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Clinical and Diagnostic Laboratory Immunology, March 2004, p. 379-386, Vol. 11, No. 2
1071-412X/04/$08.00+0 DOI: 10.1128/CDLI.11.2.379-386.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.
Department of Bacteriology, National Institute of Infectious Diseases,1 Department of Oral Health, National Institute of Public Health, Shinjuku-ku, Tokyo 162-8640, Japan2
Received 4 September 2003/ Returned for modification 19 October 2003/ Accepted 28 December 2003
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Previous studies of S. mutans infections in the oral cavities of mice have been performed by feeding the animals diets containing sucrose in the presence of glucans (13, 15, 30, 43). Since the adherence of S. mutans to the tooth surface may depend on the balance between physical adherence and synthesis of insoluble glucans in a natural environment, that infection method may be inappropriate for investigation of natural biofilm formation associated with streptococci, including S. mutans (18, 39).
The nonobese diabetogenic (NOD) mouse strain is currently the best available model for the study of insulin-dependent type 1 diabetes mellitus (IDDM) and SS (11, 31), both of which develop spontaneously and are characterized by lymphatic infiltration of the pancreas and salivary glands. Oral changes are prominent features of these diseases, which are manifested by dry mouth and hyposalivation (6, 7, 37). NOD mice are also used as an animal model for the study of oral infectious diseases associated with systemic diseases such as diabetes and SS or dry mouth.
The unique major histocompatibility complex (MHC) class II genes (I-Ag7, no expression of I-E) represent dominant susceptibility factors and mediate activated T cells during the development of diabetes in NOD mice (11, 22, 25, 36, 41, 42). In the NOD model of SS, histopathological analyses of the salivary glands in MHC-congenic strains of NOD mice have indicated that the I-Ag7 region is not required for lymphocytic infiltration (26, 31). Further, replacement of the NOD MHC class I Kd region with another haplotype, MHC class I Kwm7, as well as replacement of the MHC class II Ag7 Eg7 and class I Dd regions with the corresponding region from the other MHC haplotype, has been shown to prevent diabetes (12). However, replacement with MHC class I K does not completely prevent development of insulitis. In another report, NOD mice pretreated nasally by using peptides restricted with MHC class I Kd showed a delayed onset of spontaneous IDDM, though insulitis could not be prevented by the induction of tolerance (23).
In the present study, we attempted to establish an animal model for oral infectious diseases such as dental caries by focusing on replacement of the MHC class II and class I D region but not the class I K region in nondiabetic NOD mice by outcrossing B10.D2 mice (Kd, I-Ad, and Dd) with NOD mice (Kd, I-Ag7, and Db) because the MHC class I K region in B10.D2 mice is identical with that in NOD mice (12). The present backcrossed and intercrossed NOD mice with the MHC class II and MHC class I D region replaced with that from B10.D2 mice developed SS, however, not diabetes. We then attempted to determine whether these mice would be useful as animal models for a sucrose-free study of the initial adhesion of oral streptococci on tooth surfaces in humans.
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Animals and assessment of diabetes and saliva. NOD/LtJ and B10.D2 mice were purchased from the Jackson Laboratory (Bar Harbor, Maine) and Japan SLC (Shizuoka, Japan), respectively, and maintained in accordance with the guidelines of the National Institute of Infectious Diseases. Clinical onset of diabetes in NOD mice was determined by the presence of glucose in urine and blood. Urine was tested weekly using Uristix reagent strips (Bayer Medical Ltd., Newbury, United Kingdom) and confirmed to be positive by blood glucose measurements. After being anesthetized, the mice were injected with a cocktail of isoproterenol (0.20 µg/100 gm of body weight) and pilocarpine (0. 05 µg/100 gm) (Sigma Chemical, St. Louis, Mo.) in PBS as a secretagogue. Following the intraperitoneal injection, saliva was collected from each mouse by using a micropipette for 15 min and was stored at -80°C.
Bacterial sampling and CFU counting. All oral streptococci were cultured in brain heart infusion broth overnight and were then washed twice with sterile PBS. Chlorhexidine (0.2%)-soaked sterile cotton swabs were used for disinfecting the oral cavities of the mice, including the lower incisor teeth, which were immediately washed with sterile PBS. Oral streptococci were introduced into the oral cavities at a final concentration of 7 x 109 CFU in 250 µl of PBS in all females at 4 or 8 months of age for 2.5 min, after which the mice were not provided food or drinking water. Following inoculation, samples were collected from the labial surfaces of the lower incisor teeth with a sterile cotton ball and then dipped into 2 ml of PBS. The samples in PBS were sonicated by ultrasonic dispersion (power output, 60 W) for 10 seconds and were then poured onto Mitis-Salivarius agar plates containing 0.02 M bacitracin (MSB) by using an EDDY JET spiral system (Gunze Sangyo, Inc., Tokyo, Japan). CFU were determined after 48 h of anaerobic incubation at 37°C.
Generation of backcross mice. To generate the backcross generation, NOD mice were mated with B10.D2 mice to produce (NOD x B10.D2)F1 mice, and then heterozygous F1 mice were mated with NOD mice to produce first-generation backcross (BC1) mice. BC1, BC2, BC3, and BC7 heterozygous mice were then mated with NOD mice to produce BC2, BC3, BC4, and BC8 mice, respectively, and BC4 and BC8 heterozygous mice were intercrossed to produce N5 and N9 MHC-recombinant NOD mice. After an outcross of the NOD strain to the B10.D2 strain, repetitive backcrossing with NOD mice was performed, with breeder selections based on genomic PCRs and/or simple sequence length polymorphism (SSLP) analysis with microsatellite markers (MapPairs; Research Genetics, Huntsville, Ala.), as shown in Table 1. The PCRs (25 µl) were done using a PTC-200 (MJ Research, Watertown, Mass.) for 40 cycles (94°C, 15 seconds; 58°C, 45 seconds; 72°C, 5 min, after an initial denaturation at 94°C for 3 min) and were then analyzed on a 3% agarose gel. An SSLP analysis of the B10.D2 allele from the backcross generation identified the mice as homozygous for allelic variants characteristic of NOD mice with replacements of the MHC region with that from B10.D2 mice at all of the Idd17 linkage markers (Table 1). Typing of these markers without Idd17 confirmed the homozygous presence of the NOD-derived background genome at the identified Idd loci in the backcross generation (Table 1).
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TABLE 1. Linkage markers analyzed for homozygosity to NOD-derived Idd loci in NOD.B10.D2 congenic mice
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Histology. Pancreas specimens and submandibular glands were frozen in OCT compound. Tissue sections (5 µm) were stained with hematoxylin and eosin and were then examined for evidence of mononuclear cell inflammation. Histological observations and photomicrography were performed by using an Olympus BX50WI microscope (Olympus Inc., Tokyo, Japan).
Statistical analysis. A Kaplan-Meier cumulative survival test was used to compare the incidence of diabetes. Comparative analyses were performed by analysis of variance. A P value of < 0.05 was considered statistically significant for two-tailed comparisons. All statistical analyses were performed using StatView software for the Macintosh operating system.
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FIG. 1. Serological typing of lymphocytes. Spleen cells from NOD (A) and N5 (NOD.B10.D2) (B) female mice at 4 months of age were examined for the expression of MHC class I H-2Kd, MHC class II I-Ed, and H-2Dd by using FACS analysis. NOD, MHC class II I-Ed, and H-2Dd antigens were expressed in the NOD mice. Each histogram shows the percentage of total spleen cells from NOD and N5 (NOD.B10.D2) mice. Histograms are representative of the results of three independent experiments with 10 mice in each group, with similar results obtained in each experiment. FITC, fluorescein isothiocyanate; PE, phycoerythrin.
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FIG. 2. Cumulative incidence of diabetes and insulitis in NOD and new N5 (NOD.B10.D2) mice. (A) Mice homozygous for B10.D2 MHC avoided diabetes in comparison with the heterozygous and NOD types. (B) Insulitis scores were calculated by using hematoxylin and eosin staining of pancreas sections from F1 ( ), N5 ( ) female mice at 4 months of age. The degree of lymphocyte infiltration was graded as follows: G0, no infiltrating cells in the islets; G1, infiltrating cells adjacent to the islets; G2, infiltrating cells occupying less than 25% of the islets; G3, infiltrating cells occupying 25 to 50% of the islets; G4, infiltrating cells occupying more than 50% of the islets. For example, the percentage of G1 insulitis = (number of G1)/(G0 + G1 + G2 + G3 + G4 + G4) x 100. Results are expressed as the means ± standard deviations (SDs) of the results for 12 mice per strain. *, P < 0.001 for the results for NOD mice versus those for N5 and F1 mice.
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FIG. 3. Histology of exocrine glands from NOD, N5 (NOD.B10D2), and N9 (NOD.B10D2) female mice at 4 months of age. (A) Massive infiltration by mononuclear cells in the pancreas islets of NOD mice; (B) no infiltrating cells in the pancreas islets of N5 (NOD.B10D2) mice; (C) massive infiltration by mononuclear cells in the submandibular glands of NOD mice; and (D) moderate to massive infiltration by mononuclear cells in the submandibular glands of N5 (NOD.B10D2) mice; (E) massive infiltration by mononuclear cells in the submandibular glands of N9 (NOD.B10D2) female mice. Tissues were stained with hematoxylin and eosin. Magnification, x 100.
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FIG. 4. Salivary flow rates for various mouse strains. The total volume of secreted saliva per 100 g of body weight for NOD, N5 (NOD.B10.D2), and N9 (NOD.B10.D2) female mice was reduced compared to that for NOD-scid, F1 (NOD.B10.D2), and B10D2 female mice at 4 months of age. Data are expressed as the means ± SDs of the results for 12 mice per strain. *, P < 0.05; **, P < 0.001.
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Adhesion of oral streptococci to tooth surfaces. As shown in Fig. 5, S. mutans adhesion results revealed that bacteria adhered in higher numbers to the tooth surfaces of N5 (NOD.B10.D2) and N9 (NOD.B10.D2) mice than to those of the control B10.D2, NOD, and C57BL/6 mice at various time points. After the adhesion phase was extended from 90 to 180 min, there was a decrease in biofilm growth (Fig. 5A); however, a large number of bacteria remained on the tooth surfaces of the mice. S. mutans adhesion for N5 (NOD.B10.D2) mice (407.0 ± 93.0 CFU/ml) and NOD mice (203.0 ± 75.0 CFU/ml) was significantly higher than that for the control B10.D2 and C57BL/6 mice at 180 min after inoculation (P < 0.05) (Fig. 5A). Further, distinct differences among N5 (NOD.B10.D2), NOD, and B10.D2 mice were observed at 90 min after inoculation. Therefore, bacterial samplings in later experiments with streptococcal inoculation were performed at 90 min. Significantly greater numbers of S. mutans bacteria (879.0 ± 302.6, 600.4 ± 351.6, 691 ± 151, and 702.0 ± 205.5 CFU/ml) adhered to the tooth surfaces of NOD, BC8, N5 (NOD.B10.D2), and N9 (NOD.B10.D2) mice, respectively, than to those of B10.D2 (216.0 ± 203.0 CFU/ml), BC1 (206.0 ± 98.0 CFU/ml), and BC2 (256.0 ± 103.0 CFU/ml) mice (Fig. 5B).
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FIG. 5. Adhesion of oral streptococci on tooth surfaces of mice. (A) Adhesion of S. mutans to the tooth surfaces of NOD, B10.D2, N5 (NOD.B10.D2), and C57BL/6 female mice at 4 months of age at different time points. CFU were determined in Mitis-Salivarius agar plates containing 0.02 M bacitracin after 48 h of anaerobic incubation at 37°C. (B) Adhesion of S. mutans for NOD, B10.D2 BC1, BC4, BC2, BC8, N5 (NOD.B10.D2), and N9 (NOD.B10.D2) female mice at 8 months of age 90 min after inoculation. CFU were determined in Mitis-Salivarius agar plates containing 0.02 M bacitracin after 48 h of anaerobic incubation at 37°C. (C) Adhesion of S. mutans, S. sobrinus, S. sanguis, S. mitis, and S. salivarius for N5 (NOD.B10.D2) female mice at 8 months of age 90 min after inoculation. CFU were determined in Mitis-Salivarius agar plates after 48 h of anaerobic incubation at 37°C. (D) Adhesion of S. mutans for NOD, B10.D2, N5 (NOD.B10.D2), and N9 (NOD.B10.D2) female mice at 8 months of age 24 h after inoculation. Data were obtained from three independent experiments with 15 mice in each strain, and values are expressed as the means ± SDs of the results. *, P < 0.05.
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It has also been reported that salivary components play important roles in controlling microbial colonization in the oral cavities of individuals with SS or dry mouth (37). SS may lead to qualitative and quantitative changes in the protective salivary films or pellicles that coat hard and soft tissues (5, 6), and the loss of enamel or cemental protective pellicles could result in an increase in dental caries and periodontitis (32). Further, an alteration in the mucosal pellicle may make oral soft tissues more susceptible to desiccation and environmental insult, leading to colonization by opportunistic microflora (21, 24). The S. mutans adhesion results seen in the present experiments demonstrated that a significant number of bacteria adhered to the tooth surfaces of NOD, N5 (NOD.B10.D2), and N9 (NOD.B10.D2) mice compared to that for C57BL/6 and B10.D2 mice (Fig. 5A, B and D). Further, the NOD background gene tended to increase the binding of S. mutans to tooth surfaces as the number of backcrosses increased (Fig. 5B). However, NOD mice that develop diabetes are not suitable for studies of long-term infection by oral bacteria, as their average life span is short compared with those of N5 (NOD.B10.D2) and N9 (NOD.B10.D2) mice.
The ability of oral streptococci to bind to salivary pellicle proteins on the tooth surface is of considerable etiological significance (28, 33), and S. mutans and S. sanguis are known to be primarily involved with the formation of bacterial flora on teeth. S. sanguis and S. mitis are early colonizers of the salivary pellicle, while S. mutans colonizes later; however, the ability of each to bind to salivary proteins and glycoproteins is strong and important in biofilm development (19, 40). The present results showed a tendency for an increase in affinity of S. sanguis, S. mitis, and S. mutans for the mouse tooth surfaces (Fig. 5C). The affinity of streptococci for the tooth surfaces of patients is considered to be closely related to dry mouth and SS (1-3, 4, 34). Therefore, the N5 (NOD.B10.D2) and N9 (NOD.B10.D2) mouse strains may be useful animal models, as they presented initial adherence activities of oral streptococci on their tooth surfaces similar to those for humans with dry mouths. They may also be suitable for studies of long-term infection by oral bacteria, as their average life span is long compared to that of NOD mice.
A problem facing in vivo oral biofilm research is the lack of a naturalistic, reproducible, longitudinal monitoring system that would permit the assessment of dry mouth and oral bacterial infection in the same animal throughout the duration of the study. Studies of S. mutans infections in mouse oral cavities have been performed by feeding the animals with powdered diet 301 and diet 2000, which contain unnatural amounts of sucrose (1 and 56%, respectively) (13, 38, 43). In other infection studies, mice were provided with either a 5% sucrose diet or a sucrose-free diet, in which the 56% sucrose in diet 2000 was replaced with wheat flour (15, 30). When these methods were used, S. mutans was found to produce a larger amount of insoluble glucan in the oral cavities of mice than in normal humans. However, continuous ingestion of food containing such excess amounts of sucrose is unusual (35). Therefore, an experimental system using a generated NOD.B10.D2 strain may be more useful than those previously reported for the initial adherence of streptococci on tooth surfaces without synthesis of insoluble glucan.
In the present study, the importance of salivary flow for controlling the initial adhesion of oral streptococci in the oral cavity was also demonstrated in the mouse models of SS and dry mouth. We believe that N5 (NOD.B10.D2) and N9 (NOD.B10.D2) mice, which have a high sensitivity for initial adhesion, may be useful for in vivo biological studies of oral biofilm formation on the tooth surfaces of patients with dry mouth or SS.
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-chain. Nature 345:727-729.[CrossRef][Medline]
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