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Fast Facts: Perio Edition - Periodontitis as a Manifestation of Systemic Disease - Leukocyte Adhesion Deficiency Syndrome

Fast Facts

Fast Facts: Perio Edition Episode 60

[Andrew Johnston, RDH]
Welcome back everyone! You are listening to another episode of Fast Facts- Perio Edition brought to you by A Tale of Two Hygienists in partnership with DentistRX. And now, please welcome your host, Katrina Sanders.
[Katrina Sanders, RDH]
Hello, and welcome to Fast Facts: Perio Edition. This week, we are continuing the conversation around patients who may present with a relatively obscure disease that would fall into the category of systemic diseases that can contribute to the exacerbation of periodontitis. This week, we are looking at Leukocyte Adhesion Deficiency Syndrome. Gosh, what a mouthful that is. I want to be very clear when we're talking about these patients that have these relatively obscure or rare diseases for one reason or another, there is some type of a physiological change in this particular type of a patient that will contribute to the exacerbation of periodontal disease.
Now, when we talk specifically about patients who have Leukocyte Adhesion Deficiency Syndrome, we need to think a little bit back to dental and dental hygiene school about what we understand about how the immune system gets to the site of infection. So we know that white blood cells will travel or they will migrate to a site of inflammation or infection in the body. We call that chemotaxis. They become very attracted to some type of a chemical attractant, and they move to that area. In this case, Chemotaxis is not really affected, we are able to move our white blood cells to this area of inflammation or infection. Now, after they move to the site of infection, there's quite a dance, a choreographed dance of sorts that is required in order to get our immune components directly into the site of infection. So first, our white blood cells are going to adhere or tether themselves to our endothelium. Our endothelium, we remember, is the surface of our blood vessel. So they stick to the surface of our blood vessel. And then they start kind of rolling along that endothelium. Once we start to see them roll along, they're kind of waiting to be able to attach almost like Velcro. They're waiting to attach. And so after a few rolls back and forth, the Velcro sticks, boom! They attach into the endothelium. Once they eventually attach into that endothelium, then the white blood cell is able to move or squeeze via diapedesis, which is a fancy term for squeezing or moving these white blood cells from our blood vessel wall into the surrounding tissue and eventually, of course, to the site of infection or inflammation.
Now, why is this all important, Katrina, why are you talking about all this science talk? While I'm driving to work with my latte on a Tuesday morning? Well, because when we talk about patients who have Leukocyte Adhesion Deficiency Syndrome, there's a problem with the way these white blood cells actually adhere to that endothelium. Specifically, there is a very specific type of a protein that is responsible or necessary in order for our white blood cells to be able to adhere or tether. They help make the Velcro more sticky, so to speak. They are responsible for helping these white blood vessels to roll along, stick or adhere to that endothelium. And individuals who have Leukocyte Adhesion Deficiency Syndrome do not have appropriate levels of these proteins, which means that their white blood cells cannot tether, roll along and or fail to stick to the endothelium. Therefore, these individuals are unable to get their white blood cells to the site of infection or inflammation. Now, it should be known that these are individuals who experience this through a genetic component. There is a change in a very specific ITGB2 gene. You don't need to know that, of course, the importance being that these individuals are experiencing a mutation within that gene, which is impacting their ability to move their leukocytes  through the blood vessel component, into the site of infection. What we start to see is these individuals because they cannot fight infection will experience recurrent bacterial and fungal infections. And of course, one massive component to that, the residual component of that, are individuals then who experience delayed wound healing and progression of inflammation of the tissues that surround and support the teeth, as well as inflammatory conditions of the gingiva and, of course, eventual tooth loss in many cases.
In addition, affected individuals may also develop sores in the area that surrounds bacterial or fungal infection. So if you see patients who are experiencing recurrent infection of periodontal disease, delayed wound healing, and sores in the area, it would behoove this patient to get testing done to identify if they've experienced any type of a genetic component or change in gene expression associated with Leukocyte Adhesion Deficiency Syndrome. Join us next week as we continue the conversation around different types of diseases and conditions that contribute to periodontitis as a manifestation of systemic disease.
This has been another episode of Fast Facts - Perio Edition with Katrina Sanders, RDH. Please feel free to reach me on Instagram @thedentalwinegenist or on my website Cheers.
[Andrew Johnston, RDH]
Thank you for listening to another episode of Fast Facts - Perio Edition, brought to you in part by DentistRX makers of the InteliSonic line of power brushes. Find out more by visiting their website at We'll see you next week for another Fast Fact!

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