. The adherence of C. glabrata was also inhibited significantly by anti-C.a.IgY and anti-C.g.IgY with almost equivalent potency, indicating that their actions against C. glabrata were comparable. CONCLUSIONS This study revealed the inhibitory effects of anti-C.a.IgY and anti-C.g.IgY against the adherence of C. albicans and C. glabrata to denture base material. This finding indicates the possibility of a beneficial effect of IgYs for the prevention of denture stomatitis and candidiasis in clinical settings.
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Affiliation(s)
- Yoshiaki Kamikawa
- Department of Oral Surgery, Kagoshima University Medical and Dental Hospital, Kagoshima, Japan
| | - Junichi Fujisaki
- Department of Maxillofacial Diagnostic and Surgical Sciences, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tomohiro Nagayama
- Department of Oral Surgery, Kagoshima University Medical and Dental Hospital, Kagoshima, Japan
| | - Kiyotsugu Kawasaki
- Department of Maxillofacial Diagnostic and Surgical Sciences, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Daisuke Hirabayashi
- Department of Maxillofacial Diagnostic and Surgical Sciences, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tomofumi Hamada
- Department of Maxillofacial Diagnostic and Surgical Sciences, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Ryoich Sakamoto
- Department of Maxillofacial Diagnostic and Surgical Sciences, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroshi Mukai
- Department of Oral Surgery, Kagoshima University Medical and Dental Hospital, Kagoshima, Japan.,Department of Maxillofacial Diagnostic and Surgical Sciences, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kazumasa Sugihara
- Department of Oral Surgery, Kagoshima University Medical and Dental Hospital, Kagoshima, Japan.,Department of Maxillofacial Diagnostic and Surgical Sciences, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Olsen I, Potempa J. Strategies for the inhibition of gingipains for the potential treatment of periodontitis and associated systemic diseases. J Oral Microbiol 2014; 6:24800. [PMID: 25206939 PMCID: PMC4138498 DOI: 10.3402/jom.v6.24800] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/15/2014] [Accepted: 07/15/2014] [Indexed: 12/13/2022] Open
Abstract
Gingipains are the major virulence factors of Porphyromonas gingivalis, the main periodontopathogen. It is expected that inhibition of gingipain activity in vivo could prevent or slow down the progression of adult periodontitis. To date, several classes of gingipain inhibitors have been recognized. These include gingipain N-terminal prodomains, synthetic compounds, inhibitors from natural sources, antibiotics, antiseptics, antibodies, and bacteria. Several synthetic compounds are potent gingipain inhibitors but inhibit a broad spectrum of host proteases and have undesirable side effects. Synthetic compounds with high specificity for gingipains have unknown toxicity effects, making natural inhibitors more promising as therapeutic gingipain blockers. Cranberry and rice extracts interfere with gingipain activity and prevent the growth and biofilm formation of periodontopathogens. Although the ideal gingipain inhibitor has yet to be discovered, gingipain inhibition represents a novel approach to treat and prevent periodontitis. Gingipain inhibitors may also help treat systemic disorders that are associated with periodontitis, including cardiovascular disease, rheumatoid arthritis, aspiration pneumonia, pre-term birth, and low birth weight.
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Affiliation(s)
- Ingar Olsen
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Jan Potempa
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland ; Department of Oral Immunology and Infectious Disease, School of Dentistry, University of Louisville, Louisville, Kentucky, USA
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Han X, LaRosa KB, Kawai T, Taubman MA. DNA-based adaptive immunity protect host from infection-associated periodontal bone resorption via recognition of Porphyromonas gingivalis virulence component. Vaccine 2013; 32:297-303. [PMID: 24051159 DOI: 10.1016/j.vaccine.2013.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 08/12/2013] [Accepted: 09/06/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Porphyromonas gingivalis (Pg) is one of a constellation of oral organisms associated with human chronic periodontitis. While adaptive immunity to periodontal pathogen proteins has been investigated and is an important component of periodontal bone resorption, the effect of periodontal pathogen DNA in eliciting systemic and mucosal antibody and modulating immune responses has not been investigated. METHODS Rowett rats were locally injected with whole genomic Pg DNA in alum. Escherichia coli (Ec) genomic DNA, Fusobacterium nucleatum (Fn) genomic DNA, and saline/alum injected rats served as controls. After various time points, serum IgG and salivary IgA antibody to Ec, Fn or Pg were detected by ELISA. Serum and salivary antibody reactions with Pg surface antigens were determined by Western blot analyses and the specific antigen was identified by mass spectrometry. Effects of genomic DNA immunization on Pg bacterial colonization and experimental periodontal bone resorption were also evaluated. RESULTS Sera from Pg DNA, Ec DNA and Fn DNA-injected rats did not react with Ec or Fn bacteria. Serum IgG antibody levels to Pg and Pg surface extracts were significantly higher in animals immunized with Pg DNA as compared to the control groups. Rats injected with Pg DNA demonstrated a strong serum IgG and salivary IgA antibody reaction solely to Pg fimbrillin (41kDa), the major protein component of Pg fimbriae. In the Pg DNA-immunized group, the numbers of Pg bacteria in oral cavity and the extent of periodontal bone resorption were significantly reduced after Pg infection. CONCLUSIONS This study suggests that infected hosts may select specific genes from whole genomic DNA of the periodontal pathogen for transcription and presentation. The results indicate that the unique gene selected can initiate a host protective immune response to the parent bacterium.
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Affiliation(s)
- Xiaozhe Han
- The Forsyth Institute, Department of Immunology and Infectious Diseases, 245 First Street, Cambridge, MA, United States.
| | - Karen B LaRosa
- The Forsyth Institute, Department of Immunology and Infectious Diseases, 245 First Street, Cambridge, MA, United States
| | - Toshihisa Kawai
- The Forsyth Institute, Department of Immunology and Infectious Diseases, 245 First Street, Cambridge, MA, United States
| | - Martin A Taubman
- The Forsyth Institute, Department of Immunology and Infectious Diseases, 245 First Street, Cambridge, MA, United States
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Gaddis DE, Maynard CL, Weaver CT, Michalek SM, Katz J. Role of TLR2-dependent IL-10 production in the inhibition of the initial IFN-γ T cell response to Porphyromonas gingivalis. J Leukoc Biol 2012; 93:21-31. [PMID: 23077245 DOI: 10.1189/jlb.0512220] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
P.g., a Gram-negative bacterium, is one of the main etiological agents of the chronic inflammatory disease, periodontitis. Disease progression is thought to occur as a result of an inadequate immune response, which although happens locally, can also occur distally as a result of the dissemination of P.g. into the circulation. As IL-10 and TLR2 are pivotal molecules in the immune response that P.g. elicits, we hypothesized that TLR2-mediated IL-10 production, following the initial systemic exposure to P.g., inhibits the IFN-γ T cell response. To address this hypothesis, mice were primed with P.g., and the types of cells producing IL-10 and the capacity of T cells to produce IFN-γ following blocking or neutralization of IL-10 were assessed. Our results showed that upon initial encounter with P.g., splenic T cells and CD11b(+) cells produce IL-10, which when neutralized, resulted in a substantial increase in IFN-γ production by T cells. Furthermore, IL-10 production was dependent on TLR2/1 signaling, partly in response to the major surface protein, FimA of P.g. In addition, P.g. stimulation resulted in the up-regulation of PD-1 and its ligand PD-L1 on CD4 T cells and CD11b(+) cells, respectively. Up-regulation of PD-1 was partially dependent on IL-10 but independent of TLR2 or FimA. These results highlight the role of IL-10 in inhibiting T cell responses to the initial systemic P.g. exposure and suggest multiple inhibitory mechanisms potentially used by P.g. to evade the host's immune response, thus allowing its persistence in the host.
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Affiliation(s)
- Dalia E Gaddis
- University of Alabama at Birmingham, 845 19th Street South, Birmingham, AL 35294-2170, USA.
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Guo Y, Nguyen KA, Potempa J. Dichotomy of gingipains action as virulence factors: from cleaving substrates with the precision of a surgeon's knife to a meat chopper-like brutal degradation of proteins. Periodontol 2000 2010; 54:15-44. [PMID: 20712631 DOI: 10.1111/j.1600-0757.2010.00377.x] [Citation(s) in RCA: 239] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Jong RAM, van der Reijden WA. Feasibility and therapeutic strategies of vaccines against Porphyromonas gingivalis. Expert Rev Vaccines 2010; 9:193-208. [PMID: 20109029 DOI: 10.1586/erv.09.156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Periodontitis is a chronic infectious disease that is highly prevalent worldwide and is characterized by inflammation of the gums, and loss of connective tissue and bone support. The Gram-negative anerobic bacterium Porphyromonas gingivalis is generally accepted as the main etiological agent for chronic periodontitis. The objective of this paper is to elucidate the feasibility of achieving protection against periodontitis though immunization against P. gingivalis. Until now, animal studies have showed no complete protection against P. gingivalis. However, current knowledge about P. gingivalis structures could be applicable for further research to develop a successful licensed vaccine and alternative therapeutic strategies. This review reveals that a multicomponent vaccine against P. gingivalis, which includes structures shared among P. gingivalis serotypes, will be feasible to induce broad and complete protection.
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Affiliation(s)
- Rosa A M Jong
- Department of Oral Microbiology, Academic Centre for Dentistry Amsterdam, Universiteit van Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands.
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Pathirana RD, O'Brien-Simpson NM, Reynolds EC. Host immune responses to Porphyromonas gingivalis antigens. Periodontol 2000 2010; 52:218-37. [DOI: 10.1111/j.1600-0757.2009.00330.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Taiyoji M, Shitomi Y, Taniguchi M, Saitoh E, Ohtsubo S. Identification of Proteinaceous Inhibitors of a Cysteine Proteinase (an Arg-Specific Gingipain) from Porphyromonas gingivalis in Rice Grain, Using Targeted-Proteomics Approaches. J Proteome Res 2009; 8:5165-74. [DOI: 10.1021/pr900519z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mayumi Taiyoji
- Food Research Center, Niigata Agricultural Research Institute, Kamo, Niigata 959-1381, Japan, Graduate School of Science and Technology, Niigata University, Niigata, Niigata 950-2181, Japan, Department of Materials Science and Technology, Niigata University, Niigata, Niigata 950-2181, Japan, Venture Business Laboratory, Niigata University, Niigata, Niigata 950-2181, Japan, and Graduate School of Technology, Niigata Institute of Technology, Kashiwazaki, Niigata 945-1195, Japan
| | - Yasuyuki Shitomi
- Food Research Center, Niigata Agricultural Research Institute, Kamo, Niigata 959-1381, Japan, Graduate School of Science and Technology, Niigata University, Niigata, Niigata 950-2181, Japan, Department of Materials Science and Technology, Niigata University, Niigata, Niigata 950-2181, Japan, Venture Business Laboratory, Niigata University, Niigata, Niigata 950-2181, Japan, and Graduate School of Technology, Niigata Institute of Technology, Kashiwazaki, Niigata 945-1195, Japan
| | - Masayuki Taniguchi
- Food Research Center, Niigata Agricultural Research Institute, Kamo, Niigata 959-1381, Japan, Graduate School of Science and Technology, Niigata University, Niigata, Niigata 950-2181, Japan, Department of Materials Science and Technology, Niigata University, Niigata, Niigata 950-2181, Japan, Venture Business Laboratory, Niigata University, Niigata, Niigata 950-2181, Japan, and Graduate School of Technology, Niigata Institute of Technology, Kashiwazaki, Niigata 945-1195, Japan
| | - Eiichi Saitoh
- Food Research Center, Niigata Agricultural Research Institute, Kamo, Niigata 959-1381, Japan, Graduate School of Science and Technology, Niigata University, Niigata, Niigata 950-2181, Japan, Department of Materials Science and Technology, Niigata University, Niigata, Niigata 950-2181, Japan, Venture Business Laboratory, Niigata University, Niigata, Niigata 950-2181, Japan, and Graduate School of Technology, Niigata Institute of Technology, Kashiwazaki, Niigata 945-1195, Japan
| | - Sadami Ohtsubo
- Food Research Center, Niigata Agricultural Research Institute, Kamo, Niigata 959-1381, Japan, Graduate School of Science and Technology, Niigata University, Niigata, Niigata 950-2181, Japan, Department of Materials Science and Technology, Niigata University, Niigata, Niigata 950-2181, Japan, Venture Business Laboratory, Niigata University, Niigata, Niigata 950-2181, Japan, and Graduate School of Technology, Niigata Institute of Technology, Kashiwazaki, Niigata 945-1195, Japan
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Kato T, Uzawa A, Ishihara K. Inhibitory effect of galectin-3 on the cytokine-inducing activity of periodontopathic Aggregatibacter actinomycetemcomitans endotoxin in splenocytes derived from mice. ACTA ACUST UNITED AC 2009; 57:40-5. [PMID: 19619243 DOI: 10.1111/j.1574-695x.2009.00577.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Galectins, a family of animal lectins, are involved not only in development and differentiation but also in immunoregulation and host-pathogen interactions. Galectin-3 interacts with lipopolysaccharides in gram-negative bacteria such as Escherichia coli, Salmonella minnesota and Pseudomonas aeruginosa. The present study investigated whether galectin-3 inhibited the cytokine-inducing activity of periodontopathic bacterial lipopolysaccharides using splenocytes derived from mice of different ages. Lipopolysaccharides were extracted from Aggregatibacter actinomycetemcomitans Y4 and Porphyromonas gingivalis ATCC 33277, and then purified. Enzyme-linked immunosorbent assay (ELISA) analysis revealed that galectin-3 adhered to A. actinomycetemcomitans lipopolysaccharides, but not to the lipopolysaccharides of P. gingivalis. Splenocytes were prepared from 1- or 7-month-old C57BL/6 mice. Either A. actinomycetemcomitans lipopolysaccharides (200 ng mL(-1)) alone or lipopolysaccharides and murine galectin-3 (10 microg mL(-1)) were added to culture solutions, and the release of interleukin-6 (IL-6) and interferon-gamma (IFNgamma) from splenocytes was measured by ELISA after a 17-h incubation. In all mice tested, A. actinomycetemcomitans lipopolysaccharide stimulation significantly increased the production of IL-6 and IFNgamma (P<0.01). Murine galectin-3 suppressed lipopolysaccharide-induced cytokine production in the splenocytes of the 1-month-old mice (P<0.02 for IL-6; P<0.05 for IFNgamma), but not in the splenocytes of the 7-month-old mice. This suggests that responses change with age.
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Affiliation(s)
- Tetsuo Kato
- Laboratory of Chemistry, Tokyo Dental College, Chiba, Japan.
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Ibrahim ESM, Rahman AKMS, Isoda R, Umeda K, Van Sa N, Kodama Y. In vitro and in vivo effectiveness of egg yolk antibody against Candida albicans (anti-CA IgY). Vaccine 2008; 26:2073-80. [PMID: 18375022 DOI: 10.1016/j.vaccine.2008.02.046] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 01/28/2008] [Accepted: 02/22/2008] [Indexed: 11/15/2022]
Abstract
We prepared anti-Candida albicans antibody in chicken egg yolk (anti-CA IgY) and investigated its in vitro and in vivo effectiveness. Anti-CA IgY significantly reduced the adherence capacity of C. albicans to FaDu cells (human pharynx carcinoma cells) in a dose-dependent manner. The protective efficacy of anti-CA IgY was investigated in experimentally induced oral candidiasis in immunosuppressed mice. Oral administration of anti-CA IgY significantly reduced the number of C. albicans and the scores of the tongue lesions. Moreover, anti-CA IgY reduced the colonization of C. albicans in mice organs. These results indicate that anti-CA IgY has a protective effect against the oral candidiasis of experimentally infected mice and reduces the dissemination of C. albicans. Putting together, these results indicate that anti-CA IgY is effective against C. albicans. This effect might be due to the blocking of the binding of C. albicans to the host cells. Therefore, anti-CA IgY might be considered as a prophylactic immunotherapy or possibly an adjunctive antifungal therapy.
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Makino A, Yamada S, Okuda K, Kato T. Nicotine involved in periodontal disease through influence on cytokine levels. ACTA ACUST UNITED AC 2008; 52:282-6. [DOI: 10.1111/j.1574-695x.2007.00373.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yokoyama K, Sugano N, Rahman AKMS, Oshikawa M, Ito K. Activity of anti-Porphyromonas gingivalis egg yolk antibody against gingipains in vitro. ACTA ACUST UNITED AC 2008; 22:352-5. [PMID: 17803634 DOI: 10.1111/j.1399-302x.2007.00358.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION We investigated the effect of anti-Porphyromonas gingivalis egg yolk antibody against gingipains [immunoglobulin Y (IgY)-GP] on gingipain activity in vitro. METHODS IgY-GP was isolated from the yolks of White Leghorn hens immunized with purified gingipains. Control antibody (IgY) was isolated from the yolks of non-immunized hens. Gingipain activity was assessed according to the rate of enzymatic substrate hydrolysis. Human epithelial cells were cultured with or without gingipains and with gingipains pretreated with either IgY-GP or IgY. RESULTS Hydrolytic activity decreased in the presence of IgY-GP. Cells incubated with gingipains showed a dose-dependent loss of adhesion activity. Pretreatment of gingipains with IgY-GP was associated with strong inhibition of cell detachment, whereas pretreatment with IgY was not. CONCLUSION Our findings suggest that IgY-GP may be an effective immunotherapeutic agent in the treatment of periodontitis.
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Affiliation(s)
- K Yokoyama
- Nihon University Graduate School of Dentistry, Tokyo, Japan
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Miyachi K, Ishihara K, Kimizuka R, Okuda K. Arg-gingipain A DNA vaccine prevents alveolar bone loss in mice. J Dent Res 2007; 86:446-50. [PMID: 17452566 DOI: 10.1177/154405910708600511] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
One major pathogenic factor of Porphyromonas gingivalis is Arg-gingipain (Rgp), an arginine-specific cysteine proteinase. To clarify the effect of rgpA DNA vaccine, we immunized BALB/c mice via the abdomen with a Gene Gun or via the nasal cavity weekly for 6 weeks. After immunization, the mice were challenged orally with P. gingivalis. Immunization elicited IgG responses against P. gingivalis in both groups. Nasal immunization also induced sIgA against P. gingivalis, although Gene Gun immunization did not. Reduction of alveolar bone loss was observed in both groups at 42 days following initial infection. This effect was more pronounced in the intranasal immunization group than in the Gene Gun group. The results of this study suggest that immunization with rgpA DNA vaccine via the nasal cavity is an effective method for preventing alveolar bone loss incurred by infection with P. gingivalis.
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Affiliation(s)
- K Miyachi
- Department of Microbiology, Tokyo Dental College, 1-2-2 Masago, Mihama-ku, Chiba, 261-8502, Japan
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Yokoyama K, Sugano N, Shimada T, Shofiqur RAKM, Ibrahim ESM, Isoda R, Umeda K, Sa NV, Kodama Y, Ito K. Effects of egg yolk antibody against Porphyromonas gingivalis gingipains in periodontitis patients. J Oral Sci 2007; 49:201-6. [DOI: 10.2334/josnusd.49.201] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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