ORAL INFECTION AND INFLAMMATION IN TRANSPLANT PATIENTS

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 慢性牙周炎和口腔念珠菌病是最常见的机会性口腔感染，与疾病或治疗引起的免疫抑制有关。这些口腔感染通常是无症状的，因此可能仍未得到诊断和治疗。固体器官移植接受者代表着越来越多的慢性免疫抑制患者，他们的口腔健康状况在很大程度上没有特征性。由于最近的研究表明，慢性口腔感染可引发可能导致血管疾病的低度全身炎症，而且慢性移植物血管炎可导致移植排斥反应，因此迫切需要研究这类患者的口腔和全身炎症状态。血清白介素6(IL-6)和C反应蛋白(CRP)是公认的全身炎症的敏感标志物，已被证明在慢性牙周炎患者中升高，也是移植排斥反应的良好诊断指标。在这项建议中，我们假设在患有念珠菌口炎或慢性牙周炎的移植患者中，血清IL-6的慢性升高可能直接或间接(通过诱导CRP)与慢性同种异体移植失败有关。 为了开始探索慢性口腔机会性感染和慢性移植排斥之间的潜在关系，我们建议a)研究口腔念珠菌病和慢性牙周炎在患者群体中的患病率；b)收集这些口腔机会性感染与慢性排斥病史之间可能关联的初步数据；c)测定移植患者血清中IL-6和CRP的水平，并研究它们与i)口腔感染的存在；以及ii)口腔粘膜IL-6原位表达的水平的关系。本文提出的试点工作将为设计一项更大规模的前瞻性临床研究提供框架，该研究将最终解决口腔机会性感染在这一特殊需求患者群体的全身炎症和慢性移植排斥反应中的作用。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Chronic periodontitis and oral candidiasis are the most frequent opportunistic oral infections associated with immunosuppression caused by disease or treatment. These oral infections are frequently asymptomatic and therefore can remain undiagnosed and untreated. Solid organ transplant recipients represent a growing population of chronically immunosuppressed patients whose oral health status has been largely uncharacterized. Because recent studies have shown that chronic oral infection can trigger low grade systemic inflammation which may contribute to vascular disease and because chronic graft vasculitis can lead to transplant rejection, studies characterizing the oral and systemic inflammatory status in this patient population are urgently needed. Serum interleukin-6 (IL-6) and C-reactive protein (CRP) are well established, sensitive markers of systemic inflammation which have been shown to be elevated in chronic periodontitis patients and are also good diagnostic indicators for transplant rejection. In this proposal we hypothesize that in transplant patients with Candida stomatitis or chronic periodontitis, chronic elevation of serum IL-6 may directly or indirectly (via induction of CRP) be associated with chronic graft allograft failure. To begin to explore a potential relationship between chronic oral opportunistic infection and chronic transplant rejection we propose to a) study the prevalence of oral candidiasis and chronic periodontitis in their patients population; b) collect preliminary data on a possible association between the presence of these oral opportunistic infections and a history of chronic rejection; and c) determine the levels of IL-6 and CRP in the serum of transplant patients and study their relationship with i) the presence of oral infection; and ii) the levels of oral mucosal IL-6 expression in situ. The pilot work proposed herein will provide the framework for the design of a larger scale prospective clinical study which will conclusively address the role of oral opportunistic infections in systemic inflammation and chronic transplant rejection in this special needs patient population.