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      Frequencies of abnormal humoral and cellular immune component levels in peripheral blood of patients with recurrent aphthous ulceration

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          Abstract

          Background/purpose

          Recurrent aphthous ulceration (RAU) has an incidence of approximately 20% in general population. However, its exact cause remains unknown. Increasing evidence suggests that immunologic mechanisms may play crucial roles in the etiology of this disease.

          Materials and methods

          The peripheral blood samples were obtained from 85 patients with RAU during acute phase and 87 healthy controls. The serum levels of IgG, IgA, IgM, C3 and C4 were measured by immunoturbidimetry. In addition, the serum IgE levels were measured by electro-chemiluminescence immunoassay. Furthermore, the percentages of B, T, CD4 + T, CD8 + T lymphocytes and natural killer (NK) cells in peripheral blood were determined by flow cytometry.

          Results

          Our findings showed that the serum IgG, IgA, IgE, C3 and C4 levels of RAU patients were significantly higher than those of healthy controls. The percentages of CD4 + T cells and B cells in peripheral blood of RAU patients were significantly decreased, whereas the percentages of CD8 + T cells and NK cells of RAU patients were remarkably increased. Our results indicated that the IgG level was elevated in 18 patients (21.2%) and that the IgE level was increased in 21 patients (24.7%). Our results also showed that the frequency of abnormal IgG or IgE levels were significantly correlated with that of abnormal CD8 + T cell percentage in RAU patients.

          Conclusion

          The levels of both humoral and cellular immune components could be altered in RAU. The relationship between humoral and cellular immune may be potentially important immunologic aspects involved in the pathogenesis of RAU.

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          Most cited references34

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          The oral mucosal and salivary microbial community of Behçet's syndrome and recurrent aphthous stomatitis

          Background Behçet's syndrome (BS) is a multisystem immune-related disease of unknown etiology. Recurrent aphthous stomatitis (RAS) is characterized by the presence of idiopathic oral ulceration without extraoral manifestation. The interplay between the oral microbial communities and the immune response could play an important role in the etiology and pathogenesis of both BS and RAS. Objective To investigate the salivary and oral mucosal microbial communities in BS and RAS. Methods Purified microbial DNA isolated from saliva samples (54 BS, 25 healthy controls [HC], and 8 RAS) were examined by the human oral microbe identification microarray. Cultivable salivary and oral mucosal microbial communities from ulcer and non-ulcer sites were identified by matrix-assisted laser desorption/ionization time-of-flight analysis. Mycobacterium spp. were detected in saliva and in ulcer and non-ulcer oral mucosal brush biopsies following culture on Lowenstein-Jensen slopes and Mycobacterial Growth Indicator Tubes. Results There was increased colonization with Rothia denticariosa of the non-ulcer sites of BS and RAS patients (p<0.05). Ulcer sites in BS were highly colonized with Streptococcus salivarius compared to those of RAS (p<0.05), and with Streptococcus sanguinis compared to HC (p<0.0001). Oral mucosa of HC were more highly colonized with Neisseria and Veillonella compared to all studied groups (p<0.0001). Conclusions Despite the uncertainty whether the reported differences in the oral mucosal microbial community of BS and RAS are of causative or reactive nature, it is envisaged that restoring the balance of the oral microbial community of the ulcer sites may be used in the future as a new treatment modality for oral ulceration.
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            Etiopathogenesis of Recurrent Aphthous Stomatitis and the Role of Immunologic Aspects: Literature Review

            Recurrent aphthous stomatitis (RAS; recurrent aphthous ulcers; canker sores) belongs to the group of chronic, inflammatory, ulcerative diseases of the oral mucosa. Up to now, the etiopathogenesis of this condition remains unclear; it is, however, considered to be multifactorial. The results of currently performed studies indicate that genetically mediated disturbances of the innate and acquired immunity play an important role in the disease development. Factors that modify the immunologic response in RAS include: food allergies, vitamin and microelement deficiencies, hormonal and gastrointestinal disorders (e.g., celiac disease, Crohn’s disease, ulcerative colitis), some viral and bacterial infections, mechanical injuries and stress. In this paper, we presented the main etiopathogenetic factors of RAS with a special emphasis on the mechanisms of the immune response modification. Moreover, we discussed the crucial clinical symptoms and types of RAS together with epidemiologic data based on the current medical literature reports and our own observations.
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              Mucosal and salivary microbiota associated with recurrent aphthous stomatitis

              Background Recurrent aphthous stomatitis (RAS) is a common oral mucosal disorder of unclear etiopathogenesis. Although recent studies of the oral microbiota by high-throughput sequencing of 16S rRNA genes have suggested that imbalances in the oral microbiota may contribute to the etiopathogenesis of RAS, no specific bacterial species associated with RAS have been identified. The present study aimed to characterize the microbiota in the oral mucosa and saliva of RAS patients in comparison with control subjects at the species level. Results The bacterial communities of the oral mucosa and saliva from RAS patients with active lesions (RAS, n = 18 for mucosa and n = 8 for saliva) and control subjects (n = 18 for mucosa and n = 7 for saliva) were analyzed by pyrosequencing of the 16S rRNA genes. There were no significant differences in the alpha diversity between the controls and the RAS, but the mucosal microbiota of the RAS patients showed increased inter-subject variability. A comparison of the relative abundance of each taxon revealed decreases in the members of healthy core microbiota but increases of rare species in the mucosal and salivary microbiota of RAS patients. Particularly, decreased Streptococcus salivarius and increased Acinetobacter johnsonii in the mucosa were associated with RAS risk. A dysbiosis index, which was developed using the relative abundance of A. johnsonii and S. salivarius and the regression coefficients, correctly predicted 83 % of the total cases for the absence or presence of RAS. Interestingly, A. johnsonii substantially inhibited the proliferation of gingival epithelial cells and showed greater cytotoxicity against the gingival epithelial cells than S. salivarius. Conclusion RAS is associated with dysbiosis of the mucosal and salivary microbiota, and two species associated with RAS have been identified. This knowledge may provide a diagnostic tool and new targets for therapeutics for RAS. Electronic supplementary material The online version of this article (doi:10.1186/s12866-016-0673-z) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                Journal
                J Dent Sci
                J Dent Sci
                Journal of Dental Sciences
                Association for Dental Sciences of the Republic of China
                1991-7902
                2213-8862
                10 November 2017
                June 2018
                10 November 2017
                : 13
                : 2
                : 124-130
                Affiliations
                [a ]Department of Oral Medicine, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
                [b ]Department of Clinical Laboratory, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
                [c ]Department of Endodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
                Author notes
                []Corresponding author. Department of Oral Medicine, Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Nanjing 210008, China. Fax: +86 25 83620202. wenmei-wang@ 123456hotmail.com
                [∗∗ ]Corresponding author. Department of Oral Medicine, Nanjing Stomatological Hospital, Medical School of Nanjing University, 30 Zhongyang Road, Nanjing 210008, China. Fax: +86 25 83620202. yuwx999@ 123456sina.com
                [†]

                Huan-Huan Ruan and Guo-Yang Li contributed to this work equally.

                Article
                S1991-7902(17)30131-9
                10.1016/j.jds.2017.09.003
                6388805
                30895107
                bad6ba40-bce9-4912-bec1-a2a51f4f568a
                © 2018 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 19 January 2017
                : 22 August 2017
                Categories
                Original Article

                stomatitis,aphthous,humoral immune,cellular immune,immunoglobulins,lymphocytes

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