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Veterans Day Specials. Hundreds celebrate Indian culture at Topeka's Diwali Festival. President Trump proposes measures to help living kidney donors. Topeka crafters involve children in the craft fair. Food More. Review: The Porch's new location is bigger and boozier. But is it better? Bluestone Lane will open its first Boston location on Friday The owner of Roast Beast explains why he closed his popular shop. Ask the Carpenter: Dealing with rusty wood stoves, terrible smells. Now, it's getting thousands of orders every hour. Read an excerpt from her new memoir. Travel More.

A luxurious campground will debut near Acadia National Park in Cars More. The importance of the promoter region in elevated toxin production is still ongoing Thus far, all bacteria that show this toxin have been implicated in disease, particularly infectious disease caused by a multispecies consortium It is our belief that the toxin neutralizes the local mucosal immune response to enable other bacteria to overgrow.

However, it appears as if this mw OMP autotransporter exists as a trimer that has multiple functions. The phenotypic characteristics of ApiA include; adhesion, invasion, and complement resistance.

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As for complement resistance, based on the work of Asakawa et al. While all studies do not support the role of Aa in LAgP almost all studies of adolescents of African or Middle Eastern descent do support this observation Moreover, studies that do claim a role for Aa suggest that the JP2 type hyper-leukotoxin producing strain is more virulent The most likely explanation for these discrepancies can be placed on geographic, ethnic, and genetic differences in susceptibility and in exposure to bacteria.

However, relative to populations exposed and sensitive to Aa , we are much closer to understanding how the microbe affects the disease process as follows. Shortly after plaque development changes occur in the JE. Sampling of these antigens by antigen presenting cells causes stagnation of blood flow in these vessels, leukocyte margination, pavementing of leukocytes, and then diapedesis due to chemotactic signals guiding PMNs to mobilize in the direction of the overwhelming microbial burden bordering the epithelial barrier The first element that confronts this microbial burden is a serum exudate that consists of complement and PMNs that can kill bacteria either directly or indirectly.

Complement appears to act directly on the cell wall of bacteria, punching holes in the membrane resulting in cell lysis PMNs can engulf and degrade microbes at a rapid rate. Aa is equipped with strategies to neutralize these two potent host innate defense systems. Not only does Aa possess ApiA, a complement effector molecule, and leukotoxin, a toxin that kills PMNs, but it has been shown that, under stress, these genes are up-regulated as a defense against these host elements In the experimental model described below the association of the up-regulation of Ltx expression when Aa is under stress was shown in a model that examined an erythromycin resistant strain of Aa challenged by high doses of erythromycin [Er] The Er challenged cells showed increased biofilm formation and up-regulation of 4 genes; flp, pga, ltx, and tfox , in the Er resistant Aa strain.

This up-regulation showed an unexpected but previously demonstrated linkage between ltx, pga and flp expression when Aa was under stress Two host innate elements that appear to be related to disease susceptibility in studies of limited but well-defined subjects with LAgP are lactoferrin and PMN functionality 68 , In the case of Lf, a single nucleotide polymorphism in the N-terminal- antimicrobial region of Lf appears to have an impact on oral microbial constituents aside from Aa in these populations This Lf activity could potentially increase vulnerability to LAgP by altering microbial growth and survival although susceptibility appears to vary based on ethnicity Further, these adolescents appear to have Lf containing minimal iron that permits Aa to colonize with greater efficiency as compared to controls who have Lf with high iron content With respect to PMNs, reduced chemotaxis appears to be due to primed PMNs resulting in hyperactive PMN responsiveness, impaired phagocytosis, and overproduction of superoxide In combination these alterations in innate immunity could potentiate disease susceptibility.

Early in the disease process Aa is confronted with potent host defense systems consisting of a wall of PMNs and a high concentration of complement, both of these host defense elements can destroy Aa and other potential pathobionts. Alteration of these host defense systems could permit Aa to survive. Nevertheless, these defense systems while altered still exist and put stress on Aa and other members of the flora. Responding to the stress Aa produces agents that can neutralize host defenses to enable other microbes in the region to survive and as such acts as a useful participant in local host dysbiosis Figure 5.

In this respect Aa could be designated as a keystone pathogen Figure 5. Diagram Illustrating steps by which Aa is activated to subvert host defense. Streptococci supplies Aa with lactate in early steps in colonization process. This helps Aa attach to the native tooth surface Step 1; A. Streptococci and Aa partner. Streptococci provide Aa with lactate that helps Aa survive after binding to tooth surface Step 2; B. Excessive amounts of peroxide produced by streptococci causes stress for Aa which results in upregulation of dispB which causes Aa to migrate away from peroxide to subgingival area Step 3; C.

Stress also causes upregulation of Leukotoxin Ltx and ApiA. These two factors subvert the local host response and allow other microbes to overgrow due to dysbiosis of the host local environment. Step 4; D. Molecular and experimental models conclusively demonstrate that Aa is an early colonizer, co-colonizing with other early colonizers who produce lactate. Aa can then migrate away from stressful challenges to a more protected subgingival domain by up-regulation of dspB. Facing the challenge of an innate subgingival response, Aa can up-regulate complement resistance genes and leukotoxin production to modulate the local host immune response in order to allow for an overgrowth of a consortium of pathobionts.

Working together the consortium can overwhelm the natural resistance of the local host innate defense response and produce inflammatory cytokines that can result in connective tissue and bone loss and derangement of the attachment apparatus.

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It is still to be proven whether this scenario is unique to the non-JP2 strain of Aa or if this is a general strategy used to provoke local disease. This working hypothesis can be applied to other combinations of microbes that can operate under differing circumstances in populations distinct from the African American adolescents studied in Localized Aggressive Periodontitis.

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author would like to thank Dr s. Figurski, S. Kachlany, P. Planet, J. Kaplan and N.

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Rammasubbu for their unwavering commitment to achieving a better understanding of the role of Aa in disease. There have been many manuscripts that were not included in this review due to the focused nature of the review and I therefore would like to take this opportunity to apologize to those who have devoted time and effort to our understanding of this area but who I failed to acknowledge due to the limited scope of this review. Slots J. The predominant cultivable organisms in juvenile periodontitis.

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Scand J Dent Res. Studies of the microbiology of periodontosis. J Periodontol.

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Klinger R. Untersuchungen uber,enschliche aktinomykose. Centralblat Bacteriol. Google Scholar. Infection due to Actinobacillus actinomycetemcomitans : 15 cases and review. Rev Infect Dis. Zambon JJ. Actinobacillus actinomycetemcomitans in human periodontal disease. J Clin Periodontol. A consortium of Aggregatibacter actinomycetemcomitans, Streptococcus parasanguinis , and Filifactor alocis is present in sites prior to bone loss in a longitudinal study of localized aggressive periodontitis. J Clin Microbiol. Aggregatibacter actinomycetemcomitans and its relationship to initiation of localized aggressive periodontitis: longitudinal cohort study of initially healthy adolescents.

Virulence factors of Actinobacillus actinomycetemcomitans. Periodontol J Oral Biol. Ritz HL. Microbial population shifts in developing human plaque. Archs Oral Biol. Listgarten MA.

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