Salivary Secretory Leukocyte Protease Inhibitor and Oral Candidiasis in Human Immunodeficiency Virus Type 1-Infected Persons

Abstract

Oropharyngeal candidiasis, typically caused by Candida albicans, is the most common oral disease associated with human immunodeficiency virus type 1 (HIV-1) infection. Secretory leukocyte protease inhibitor (SLPI), a 12-kDa antiprotease, suppresses the growth of C. albicans in vitro. To determine whether the mucosal protein plays a role in protecting oral tissues against fungal infection, we conducted a cross-sectional study investigating the oral and systemic health and salivary SLPI levels in 91 dentate HIV-1-infected adults receiving medical care in the southeastern United States. Participants with a self-reported history of clinical oropharyngeal candidiasis during the previous 2 years constituted the test group (n ‫؍‬ 52), while the comparison group (n ‫؍‬ 39) had no oropharyngeal candidiasis during that period. Data collected from medical records, oral examination, and SLPI enzyme-linked immunosorbent assay quantitation of whole saliva were analyzed by t test, analysis of variance, linear regression, and unconditional logistic regression. The test group had a significantly higher mean salivary SLPI level than the comparison group (1.9 g/ml versus 1.1 g/ml, P < 0.05). Linear regression modeling identified CD4 cell count and history of oropharyngeal candidiasis as key predictors of salivary SLPI and revealed a significant interaction (P < 0.05) between immunosuppression (CD4 cell count below 200 cells/l) and positive history of oropharyngeal candidiasis in predicting salivary SLPI level. By logistic regression modeling, a salivary SLPI level exceeding 2.1 g/ml, low CD4 count, antiretroviral monotherapy, and smoking were key predictors of oropharyngeal candidiasis. These data support a key role for SLPI in the oral mucosal defense against C. albicans. The antimicrobial mucosal protein may serve as an indicator of previous oropharyngeal candidiasis infection among immunosuppressed persons.

Detection of HCV-RNA in Saliva of HIV-HCV Coinfected Patients

“…Navazesh et al 38 have related this glandular hypofunction to HAART and a low CD4 lymphocyte count. Finally, the presence of HCV-RNA in saliva could also be conditioned by the expression and activity of endogenous mucosa-associated proteins such as salivary secretory leukocyte protease inhibitor, 39,40 although it has not been demonstrated that they have virucidal activity against HCV.…”

SLPI and elafin: one glove, many fingers

“…For example, salivary SLPI levels are increased in HIV patients with previous or current oral thrush [87], and increased infant SLPI salivary and vaginal fluid levels are associated with reduced maternal-infant HIV transmission through infected breast milk and at childbirth respectively [88,89]. Conversely low SLPI levels are found in individuals with frequently reported COPD (chronic obstructive pulmonary disease) exacerbations and in females with repeated lower genital tract infections [90,91].…”

Anti-Inflammatory and Antimicrobial Roles of Secretory Leukocyte Protease Inhibitor

“…They also found partial inhibition of fungal protease activity by recombinant SLPI (rSLPI), a putative virulence factor of A. fumigatus, and subsequent inhibition of the inductive proinflammatory cytokine response in cultured human airway epithelial cell lines. In a recent study, Chattopadhyay and coworkers (4) showed that the increase of salivary SLPI levels (to Ͼ2.1 g/ml) along with other factors, such as low levels of CD4, antiretroviral monotherapy, and smoking, is a key predictor of oral candidiasis in human immunodeficiency virus type 1 (HIV-1)-infected persons. A possible biological explanation for this association is that SLPI is up-regulated in response to the infection in order to kill the pathogen and resolve the disease.…”