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Infection and Immunity, March 2004, p. 1725-1732, Vol. 72, No. 3
0019-9567/04/$08.00+0 DOI: 10.1128/IAI.72.3.1725-1732.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.
Fimbriated Porphyromonas gingivalis Is More Efficient than Fimbria-Deficient P. gingivalis in Entering Human Dendritic Cells In Vitro and Induces an Inflammatory Th1 Effector Response
Ravi Jotwani and Christopher W. Cutler*
Department of Periodontics, School of Dental Medicine, Stony Brook University, Stony Brook, New York 11794-8703
Received 3 October 2003/
Returned for modification 15 November 2003/
Accepted 4 December 2003

ABSTRACT
Porphyromonas gingivalis is a fimbriated mucosal pathogen implicated
in chronic periodontitis (CP). The fimbriae are required for
invasion of the gingival mucosa and for induction of CP in animal
models of periodontitis. CP is associated with infection of
immature dendritic cells (DCs) by
P. gingivalis in situ and
with increased numbers of dermal DCs (DDCs) and mature DCs in
the lamina propria. The role of fimbriae in gaining entry into
human DCs and how this modulates the inflammatory and effector
immune responses, however, have not been explored. To address
this, we generated monocyte-derived DCs (MDDCs) in vitro which
phenotypically and functionally resemble DDCs. We show here
that virulent fimbriated
P. gingivalis 381, in contrast to its
fimbria-deficient mutant,
P. gingivalis DPG3, efficiently gains
entry to MDDCs in a manner dependent on active cell metabolism
and cytoskeletal rearrangement. In addition, uptake of 381,
unlike DPG3, induces DCs to undergo maturation, upregulate costimulatory
molecules, and secrete inflammation cytokines interleukin-1ß
(IL-1ß), IL-6, tumor necrosis factor alpha, IL-10,
and IL-12. Moreover, MDDCs pulsed with 381 also stimulated a
higher autologous mixed lymphocyte reaction and induced a Th1-type
response, with gamma interferon (IFN-

) being the main cytokine.
Monocytes used as controls demonstrated fimbria-dependent uptake
of 381 as well but produced low levels of inflammatory cytokines
compared to MDDCs. When MDDCs were pulsed with recombinant fimbrillin
of
P. gingivalis (10 µg/ml), maturation of MDDCs was also
induced; moreover, matured MDDCs induced proliferation of autologous
CD4
+ T cells and release of IFN-

. Thus, these results establish
the significance of
P. gingivalis fimbriae in the uptake of
P. gingivalis by MDDCs and in induction of immunostimulatory
Th1 responses.

INTRODUCTION
Porphyromonas gingivalis is an oral pathogen associated with
chronic periodontitis (CP), an infection of mucosal tissues
that surround the dentition, which causes destruction of the
alveolar bone and tooth loss (
15). Recent studies have linked
CP to increased risk of coronary vascular disease and preterm
labor and have also identified
P. gingivalis as one of the pathogens
that enters the bloodstream after crossing the oral mucosal
barrier and probably is instrumental in systemic manifestations
(reviewed in reference
5). This is corroborated by several lines
of evidence, most notably the presence of
P. gingivalis and
other species in atheromatous plaques from carotid endarterectomy
specimens (
24).
P. gingivalis expresses a variety of virulence
determinants that enable it to perturb the innate defenses and/or
invade mucosa (reviewed in references
15,
25, and
40). Among
these, fimbriae are important cell surface virulence factors
involved in adherence of
P. gingivalis to host cells. The fimbriae
of
P. gingivalis are critical determinants for induction of
periodontitis in rats and, when used as immunogens, can reduce
periodontal destruction in this model (
14). In vitro, fimbriae
are required for
P. gingivalis to invade epithelial cells (
32,
45,
54), endothelial cells (
13), and fibroblasts (
30) and to
activate peritoneal macrophages (
50) and THP-1 cells (
21) (reviewed
in reference
13). Mutation of the
fimA gene, encoding fimbrillin,
the major subunit of the fimbriae, prevents
P. gingivalis adherence
to, and invasion of, host cells (
22).
P. gingivalis fimbriae
thus represent important cell structures involved in mucosal
pathogenesis and periodontitis by facilitating colonization
and invasion of mucosal cells and induction of inflammatory
responses (
33).
Immature dendritic cells (DCs) reside in the mucosa and are well equipped to capture a diverse array of antigens, apoptotic bodies, and allergens (reviewed in references 8 and 43) which can stimulate their maturation. Maturation of DCs is accompanied by downregulation of antigen capture machinery and upregulation of antigen-presenting molecules and production of cytokines required to prime naive T cells in lymphoid organs (reviewed in references 4, 8, and 49). In the human gingiva, the presence of the epidermal DCs, Langerhans cells, has been documented in many studies (17, 27, 28, 44, 46). Studies performed in our lab have demonstrated that the human gingiva contains two major subpopulations of DCs: immature Langerhans cells restricted to the epidermis and dermal dendritic cells (DDCs) restricted to the lamina propria (27). During CP there is an increase in the number of DDCs and CD83+ mature DCs in the lamina propria. Furthermore, by double immunofluorescence labeling, DCs appear to be undergoing maturation in situ (in CP) and surrounded with large clusters of CD4+ T cells (27). However, the stimuli that lead to their maturation and the type of T-cell response that might be generated in the lymphoid tissues remain ill defined, although P. gingivalis contacts DCs in situ (9). Several mechanistic studies emphasize the important role of the CD4+ T-cell response in the destruction of alveolar bone, a characteristic of CP (3, 51).
In the present study we generated monocyte-derived DCs (MDDCs) in vitro, which are very similar phenotypically and functionally to DDCs (4, 8, 49) that have been identified in human gingiva (27). We observed that fimbriated strain 381, but not afimbriated mutant DPG3, gains efficient entry into MDDCs and stimulates efficient maturation, costimulatory molecule expression, and cytokine production. Furthermore, MDDCs pulsed with 381 or its recombinant fimbrillin (r-Fim) induced a Th1-type response in autologous mixed lymphocyte reactions (MLR) and autologous CD4+ T cells, with gamma interferon (IFN-
) being the main cytokine.

MATERIALS AND METHODS
Bacterial strains, growth conditions, bacterial labeling and uptake, and r-Fim.
P. gingivalis wild-type strain 381 and the corresponding
fimA mutant, DPG3, were used in this study and were maintained on
anaerobic blood agar (Fischer Scientific Co., Springfield, N.J.)
and blood agar supplemented with erythromycin (10 µg/ml),
respectively (
37). Cultures were maintained at 37°C in an
anaerobic glove box (Coy Laboratory Products, Inc., Ann Arbor,
Mich.) in an atmosphere of 85% N
2-5% H
2,-10% CO
2 for 3 to 5
days. For MDDC uptake experiments, cultures were transferred
from plates into Schaedler broth (Difco, Detroit, Mich.) until
the late log phase of growth and bacterial cells were labeled
with 4',6'-diamidino-2-phenylindole (DAPI) (Sigma Chemical Co.,
St. Louis, Mo.) as described previously (
7). Bacteria were added
to MDDCs in polypropylene tubes at a 25:1 ratio of bacteria
to DCs. After 0.5, 1, 2, and 18 h in culture medium, 50-µl
aliquots were removed and added to cytospin chambers. After
cytocentrifugation, cyanoacrylate was added as a fixative and
cover slips were put in place. See Fig.
1B and C for images
of typical microscopic fields. An independent party coded the
slides, and measurements (percentage of MDDCs that had taken
up at least two bacterial cells per field for 10 fields per
slide) were acquired blinded, as described previously (
7). The
percent viable DCs (typically >90% after 24 h) were monitored
by trypan blue exclusion and did not differ between the strains
(data not shown). Recombinant fimbrillin
(r
-Fim) was generated
in
Escherichia coli DH5

host cells and purified as described
previously (
48), and purity was confirmed by silver staining,
which showed a single component with no detectable contaminants
(data not shown)
DC cultures and multiparameter flow cytometry analysis.
MDDCs were generated as previously described (
9,
28). Briefly,
MCs were isolated from mononuclear fractions of peripheral blood
by negative selection and seeded in the presence of granulocyte-macrophage
colony-stimulating factor and interleukin-4 (IL-4) (1
x 10
5 to 2
x 10
5 cells/ml) for 6 to 8 days, after which flow cytometry
was performed to confirm the immature DC phenotype (CD1a
+ CD83
-)
(see Fig.
2A). Cell surface markers of DCs were evaluated by
four-color immunofluorescence staining with the following monoclonal
antibodies (MAbs): CD1a- FITC (Biosource), CD40-PE (Coulter/Immunotech),
CD80-PE (Becton Dickinson), CD83-PE (Immunotech), CD86- PE (Pharmingen),
HLA-DR-PerCP (Becton Dickinson), and CD14- APC (Caltag). After
30 min at 4°C and washing with staining buffer (phosphate-buffered
saline [pH 7.2], 2 mM EDTA, 2% fetal bovine serum), cells were
fixed in 1% paraformaldehyde. Analysis was performed with a
FACScalibur flow cytometer (Becton Dickinson). Marker expression
was analyzed as the percentage of positive cells in the relevant
population defined by forward-scatter and side-scatter characteristics.
Expression levels were evaluated by assessing mean fluorescence
intensity (MFI) indices calculated by relating MFI noted with
the relevant MAb to that obtained with the isotype control MAb
for samples labeled in parallel and acquired using the same
setting.
Cytokines from MDDCs.
Culture supernatants were collected from MDDCs pulsed with
P. gingivalis 381, DPG3, and r
-Fim for 24 h. Culture supernatants
were analyzed by flow cytometry using a cytometric bead array
(CBA kit; BD Biosciences, SanDiego, Calif.). Based on a standard
curve achieved for each cytokine, the CBA software calculates
levels in picograms per milliliter.
MLR and CD4+ T-cell proliferation.
For proliferation experiments with P. gingivalis-pulsed MDDCs (see Fig. 4), responder cells were autologous lymphocytes purified from human buffy coats as described previously (9, 28). For proliferation experiments with r-Fim-pulsed MDDCs (see Fig. 5C), responder cells were autologous CD4+ T cells (9, 28) isolated from the mononuclear fraction of buffy coats through positive selection, using anti-CD4 MAb and goat anti-mouse immunoglobulin G-coated microbeads (Miltenyi Biotech GmbH, Gladbach, Germany). Isolation of CD4+ cells was achieved using Minimacs separation columns (Miltenyi Biotech GmbH) as described by the manufacturer. In all r-Fim experiments the isolated cells were 80 to 90% CD4+, as determined by staining with fluorescein isothiocyanate-conjugated anti-CD4 MAb followed by flow cytometry analysis (results not shown). MDDCs were washed extensively after a 24-h pulsing with antigens and cultured at graded doses (5,000, 1,000, and 300 DCs, all per 200 µl) in complete RPMI medium with 10% heat-treated fetal calf serum with autologous lymphocytes (50,000 cells/200 µl). Proliferation was determined after 5 days by uptake of tritiated thymidine (1 µCi/well for the last 16 h).
Statistical analyses.
Results of in vitro uptake, cytokine levels, and MLR were analyzed
by either Student's
t test (
P < 0.05) or the Kruskall-Wallis
test (
P < 0.05) (Minitab, State College, Pa.).

RESULTS
Entry of P. gingivalis into MDDCs is fimbria dependent, requires active cell metabolism, and cytoskeletal rearrangement.
Based upon evidence that
P. gingivalis fimbriae mediate induction
of periodontitis in rats (
14) and facilitate entry of
P. gingivalis into other host cells (
13,
22,
32,
33,
50,
54), we postulated
that entry into MDDCs would also be fimbria dependent. Our results
show that, indeed, the fimbriated strain 381 rapidly gained
access to over 10% of MDDCs after only 1 h of coculture. This
increased to over 50% after 18 h (Fig.
1A). Digital images acquired
with a 100
x objective (Fig.
1B) show multiple DAPI-labeled
P. gingivalis 381 cells (white arrows) inside MDDCs. In contrast,
the fimbria-deficient mutant DPG-3 did not gain access to MDDCs
until about 18 h, when low-level internalization was observed
(Fig.
1A and C). Electron microscopy confirmed intracellular
localization of
P. gingivalis into multivesiculated compartments
(MVC), as well as the presence of clusters of
P. gingivalis contained within apparent vacuoles in the cytoplasm (Fig.
1D).
Capture was dependent on active cell metabolism and cytoskeletal
rearrangement, as evidenced by experiments carried out at 4°C
and with cytochalasin D pretreatment (Fig.
1E). Expression of
fimbriae also correlated with capture by control MCs (Fig.
1F).
We also conducted experiments to establish the role of integrins
in uptake of 381 by MDDCs (data not shown). It was found that
though immature MDDCs express ß
1 and ß
2 integrins on their surface, blocking these receptors with MAbs
did not alter uptake of 381.
Fimbriated P. gingivalis or r-Fim induce maturation and costimulatory molecule expression on MDDCs.
The pathophysiology of CP in humans involves infiltration of the lamina propria with multiple DC subpopulations that are in the process of maturation or have matured (27). Accordingly, we analyzed the ability of fimbriated and afimbriated P. gingivalis to induce MDDC maturation and costimulatory molecule expression. Preliminary study of the kinetics of maturation and costimulation (data not shown) of MDDCs in response to P. gingivalis established 18 h as a peak; thus, 18 h was consistently used for analysis of maturation and costimulation (as well as cytokine secretion and T-cell proliferation [see Fig. 3 and 4]). As shown in Fig. 2B, 381 induced upregulation of HLA-DR, CD83, and the costimulatory molecules CD80 and CD86. In contrast, DPG3 did not induce upregulation of HLA-DR or CD83 and was a relatively weak inducer of CD80 and CD86 (Fig. 2C). Exposure of MDDCs to r-Fim for 18 h also induced DC maturation and costimulatory molecule expression (see Fig. 5A), although HLA-DR was not upregulated to any extent. Progenitor MCs did not express CD83 or costimulatory molecules after exposure to 381 or DPG3 (Fig. 2D).
Fimbriated P. gingivalis and r-Fim stimulate MDDCs to secrete an inflammatory and dysregulatory cytokine profile.
The local cytokine response in CP (reviewed in references
12 and
47) includes elevated levels of tumor necrosis factor alpha
(TNF-

), IL-8, IL-6, IL-10, IL-12, and IFN-

. We reasoned that
fimbriae would be a significant determinant of the ability of
P. gingivalis to induce secretion of inflammatory cytokines/chemokines
by MDDCs. The results indicate that indeed, fimbriated
P. gingivalis 381 stimulates elevated levels of TNF-

, IL-6, IL-10, IL-12,
and IL-8 (Fig.
3A). In contrast, afimbriated DPG-3 stimulated
low levels of TNF-

and IL-6 and undetectable levels of IL-10
and IL-12. Interestingly, high levels of the chemokine IL-8
were released regardless of the strain. Relative to MDDCs, progenitor
MCs secreted low to undetectable levels of all cytokines, except
for IL-8, which was equivalent to that secreted by MDDCs (Fig.
3B). r
-Fim induced MDDCs to secrete IFN-

and very high levels
of TNF-

and IL-10 (Fig.
4B).
Fimbriated P. gingivalis or r-Fim induces MDDCs to become immunostimulatory cells.
Our in situ results suggest that the immunopathology of CP involves the formation of immune conjugates between CD83+ mature DCs and CD4+ T cells in diseased lamina propria (27). On the basis of this backdrop and the results presented above, we predicted that MDDCs pulsed with 381, relative to DPG3, would be more potent immunostimulatory cells in vitro. Accordingly, we cocultured 381- or DPG3-pulsed MDDCs (or MCs) with autologous lymphocytes (Fig. 5A) for 5 days. The results indicate that, indeed, MDDCs pulsed with 381 were immunostimulatory for autologous lymphocytes while MDDCs pulsed with afimbriated P. gingivalis were weakly immunostimulatory. MCs pulsed with either P. gingivalis strain (Fig. 5B) did not stimulate an autologous lymphocyte response. MDDCs pulsed with r-Fim were also immunostimulatory for CD4+ T cells, but to a lesser extent than those pulsed with whole intact 381. The T cells proliferated (Fig. 4C) and released >1,000 pg of IFN-
/ml (Fig. 4D) but did not release TNF-
, IL-10, or IL-2.

DISCUSSION
The present study analyzed the ability of two
P. gingivalis strains to gain entry into cultured MDDCs: fimbria-deficient
mutant
P. gingivalis DPG3 and its fimbriated parent strain,
381. Our results show that fimbriae are essential for this mucosal
pathogen to gain entry into MDDCs efficiently (Fig.
1A to C)
and that entry requires an intact MDDC cytoskeleton and active
cell metabolism (Fig.
1E); moreover, entry culminates in packaging
of
P. gingivalis into MVC (Fig.
1D). Our in situ studies have
previously documented that
P. gingivalis gains entry into immature
DCs in situ in diseased human gingiva (
9), but the role of its
virulence characteristics in this regard have not been defined.
Studies with nonphagocytic epithelial and endothelial cells
have also shown the requirement for
P. gingivalis fimbriae in
adherence to and invasion of these cells (
13,
32,
54). Greater
adherence to and invasion of an oral epithelial cell line (KB)
was observed with wild-type
P. gingivalis strains 33277, 381,
and A7436, as compared to
fimA mutants DPG3 and MPG1 (
37). It
has been shown that fimbriated
P. gingivalis directs its entry
into epithelial and endothelial cells by exploiting host cell
signaling pathways (
13,
32,
54). Receptors to which
P. gingivalis fimbriae can bind have been identified and include ß
1 integrins (
54) and cytokeratin 14 (
48) on epithelial cells and
ß
2 integrins, Toll-like receptor 2, and CD14 on macrophages/MCs
(
39,
50).
P. gingivalis fimbrial adhesion to gingival epithelial
cells represents a key step in the induction of the invasive
process, which is accompanied by a transient increase in cytosolic
Ca
2+ concentration, activation of JNK, and inactivation of ERK1/ERK2
mitogen-activated protein kinases (
26,
53). Studies performed
with mouse peritoneal macrophages demonstrated that ß
2 integrins (CD11/CD18) are used by
P. gingivalis fimbriae as
cellular receptors for binding; moreover, the ß chain
(CD18) plays a central role in signaling (
50). However, although
immature MDDCs express ß
1 and ß
2 integrins
on their surface, blocking these receptors with MAbs did not
alter uptake of 381 (data not shown). However, like epithelial
cells, treatment of MDDCs with cytochalasin D completely inhibited
the uptake of 381, suggesting the requirement for actin polymerization
(
28). Further studies will be required to identify the receptor(s)
involved in the uptake of fimbriated
P. gingivalis 381 by MDDCs.
We showed by fluorescence-activated cell sorter (FACS) analysis that entry by fimbriated 381 upregulates the maturation marker CD83, costimulatory molecules B7.1 (CD80) and B7.2 (CD86), and antigen-presenting molecule HLA-DR on the cell surface (Fig. 2B). This observation is particularly relevant to our original finding that the immunopathology of CP (which is caused by P. gingivalis and other species) involves in situ maturation of DCs (19), including Langerhans cells and dermal DCs (27). The presence of mature DCs in CP has since been corroborated independently from several laboratories (1, 6, 34).
We further show that fimbriated P. gingivalis stimulates MDDCs to secrete inflammatory cytokines TNF-
and IL-6, the immunoregulatory cytokine IL-10, and the chemokine IL-8, while lower levels of IFN-
, IL-12, and IL-1B were elicited (Fig. 3A). In contrast, DPG3 induced much lower levels of all cytokines except IL-8 (Fig. 3A). MCs were not as responsive as MDDCs, producing lower levels of cytokines, with fewer differences evident between 381 and DPG3 (Fig. 3B). Several studies have shown that P. gingivalis fimbriae induce inflammatory cytokines IL-1
, IL-1ß, IL-6, and TNF-
from gingival fibroblasts, epithelial cells, and MCs/macrophages (23, 39, 50). Both IL-1 and TNF-
are important local regulatory factors in bone remodeling (19, 31) and apparently play an important role as immunological mediators in periodontal inflammation and the destruction of alveolar bone (2, 11, 20, 38). Interestingly, in the present study both MDDCs and MCs released comparable levels of the chemokine IL-8 regardless of the bacterial strain (Fig. 3). IL-8 is a potent chemokine which directs migration of neutrophils to the site of inflammation. Induction of IL-8 in gingival epithelial and endothelial cell lines by fimbriated P. gingivalis is controversial. Some investigators have shown increased levels (42), whereas others have shown downregulation of IL-8 (10, 36). Differences in the observations have been attributed to differences in growth conditions of P. gingivalis and in the size of the inocula (36). Understanding the modulation and regulation of chemokines and their receptors by fimbriated and afimbriated P. gingivalis may prove helpful in understanding the pathogenesis of periodontitis.
In the present study P. gingivalis-pulsed MDDCs were cocultured with graded doses of autologous lymphocytes. The lymphocytes demonstrated greater proliferation as compared to those cocultured with DPG3-pulsed MDDCs (Fig. 5A); moreover, the lymphocytes produced higher levels of IFN-
and lower levels of TNF-
, IL-10,and IL-2, consistent with a Th1 effector response. The r-Fim of P. gingivalis also induced a Th1- type response (Fig. 4). Production of high levels of IFN-
in response to P. gingivalis 381, suggestive of Th1 response, has also been observed in another recent study (1). To establish the type of Th response, gingival T-cell lines and clones specific to P. gingivalis were generated by pulsing DCs cells with 381. The results show that all T-cell clones were positive for CD4 and the majority produced IFN-
and a minimal or negligible amount of IL-5 (1). The present study used lymphocytes purified from peripheral blood of a subject with undefined periodontal status. The gingiva contains an array of local T cells specific for other periodontal pathogens (52). Th1/Th2 polarization is also affected by pattern recognition receptors on DCs, the nature of the pathogens, DC subsets, cytokine released by T cells, and other cells in the vicinity (41). A general lack of Th1 or Th2 cytokine polarization best describes the cytokine microenvironment in CP (18). Our published studies of mice in vivo (42) and of human MDDCs in vitro (29) indicate that the lipopolysaccharide of P. gingivalis shifts the DC response away from Th1, towards Th2. Thus, different antigens or structures from the same bacterial species appear to induce diametrically opposed effector responses. This is evocative of the ability of other human pathogens, most notably the helminth parasites, to produce different components that induce different effector responses in an apparent effort to protect themselves from elimination (reviewed in reference 35). MDDCs pulsed with r-Fim induced limited proliferation of autologous CD4+ T cells in the present study and also did not upregulate HLA-DR (Fig. 4C). Thus, further development of fimbria-based vaccines for CP (16) should include basic study of the ability of candidate molecules to be processed and presented in vitro prior to in vivo vaccine studies.

ACKNOWLEDGMENTS
This study was supported by Public Health Service grants DE1432803
and DE13154-01 from the National Institute of Dental and Craniofacial
Research.
Special thanks to H. Sojar, SUNYBuffalo, for the purified r-Fim.

FOOTNOTES
* Corresponding author. Mailing address: Department of Periodontics, School of Dental Medicine, Stony Brook University, Stony Brook, NY 11794-8703. Phone: (631) 632-3025. Fax: (631) 632-3113. E-mail:
ccutler{at}notes.cc.sunysb.edu.

Editor: J. T. Barbieri

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Infection and Immunity, March 2004, p. 1725-1732, Vol. 72, No. 3
0019-9567/04/$08.00+0 DOI: 10.1128/IAI.72.3.1725-1732.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.
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