Synergistic antimicrobial potential of EGCG and fosfomycin against biofilms associated with endodontic infections

Abstract Objective This study aimed to evaluate the cytotoxicity and synergistic effect of epigallocatechin gallate (EGCG) and fosfomycin (FOSFO) on biofilms of oral bacteria associated with endodontic infections. Methodology This study determined minimum inhibitory and bactericidal concentration (MIC/MBC) and fractionated inhibitory concentration (FIC) of EGCG and FOSFO against Enterococcus faecalis, Actinomyces israelii, Streptococcus mutans, and Fusobacterium nucleatum. Monospecies and multispecies biofilms with those bacteria formed in polystyrene microplates and in radicular dentin blocks of bovine teeth were treated with the compounds and control chlorhexidine (CHX) and evaluated by bacterial counts and microscopy analysis. Toxicity effect of the compounds was determined on fibroblasts culture by methyl tetrazolium assays. Results The combination of EGCG + FOSFO demonstrated synergism against all bacterial species, with an FIC index ranging from 0.35 to 0.5. At the MIC/FIC concentrations, EGCG, FOSFO, and EGCG+FOSFO were not toxic to fibroblasts. EGCG+FOSFO significantly reduced monospecies biofilms of E. faecalis and A. israelli, whereas S. mutans and F. nucleatum biofilms were eliminated by all compounds. Scanning electron microscopy of multispecies biofilms treated with EGCG, EGCG+FOSFO, and CHX at 100x MIC showed evident biofilm disorganization and substantial reduction of extracellular matrix. Confocal microscopy observed a significant reduction of multispecies biofilms formed in dentin tubules with 84.85%, 78.49%, and 50.6% of dead cells for EGCG+FOSFO, EGCG, and CHX at 100x MIC, respectively. Conclusion EGCG and fosfomycin showed a synergistic effect against biofilms of oral pathogens related to root canal infections without causing cytotoxicity.

Effect of S. mutans combinations with bifidobacteria/lactobacilli on biofilm and enamel demineralization

Abstract The present study evaluated the ability of Bifidobacterium and Lactobacillus species associated with streptococci to increase insoluble extracellular polysaccharide (EPS) production and initial caries lesion progression. Bovine enamel blocks (n = 190; 4 mm x 4 mm) were prepared, selected according to initial surface hardness (SH), and divided into two groups: a) double combinations: S. mutans with Bifidobacterium or Lactobacillus, and b) triple combinations: S. mutans and S. sobrinus with Bifidobacterium or Lactobacillus species. The blocks were exposed to the bacterial associations for 7 days. Subsequently, quantity of EPS from biofilms and caries lesion depth were determined by means of colorimetric and cross-sectional enamel hardness (ΔKHN) analysis. The data were submitted to one-way analysis of variance, followed by the Bonferroni test (p < 0.05). S. mutans with B. animalis or B. dentium produced a higher quantity of EPS; S. mutans + B. animalis led to the highest ∆KHN. S. mutans + S. sobrinus + B. longum induced greater EPS and ∆KHN values. In conclusion, associations of B. animalis and B. longum with streptococci promoted EPS production and caries lesion progression.

Efeito isolado ou combinado de flavonoides e peptídeos catiônicos sobre biofilme endodôntico e sua influência na viabilidade celular, capacidade de migração e inibição de citocinas em fibroblastos / Effect of flavonoids and cationic peptides, alone or in combination, on endodontic biofilm and their influence on cell viability, migration capacity and inhibition of cytokines in fibroblasts

Este trabalho foi dividido em dois capítulos que objetivou avaliar: 1) o efeito isolado ou combinado do flavonoide epigallocatechin-3-gallate (EGCG) em associação com o peptídeo LL-37 e seu análogo KR-12-a5 sobre a viabilidade celular de fibroblastos e sobre cultura planctônica, biofilme simples, dual-espécies e túbulos dentináios e 2) as interações sinérgicas do EGCG e proantocianidina do oxicoco (A-type cranberry proanthocyanidins, AC-PAC), quando usado em combinação com LL-37 ou KR-12-a5 sobre a viabilidade celular, a capacidade de migração e inibição das citocinas em cultura de fibroblastos (HGF-1), quando estimuladas ou não pelo lipopolissacarídeo de A. actinomycetencomitans (LPS). No capítulo 1, a concentração inibitória mínima (MIC), a concentração bactericida mínima (MBC) e concentração inibitória fracionária (FIC) de EGCG, LL-37 e KR-12-a5 foram determinadas a partir de valores decrescentes dos compostos por meio dos métodos de microdiluição e checkerboard contra Streptococcus mutans, Enterococcus faecalis, Actinomyces israelii e Fusobacterium nucleatum após 24 horas de tratamento. Fibroblastos da linhagem L-929 foram expostos a combinações de EGCG com peptídeos em diferentes concentrações e o metabolismo celular avaliado por ensaios de MTT. Os compostos com melhor efeito antimicrobiano e citotóxico foram avaliados por 24-36h, isoladamente ou em combinação, em biofilmes individuais ou biofilmes de dual-espécies com E. faecalis formados em placas de poliestireno por 48h por meio de contagem bacteriana. Os biofilmes de E. faecalis também foram cultivados em túbulos dentinários por 2 semanas, tratados com EGCG, KR-12-a5 e EGCG + KR-12-a5 e a porcentagem de células mortas foi determinada pela análise de imagens usando Microscopia Confocal. No capítulo 2, a linhagem celular de fibroblastos gengivais humanos primários HGF-1 foi pré-tratada durante 2 h com EGCG ou AC-PAC a 25 e 12,5 µg / mL, LL-37 ou KR-12-a5 a 0,06 e 0,03 µM ou com uma combinação de EGCG + ACPAC; AC-PAC + KR-12-a5; AC-PAC + LL-37; EGCG + KR-12-a5 ou EGCG + LL-37, nas mesmas concentrações. As culturas celulares foram então estimuladas com 50 µg/mL de LPS por 24-48h. A viabilidade celular e migração foram analisadas usando ensaios colorimétricos e fluorescentes, respectivamente. A quantificação de citocinas foi determinada por ensaios multiplex ELISA. Os resultados mostraram que em condições planctônicas, EGCG + KR-12-a5 apresentaram efeito sinérgico ou aditivo contra todas as bactérias testadas, com FIC menor que os valores de MIC obtidos pelos compostos isolados. As combinações de EGCG e peptídeos testados não foram tóxicas para os fibroblastos, uma vez que o crescimento celular foi superior a 70%. Em condições de biofilme simples, EGCG + KR-12-a5 eliminou S. mutans e A. israelii e reduziu E. faecalis e F. nucleatum. Para biofilmes de duas espécies, quando E. faecalis foi combinado com S. mutans, EGCG + KR-12-a5 teve efeito sinérgico eliminando S. mutans e reduzindo estatisticamente as contagens de E. faecalis. Em biofilmes associando E. faecalis e A. israelii ou F. nucleatum, EGCG + KR-12-a5 eliminaram E. faecalis e promoveram redução de A. israelii e F. nucleatum, embora não tenha sido observada diferença estatística entre os compostos. EGCG + KR-12-a5 reduziu mais de 80% dos biofilmes de E. faecalis nos túbulos dentinários. Dentre os grupos experimentais estudados, o EGCG, principalmente a 25 e 12,5 µg/mL estimulou o crescimento de fibroblastos, protegendo-os dos efeitos do LPS. Efeito sinérgico entre EGCG + AC-PAC, EGCG + LL-37 e EGCG + KR-12-a5 no metabolismo celular também foi observado na presença de LPS. Combinações do EGCG com AC-PAC ou KR-12-a5 e AC-PAC com LL-37 foram capazes de aumentar estatisticamente a migração celular. EGCG, AC-PAC, LL-37 e KR-12-a5 promoveram a redução de citocinas individualmente ou em combinação (EGCG + AC-PAC e EGCG + KR12-a5) mais especificamente para IL-6, IL-8, GM- CSF e TNF-α. Conclui-se que a associação de EGCG e KR-12-a5 é citocompatível e promove um efeito sinérgico contra bactérias associadas a infecções endodônticas, sob condições planctônicas e de biofilme. O EGCG, isoladamente ou associado ao AC-PAC e ao KR-12-a5, aumenta a viabilidade e migração celular, bem como a inibição de citocinas por fibroblastos estimulados por LPS. A associação de EGCG com KR-12-a5 poderia ser uma opção de princípio ativo em medicações para fins endodônticos(AU)

This study was divided in two chapters that aimed to evaluate: 1) the effect of flavonoid epigallocatechin-3-gallate (EGCG), cationic peptide LL-37 peptide and its analogue KR12-a5, alone or in combination, on fibroblast cell viability and on bacteria in planktonic and single/dual-species biofilms/dentin tubules; 2) the synergistic interactions of EGCG and cranberry proanthocyanidins (A-type cranberry proanthocyanidins, AC-PAC), when used in combination with LL-37 or KR-12-a5 on cell viability, the ability to induce cell migration and inhibit cytokines in culture of fibroblasts (HGF-1) when stimulated or not by the lipopolysaccharide of A. actinomycetencomitans (LPS). For the chapter 1, Minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and fractional inhibitory concentration (FIC) of EGCG, LL-37 and KR-12-a5 were determined from decreasing values of the compounds by Streptococcus mutans, Enterococcus faecalis, Actinomyces israelii and Fusobacterium nucleatum against microdilution and checkerboard after 24 hours of treatment. L-929 fibroblasts were exposed to combinations of EGCG with peptides at different concentrations and cell metabolism assessed by MTT assays. The compounds if the best antimicrobial and cytotoxic effect were also evaluated for 24-36h, alone or in combination, in 48h singleor dual-species biofilms with E. faecalis formed on polystyrene plates by bacterial counting. E. faecalis biofilms were also cultured in dentin tubules for 2 weeks and treated with EGCG, KR-12-a5 and EGCG + KR-12-a5 to determine the percentage of dead cells by analysis of images using Confocal Microscopy. For the chaper 2, primary human gingival fibroblast HGF-1 cell line was pretreated for 2 h with either EGCG or AC-PAC at 25 and 12.5 µg/mL, LL-37 or KR-12-a5 at 0.03 and 0.06 µM or with a combination of EGCG + AC-PAC; AC-PAC + KR-12-a5; AC-PAC + LL-37; EGCG + KR-12-a5 or EGCG + LL37, at the same concentrations. Cell cultures were then stimulated with 50 µg/mL LPS for 24-48h. Cell viability and migration were analyzed using colorimetric and fluorescent assays, respectively. Quantification of cytokines was determined by multiplex ELISA assays. The results show that in planktonic conditions, EGCG + KR-12- a5 showed a synergistic or additive effect against all the bacteria tested, with FIC lower than the MIC values obtained by the compounds alone. Combinations of EGCG and peptides tested were not toxic to fibroblasts, since cell growth was higher than 70%. Under single biofilm conditions, EGCG + KR-12-a5 eliminated S. mutans and A. israelii and reduced E. faecalis and F. nucleatum. For dual- species biofilms, when E. faecalis was combined with S. mutans, EGCG + KR-12-a5 had a synergistic effect by eliminating S. mutans and statistically reducing E. faecalis counts. In biofilms associated with E. faecalis and A. israelii or F. nucleatum, EGCG + KR-12-a5 eliminated E. faecalis and promoted reduction of A. israelii and F. nucleatum, although no statistical difference was observed between the compounds. EGCG + KR-12-a5 reduced more than 80% of the E. faecalis biofilms in the dentin tubules. Among the experimental groups studied, EGCG, mainly at 25 and 12.5 µg/mL stimulated the growth of fibroblasts, protecting them from the effects of LPS. Synergistic effect between EGCG + AC-PAC, EGCG + LL-37 and EGCG + KR12-a5 on cell metabolism was also observed in the presence of LPS. Combinations of EGCG with AC-PAC or KR-12-a5 and AC-PAC with LL-37 were able to increase statistically cell migration. EGCG, AC-PAC, LL-37 and KR-12-α5 promoted cytokine reduction individually or in combination (EGCG + AC-PAC and EGCG + KR-12-a5) more specifically for IL-6, IL-8, GM-CSF and TNF-α. The association of EGCG and KR-12-a5 was cytocompatible and promoted a synergistic effect against bacteria associated with endodontic infections under planktonic and biofilm conditions. EGCG, alone or in combination with AC-PAC and KR-12-a5, increases cell viability and migration, as well as inhibition of cytokines by LPS-stimulated fibroblasts. The association of EGCG with KR12-a5 could be an option as active principle for medications to be used for endodontic purposes(AU)

Frequency of Porphyromonas gingivalis fimA in smokers and nonsmokers after periodontal therapy

Abstract Porphyromonas gingivalis is one of the most important Gram-negative anaerobe bacteria involved in the pathogenesis of periodontitis. P. gingivalis has an arsenal of specialized virulence factors that contribute to its pathogenicity. Among them, fimbriae play a role in the initial attachment and organization of biofilms. Different genotypes of fimA have been related to length of fimbriae and pathogenicity of the bacterium. Objectives The aim of this study was to identify 5 types of fimA genotype strains in smokers and nonsmokers with periodontitis, before and after periodontal therapy. Material and Methods Thirty-one patients with periodontitis harboring P. gingivalis were selected: 16 nonsmokers (NS) and 15 smokers (SM). Clinical and microbiological parameters were evaluated at baseline and 3 months after periodontal treatment, namely: plaque index, bleeding on probe, probing depth, gingival recession and clinical attachment level. The frequency of P. gingivalis and fimA genotype strains were determined by polymerase chain reaction. Results Type I fimA was detected in the majority of SM and NS at baseline, and the frequency did not diminish after 3 months of treatment. The frequency of type II genotype was higher in SM than NS at baseline. After 3 months, statistical reduction was observed only for types II and V fimA genotypes in SM. The highest association was found between types I and II at baseline for NS (37.5%) and SM (53.3%). Conclusion The most prevalent P. gingivalis fimA genotypes detected in periodontal and smoker patients were genotypes I and II. However, the presence of fimA genotype II was higher in SM. Periodontal treatment was effective in controlling periodontal disease and reducing type II and V P. gingivalis fimA.

In vitro and in vivo evaluations of glass-ionomer cement containing chlorhexidine for Atraumatic Restorative Treatment

Abstract Objectives: Addition of chlorhexidine has enhanced the antimicrobial effect of glass ionomer cement (GIC) indicated to Atraumatic Restorative Treatment (ART); however, the impact of this mixture on the properties of these materials and on the longevity of restorations must be investigated. The aim of this study was to evaluate the effects of incorporating chlorhexidine (CHX) in the in vitro biological and chemical-mechanical properties of GIC and in vivo clinical/ microbiological follow-up of the ART with GIC containing or not CHX. Material and Methods: For in vitro studies, groups were divided into GIC, GIC with 1.25% CHX, and GIC with 2.5% CHX. Antimicrobial activity of GIC was analyzed using agar diffusion and anti-biofilm assays. Cytotoxic effects, compressive tensile strength, microhardness and fluoride (F) release were also evaluated. A randomized controlled trial was conducted on 36 children that received ART either with GIC or GIC with CHX. Saliva and biofilm were collected for mutans streptococci (MS) counts and the survival rate of restorations was checked after 7 days, 3 months and one year after ART. ANOVA/Tukey or Kruskal-Wallis/ Mann-Whitney tests were performed for in vitro tests and in vivo microbiological analysis. The Kaplan-Meier method and Log rank tests were applied to estimate survival percentages of restorations (p<0.05). Results: Incorporation of 1.25% and 2.5% CHX improved the antimicrobial/anti-biofilm activity of GIC, without affecting F release and mechanical characteristics, but 2.5% CHX was cytotoxic. Survival rate of restorations using GIC with 1.25% CHX was similar to GIC. A significant reduction of MS levels was observed for KM+CHX group in children saliva and biofilm 7 days after treatment. Conclusions: The incorporation of 1.25% CHX increased the in vitro antimicrobial activity, without changing chemical-mechanical properties of GIC and odontoblast-like cell viability. This combination improved the in vivo short-term microbiological effect without affecting clinical performance of ART restorations.