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Wang C, Nambu T, Takigawa H, Maruyama H, Mashimo C, Okinaga T. Effect of 5-aminolevulinic acid-mediated photodynamic therapy against Fusobacterium nucleatum in periodontitis prevention. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2024; 256:112926. [PMID: 38714001 DOI: 10.1016/j.jphotobiol.2024.112926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/20/2024] [Accepted: 04/25/2024] [Indexed: 05/09/2024]
Abstract
Periodontitis, a chronic infectious disease leading to gingival atrophy and potential tooth loss through alveolar bone resorption, is closely linked to the oral microbiome. Fusobacterium nucleatum, known to facilitate late-stage bacterial colonization in the oral microbiome, plays a crucial role in the onset of periodontitis. Controlling F. nucleatum abundance is vital for preventing and treating periodontal disease. Photodynamic therapy combined with 5-aminolevulinic acid (ALA-PDT) has been reported to be bactericidal against Pseudomonas aeruginosa and Staphylococcus aureus. We aimed to investigate the bactericidal potential of ALA-PDT against F. nucleatum, which was evaluated by examining the impact of varying 5-ALA concentrations, culture time, and light intensity. After ALA-PDT treatment, DNA was extracted from interdental plaque samples collected from 10 volunteers and sequenced using the Illumina MiSeq platform. To further elucidate the bactericidal mechanism of ALA-PDT, porphyrins were extracted from F. nucleatum following cultivation with 5-ALA and subsequently analyzed using fluorescence spectra. ALA-PDT showed a significant bactericidal effect against F. nucleatum. Its bactericidal activity demonstrated a positive correlation with culture time and light intensity. Microbiota analysis revealed no significant alteration in α-diversity within the ALA-PDT group, although there was a noteworthy reduction in the proportion of the genus Fusobacterium. Furthermore, fluorescence spectral analysis indicated that F. nucleatum produced an excitable photosensitive substance following the addition of 5-ALA. Overall, if further studies confirm these results, this combined therapy could be an effective strategy for reducing the prevalence of periodontitis.
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Affiliation(s)
- Chao Wang
- Graduate School of Dentistry (Bacteriology), Osaka Dental University, Hirakata, Osaka 573-1121, Japan
| | - Takayuki Nambu
- Department of Microbiology, Osaka Dental University, Hirakata, Osaka 573-1121, Japan.
| | - Hiroki Takigawa
- Department of Microbiology, Osaka Dental University, Hirakata, Osaka 573-1121, Japan
| | - Hugo Maruyama
- Department of Microbiology, Osaka Dental University, Hirakata, Osaka 573-1121, Japan
| | - Chiho Mashimo
- Department of Microbiology, Osaka Dental University, Hirakata, Osaka 573-1121, Japan
| | - Toshinori Okinaga
- Department of Microbiology, Osaka Dental University, Hirakata, Osaka 573-1121, Japan.
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Sangha JS, Barrett P, Curtis TP, Métris A, Jakubovics NS, Ofiteru ID. Effects of glucose and lactate on Streptococcus mutans abundance in a novel multispecies oral biofilm model. Microbiol Spectr 2024; 12:e0371323. [PMID: 38376204 PMCID: PMC10986578 DOI: 10.1128/spectrum.03713-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/16/2024] [Indexed: 02/21/2024] Open
Abstract
The oral microbiome plays an important role in protecting oral health. Here, we established a controlled mixed-species in vitro biofilm model and used it to assess the impact of glucose and lactate on the ability of Streptococcus mutans, an acidogenic and aciduric species, to compete with commensal oral bacteria. A chemically defined medium was developed that supported the growth of S. mutans and four common early colonizers of dental plaque: Streptococcus gordonii, Actinomyces oris, Neisseria subflava, and Veillonella parvula. Biofilms containing the early colonizers were developed in a continuous flow bioreactor, exposed to S. mutans, and incubated for up to 7 days. The abundance of bacteria was estimated by quantitative polymerase chain reaction (qPCR). At high glucose and high lactate, the pH in bulk fluid rapidly decreased to approximately 5.2, and S. mutans outgrew other species in biofilms. In low glucose and high lactate, the pH remained above 5.5, and V. parvula was the most abundant species in biofilms. By contrast, in low glucose and low lactate, the pH remained above 6.0 throughout the experiment, and the microbial community in biofilms was relatively balanced. Fluorescence in situ hybridization confirmed that all species were present in the biofilm and the majority of cells were viable using live/dead staining. These data demonstrate that carbon source concentration is critical for microbial homeostasis in model oral biofilms. Furthermore, we established an experimental system that can support the development of computational models to predict transitions to microbial dysbiosis based on metabolic interactions.IMPORTANCEWe developed a controlled (by removing host factor) dynamic system metabolically representative of early colonization of Streptococcus mutans not measurable in vivo. Hypotheses on factors influencing S. mutans colonization, such as community composition and inoculation sequence and the effect of metabolite concentrations, can be tested and used to predict the effect of interventions such as dietary modifications or the use of toothpaste or mouthwash on S. mutans colonization. The defined in vitro model (species and medium) can be simulated in an in silico model to explore more of the parameter space.
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Affiliation(s)
- Jay S. Sangha
- School of Engineering, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paul Barrett
- Safety and Environmental Assurance Centre, Unilever, Colworth Science Park, Sharnbrook, United Kingdom
| | - Thomas P. Curtis
- School of Engineering, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Aline Métris
- Safety and Environmental Assurance Centre, Unilever, Colworth Science Park, Sharnbrook, United Kingdom
| | - Nicholas S. Jakubovics
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Irina D. Ofiteru
- School of Engineering, Newcastle University, Newcastle upon Tyne, United Kingdom
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Gonca S, Polat B, Ozay Y, Ozdemir S, Kucukkara I, Atmaca H, Dizge N. Investigation of diode laser effect on the inactivation of selected Gram-negative bacteria, Gram-positive bacteria and yeast and its disinfection on wastewater and natural milk. ENVIRONMENTAL TECHNOLOGY 2023; 44:1238-1250. [PMID: 34709976 DOI: 10.1080/09593330.2021.2000036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/18/2021] [Indexed: 06/13/2023]
Abstract
Disinfection can be accomplished by adding external chemical agents to kill harmful microorganisms or by removing them using membranes. However, most chemicals are toxic for humans and animals if it is consumed above a certain concentration. Likewise, membranes have fouling problems. The aim of this study is to investigate the effect of diode laser, which is an environmentally friendly application, on pathogenic microorganisms such as Escherichia coli (ATCC 10536), Staphylococcus aureus (ATCC 6538) and Candida albicans. To reveal the effect of diode laser on aforementioned, various parameters have been studied on how diode laser type, laser irradiation time, laser power density, laser penetration efficiency and biofilm inhibition affect microorganisms. As a result of the study, it was observed that the blue laser was more effective than red and green lasers, and the inhibition rates for 15 min at 0.36 W/cm2 laser power density were 65.9% > 34.52% > 43.63% for S. aureus, E. coli and C. albicans, respectively. After 30 min of blue laser irradiation, the microbial growth inhibitions were found as 85.39%, 41.18% and 54.55% for S. aureus, E. coli and C. albicans, respectively. The highest biofilm inhibition was 94.61% when S. aureus cells were exposed to blue laser irradiation for 60 min. The microbial growth kinetics on three microorganisms were tested by using at 0.54 W/cm2 laser power density for 28 h, and there were not observed any microbial development in microbial cultures. Moreover, blue laser irradiation was successfully disinfected wastewater and natural milk at 0.54 W/cm2 laser power density.
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Affiliation(s)
- Serpil Gonca
- Faculty of Pharmacy, Department of Pharmaceutical Microbiology, Mersin University, Mersin, Turkey
| | - Barıs Polat
- Department of Physics, Mersin University, Mersin, Turkey
| | - Yasin Ozay
- Department of Environmental Engineering, Mersin University, Mersin, Turkey
| | - Sadin Ozdemir
- Food Processing Programme, Technical Science Vocational School, Mersin University, Mersin, Turkey
| | | | - Halil Atmaca
- Department of Physics, Mersin University, Mersin, Turkey
| | - Nadir Dizge
- Department of Environmental Engineering, Mersin University, Mersin, Turkey
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Cymbopogon citratus Essential Oil Increases the Effect of Digluconate Chlorhexidine on Microcosm Biofilms. Pathogens 2022; 11:pathogens11101067. [PMID: 36297124 PMCID: PMC9607486 DOI: 10.3390/pathogens11101067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/24/2022] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
The aim of this study was to evaluate the effect of the Cymbopogon citratus essential oil and its association with chlorhexidine on cariogenic microcosm biofilm composition and acidogenicity. Minimum inhibitory and bactericide concentrations from the essential oil and chlorhexidine were determined by broth microdilution assay. Microcosms (polymicrobial) biofilms were produced on glass coverslips, using inoculum from human saliva in McBain culture medium (0.5% sucrose exposure for 6 h/day) for 3 days in 24-well plates. The biofilms were treated twice a day and their composition was evaluated by microorganism quantification. The acidogenicity was evaluated by measuring the pH of the spent culture medium in contact with the biofilm. Overall, the association of C. citratus and chlorhexidine reduced total bacterial counts and aciduric bacteria (maximum reduction of 3.55 log UFC/mL) in microcosm biofilms. This group also presented the lowest acidogenicity even when exposed to sucrose-containing medium. C. citratus essential oil increases the effect of digluconate chlorhexidine on microcosm biofilms. Based on these findings, this study can contribute to the development of new formulations that might allow for the use of mouthwashes for a shorter period, which may reduce undesirable effects and increase patient compliance to the treatment.
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Comparison between Single and Multi-LED Emitters for Photodynamic Therapy: An In Vitro Study on Enterococcus faecalis and Human Gingival Fibroblasts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053048. [PMID: 35270740 PMCID: PMC8910628 DOI: 10.3390/ijerph19053048] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022]
Abstract
Aim of the study: The aim was to evaluate the effects of two LED devices, TL-01 and TL-03 in photodynamic therapy (PDT), on Enterococcus faecalis and on human gingival fibroblasts (HGFs). TL-01, characterized by a single emitter, irradiates one periodontal site at a time, whereas the multi-led device (TL-03) irradiates all vestibular sites of a single arch at a time. Methods: E. faecalis bacterial suspensions and HGFs were incubated for 45 min with Aladent gel (ALAD) containing 5-aminolevulinic acid and then exposed to LED devices (ALAD-PDT), having different distance and timing of irradiation (TL-01 N (0.5 mm, for 7 min), TL-03 N (0.5 mm, 15 min) and TL-03 F (30.0 mm, 15 min)). For bacterial suspension, the colony forming units and the live/dead staining were evaluated after 24 h, while the protoporphyrin IX (PpIX) content was monitored in all phases of the experimentation. For HGFs, the cell viability, proliferation, cell morphology, and adhesion were evaluated at 24 h. Results: Both TL-01 and TL-03 showed a significant reduction of bacterial load. The photoinactivation was inversely proportional to the PpIX accumulation. TL-01 and TL-03 promoted proliferation and adhesion of HGFs. Conclusions: Both tested devices for ALAD-PDT were equally effective in significantly reducing Enterococcus faecalis growth and in promoting HGFs proliferation and adhesion, in vitro.
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Wang Y. Liposome as a delivery system for the treatment of biofilm-mediated infections. J Appl Microbiol 2021; 131:2626-2639. [PMID: 33650748 DOI: 10.1111/jam.15053] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 12/11/2022]
Abstract
Biofilm formation by pathogenic microorganisms has been a tremendous challenge for antimicrobial therapies due to various factors. The biofilm matrix sequesters bacterial cells from the exterior environment and therefore prevents antimicrobial agents from reaching the interior. In addition, biofilm surface extracellular polymeric substances can absorb antimicrobial agents and thus reduce their bioavailability. To conquer these protection mechanisms, liposomes have been developed into a drug delivery system for antimicrobial agents against biofilm-mediated infections. The unique characteristics of liposomes, including versatility for cargoes, target-specificity, nonimmunogenicity, low toxicity, and biofilm matrix-/cell membrane-fusogenicity, remarkably improve the effectiveness of antimicrobial agents and minimize recurrence of infections. This review summarizes current development of liposomal carriers for biofilm therapeutics, presents evidence in their practical applications and discusses their potential limitations.
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Affiliation(s)
- Y Wang
- School of Agriculture and Food Sciences, University of Queensland, St Lucia, Qld, Australia
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Chen Z, Ni D, Zhang W, Stressler T, Mu W. Lactic acid bacteria-derived α-glucans: From enzymatic synthesis to miscellaneous applications. Biotechnol Adv 2021; 47:107708. [PMID: 33549610 DOI: 10.1016/j.biotechadv.2021.107708] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/21/2020] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
Lactic acid bacteria (LAB) are capable of producing a variety of exopolysaccharide α-glucans, such as dextran, mutan, reuteran, and alternan. Their structural diversity allows LAB-derived α-glucans to hold vast commercial value and application potential in the food, cosmetic, medical, and biotechnology fields, garnering much attention in recent years. Glycoside Hydrolase 70 family (GH70) enzymes are efficient tools for the biosynthesis of α-glucans with various sizes, linkage compositions, and degrees of branching, using renewable and low-cost sucrose and starch as substrates. To date, plenty of various LAB-derived GH70 glucansucrases (especially dextransucrase) have been biochemically characterized to synthesize α-glucans from sucrose with a variety of structural organizations. This review mainly aimed at the biotechnological synthesis of α-glucans using GH70 family enzymes and their diverse (potential) applications. The purification, structural analysis and physicochemical properties of α-glucan polysaccharides were reviewed in detail. Synchronously, some new insights and future perspectives of LAB-derived α-glucans enzymatic synthesis and applications were also discussed. To expand the range of applications, the physicochemical properties and bioactivities of LAB-derived α-glucans, other than dextran, should be further explored. Additionally, screening novel GH70 subfamily starch-acting enzymes is conducive to expanding the repertoire of α-glucans.
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Affiliation(s)
- Ziwei Chen
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Dawei Ni
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Wenli Zhang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Timo Stressler
- Independend Researcher, 64546 Mörfelden-Walldorf, Germany
| | - Wanmeng Mu
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu 214122, China; International Joint Laboratory on Food Safety, Jiangnan University, Wuxi, Jiangsu 214122, China.
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Yadav R, Kanwar IL, Haider T, Pandey V, Gour V, Soni V. In situ gel drug delivery system for periodontitis: an insight review. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2020. [DOI: 10.1186/s43094-020-00053-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Abstract
Background
Periodontitis is a microbial disease that leads to inflammation in the tooth-supporting tissues of the oral cavity that is common among the elderly. It is initiated by oral inflammation induced by bacterial dysbiosis. Choosing an appropriate antimicrobial agent with the right course of drug administration is the key to successful periodontal therapy. In recent times, with more biomarkers and the development of new technologies, several point-of-care testing (POCT) platforms have been developed for the diagnosis and monitoring of periodontitis. This review focuses on oral microbiology and the pathogenesis of periodontitis as well as recent insights into the in situ gel system for periodontitis.
Design
An exhaustive search was conducted in the following scientific databases Science Direct, Springer, Pub Med, and Google Scholar to review all relevant literatures. This is a comprehensive narrative review of the literature, summarizing the perspectives of the authors.
Results
Novel in situ forming gel is introduced at the site that shows a promising potential to overcome one of the main practical obstacles associated with the treatment of local periodontitis: partial adhesion to the surrounding tissue, causing in the accidental expulsion of at least parts of the implants from patient’s pockets. This results in a large residence time of the system at the site of action and uncertainty of the final exposure to the drug.
Conclusion
From the reviewed literature, it is concluded that experimental evidence suggests that the in situ gel-forming systems can be useful in treating several common diseases of the oral cavity. Future research should focus on clinical studies to be performed for the in situ gel to make a significant contribution to periodontitis.
Graphical abstract
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9
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Deciphering Streptococcal Biofilms. Microorganisms 2020; 8:microorganisms8111835. [PMID: 33233415 PMCID: PMC7700319 DOI: 10.3390/microorganisms8111835] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/10/2020] [Accepted: 11/17/2020] [Indexed: 12/19/2022] Open
Abstract
Streptococci are a diverse group of bacteria, which are mostly commensals but also cause a considerable proportion of life-threatening infections. They colonize many different host niches such as the oral cavity, the respiratory, gastrointestinal, and urogenital tract. While these host compartments impose different environmental conditions, many streptococci form biofilms on mucosal membranes facilitating their prolonged survival. In response to environmental conditions or stimuli, bacteria experience profound physiologic and metabolic changes during biofilm formation. While investigating bacterial cells under planktonic and biofilm conditions, various genes have been identified that are important for the initial step of biofilm formation. Expression patterns of these genes during the transition from planktonic to biofilm growth suggest a highly regulated and complex process. Biofilms as a bacterial survival strategy allow evasion of host immunity and protection against antibiotic therapy. However, the exact mechanisms by which biofilm-associated bacteria cause disease are poorly understood. Therefore, advanced molecular techniques are employed to identify gene(s) or protein(s) as targets for the development of antibiofilm therapeutic approaches. We review our current understanding of biofilm formation in different streptococci and how biofilm production may alter virulence-associated characteristics of these species. In addition, we have summarized the role of surface proteins especially pili proteins in biofilm formation. This review will provide an overview of strategies which may be exploited for developing novel approaches against biofilm-related streptococcal infections.
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Kim YG, Kim MO, Kim SH, Kim HJ, Pokhrel NK, Lee JH, Lee HJ, Kim JY, Lee Y. 6-Shogaol, an active ingredient of ginger, inhibits osteoclastogenesis and alveolar bone resorption in ligature-induced periodontitis in mice. J Periodontol 2020; 91:809-818. [PMID: 31675438 DOI: 10.1002/jper.19-0228] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/28/2019] [Accepted: 08/28/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Periodontitis is an inflammatory disease of the tissues surrounding teeth that causes destruction of connective tissues. During the progress of periodontitis, osteoclasts are solely accountable for the resorption of alveolar bones that leads to the loss of teeth if not properly treated. Thus, the development of effective anti-resorptive therapies will greatly benefit the treatment of periodontitis patients. In the present study, we suggest an inhibitory effect of 6-shogaol, an ingredient of ginger, on osteoclast differentiation and bone resorption. METHODS Mouse bone marrow cells were cultured in the presence of macrophage-colony stimulating factor and receptor activator of nuclear factor-κB ligand (RANKL) to investigate the effect of 6-shogaol on osteoclast differentiation and intracellular signaling pathways. 6-shogaol significantly reduced osteoclast differentiation, actin ring formation, and resorption. In the presence of 6-shogaol, osteoclast signaling including the RANKL-induced activation of mitogen-activated protein kinases, Ca2+ oscillation, generation of reactive oxygen species, and nuclear factor of activated T-cells, cytoplasmic 1 nuclear translocation was significantly inhibited in vitro. Furthermore, a ligature-induced periodontitis model in mice was used to determine the role of 6-shogaol in vivo. RESULTS The administration of 6-shogaol prevented osteoclastogenesis and alveolar bone resorption induced by ligature. Furthermore, the ligature-induced number of macrophages and neutrophils as well as the expression of interleukin-1β and tumor necrosis factor-α were considerably lower in the periodontal tissues following shogaol injection. CONCLUSION These results confirm the anti-osteoclastogenic effect of 6-shogaol and suggest the possibility of application as an anti-resorptive strategy in periodontitis.
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Affiliation(s)
- Yong-Gun Kim
- Department of Periodontology, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Myoung Ok Kim
- Department of Animal Biotechnology, College of Ecology and Environmental Science, Kyungpook National University, Sangju, Korea
| | - Sung-Hyun Kim
- Department of Bio-Medical Analysis, Korea Polytechnic College, Chungnam, Korea
| | - Hyo Jeong Kim
- Department of Biochemistry, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Nitin Kumar Pokhrel
- Department of Biochemistry, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Ji Hye Lee
- Department of Oral Pathology, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Heon-Jin Lee
- Department of Oral Microbiology, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Jae-Young Kim
- Department of Biochemistry, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Youngkyun Lee
- Department of Biochemistry, School of Dentistry, Kyungpook National University, Daegu, Korea
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11
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Zhang G, Lu M, Liu R, Tian Y, Vu VH, Li Y, Liu B, Kushmaro A, Li Y, Sun Q. Inhibition of Streptococcus mutans Biofilm Formation and Virulence by Lactobacillus plantarum K41 Isolated From Traditional Sichuan Pickles. Front Microbiol 2020; 11:774. [PMID: 32425911 PMCID: PMC7203412 DOI: 10.3389/fmicb.2020.00774] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/31/2020] [Indexed: 02/05/2023] Open
Abstract
Among cariogenic microbes, Streptococcus mutans is considered a major etiological pathogen of dental caries. Lactobacilli strains have been promoted as possible probiotic agents against S. mutans, although the inhibitory effect of Lactobacilli on caries has not yet been properly addressed. The objective of this study was to screen Lactobacillus strains found in traditional Sichuan pickles and to evaluate their antagonistic properties against S. mutans in vitro and in vivo. In the current study, we analyzed 54 Lactobacillus strains isolated from pickles and found that strain L. plantarum K41 showed the highest inhibitory effect on S. mutans growth as well as on the formation of exopolysaccharides (EPS) and biofilm in vitro. Scanning electron microscopy (SEM) and confocal laser scanning microscope (CLSM) revealed the reduction of both EPS and of the network-like structure in S. mutans biofilm when these bacteria were co-cultured with strain L. plantarum K41. Furthermore, when rats were treated with strain L. plantarum K41, there was a significant reduction in the incidence and severity of dental caries. Due to K41's origin in a high salinity environment, it showed a high tolerance to acids and salts. This may give this strain an advantage in harsh oral conditions. Results showed that L. plantarum K41 isolated from traditional Sichuan pickles effectively inhibited S. mutans biofilm formation and thus possesses a potential inhibitory effect on dental caries in vivo.
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Affiliation(s)
- Guojian Zhang
- Department of Food Science and Technology, College of Light Industry, Textile and Food Engineering, Sichuan University, Chengdu, China
| | - Miao Lu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodonics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Rongmei Liu
- Key Laboratory of Bio-resources & Eco-environment of the Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Yuanyuan Tian
- Key Laboratory of Bio-resources & Eco-environment of the Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Viet Ha Vu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodonics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yang Li
- Key Laboratory of Bio-resources & Eco-environment of the Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Bao Liu
- Key Laboratory of Bio-resources & Eco-environment of the Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Ariel Kushmaro
- Avram and Stella Goldstein-Goren Department of Biotechnology Engineering, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Yuqing Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodonics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qun Sun
- Department of Food Science and Technology, College of Light Industry, Textile and Food Engineering, Sichuan University, Chengdu, China
- Key Laboratory of Bio-resources & Eco-environment of the Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
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12
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Wongsuwan N, Dwivedi A, Tancharoen S, Nasongkla N. Development of dental implant coating with minocycline-loaded niosome for antibacterial application. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101555] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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13
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Dorina L, Annalisa P, Ornella D, Alessandro B, Liliana O, Marco G, Di Girolamo M, Valentina C. The use of a new chemical device based on silver and cationic surfactants as a new approach for daily oral hygiene: A preliminary study on a group of periodontal patients. Int J Immunopathol Pharmacol 2020; 33:2058738419868101. [PMID: 31663443 PMCID: PMC6822178 DOI: 10.1177/2058738419868101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to evaluate the abatement power of oral microbial
loading of a new gel formulation based on the complex silver-2-mercaptobenzoate,
chlorhexidine digluconate and didecyldimethylammonium chloride (named ADC)
through polymerase chain reaction (PCR). The study sample consists of a group of
20 patients with chronic periodontal disease. Patients were over 25 years of age
and did not undergo surgical or non-surgical periodontal treatment in the
previous 6 months. The study sample was allotted into two groups of 10 patients
each, homogeneous by age and sex. The test group received a bottle containing
ADC gel, while the control group received an identical one containing placebo,
similar to ADC in consistence, colour, taste and odour. Sub-gingival samples of
four sites, one in each quadrant, of greatest probing depth in each patient were
used. Microbiological analyses were performed at baseline and at day 15. Paired
t test was performed to detect statistical significant reduction in total
bacterial loading and oral pathogens in the study groups. The analysis showed a
statistically significant reduction in the total bacterial loading evaluated
pre- and post-treatment (P = 0.029) in the study groups. In the
control group, the decrease in total bacterial loading was not significant
(P = 0.279). Clinically, ADC gel does not have any side
effects and discomfort such as pain, burning, tingling sensation or numbness and
produces no adverse reactions in time. Our study aimed to evaluate the efficacy
of a new chemical formulation with antibacterial properties to use for daily
oral hygiene with a preliminary study. Our results showed a statistically
significant reduction in total bacterial loading after treatment, but the
limitations of our study do not allow us to demonstrate the clinical efficacy of
the ADC gel.
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Affiliation(s)
- Lauritano Dorina
- Department of Medicine and Surgery, Centre of Neuroscience of Milan, University of Milan-Bicocca, Milan, Italy
| | - Palmieri Annalisa
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - D'Orto Ornella
- Maxillofacial and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bolzoni Alessandro
- Maxillofacial and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Ottria Liliana
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Gargari Marco
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Michele Di Girolamo
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Candotto Valentina
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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14
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Rapid Multiplex Real-Time PCR Method for the Detection and Quantification of Selected Cariogenic and Periodontal Bacteria. Diagnostics (Basel) 2019; 10:diagnostics10010008. [PMID: 31877891 PMCID: PMC7168300 DOI: 10.3390/diagnostics10010008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/14/2019] [Accepted: 12/18/2019] [Indexed: 12/13/2022] Open
Abstract
Dental caries and periodontal diseases are associated with a shift from symbiotic microbiota to dysbiosis. The aim of our study was to develop a rapid, sensitive, and economical method for the identification and quantification of selected cariogenic and periodontal oral bacteria. Original protocols were designed for three real-time multiplex PCR assays to detect and quantify the ratio of 10 bacterial species associated with dental caries (“cariogenic” complex) or periodontal diseases (red complex, orange complex, and Aggregatibacter actinomycetemcomitans). A total number of 60 samples from 30 children aged 2–6 years with severe early childhood caries and gingivitis were tested. In multiplex assays, the quantification of total bacterial (TB) content for cariogenic bacteria and red complex to eliminate differences in quantities caused by specimen collection was included. The mean counts for the TB load and that of ten evaluated specimens corresponded to previously published results. We found a significant difference between the microbial compositions obtained from the area of control and the affected teeth (p < 0.05). Based on this comprehensive microbiological examination, the risk of dental caries or periodontal inflammation may be determined. The test could also be used as a tool for behavioral intervention and thus prevention of the above-mentioned diseases.
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15
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Mortazavian H, Picquet GA, Lejnieks J, Zaidel LA, Myers CP, Kuroda K. Understanding the Role of Shape and Composition of Star-Shaped Polymers and their Ability to Both Bind and Prevent Bacteria Attachment on Oral Relevant Surfaces. J Funct Biomater 2019; 10:E56. [PMID: 31861070 PMCID: PMC6963222 DOI: 10.3390/jfb10040056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 11/23/2022] Open
Abstract
In this study, we have prepared a series of 4- and 6-arm star-shaped polymers with varying molecular weight and hydrophobicity in order to provide insight into the role and relationship that shape and composition have on the binding and protecting of oral relevant surfaces (hydroxyapatite, HAP) from bacteria colonization. Star-shaped acrylic acid polymers were prepared by free-radical polymerization in the presence of chain transfer agents with thiol groups, and their binding to the HAP surfaces and subsequent bacteria repulsion was measured. We observed that binding was dependent on both polymer shape and hydrophobicity (star vs. linear), but their relative efficacy to reduce oral bacteria attachment from surfaces was dependent on their hydrophobicity only. We further measured the macroscopic effects of these materials to modify the mucin-coated HAP surfaces through contact angle experiments; the degree of angle change was dependent on the relative hydrophobicity of the materials suggesting future in vivo efficacy. The results from this study highlight that star-shaped polymers represent a new material platform for the development of dental applications to control bacterial adhesion which can lead to tooth decay, with various compositional and structural aspects of materials being vital to effectively design oral care products.
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Affiliation(s)
- Hamid Mortazavian
- Department of Biologic and Materials Sciences & Prosthodontics, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA; (H.M.); (J.L.)
| | - Guillaume A. Picquet
- Oral Care Early Research, Colgate-Palmolive Company, Piscataway, NJ 08855, USA; (G.A.P.); (L.A.Z.)
| | - Jānis Lejnieks
- Department of Biologic and Materials Sciences & Prosthodontics, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA; (H.M.); (J.L.)
| | - Lynette A. Zaidel
- Oral Care Early Research, Colgate-Palmolive Company, Piscataway, NJ 08855, USA; (G.A.P.); (L.A.Z.)
| | - Carl P. Myers
- Oral Care Early Research, Colgate-Palmolive Company, Piscataway, NJ 08855, USA; (G.A.P.); (L.A.Z.)
| | - Kenichi Kuroda
- Department of Biologic and Materials Sciences & Prosthodontics, School of Dentistry, University of Michigan, Ann Arbor, MI 48109, USA; (H.M.); (J.L.)
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16
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Özdoğan AI, İlarslan YD, Kösemehmetoğlu K, Akca G, Kutlu HB, Comerdov E, Iskit AB, Şenel S. In vivo evaluation of chitosan based local delivery systems for atorvastatin in treatment of periodontitis. Int J Pharm 2018; 550:470-476. [PMID: 30194012 DOI: 10.1016/j.ijpharm.2018.08.058] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 12/19/2022]
Abstract
Periodontitis is a local inflammatory disease initiated by bacteria accumulation and results in cytokine mediated alveolar bone resorption and tissue destruction. In this study, the effect of locally delivered atorvastatin (2% w/v) containing chitosan formulations in the treatment of periodontitis was evaluated in rats with ligature induced periodontitis. The levels of interleukin-1beta (IL-1β), IL-6, IL-8, IL-10, transforming growth factor-β1 (TGF-β1), TGF-β2 and TGF-β3 were measured after treatment with formulations. Histomorphometric analysis included the measurements of the area of alveolar bone and the distance between cemento-enamel junction (CEJ) and connective tissue attachment to tooth. Inflammatory and osteoclastic activity scores were given semiquantitatively. Following the administration of atorvastatin, release of pro-inflammatory (IL-1β, IL-6 and IL-8) and anti-inflammatory (TGF-β1 and TGF-β2) cytokines was found to decrease, with a significant alveolar bone healing, when compared to that of control. The anti-inflammatory effect was observed to enhance in presence of chitosan. These findings suggest that chitosan based delivery system for a statin group drug, atorvastatin is a promising for the treatment of periodontal disease.
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Affiliation(s)
- A Işılay Özdoğan
- Hacettepe University, Faculty of Pharmacy, Department of Pharmaceutical Technology, Ankara 06100, Turkey
| | - Yağmur D İlarslan
- Hacettepe University, Faculty of Dentistry, Department of Periodontology, Ankara 06100, Turkey
| | - Kemal Kösemehmetoğlu
- Hacettepe University, Faculty of Medicine, Department of Pathology, Ankara 06100, Turkey
| | - Gülçin Akca
- Gazi University, Faculty of Dentistry, Department of Medical Microbiology, Ankara 06510, Turkey
| | - H Burak Kutlu
- Hacettepe University, Faculty of Dentistry, Department of Periodontology, Ankara 06100, Turkey
| | - Elnur Comerdov
- Hacettepe University, Faculty of Dentistry, Department of Periodontology, Ankara 06100, Turkey
| | - Alper B Iskit
- Hacettepe University, Faculty of Medicine, Department of Medical Pharmacology, Ankara 06100, Turkey
| | - Sevda Şenel
- Hacettepe University, Faculty of Pharmacy, Department of Pharmaceutical Technology, Ankara 06100, Turkey.
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17
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Silver-Based Chemical Device as an Adjunct of Domestic Oral Hygiene: A Study on Periodontal Patients. MATERIALS 2018; 11:ma11081483. [PMID: 30127307 PMCID: PMC6120029 DOI: 10.3390/ma11081483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 12/13/2022]
Abstract
The use of chemical devices for periodontitis treatment has led to new strategies aiming primarily to control infections. Over the last few years, new chemical devices have been subjected to many scientific and medical studies. The purpose of the present study was to assess the effect of a new silver based chemical devices gel named "Hydrosilver Plus Gel", abbreviated here as Hydrosilver, on the pathogenic microorganisms, using Polymerase Chain Reaction (PCR) for microbiological analysis. Materials and methods: Ten patients with a diagnosis of chronic periodontitis in the age group >25 years were selected. None of these patients had received any surgical or non-surgical periodontal therapy, and demonstrated radiographic evidence of moderate bone loss. After scaling and root planning, patients received Hydrosilver to be used at home. Four non-adjacent sites in separate quadrants were selected in each patient for monitoring, based on criteria that the sites localise chronic periodontitis. Microbial analysis was analysed at baseline and at Day 15. SPSS program was used for statistical purposes and a paired samples correlation was performed at the end of the observation period. Results: Mean amounts of bacterial loading before and after Hydrosilver treatment reduced statistically significantly (p = 0.002). Conclusions: The present study demonstrated that Hydrosilver has a good impact on oral biofilm. Additional studies are needed to detect the efficacy of this chemical device.
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18
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Borisova D, Haladjova E, Kyulavska M, Petrov P, Pispas S, Stoitsova S, Paunova-Krasteva T. Application of cationic polymer micelles for the dispersal of bacterial biofilms. Eng Life Sci 2018; 18:943-948. [PMID: 32624888 DOI: 10.1002/elsc.201800040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/26/2018] [Accepted: 05/17/2018] [Indexed: 12/16/2022] Open
Abstract
Contamination of surfaces in hospitals and food industry by bacterial biofilms is a serious health risk. Of concern is their resistance to routine antibacterials and disinfectants. This requires the development of novel approaches to biofilm detachment. The study evaluates the effectiveness of cationic polymer micelles (CPMs) against pre-formed biofilms. CPMs based on different polycations were used. The hydrodynamic radius of the particles ranged from 16 to 360 nm. Biofilms of Escherichia coli 420, Pseudomonas aeruginosa PAO1, Staphylococcus aureus 29213 and Bacillus subtilis 168 were cultivated for 24 h then the pre-formed biofilms were treated with the CPMs for 2, 4 or 6 h. Biofilm biomass was evaluated by the crystal violet assay, and live/dead fluorescence test was applied for bacterial viability. The ability of CPMs to interact with pre-formed biofilms of the model strains was evaluated. We observed that the most effective CPMs were those based on poly(2-(dimethylamino)ethyl methacrylate) copolymers which reduced the biofilm biomass three- to four-fold compared with the treatment of the biofilm with water. Significantly reduced vitality of the bacteria in the biofilms was registered by the live/dead stain. The results indicate the applicability of the CPMs for disinfection of biofilm-contaminated surfaces and the treatment of wounds.
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Affiliation(s)
- Dayana Borisova
- The Stephan Angeloff Institute of Microbiology Bulgarian Academy of Science Sofia Bulgaria
| | - Emi Haladjova
- Institute of Polymers Bulgarian Academy of Sciences Sofia Bulgaria
| | - Mariya Kyulavska
- Institute of Polymers Bulgarian Academy of Sciences Sofia Bulgaria
| | - Petar Petrov
- Institute of Polymers Bulgarian Academy of Sciences Sofia Bulgaria
| | - Stergios Pispas
- Theoretical and Physical Chemistry Institute National Hellenic Research Foundation Athens Greece
| | - Stoyanka Stoitsova
- The Stephan Angeloff Institute of Microbiology Bulgarian Academy of Science Sofia Bulgaria
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19
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Zhao KQ, Wu Y, Yi YX, Feng SJ, Wei RY, Ma Y, Zheng CQ, Qu D. An In Vitro Model to Study the Effect of 5-Aminolevulinic Acid-mediated Photodynamic Therapy on Staphylococcus aureus Biofilm. J Vis Exp 2018. [PMID: 29708549 DOI: 10.3791/57604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Staphylococcus aureus (S. aureus) is a common human pathogen, which causes pyogenic and systemic infections. S. aureus infections are difficult to eradicate not only due to the emergence of antibiotic-resistant strains but also its ability to form biofilms. Recently, photodynamic therapy (PDT) has been indicated as one of the potential treatments for controlling biofilm infections. However, further studies are required to improve our knowledge of its effect on bacterial biofilms, as well as the underlying mechanisms. This manuscript describes an in vitro model of PDT with 5-aminolevulinic acid (5-ALA), a precursor of the actual photosensitizer, protoporphyrin IX (PpIX). Briefly, mature S. aureus biofilms were incubated with ALA and then exposed to light. Subsequently, the antibacterial effect of ALA-PDT on S. aureus biofilm was quantified by calculating the colony forming units (CFUs) and visualized by viability fluorescent staining via confocal laser scanning microscopy (CLSM). Representative results demonstrated a strong antibacterial effect of ALA-PDT on S. aureus biofilms. This protocol is simple and can be used to develop an in vitro model to study the treatment of S. aureus biofilms with ALA-PDT. In the future, it could also be referenced in PDT studies utilizing other photosensitizers for different bacterial strains with minimal adjustments.
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Affiliation(s)
- Ke-Qing Zhao
- Department of Otorhinolaryngology-Head and Neck Surgery, Eye & ENT Hospital, Shanghai Key Clinical Disciplines of otorhinolaryngology, Fudan University;
| | - Yang Wu
- Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Department of Medical Microbiology and Parasitology, School of Basic Medical Science, Shanghai Medical College of Fudan University
| | - Yu-Xi Yi
- Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Department of Medical Microbiology and Parasitology, School of Basic Medical Science, Shanghai Medical College of Fudan University
| | - Si-Jia Feng
- Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Department of Medical Microbiology and Parasitology, School of Basic Medical Science, Shanghai Medical College of Fudan University
| | - Ruo-Yan Wei
- Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Department of Medical Microbiology and Parasitology, School of Basic Medical Science, Shanghai Medical College of Fudan University
| | - Ying Ma
- Department of Dermatology, Huashan Hospital, Fudan University
| | - Chun-Quan Zheng
- Department of Otorhinolaryngology-Head and Neck Surgery, Eye & ENT Hospital, Shanghai Key Clinical Disciplines of otorhinolaryngology, Fudan University
| | - Di Qu
- Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Department of Medical Microbiology and Parasitology, School of Basic Medical Science, Shanghai Medical College of Fudan University
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20
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Wei Y, Chang YH, Liu CJ, Chung RJ. Integrated Oxidized-Hyaluronic Acid/Collagen Hydrogel with β-TCP Using Proanthocyanidins as a Crosslinker for Drug Delivery. Pharmaceutics 2018; 10:E37. [PMID: 29561754 PMCID: PMC6030783 DOI: 10.3390/pharmaceutics10020037] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 02/07/2023] Open
Abstract
The susceptibility of guided bone regeneration (GBR) material to infection by pathogens at wound sites during bone healing has often been overlooked. The objective of this study was the synthesis and characterization of a potential material for antibacterial GBR application. In the current study, the mechanical strength and biocompatibility of a composite restoration material-made of oxidized hyaluronic acid (HA)/type I collagen hydrogel integrated with tricalcium phosphate (β-TCP) using a natural crosslinking agent, oligomeric proanthocyanidins (OPCs)-were evaluated. The suitability of the material as a carrier matrix for antibacterial applications was evaluated by following the drug-release profile of tetracycline loaded within the composite. Results indicated that this composite material had a high swelling ratio of 420% and mechanical strength of 25 kPa while remaining at more than 60% of the weight after 30 days of an in vitro degradation test with good biocompatibility in promoting the proliferation of MG-63 cells. Drug release studies further showed that 93% of the tetracycline was released after 5 days, which supports this GBR material's capability to release antibacterial drugs while keeping other required GBR material design functions.
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Affiliation(s)
- Yang Wei
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 106, Taiwan.
| | - Yu-Han Chang
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linko 244, Taiwan.
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linko 244, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
| | - Chung-Jui Liu
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 106, Taiwan.
| | - Ren-Jei Chung
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 106, Taiwan.
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