A variety of studies have attempted to address the question of whether antibodies might be protective, in which case they might be expected to be higher in controls than in patients, or whether antibodies might reflect the antigenic load in which case they would be expected to be higher in patients than in controls.
Studies of antibodies in humans in oral candidiasis have used both serum and saliva, with the main objectives of identifying responses in relation to clinical disease or sometimes using antibodies to identify individual genes expressed (Cheng et al., 2003).
A summary of the studies is shown in Table 3.3. With regard to salivary IgA antibodies, they have been found to be raised in patients with CAC (Kantardjiev and Popova, 2002) using immunofluorescence and whole cells and in patients with malignancies (Dorko et al., 2002). However, salivary antibodies were not found to be raised in two groups of HIV-positive subjects using whole cells and enzyme-linked immunosor-bent assay (ELISA) (Belazi et al., 2002; Wozniak et al., 2002), while serum IgG antibodies were reduced.
A non-specific role of IgA has been suggested by the finding that in patients who are Candida positive, the carriage rate of Candida is inversely proportional to the non-specific secretory IgA level whereas serum levels are unrelated (Kurnatowski and Kurnatowska, 1999).
In addition to secreted aspartyl pro-teinases (Saps), other specific antigens of Candida have been examined including heat shock mannoproteins. Antibodies in saliva and in serum have been reported against these mannoproteins in patients with oral or vaginal candidiasis (Ivanyi and Ivanyi, 1990; Swoboda et al., 1993; Polonelli et al., 1994). Kozel et al. (2004) used serum to identify antibodies reactive with C. albicans mannan and showed a normal distribution in 34 subjects though no account was taken of Candida colonisation. Functionally, however, the anti-mannan IgG did not appear to be needed for opsonophagocytic killing by neutrophils as long as there was normal complement levels in the individuals.
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