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CRITICAL REVIEWS IN ORAL BIOLOGY & MEDICINE |
Saliva: a Dynamic Proteome
E.J. Helmerhorst* and
F.G. Oppenheim
Boston University Goldman School of Dental Medicine, Department of Periodontology and Oral Biology, 700 Albany Street CABR W-201, Boston, MA 02118, USA
Correspondence: * corresponding author, helmer{at}bu.edu
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ABSTRACT
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The proteome of whole saliva, in contrast to that of serum, is highly susceptible to a variety of physiological and biochemical processes. First, salivary protein secretion is under neurologic control, with protein output being dependent on the stimulus. Second, extensive salivary protein modifications occur in the oral environment, where a plethora of host- and bacteria-derived enzymes act on proteins emanating from the glandular ducts. Salivary protein biosynthesis starts with the transcription and translation of salivary protein genes in the glands, followed by post-translational processing involving protein glycosylation, phosphorylation, and proteolysis. This gives rise to salivary proteins occurring in families, consisting of structurally closely related family members. Once glandular secretions enter the non-sterile oral environment, proteins are subjected to additional and continuous protein modifications, leading to extensive proteolytic cleavage, partial deglycosylation, and protein-protein complex formation. All these protein modifications occur in a dynamic environment dictated by the continuous supply of newly synthesized proteins and removal by swallowing. Understanding the proteome of whole saliva in an environment of continuous turnover will be a prerequisite to gain insight into the physiological and pathological processes relevant to oral health, and be crucial for the identification of meaningful biomarkers for oral disease.
Key Words: saliva proteomics polymorphic proteolysis glycosylation phosphorylation degradation complexation diagnostics oral
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(1) INTRODUCTION
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The promise of understanding the functional significance of whole saliva, as well as its value for serving as a diagnostic fluid, is highly dependent on our ability to establish its composition. Most proteins and peptides present in whole saliva have undergone a complex series of molecular processes, which ultimately define their structures. The onset of these processes occurs at the biosynthetic level within the gland, while terminal processing of the protein/peptides takes place after secretion into the oral cavity. In the lifetime of a salivary protein, four principal phases can be distinguished. Phase 1 consists of the basic cellular process of protein biosynthesis, based on its genetic blueprint. Phase 2 is characterized by intracellular post-translational modifications prior to secretion of the protein into the ductal system. Phase 3 consists of modifications incurred during secretion and transit through the ductal tree. Phase 4 represents extensive modifications to salivary proteins after their release into the non-sterile environment of the oral cavity. This last phase has profound consequences for the proteome of whole saliva, since the population of proteins and peptides undergoes continued modifications in the time span between entry into and clearance from the oral cavity. The definition of the whole-saliva proteome is therefore highly variable, dependent on time and the nature and amounts of agents capable of protein/peptide modifications.
The purpose of this review is to summarize current knowledge on salivary protein alterations and modifications, from the moment the gene has been expressed in the gland until the moment the protein will be removed from the oral cavity by being swallowed. Recognizing the dynamic composition of the salivary proteome is important not only vis-à-vis salivary protein function, but also with regard to the growing interest in saliva-based diagnostics.
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(2) SALIVARY PROTEIN GENE TRANSLATION
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The major salivary protein families together constitute > 95% of the salivary protein content. The genes encoding for the acidic proline-rich proteins are PRH1 and PRH2 (Maeda, 1985), for basic proline-rich proteins PRB1 to PRB4 (Maeda, 1985) and PBII(SMR3B) (Isemura, 2000), for amylase AMY1 (Nishide et al., 1986), for high-molecular-weight mucous glycoprotein MUC5B (Desseyn et al., 1997), for low-molecular-weight mucous glycoprotein MUC7 (Bobek et al., 1993), for agglutinin DMBT1 (Prakobphol et al., 2000), for cystatins CST1 to CST5 (Saitoh and Isemura, 1993), for histatins HIS1 and HIS2 (Sabatini and Azen, 1989), and for statherin STATH (Dickinson et al., 1987; Sabatini et al., 1993). The genes and their translation products are summarized in Table 1 .
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(3) POST-TRANSLATIONAL MODIFICATIONS
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What distinguishes glandular salivary secretions from most other body fluids is that their constituents are mostly present as protein families of structurally closely related family members. This diversity is the result of allelic variation, gene duplication, alternative splicing events, and post-translational modifications (Azen and Maeda, 1988; Azen, 1993; Oppenheim et al., 2007). Post-translational salivary protein modifications have been widely studied in salivary proteins isolated from glandular salivary secretions. Strictly speaking, the modifications in these proteins could have taken place either intracellularly or during ductal transport. While the term post-translational is usually restricted to intracellular processes, in this review, we will use it for salivary protein modifications occurring at any point after protein synthesis, but prior to the release of proteins into the oral cavity. Post-translational protein alterations may be gland-specific and encompass the whole spectrum of glycosylation, acylation, deamidation, sulfation, phosphorylation, and proteolysis. Most of the evidence obtained so far points to functional significance related to glycosylation, phosphorylation, and proteolysis.
(3.A) Glycosylation
By weight, the majority of the salivary proteins are glycosylated. The heavily glycosylated proteins are mucous glycoprotein 1 (MG1), mucous glycoprotein 2 (MG2), agglutinin, glycosylated proline-rich proteins (PRPs), and secretory immunoglobulin A (sIgA). In general, the non-glycosylated salivary proteins are smaller and consist of acidic and basic PRPs, cystatins, statherins, and histatins. The glycosylated proteins undergo N-linked glycosylation (reviewed in Kornfeld and Kornfeld, 1985; Weerapana and Imperiali, 2006) and/or O-linked glycosylation (Ten Hagen et al., 2003; reviewed in Hang and Bertozzi, 2005). With the combined use of nuclear magnetic resonance (NMR) and mass spectrometry (MS), it has become feasible for investigators to structurally unravel complex sugar moieties and to gain insight into the tremendous diversity in the glycosylation pattern of the major salivary glycoproteins.
(3.A.1) Glycosylation of Amylase
Amylase is secreted mainly by the parotid gland in both glycosylated and non-glycosylated isoforms (Kauffman et al., 1973). In pancreatic amylase, which is highly homologous to salivary amylase, it has been established that only the Asn461 residue is glycosylated (Rydberg et al., 1999). Salivary amylase contains neutral and sialic acid-containing sugar moieties, all expressing Lewis x (Lex) epitopes (Yamashita et al., 1980) (Table 2 ). Originally, the various amylase isoforms in saliva were believed to arise solely from deamidation of the glycosylated and non-glycosylated isoforms (Keller et al., 1971; Karn et al., 1973, 1974), but revised models have been reported (Bank et al., 1991). Mass spectrometric analyses of the various isoforms of amylase in saliva have revealed that the amylase protein family contains more species than previously recognized (Hardt et al., 2005; Hirtz et al., 2005). The functional role of the sugar moiety in amylase has not yet been established. Amylase catalyzes the hydrolysis of 1 4 glycosidic linkages in starch, and both glycosylated and non-glycosylated amylases exhibit activity (Srivastava, 1991; Koyama et al., 2000). Apart from functioning as a digestive enzyme, an additional role for amylase in the oral cavity may relate to its capacity to bind to some oral micro-organisms, including S. gordonii (formerly called S. sanguis genotype I), S. mitis genotype II, and S. oralis (Scannapieco et al., 1989; Murray et al., 1992; Scannapieco, 1994). Both the glycosylated and non-glycosylated amylase preparations bind to S. gordonii, and it thus appears that glycosylation is a prerequisite neither for glycolytic activity nor for binding to bacteria. Salivary amylase is also a prominent constituent of the in vivo-formed acquired enamel pellicle and the mucosal pellicle, in which the glycosylated and non-glycosylated forms, respectively, predominate (Al-Hashimi and Levine, 1989; Bradway et al., 1992).
(3.A.2) Glycosylation of Proline-rich Glycoproteins (PRG)
The most prominent glycosylated protein in parotid secretions is PRG, also named GI. Other basic glycosylated proline-rich proteins include Ps, CON1, and CON2 (Azen and Maeda, 1988). Population studies have shown that PRG is present in saliva in various isoforms, of which the 39- and 89-kDa isoforms are the most frequently observed (Maeda et al., 1985; Murray et al., 1992). Extensive efforts have been made to characterize the carbohydrate composition of PRG isolated from parotid saliva (Levine et al., 1969; Reddy et al., 1982). It contains about 50% carbohydrate and is primarily N-glycosylated. By NMR and mass spectrometry, 27 highly fucosylated structures have been resolved, some of which contain sialic acid (Gillece-Castro et al., 1991). As in amylase, the PRG structure contains peripheral Lex linkages (Table 2 ). The most abundant PRG oligosaccharide species, though, carry the Lewis y (Ley) determinant, which is primarily found on PRG (Prakobphol et al., 1998). Glycosylation of the basic PRPs endows these molecules with unique lubricating properties (Hatton et al., 1985), common to all highly glycosylated proteins in saliva (Levine et al., 1987a). Lubrication helps to protect hard and soft oral tissues against abrasive forces during mastication and facilitates speech. PRG binds to a variety of bacteria, particularly F. nucleatum, but also to various streptococci, including S. mitis and S. sanguis (Nagata et al., 1983; Bergey et al., 1986; Levine et al., 1987a; Gillece-Castro et al., 1991; Ruhl et al., 2004). Unsubstituted Galβ1 4GlcNAc residue units present in PRG have been identified as epitopes recognized by F. nucleatum, explaining the high affinity of PRGs for this micro-organism (Prakobphol et al., 1987; Gillece-Castro et al., 1991; Azen et al., 1993b). F. nucleatum has been associated with periodontal disease (Bolstad et al., 1996), and PRG-mediated agglutination of this micro-organism could facilitate its clearance from the oral cavity.
(3.A.3) Glycosylation of Mucous Glycoprotein 2 (MG2)
MG1 and MG2 constitute the bulk of the salivary proteins secreted by the submandibular/sublingual glands. These glycoproteins are frequently referred to by their gene names, MUC5B and MUC7, respectively. MG2 contains multiple threonine-, serine-, proline-, and alanine-rich repeats, which display extensive O-glycosylation (Bobek et al., 1993). About 68% of the weight of the protein is carbohydrate. Initial characterizations of the O-linked carbohydrate units of MG2 showed that approximately 80% of the oligosaccharides consist of Galβ1 3GalNAc that either are unsubstituted, or are substituted with a terminal fucose or sialic acid residue (Reddy et al., 1985). With further structural characterizations by mass spectrometry and nuclear magnetic resonance, 41 different oligosaccharide structures containing up to 12 sugar residues have been structurally characterized (Prakobphol et al., 1998). The most prominent structures expressed sialyl-T antigen, Lex, and sialyl-Lex (sLex) determinants. Lex and sLex were identified in the latter study as the most prominent motifs on MG2 (Table 2 ). As described above for the glycosylated PRPs, the heavy glycosylation of MG2 explains its viscoelastic and rheological properties, important for masticatory lubrication. Each of the expressed lectin epitopes can serve as a specific ligand for oral microbial species. Indeed, a large array of different Gram-positive and Gram-negative oral microbial species bind to MG2 (Murray et al., 1992; Amerongen et al., 1995). The association between MG2 and bacteria in solution leads to the formation of aggregates and bacterial clearance from the oral cavity. As such, mucins can be considered part of the innate oral defense system. Surprisingly, the prominent Lex and sLex epitopes in MG2 do not represent binding ligands for many oral bacterial strains, but rather seem to be involved in governing lymphocyte tracking, suggesting diverse functions for MG2 in the oral cavity (Prakobphol et al., 1999).
(3.A.4) Glycosylation of Mucous Glycoprotein 1 (MG1)
MG1 is the MUC5B gene product and represents the largest and the most heavily glycosylated protein fraction in human saliva. It has recently been suggested that MG1 may also contain an even larger product encoded by the MUC19 gene (Chen et al., 2004; Culp et al., 2004), but this product has not been identified in any of the saliva proteome analyses (e.g., Wilmarth et al., 2004; Hu et al., 2005). MG1 isolated from human submandibular/sublingual saliva contains about 78% carbohydrate (Loomis et al., 1987; Offner and Troxler, 2000). Over half of the oligosaccharides are neutral (56%), over one-quarter (26%) are sialylated, and 19% are sulfated. By mass spectrometry, at least 62 different types of neutral and 25 types of sialylated structures have been characterized, indicating that the level of heterogeneity in the glycosylation of MG1 exceeds that of PRG and MG2 (Thomsson et al., 2002). Fucose is present in the form of blood group epitopes, including H types 1 and 2, Lea, Leb, Lex, sLex, and Ley. In fact, MG1 is the primary carrier of the ABH, Lea, and Leb blood group antigens in saliva (Prakobphol et al., 1993). The heterogenous glycosylation of MG1 has several biological implications. The numerous O-glycosylations in MG1 result in a large, extended, soluble gel-forming mucin. MG1 is abundantly present in the early enamel pellicle and, as such, serves as an interface between the tooth surface and the oral environment (Tabak et al., 1985; Al-Hashimi and Levine, 1989). It is also part of mucosal pellicles, where it provides a permeability barrier for the protection of the oral mucosal epithelium against environmental insult and desiccation (Tabak et al., 1982; Bradway et al., 1992; Amerongen et al., 1995). Despite the expression of a wide variety of oligosaccharide structures on MG1, it appears to bind fewer bacteria than MG2 (Prakobphol et al., 2005). Helicobacter pylori strains bind to MG1, depending on the strain-dependent specificity for Lewis blood group epitopes (Mahdavi et al., 2002; Prakobphol et al., 2005). Such specificity may point toward the predisposition of certain individuals for colonization with certain microbial species, which would of great interest from a diagnostic point of view.
(3.A.5) Glycosylation of Agglutinin (gp-340)
Agglutinin is the second largest glycoprotein in salivary secretions. It is identical to the lung scavenger protein gp-340 and contains 14 potential N-glycosylation sites. Agglutinin contains about 25% carbohydrate (Prakobphol et al., 2005) and is N-glycosylated (Ramachandran et al., 2006). Purified agglutinin from either parotid saliva or submandibular/sublingual saliva expressed Lea and Ley as well as sLex epitopes, and some glycoforms contained ABH epitopes (Ligtenberg et al., 2000; Prakobphol et al., 2000; Eriksson et al., 2007) (Table 2 ). The functions of agglutinin have been mainly attributed to its capacity to aggregate bacteria. Microbial clearance following adhesion and aggregation is particularly beneficial if the protein binds pathogens. Agglutinin shows a high binding affinity for S. mutans, and this association is so specific that it has been used to isolate agglutinin from parotid secretions (Ericson and Rundegren, 1983; Ligtenberg et al., 2000; Prakobphol et al., 2000). Interestingly, the carbohydrate residues on agglutinin do not appear to be involved in the binding to S. mutans, and a peptidic recognition site for this micro-organism in agglutinin has been identified (Bikker et al., 2002, 2004). Agglutinin also binds to several other oral streptococci and to H. pylori (Prakobphol et al., 2000). It furthermore exhibits human immunodeficiency virus (HIV) and influenza A-neutralizing activities. While the non-glycosylated N-terminus of agglutinin is responsible for the interaction with the HIV virus (Wu et al., 2006), the types of sialic acid linkages on agglutinin are an important determinant for anti-influenza A virus activity (Hartshorn et al., 2006).
(3.A.6) Glycosylation of Secretory Immunoglobulin A (sIgA)
The most abundant immunoglubulin in saliva, sIgA, is a complex comprised of multiple polypeptides. It consists of a secretory component (SC), which is covalently attached to two IgA molecules containing a joining (J) chain. The SC component is produced by acinar cells, whereas the IgA and J molecules are synthesized by the plasma cells close to the glandular epithelium, indicating that two types of cells are involved in the production and post-translational modification of the sIgA complex (Norderhaug et al., 1999). The heavy chains, SC, and J chain are N-glycosylated, and the heavy chains of some sIgA isotypic variants are furthermore O-glycosylated. Notably, the Fab regions, involved in specific antigen recognition, are not glycosylated (Royle et al., 2003). The largest variation in N-linked oligosaccharide structures is found on SC, expressing all of the possible sialylated and non-sialylated Lewis isotopes (Table 2 ). The O-linked glycans on the heavy chain of sIgA1 are equally complex and contain many different sugar epitopes (Royle et al., 2003). The glycosylation of sIgA and other salivary glycoproteins may function to protect these proteins from proteolytic activity (Crottet and Corthesy, 1998). Furthermore, the N-linked glycosylation sites in the heavy chain are important for the secretion and dimerization of the antibody (Taylor and Wall, 1988; Atkin et al., 1996). The large variety of expressed Lewis-type structures on SC endows sIgA with the capacity to bind to a large number of bacteria via domains that do not involve the Fab region. Indeed, SC binds to H. pylori (Falk et al., 1993), S. pneumonia (Hammerschmidt et al., 1997), and E. coli (Wold et al., 1990). With respect to its lectin-binding properties and bacteria binding, sIgA shows striking similarities to some other salivary glycoproteins. It has been suggested that sIgA may participate both in adaptive immunity, via its Fab parts, as well as in innate immune systems, via its glycosylated regions (Royle et al., 2003).
(3.B) Phosphorylation
The phosphorylated salivary proteins are comprised of the acidic proline-rich proteins, statherin, histatin 1, and some cystatin family members (cystatins S and SA-III). Most salivary phosphoproteins are fully and faithfully phosphorylated at the serine residues dedicated to be phosphorylated. Recently, with sensitive mass spectrometric approaches, minor, unusually phosphorylated species of the known salivary phosphoproteins have been detected (Inzitari et al., 2005, 2006, 2007). It is widely recognized that the state of salivary supersaturation with respect to calcium phosphate salts is due to the biological roles of phosphorylated salivary proteins. Protein phosphorylation adds a negative charge to the molecule, which appears to dictate, in large part, the affinity of the protein for the enamel surface. Hence, an important biological role of the phosphorylation of salivary proteins is related to mineral homeostasis.
(3.B.1) Phosphorylation of Acidic PRPs
All acidic PRPs are phosphorylated at residues 8 and 22 (Wong et al., 1979; Wong and Bennick, 1980). Mono- and non-phosphorylated species are rarely observed. Interestingly, a recent report showed that, in newborns, the percentages of non-phosphorylated and monophosphorylated acidic PRPs are much higher than in adults, suggesting that phosphokinase expression or activity is not yet fully developed at a young age (Inzitari et al., 2007). The specific phosphorylation of the Ser8 and the Ser22 residues in acidic PRPs was demonstrated upon expression of PRP constructs into a human submandibular gland cell line (Drzymala et al., 2000). The Ser8 phosphorylation site in acidic PRPs is confined to the sequence Ser-Xaa-Glu/pSer, which is the recognition site for Golgi casein kinase (G-CK; Lasa et al., 1997). Interestingly, Ser22 in acidic PRP does not comply with this sequence requirement, but it is consistent with an alternative consensus sequence for G-CK, namely, Ser-Xaa-Gln-Xaa-Xaa-Asp/Glu (Brunati et al., 2000). Acidic PRPs are effective inhibitors of calcium phosphate crystal growth, but not of primary calcium phosphate precipitation at physiological concentrations (Hay et al., 1979). Their calcium-binding affinity and inhibitory activities reside in the highly charged N-terminal 30 amino acids containing the two phosphoserine residues (Bennick et al., 1981; Hay et al., 1987). Data have provided ample evidence for the importance of protein phosphorylation and the simultaneous presence of both phosphoserines for the biological functions of acidic PRPs pertaining to mineral homeostasis (Hay et al., 1979, 1987).
(3.B.2) Phosphorylation of Statherin
Statherin was the first fully sequenced salivary phosphoprotein (Schlesinger and Hay, 1977). It contains two vicinal phosphoserine residues (Ser2-Ser3), followed by two glutamic acid residues (Glu4-Glu5). This tetrapeptide domain (Ser2-Ser3-Glu4-Glu5) contains two tripeptide sequences of the Ser-Xaa-Glu type that, in principle, could be recognized by G-CK phosphokinase. Statherin exhibits a high affinity for hydoxyapatite, and inhibits both crystal growth of calcium phosphate salts and spontaneous precipitation of calcium phosphate from a supersaturated solution. Statherin is the most effective inhibitor of calcium phosphate precipitation among other salivary phosphoproteins. The capacity to prevent crystal growth is localized in the N-terminal 6 amino acid residues containing both phosphoserines. Overall, the negative charges responsible for these functions are not restricted to phosphoserines, but also include contributions made by aspartic and glutamic residues (Hay et al., 1979; Raj et al., 1992; Tamaki et al., 2002).
(3.B.3) Phosphorylation of Histatin 1
Histatins 1 and 3 are the two primary histatin gene products. Histatin 1 is phosphorylated at Ser2 in the Ser2-Asp3-Glu4 context. In histatin 3, Glu4 is substituted by Ala4, abolishing the kinase recognition site and preventing the phosphorylation of Ser2 (Oppenheim et al., 1986, 1988). Functional comparisons between native histatin 1 and recombinantly expressed histatin 1, lacking phosphate, have shown that the phosphate group has no significant impact on the antifungal properties of histatin 1 (Driscoll et al., 1995). This observation is consistent with the fact that the middle region, rather than the N-terminus, of histatins contains the fungicidal domain (Lamkin and Oppenheim, 1993). In contrast, non-phosphorylated recombinant histatin 1 exhibits reduced affinity for hydroxyapatite, as compared with native histatin 1, thus indicating that the phosphate group specifically, or its negative charge, is a determining factor in governing the functional interaction of histatin 1 with tooth enamel mineral (Driscoll et al., 1995).
(3.B.4) Phosphorylation of Cystatin S and SA-III
Among the family of salivary cystatins, only cystatin S is phosphorylated. In contrast to other salivary phosphoproteins, cystatin S shows an interesting extent of heterogeneous phosphorylation not observed in other salivary phosphoproteins. It is either non-phosphorylated, or phosphorylated at Ser3, or at Ser1 and Ser3 (Isemura et al., 1991; Ramasubbu et al., 1991). In view of the Ser-Xaa-Glu/Pser recognition site of the G-CK phosphokinase, Ser1 would become a recognition site for this enzyme after phosphorylation of Ser3. Analysis of a variant of cystatin S, called cystatin SA-III, provided evidence for four phosphate groups associated with Ser3, Ser99, Ser112, and Ser116, making this the only salivary protein to date with phosphorylated residues in both the N- and the C-termini (Lamkin et al., 1991). Removal of the phosphate groups by alkaline phosphatase treatment reduces the affinity of cystatins (called cysteine-containing phosphoproteins at the time) for hydroxyapatite (Shomers et al., 1982). The main function of cystatins in the oral cavity is related to their strong inhibitory activity toward various cysteine proteases (Minakata and Asano, 1984; Barrett, 1986; Isemura et al., 1986). Both non-phosphorylated and phosphorylated cystatin members display this activity, and the activity is retained upon dephosphorylation of the phosphorylated isoforms (Ramasubbu et al., 1991; Saitoh et al., 1991; Lamkin and Oppenheim, 1993). The main function of cystatin phosphorylation therefore remains elusive.
(3.C) Proteolytic Processing
Most salivary proteins with molecular weights < 40 kDa are post-translationally cleaved into smaller fragments before their release into the oral cavity. Proteolysis can be either complete, leaving no trace of the parent protein, or partial, yielding a mixture of intact and cleavage products (Cai and Bennick, 2004). In the latter case, the ratio of uncleaved to cleaved product is oftentimes strikingly constant and flow-rate-independent. The constancy of this ratio suggests that post-translational proteolysis is a tightly controlled process. The mechanism of control has not been elucidated, but could be explained by sequestration and selective fusion of protein- and protease-containing vesicles within the acinar cell. This possibility is schematically depicted in Fig. 1 . The biological significance of proteolytic protein processing could be to expand the salivary protein repertoire without the need for additional genes encoding for such proteins. In most cases, the fragments generated retain their biological activity (Lu and Bennick, 1998), or may even be more active than the primary gene product (Madapallimattam and Bennick, 1990; Xu et al., 1991). When a protein is cleaved into two active fragments, degradation can be considered a means to increase the concentration of active components on a molar basis. The generation of different peptides from a single translation product could also be beneficial with regard to cooperativity and synergism of the products affecting various biological functions.

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Figure 1. Hypothetical model explaining the constant ratio of histatin 3 to histatin 5 in glandular secretions.
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(3.C.1) Proteolytic Processing of Basic PRPs
The cleavage of the basic PRB1, PRB2, and PRB4 products is complete, as evidenced from the absence of any of these intact primary translation products in salivary secretions. Eight electrophoretically distinct basic PRP peptides have been described: Pe (=DEAEII-2), PmF, PmS, Ps, Pc, Con1, Con2, and Po (Azen et al., 1979; Kauffman and Keller, 1979; Azen and Denniston, 1980; Anderson et al., 1982; Azen and Yu, 1984a,b; Karn et al., 1985). Simultaneously, the amino acid sequences of basic proline-rich fragments were determined and named P-D, P-E, P-F, P-H, and P-I (Isemura et al., 1982; Saitoh et al., 1983a,b,c), II-1, II-2, IB-1, IB-7, and IB-8a (Kauffman et al., 1982, 1986, 1991). Five other peptides (IB-5, IB-9, IB-8c, IB-4, and IB-6) were identical to peptides P-D, P-E, P-F, P-H, and P-I, respectively. When the gene structure of the basic PRP family became available (Maeda, 1985), the identified peptides could be matched to predicted protein sequences, and the differences in nomenclature resolved (Azen and Maeda, 1988; Lyons et al., 1988; Azen et al., 1993a, 1996; Stubbs et al., 1998) (Table 3 ). The presence and spatial distribution of carbohydrate chains in the glycosylated PRPs seem to be determining factors in their susceptibility to proteolysis. The non-glycosylated regions of basic PRPs are cleaved at Arg-Ser-Xaa-Arg , where the arrow indicates the site after which cleavage occurs (Stubbs et al., 1998). The Arg-Xaa-Xaa-Arg sequence is a typical recognition site for protein convertases such as furin (Bresnahan et al., 1990), and some evidence that this enzyme is involved in the processing of basic PRPs in vivo has been obtained (Chan and Bennick, 2001). While the basic PRPs are prominent and well-characterized in terms of their structure, their functions in the oral cavity are not well-established. They bind and precipitate tannins, a dietary constituent with side-effects that are potentially toxic if not neutralized by salivary proteins (Hagerman and Butler, 1981; Yan and Bennick, 1995; Lu and Bennick, 1998). Cleavage of the PRB4 gene product yields a non-glycosylated tannin-binding fragment (IB-5) and a glycosylated fragment (II-1) with lubricating properties, thus generating two fragments with different functional capacities (Lu and Bennick, 1998). The biological function of basic PRPs, and the purpose for the generation of multiple highly homologous peptides, are otherwise poorly understood. It may be of interest that a subset of small basic PRP peptides in parotid secretion differs between caries-susceptible and caries-resistant individuals. This suggests that the proteolytic pattern of basic PRPs could be of diagnostic value and potentially provide markers for caries susceptibility (Ayad et al., 2000).
(3.C.2) Proteolytic Processing of Acidic PRPs
The acidic PRPs are comprised of PRP1, PRP2, PIF-s, Db-s, and Pa. The 150-residue acidic PRPs (PRP1, PRP2, and PIFs) are partially cleaved post-translationally after Arg106, generating PRP3, PRP4, and PIFf, respectively, and a C-terminal 44-residue fragment that is identical in all proteins (Bennick, 1982; Hay et al., 1988, 1994). Db-s is 171 residues in length, due to a 21-residue insert after Gly83. It is cleaved at the same, but shifted, cleavage site, generating Db-f and the 44-residue C-terminal fragment. All acidic PRPs are cleaved at Arg-Pro-Pro-Arg , which, in contrast to the Arg-Ser-Xaa-Arg sequence, is not recognized by furin (Cai and Bennick, 2004). In the acidic Pa protein, the first Arg residue is substituted by a Cys residue, abolishing the protease recognition site. An enzyme capable of acidic PRP processing has been purified from human sublingual glands, and has been tentatively classified as a metal- and thiol-dependent protease (Cai and Bennick, 2004). Functionally, it is of interest that cleavage of all acidic PRPs leads to the release of the same 44-residue carboxy terminal peptide at high molar quantities. This would suggest an important biological function for this peptide in the oral cavity. The 44-residue fragment, but not any of the 150-residue parent proteins, is effective in the precipitation of tannin (Lu and Bennick, 1998). It also noteworthy that the 44-residue carboxy terminal peptide in the intact PRPs contains the ligand for bacterial binding after protein adsorption (Gibbons et al., 1991), suggesting that PRP processing may lower bacterial binding to the tooth surface.
(3.C.3) Proteolytic Processing of Histatins
The major proteolytic histatin fragment formed during biosynthesis is histatin 5, which arises from a chymotryptic-like cleavage in histatin 3 after Tyr24 (Oppenheim et al., 1986, 1988). The almost constant ratio of histatin 3 to histatin 5 in parotid secretions poses interesting questions regarding the biological control of the proteolytic processing of histatin 3. A possible mechanism consistent with this observation is shown in Fig. 1 . Parotid secretions contain eight minor, chromatographically detectable, histatin fragments varying in length from 12 to 25 residues. In addition, smaller histatin fragments containing from 4 to 10 residues have been identified and characterized (Troxler et al., 1990; Perinpanayagam et al., 1995). More recent and sensitive mass spectrometric analysis of proteins present in parotid secretions has expanded the histatin peptide repertoire to at least 50, pointing toward extensive proteolysis of histatins in the glands (Hardt et al., 2005). Most of these peptides, however, are likely present in low concentrations, and the biological significance of the minor species remains to be explored. The enzymes responsible for histatin processing have not yet been identified. Furin, which has been implicated in the processing of PRPs (Chan and Bennick, 2001), does not seem a likely candidate for histatin processing, since histatins are inhibitors of this enzyme (Basak et al., 1997). Histatins exhibit multiple antifungal and antibacterial activities that may or may not be affected by proteolysis. The antifungal activity of histatin 5 exceeds that of histatin 3, pointing toward a potential biological advantage for the generation of this fragment (Xu et al., 1991; Helmerhorst et al., 2005). The fungicidal domain, consisting of residues 12–25 in histatin 3, is present in most of the longer naturally occurring histatin fragments (Troxler et al., 1990; Lamkin and Oppenheim, 1993; Xu et al., 1993), suggesting that post-translational proteolysis would not necessarily reduce the antimicrobial properties associated with the unprocessed parent protein.
(3.C.4) Proteolytic Processing of Statherin
The proteolytic processing of statherin and its splice variant SV-2 consists of the cleavage of the C-terminal Phe residue (Jensen et al., 1991). This modification renders the statherin degradation products somewhat less hydrophobic than the original protein, but overall, the protein remains quite hydrophobic, due to the presence of multiple Tyr residues comprising almost of the statherin sequence. It is not known if and how the removal of the C-terminal Phe residues affects the known functions of statherin.
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(4) SALIVARY PROTEIN MODIFICATIONS IN WHOLE SALIVA
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The in vivo structure-function relationship of salivary proteins in the oral cavity is dictated not only by post-translational protein processing in the gland, but also by protein modifications that occur after glandular secretions are mixed with whole saliva. Whole saliva is non-sterile and contains various non-exocrine contributors, including gingival crevicular fluid, oral bacteria, desquamated epithelial cells, and neutrophils and their products. Not surprisingly, oral fluid contains a variety of host- and bacteria-derived enzymes, such as proteases, glycosidases, and transferases (Chauncey, 1961; Makinen, 1966). Exposure of glandular proteins to these enzymes results in multiple structural modifications. Indeed, the proteomes of parotid and submandibular secretions differ in many respects from that of whole saliva, as visualized by two-dimensional PAGE (Yao et al., 2003; Walz et al., 2006). Protein-protein interactions in the whole salivary environment, furthermore, lead to the formation of heterotypic complexes, which may aggregate to form globular super complexes (Young et al., 1999; Soares et al., 2004). In addition, novel and hybrid salivary molecules are generated through the formation of intra- and intermolecular covalent linkages (Iontcheva et al., 1997; Yao et al., 2000; Cabras et al., 2006). Our understanding of salivary protein modifications in whole saliva and its impact on function is far from complete and lags behind existing knowledge on protein processing occurring during biosynthesis in the gland. Knowledge of whole saliva protein modifications appears to be critically important in view of the fact that whole saliva directly surrounds oral soft and hard tissues and should contain the elements required for host protection. Furthermore, it is expected that whole saliva, rather than glandular secretions, will harbor the biomarkers useful for oral diagnostics.
(4.A) Protein Degradation in Whole Saliva
The concentrations of histatin and acidic PRPs in whole saliva are drastically lower than those in parotid secretions (Fig. 2 ) or in submandibular/sublingual secretions (data not shown), despite the fact that these glands produce the bulk of the whole saliva fluid volume. Their low levels in whole saliva coincide with the presence of multiple degradation fragments with a high electrophoretic mobility, indicative of proteolytic breakdown. Not all salivary proteins are equally susceptible to proteolytic breakdown, and those that are most susceptible are histatins, statherin, acidic PRPs, and basic non-glycosylated PRPs (Baum et al., 1976; Kousvelari et al., 1980; Minaguchi et al., 1988; Castagnola et al., 2004; Vitorino et al., 2004; Inzitari et al., 2005, 2006; Helmerhorst et al., 2006). The extensive proteolysis of these proteins in the oral environment emphasizes that whole saliva is not a suitable source for the study of their biosynthesis and post-translational modifications, as has been occasionally attempted (Castagnola et al., 2004; Inzitari et al., 2005). The structural and functional consequences of the degradation of histatins and acidic PRPs occurring in the oral cavity have been investigated in more detail.

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Figure 2. Analysis of the composition of parotid and whole saliva from four individuals by anionic and cationic PAGE. Stimulated parotid secretion was collected on ice with the aid of a Lashley cup placed over the Stensens duct, with sour candies used for stimulation. Stimulated whole saliva was collected into tubes containing PMSF and EDTA which were placed on ice. All samples were boiled immediately after collection. Aliquots (100 µL) were analyzed by cationic PAGE (upper panel), or by anionic PAGE (lower panel), for visualization of histatins and acidic acidic PRPs, respectively (Davis, 1964; Ornstein, 1964; Baum et al., 1977). Lanes 1 to 4 contain samples from participants 1 to 4, respectively.
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(4.A.1) Degradation of Histatins in Whole Saliva
Histatins are rapidly degraded when parotid secretions are mixed with whole saliva (Baum et al., 1976; Payne et al., 1991). The time-dependent analysis of the electrophoretically resolved histatin fragments (previously called HRPs, for histidine-rich proteins) in mixtures of whole saliva and parotid secretions showed the complete disappearance of histatin 3, the relatively sustained levels of histatin 1, and an increase in smaller histatin fragments over a 24-hour incubation time period. The time-course of the degradation of synthetic histatin 5 in whole saliva studied by mass spectrometry has provided insight into the immediate structural changes affecting histatins upon entering the oral cavity (Helmerhorst et al., 2006). Nineteen early degradation fragments were characterized, of which 16 were derived from single but different proteolytic cleavage events, and three resulted from more than one cleavage event (Fig. 3 ). Seven of the identified fragments (Asp1-Lys11, Asp1-Arg12, Asp1-Lys13, Arg12-Tyr24, Phe14-Tyr24, Lys5-Arg12, and Arg6-Lys13) had also been detected in whole saliva (Castagnola et al., 2004), which contains early- as well as end-stage histatin 5 degradation fragments. Comparison of the early histatin 5 breakdown products with those naturally present in whole saliva (Fig. 3 ) allows for the identification of Tyr10, Lys11, Arg12, Lys13, His15, Glu16, Lys17, and His18 as primary cleavage sites, and Lys5, Arg6, His7, and Arg22 as subsequent or end-stage cleavage sites. The obtained results point toward the involvement of multiple enzymes with various proteolytic specificities in histatin degradation in the oral cavity. The partial inhibition of histatin proteolysis in whole saliva by phenyl-methyl-sulfonyl fluoride (PMSF) and trylasol (aprotinin) suggests the participation of serine proteases in this process (Baum et al., 1976). An interesting observation was that histatin proteolysis is not linearly related to the loss of biological function. Under incubation conditions where added histatin 5 had completely disappeared, the degradation mixture still retained 50% of the antifungal activity (Helmerhorst et al., 2006). A closer examination of the 19 early degradation fragments indicated that for 6 of these, antifungal activity could be expected based on prior structure-function analysis of synthesized histatin fragments (Raj et al., 1990; Xu et al., 1993). The evidence presented shows that whole-saliva-associated proteolysis of histatins, and possibly of other salivary proteins, does not instantly abolish their biological activities. This would be an important consideration regarding their functionality in the oral environment.
(4.A.2) Degradation of Acidic PRPs in Whole Saliva
Whole saliva contains many small phosphopeptides which derive from the proteolysis of phosphorylated salivary proteins (Minaguchi et al., 1988). Most of these phosphopeptides originate from acidic PRPs, which are the most abundant salivary phosphoproteins. The appearance of phosphopeptides in mixtures of whole saliva and parotid secretion could be greatly reduced in the presence of PMSF, indicating that serine proteases are involved in the degradation of acidic PRPs as well (Minaguchi et al., 1988). Phosphopeptides derived from acidic PRPs are more effective in the inhibition of calcium phosphate precipitation than the intact PRPs. It seems that the structural properties and the concentrations of phosphopeptides that are actually present in whole saliva are adequate to fulfill, in part, the functions associated with the intact PRP proteins (Minaguchi et al., 1988; Madapallimattam and Bennick, 1990).
(4.A.3) Degradation of Cystatins in Whole Saliva
Whole saliva contains cystatin variants that are 113 residues in length (Isemura et al., 1984a,b, 1986, 1987) and arise from post-secretory degradation of the full-length cystatins, which are 121 residues in length (Hawke et al., 1987; Al-Hashimi et al., 1988; Saitoh et al., 1988). Both the full-length and the N-terminally truncated forms of cystatins are present in whole saliva, and both forms exhibit cystatin protease inhibitory activities (Bobek et al., 1994). This is an important observation, since it indicates that the biological activity of cystatins is retained in the proteolytic environment of the oral cavity.
(4.B) Protein Deglycosylation in Whole Saliva
Partial deglycosylation of salivary glycoproteins in whole saliva is caused by enzymes produced by oral bacteria which subsequently utilize the released carbohydrate moieties for growth. Streptococci produce a large variety of glycosidases, and many oral streptococci are able to grow in batch culture with mucin as the sole source of carbohydrates (van der Hoeven et al., 1990). One of the glycosidic enzymes produced by streptococci is neuraminidase, which cleaves terminal sialic acid residues from carbohydrate moieties (Perlitsh and Glickman, 1966; Briscoe et al., 1972). The structural alteration of terminal sugar epitopes creates new, and abolishes existing, binding ligands for oral bacteria (Leach, 1963). Neuraminidase treatment of mucous glycoproteins completely abolishes its ability to aggregate S. sanguis, whereas the binding of S. mutans is unaffected (McBride and Gisslow, 1977; Levine et al., 1978). Since many oral bacteria recognize sugar epitopes, modification of these ligands by salivary neuraminidase and other oral glycosidases may have profound effects on the binding epitopes of these organisms and their capacity to colonize the oral cavity.
(4.C) Protein-Protein Interactions in Whole Saliva
Most proteins in cellular biological systems function as part of intricate molecular networks that involve multiple protein-protein interactions. Protein-protein interactions are numerous in the oral environment, which contains a large variety of proteins originating from many different sources. The ensuing interactions reflect a whole spectrum of affinities, resulting in dissociable and non-dissociable protein-protein complexes (Iontcheva et al., 1997; Bruno et al., 2005). The salivary protein complexes formed in the oral cavity represent entirely new biological entities, and differ not only in structure, but likely also in function from isolated salivary proteins in solution.
(4.C.1) Protein Complex Formation in Whole Saliva
Salivary mucins and other glycoproteins have a high propensity to form homotypic and heterotypic complexes with other proteins. MG2 (MUC7) forms complexes with sIgA, amylase, acidic PRP2, basic PRP3, statherin, histatin 1, and lactoferrin (Loomis et al., 1987; Biesbrock et al., 1991; Soares et al., 2003; Bruno et al., 2005). The large-molecular-weight glycoprotein MG1 also interacts with multiple salivary constituents, but not with sIgA (Iontcheva et al., 1997, 2000). Investigators have speculated on the functional benefits of protein complex formation. Many of the protein-protein complexes bind to bacteria, and such associations, in some cases, have shown to enhance bacterial agglutination and clearance from the oral cavity (Rundegren and Arnold, 1987a,b; Biesbrock et al., 1991; Oho et al., 1998). Mucin binding could prolong the residence time of the binding partners in the oral cavity by retarding proteolytic degradation. Complexing of mucins with protective molecules, such as lysozyme, may concentrate these components at various tissue-environmental interfaces (Levine et al., 1987a). Protein complexes may also act as a vehicle for the slow release of proteins to sites in the oral cavity where their activity is required (Iontcheva et al., 1997).
Some of the protein-protein complexes in whole saliva further aggregate into globular, micelle-like structures. These structures are virtually undetectable in glandular secretions and are primarily present in whole saliva (Young et al., 1999). A calculated 4.7–20% of total whole salivary proteins are present in the form of micellar aggregates. Interestingly, only a selected number of salivary proteins can be immunologically identified in micelles (Soares et al., 2004). It appears that only protein-protein complexes containing MG2 would further organize to form the particulate, micelle-like globular structures (Soares et al., 2004). Since the amino acid composition of micelles is virtually identical to that of the early acquired enamel pellicle, salivary micelles have been considered the early participants of protein films formed on the tooth surface (Young et al., 1999).
(4.C.2) Covalent Cross-linking of Salivary Proteins
Strong evidence points to the formation of covalent protein-protein interactions at the mucosal pellicle (Bradway et al., 1989, 1992; Bradway and Levine, 1993). Buccal epithelial cells express the enzyme transglutaminase, which catalyzes the formation of a -glutamyl- -lysine isopeptide bond between a glutamine and a lysine residue (Abe et al., 1977; Williams-Ashman and Canellakis, 1980). Incubation of parotid secretions with pure acidic PRPs with buccal epithelial cells leads to the formation of new, non-dissociable, high-molecular-weight macromolecules. In in vitro experiments, histatins and statherin have been found to be suitable lysyl substrates for transglutaminase-mediated cross-linking to a glutamyl donor. Statherin is also able to serve as a glutamyl donor for binding to a lysyl donor (Yao et al., 1999). Recently, a cyclic form of statherin has been identified in whole saliva resulting from intra-molecular cross-linking between Lys6 and Gln37 (Cabras et al., 2006). Evidence for the in vitro formation of PRP-statherin hybrid molecules has also been obtained (Yao et al., 2000). Transglutaminase-mediated intra- and intermolecular modifications leading to circularized and hybrid salivary proteins add an additional level of structural diversity to the whole salivary proteome.
Because transglutaminase levels are low in saliva, the functional role of transglutamination is likely restricted to processes occurring at the mucosal surface. The formation of non-dissociable complexes of salivary proteins to the mucosal pellicle can create new bacterial binding sites or mask existing binding sites. An example of the latter is the binding of germinated Candida albicans cells to buccal epithelium (Bradway and Levine, 1993; Staab et al., 1999). Since acidic PRPs as well as C. albicans cell wall proteins serve as substrates for epithelium-associated transglutaminase, it has been speculated that PRPs may compete with C. albicans for binding to the oral mucosal cell surface and interfere with Candida colonization (Bradway and Levine, 1993).
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(5) CONCLUSION
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It is evident that a large body of knowledge exists on the structure of individual salivary proteins at the biosynthetic level. Considerable information has been obtained on the function of pure salivary proteins and derived peptides from experiments performed in vitro. More recent efforts in salivary research have begun to elucidate the complex interplay between salivary proteins and enzymes resident in whole saliva. This interplay leads to a whole host of novel components, and the interactions of such components with oral structures is pivotal for our understanding of oral health mechanisms. Whole saliva represents a very dynamic fluid. The flow-rate-dependent influx of glandular secretion and the intermittent removal of whole saliva by swallowing create an influx and efflux dynamic difficult to approach experimentally. Superimposed on those conditions are variables that relate to the enzymology associated with whole saliva dictated by micro-organisms and host cells. To aid our understanding of the physiological and pathological processes relevant to oral health, it is imperative that the dynamics of whole saliva be addressed at the molecular level. While this represents considerable challenges, the results of such studies will provide insights into salivary function and will be critical for the development of saliva-based diagnostic applications.
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ACKNOWLEDGMENTS
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The authors pay tribute to the pioneering work of Patricia J. Keller, the first woman professor in the University of Washingtons School of Dentistry, who died on April 1, 2007. Her work in the field of salivary protein biochemistry, particularly her efforts on the characterization of salivary amylases and basic proline-rich proteins, represent benchmark contributions toward understanding of the polymorphisms dominating the salivary exocrine systems. The authors also acknowledge their NIH/NIDCR support from grants DE05672, DE07652, DE16699, and DE14950.
Received for publication April 18, 2007.
Revision received May 21, 2007.
Accepted for publication May 21, 2007.
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Journal of Dental Research, Vol. 86, No. 8,
680-693 (2007)
DOI: 10.1177/154405910708600802

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C. Dawes
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[Abstract]
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