Reversible fluoride uptake and release byStreptococcus mutans GS-5 and FA-1

Fluoride and organic weak acids as modulators of microbial physiology

Fluoride is widely used as an anticaries agent in drinking water and a variety of other vehicles. This use has resulted in major health benefits. However, there are still open questions regarding the mechanisms of anticaries action and the importance of antimicrobial effects in caries reduction. Fluoride acts in multiple ways to affect the metabolism of cariogenic and other bacteria in the mouth. F(-)/HF can bind directly to many enzymes, for example, heme-containing enzymes or other metalloenzymes, to modulate metabolism. Fluoride is able also to form complexes with metals such as aluminum or beryllium, and the complexes, notably AlF(4)(-) and BeF(3)(-).H(2)O, can mimic phosphate with either positive or negative effects on a variety of enzymes and regulatory phosphatases. The fluoride action that appears to be most important for glycolytic inhibition at low pH in dental plaque bacteria derives from its weak-acid properties (pK(a)=3.15) and the capacity of HF to act as a transmembrane proton conductor. Since many of the actions of fluoride are related to its weak-acid character, it is reasonable to compare fluoride action to those of organic weak acids, including metabolic acids, food preservatives, non-steroidal anti-inflammatory agents and fatty acids, all of which act to de-energize the cell membrane by discharging DeltapH. Moreover, with the realization that the biofilm state is the common lifestyle for most microorganisms in nature, there is need to consider interactions of fluoride and organic weak acids with biofilm communities. Hopefully, this review will stimulate interest in the antimicrobial effects of fluoride or other weak acids and lead to more effective use of the agents for disease control and other applications.

Effect of fluoride on glucose incorporation and metabolism in biofilm cells of Streptococcus mutans

The aim of this study was two-fold: firstly, to study the effect of high fluoride concentrations on carbohydrate metabolism in Streptococcus mutans present in biofilms on hydroxyapatite; and, secondly, to evaluate the effect of fluoride-bound hydroxyapatite on lactic acid formation in growing biofilms of Strep. mutans. Biofilms of a clinical strain of Strep. mutans on saliva-coated hydroxyapatite beads were incubated with sodium fluoride over a wide range of concentrations. At high fluoride concentrations (>10 mM) the incorporation of [14C]-labeled glucose decreased by 80-85%, at both pH 7.0 and 5.6. At lower fluoride concentrations, the effect of fluoride on the incorporation of labeled glucose was pH-dependent in both biofilm cells and in planktonic cells. At pH 7.0, fluoride at concentrations < 10 mM had little or no effect. Pretreatment of hydroxyapatite discs with fluoride varnish (Fluor Protector) or fluoride solutions caused a statistically significant reduction of lactic acid formation in associated, growing biofilms of Strep. mutans. Fluoride varnish and 0.2% (47.6 mM) sodium fluoride solution exhibited a statistically significant inhibitory effect on lactate production.

Antimicrobial actions of fluoride for oral bacteria

Fluoride is widely used as a highly effective anticaries agent. Although it is felt that its anticaries action is related mainly to effects on mineral phases of teeth and on the process of remineralization, fluoride also has important effects on the bacteria of dental plaque, which are responsible for the acidification of plaque that results in demineralization. The results of recent studies have shown that fluoride can affect bacterial metabolism through a set of actions with fundamentally different mechanisms. It can act directly as an enzyme inhibitor, for example for the glycolytic enzyme enolase, which is inhibited in a quasi-irreversible manner. Direct action seems also to occur in inhibition of heme-based peroxidases with binding of fluoride to heme. The flavin-based peroxidases of many oral bacteria are insensitive to fluoride. Another mode of action involves formation of metal-fluoride complexes, most commonly AlF4-. These complexes are responsible for fluoride inhibition of proton-translocating F-ATPases and are thought to act by mimicking phosphate to form complexes with ADP at reaction centers of the enzymes. However, the actions of fluoride that are most pertinent to reducing the cariogenicity of dental plaque are those related to its weak-acid character. Fluoride acts to enhance membrane permeabilities to protons and compromises the functioning of F-ATPases in exporting protons, thereby inducing cytoplasmic acidification and acid inhibition of glycolytic enzymes. Basically, fluoride acts to reduce the acid tolerance of the bacteria. It is most effective at acid pH values. In the acidic conditions of cariogenic plaque, fluoride at levels as low as 0.1 mM can cause complete arrest of glycolysis by intact cells of Streptococcus mutans. Overall, the anticaries actions of fluoride appear to be complex, involving effects both on bacteria and on mineral phases. The antibacterial actions of fluoride appear themselves to be complex but to be dominated by weak-acid effects.

Diminished acid tolerance of plaque bacteria caused by fluoride

Fluoride acts to reduce acid tolerances of plaque bacteria by upsetting normal proton currents across cell membranes. Streptococcus mutans was found to be unusually sensitive to fluoride, in part because its F1F0, proton-translocating ATPase is directly inhibited by fluoride at plaque levels. Thus, not only does fluoride serve in the HF form to bring extruded protons back into the cell, but it also reduces the capacity of the cell to extrude protons. Reductions in acid tolerance caused by fluoride would be expected to result in concomitant reductions in cariogenic potential.

Biochemical effects of fluoride on oral bacteria

Fluoride inhibition of carbohydrate metabolism by the acidogenic plaque microflora is well-established, although it has not always been appreciated that oral bacteria vary considerably in their susceptibility to fluoride. Early studies demonstrated that the F-induced reduction in acid production was due, in part, to the inhibition of the glycolytic enzyme, enolase, which converts 2-P-glycerate to P-enolpyruvate. The decreased output of PEP in the presence of F, in turn, results in the inhibition of sugar transport via the PEP phosphotransferase system (PTS). Bacterial accumulation of fluoride involves the transport of HF, a process requiring a transmembrane pH difference or pH gradient, which is generated only by metabolically active cells. The uptake of HF into the more alkaline cytoplasm results in the dissociation of HF to H+ and F- and, if allowed to continue, the accumulation of protons acidifies the cytoplasm, causing a reduction in both the proton gradient and enzyme activity. Current information indicates that in addition to enolase, F- also inhibits the membrane-bound, proton-pumping H+/ATPase, which is involved in the generation of proton gradients through the efflux of protons from the cell at the expense of ATP. Thus, fluoride has the dual action of dissipating proton gradients and preventing their generation through its action on H+/ATPase. The collapse of transmembrane proton gradient, in turn, reduces the ability of cells to transport solutes via mechanisms involving proton motive force. In spite of these known effects on the bacterial cell, there is no general agreement that the anti-microbial effects of F contribute to the anti-caries effect of fluoride.(ABSTRACT TRUNCATED AT 250 WORDS)

Fluoride inhibition of proton-translocating ATPases of oral bacteria

The ATPases of isolated membranes of lactic acid bacteria were found to be inhibited by fluoride in a complex manner. Among the enzymes tested, that of Streptococcus mutans GS-5 was the most sensitive to fluoride, and the initial rate of hydrolysis of ATP was reduced 50% by approximately 3 mM fluoride. The enzyme of Lactobacillus casei ATCC 4646 was the most resistant, and about 25 mM fluoride was required for 50% inhibition. The response to fluoride appeared to involve reversible, noncompetitive inhibition during short exposure to low levels of fluoride and nonreversible inhibition at higher fluoride levels. In addition, kinetic studies of the effects of fluoride on the enzymes of membranes of S. mutans and L. casei indicated that reversible inhibition was at least partly overcome at high levels of either ATP or Mg. The effects of pH on fluoride inhibition of ATPases were markedly different from the effects of pH on inhibition of acid/base regulation of intact cells by fluoride. It appeared that formation of HF was not required for inhibition of the ATPases. F1 ATPases isolated from the membranes by washing with buffers of low ionic strength proved to be less sensitive to fluoride than the membrane-associated F1F0 holoenzymes, and it was concluded that the F0 or membrane sector of the holoenzyme is involved in fluoride inhibition.

Fluoride uptake and fluoride resistance in oral streptococci

Fluoride uptake was examined in the highly F-sensitive Streptococcus salivarius strain 25975, the F-resistant mutant Flr103, and the relatively insensitive S. sanguis H7PR3. F was taken up by all strains from media at neutral pH, containing 1 or 10 micrograms F/ml (0.053-0.526 mmol/L), and uptake was directly proportional to the delta pH that was maintained by the cells. The final intracellular concentrations of F in the F-resistant strains were higher than those in the F-sensitive strain. Similar differences in F uptake were observed in buffer at pH 5.5, although both delta pH and F uptake were higher in all strains at the lower pH. These experiments demonstrate that resistance to F does not necessarily involve the exclusion of F from the cells. The lower uptake of F by F-sensitive cells is attributed to the finding that F dissipates the transmembrane pH gradient, and this, in turn, limits the concentration of intracellular F.