Enterococcus faecalis Adhesin, Ace, Mediates Attachment to Particulate Dentin

Enterococcus faecalis in secondary apical periodontitis: Mechanisms of bacterial survival and disease persistence

Enterococcus faecalis is a commensal bacterium commonly found in the human gastrointestinal tract. However, in individuals with compromised immune systems, the pathogen can lead to severe illness. This opportunistic pathogen is associated with secondary apical diseases and is adept at resisting antibiotics and other forms of treatment because of its numerous virulence factors. Enterococcus faecalis is capable of disrupting the normal functions of immune cells, thereby hindering the body's ability to eradicate the infection. However, intensive research is needed in further understanding the adverse immunomodulatory effects of E. faecalis. Potential strategies specific for eradicating E. faecalis have proven beneficial in the treatment of persistent secondary apical periodontitis.

Efficacy of Calcium Hydroxide/Saline versus Calcium Hydroxide/Artemisia persica Essential Oil as Intracanal Medicament to Improve Radiographic Visualization of Periapical Lesions in Necrotic Teeth: A Randomized Clinical Trial

Objectives

This study aimed to compare the efficacy of calcium hydroxide (CH)/saline and CH/Artemisia persica (A. persica) essential oil as an intracanal medicament for radiographic resolution of periapical (PA) lesions in necrotic teeth.

Materials and Methods

This randomized clinical trial was conducted on 22 patients with necrotic teeth and PA lesions presenting to two private endodontic offices. The patients were randomly divided into two groups (n = 11) to receive CH/saline (control group) and CH/A. persica essential oil (10%) (intervention group) as intracanal medicaments between treatment sessions. The size of PA radiolucency was measured on parallel PA radiographs taken before treatment and also at 1 and 3 months after completion of treatment. The mean time of healing of PA lesions was also compared between the two groups. Data were analyzed by the independent t-test, chi-square test, and Fisher's exact test (alpha = 0.05).

Results

No significant difference was found between the two groups regarding the changes in the size of PA lesions, relative healing percentage, and speed of healing, neither at 1 nor at 3 months postoperatively (P > 0.05). Regarding the presence/absence of clinical symptoms in the second treatment session, the intervention group showed greater resolution of symptoms, although the difference did not reach statistical significance (P > 0.05).

Conclusion

According to the present results, it appears that the addition of A. persica essential oil to CH for application as intracanal medicament does not add any particular advantage.

In Vivo Role of Two-Component Regulatory Systems in Models of Urinary Tract Infections

Two-component signaling systems (TCSs) are finely regulated mechanisms by which bacteria adapt to environmental conditions by modifying the expression of target genes. In bacterial pathogenesis, TCSs play important roles in modulating adhesion to mucosal surfaces, resistance to antibiotics, and metabolic adaptation. In the context of urinary tract infections (UTI), one of the most common types infections causing significant health problems worldwide, uropathogens use TCSs for adaptation, survival, and establishment of pathogenicity. For example, uropathogens can exploit TCSs to survive inside bladder epithelial cells, sense osmolar variations in urine, promote their ascension along the urinary tract or even produce lytic enzymes resulting in exfoliation of the urothelium. Despite the usefulness of studying the function of TCSs in in vitro experimental models, it is of primary necessity to study bacterial gene regulation also in the context of host niches, each displaying its own biological, chemical, and physical features. In light of this, the aim of this review is to provide a concise description of several bacterial TCSs, whose activity has been described in mouse models of UTI.

Enterococcus Virulence and Resistant Traits Associated with Its Permanence in the Hospital Environment

Enterococcus are opportunistic pathogens that have been gaining importance in the clinical setting, especially in terms of hospital-acquired infections. This problem has mainly been associated with the fact that these bacteria are able to present intrinsic and extrinsic resistance to different classes of antibiotics, with a great deal of importance being attributed to vancomycin-resistant enterococci. However, other aspects, such as the expression of different virulence factors including biofilm-forming ability, and its capacity of trading genetic information, makes this bacterial genus more capable of surviving harsh environmental conditions. All these characteristics, associated with some reports of decreased susceptibility to some biocides, all described in this literary review, allow enterococci to present a longer survival ability in the hospital environment, consequently giving them more opportunities to disseminate in these settings and be responsible for difficult-to-treat infections.

Prevalence and conservation of ebp genes in Enterococcus faecalis originated from animals

AIMS

The study aimed to investigate the prevalence and conservation of endocarditis and biofilm-associated pili (ebp) genes in Enterococcus faecalis originated from animals and the potential of developing Ebp into serological diagnostic and vaccine targets.

METHODS AND RESULTS

In this work, we investigated the prevalence and conservation of ebp genes in 116 strains of E. faecalis originated from animals by using PCR and sequencing methods. The results demonstrated the presence of ebp genes (ebpA, ebpB and ebpC) in all 116 strains of E. faecalis, and their amino acid homology ranges from 96.6% to 100.0%. Moreover, the phylogenetic analysis of ebp genes in all 164 E. faecalis strains (including 48 reference strains) revealed that ebp genes show no significant correlation with species origins and regions of E. faecalis, indicating that ebp genes are conserved features in E. faecalis, even though it evolved under environmental pressures from various regions and origins. Given that EbpA1 as a part of the adhesion protein EbpA has immunogenicity, we further determined whether amino acid mutations have effects on the function and 3D structure of EbpA1. The results showed that two of the 26 mutations, at amino acids positions 178 and 387, had deleterious effects on the biological function of EbpA1 protein, while all mutations had no effect on the 3D structure or binding pockets of EbpA1 protein.

CONCLUSIONS

This study suggests that ebp genes are prevalent and conserved in E. faecalis originated from diverse animal origins and regions. EbpA1 could be a potential target for serological diagnosis and vaccine development to prevent E. faecalis infection.

SIGNIFICANCE AND IMPACT OF STUDY

The current study provides data to support further research on Ebp as a serological diagnostic and vaccine target against E. faecalis infection.

Retrospective Study on Tooth Shell Technique Using Endodontically Treated Teeth in Lateral Ridge Augmentation

Autogenous dentin has been reported to be a suitable grafting material for certain indications. The purpose of this study was to assess the feasibility of using endodontically treated teeth for this application. In the present retrospective study, one-stage augmentation of lateral ridge defects with a dentin shell and particulate (tooth shell technique (TST)) either obtained from endodontically treated teeth (ETT, 17 patients with 21 implants) or non-endodontically treated teeth (NETT, 17 patients with 24 implants) were analyzed. Follow-up was conducted 3 months after augmentation. The target parameters were biological complications, horizontal hard tissue loss, osseointegration, and the integrity of the buccal lamella. Only minor complications occurred in three implants from three patients, including two cases of wound dehiscence (one each in ETT and NETT) and a localized three-walled defect in the NETT group, which was solved by re-augmentation. All the implants were osseointegrated and the integrity of the buccal lamella was preserved. The mean difference of the resorption of the crestal width and the buccal lamella did not differ statistically between the two groups. As TST using ETT showed, the results comparable to those of NETT dentin from endodontically treated teeth can be safely applied with predictable results for this grafting technique.

Homeopathic consideration for resistant endodontic bacteria Enterococcus faecalis: An in vitro comparative disc diffusion study

Background:

Homeopathy is one of the commonly used systems of complementary or alternative medicine. The present study was conducted with an aim to compare the antibacterial efficacy of two commonly used homeopathic medicaments acid benzoicum 30C (SBL Pvt Ltd) and silicea 6C (SBL Pvt Ltd) with that of calcium hydroxide (Deepti Ltd) as intracanal medicament against Enterococcus faecalis (ATCC-29212).

Materials and Methods:

The test organism used for the study was E. faecalis. Petri plates with 20 ml of sheep blood agar were inoculated with 0.1 ml of the microbial suspensions. The medicaments to be tested for antimicrobial efficacy against E. faecalis were divided into three groups: Group A (acid benzoicum), Group B (silicea), and Group C (calcium hydroxide). The antimicrobial activity of each medicament was measured and expressed in terms of the mean of the diameter of zone of inhibition (in mm) produced by each extract at the end of the incubation period. ANOVA and Tukey's honestly-significant difference posthoc test were used for the intergroup comparison. P < 0.05 was considered statistically significant.

Results:

Group A (acid benzoicum) showed the maximum zone of inhibition against Gram-positive E. faecalis (17.2 ± 0.65), and the difference between the groups related to the antibacterial activity was highly significant (P < 0.001). A statistically significant difference was observed between the three groups on the intergroup comparison (P < 0.001).

Conclusion:

In the present in vitro study, antimicrobial activity of the acid benzoicum extract was the highest followed by silicea extract and then calcium hydroxide.

The enterococcal PASTA kinase: A sentinel for cell envelope stress

Enterococci are Gram-positive, opportunistic pathogens that reside throughout the gastrointestinal tracts of most terrestrial organisms. Enterococci are resistant to many antibiotics, which makes enterococcal infections difficult to treat. Enterococci are also particularly hardy bacteria that can tolerate a variety of environmental stressors. Understanding how enterococci sense and respond to the extracellular environment to enact adaptive biological responses may identify new targets that can be exploited for development of treatments for enterococcal infections. Bacterial eukaryotic-like serine/threonine kinases (eSTKs) and cognate phosphatases (STPs) are important signaling systems that mediate biological responses to extracellular stimuli. Some bacterial eSTKs are transmembrane proteins that contain a series of extracellular repeats of the penicillin-binding and Ser/Thr kinase-associated (PASTA) domain, leading to their designation as "PASTA kinases." Enterococcal genomes encode a single PASTA kinase and its cognate phosphatase. Investigations of the enterococcal PASTA kinase revealed its importance in resistance to antibiotics and other cell wall stresses, in enterococcal colonization of the mammalian gut, clues about its mechanism of signal transduction, and its integration with other enterococcal signal transduction systems. In this review, we describe the current state of knowledge of PASTA kinase signaling in enterococci and describe important gaps that still need to be addressed to provide a better understanding of this important signaling system.

Influence of Endodontic Procedure on the Adherence of Enterococcus faecalis

INTRODUCTION

The purpose of this study was to investigate the effects of instrumentation and irrigation on the initial adherence of Enterococcus faecalis to root canal dentin and to explore initial microbial adhesion to root filling materials.

METHODS

The following specimens were prepared: instrumented and uninstrumented dentin, dentin treated with different irrigation protocols, and root filling materials. The number of E. faecalis cells adhered on dentin was measured. The adhesion force of E. faecalis cells on different materials and the roughness of different surfaces were measured. The contact angle of the surfaces was recorded. The results were analyzed using the t test.

RESULTS

Instrumented dentin specimens had a significantly higher amount of E. faecalis adherence than uninstrumented dentin. There were higher numbers of adhering bacteria on the dentin when EDTA was used alone (P < .05) compared with other irrigants alone. The use of chlorhexidine (CHX) as the last irrigant for a certain time resulted in a reduced number of adhering bacteria when the specimens were first exposed to sodium hypochlorite (NaOCl) followed by EDTA. EDTA used alone had the highest adhesion force followed by NaOCl alone and CHX alone (P < .05). Dentin treated with EDTA alone had the highest roughness and contact angle followed by NaOCl alone and CHX alone (P < .05). CHX added as the final irrigant after NaOCl with EDTA irrigation reduced the contact angle (P < .05). Larger amounts of adhering bacteria and higher adhesion force were detected on the surface of gutta-percha and sealer than on the dentin surface (P < .05).

CONCLUSIONS

Instrumentation and irrigation alter the initial adherence of E. faecalis to root canal dentin and the surface properties of the dentin as well.

Anti-Ace monoclonal antibody reduces Enterococcus faecalis aortic valve infection in a rat infective endocarditis model

Ace (Adhesin to collagen from Enterococcus faecalis) is a cell-wall anchored protein that is expressed conditionally and is important for virulence in a rat infective endocarditis (IE) model. Previously, we showed that rats immunized with the collagen binding domain of Ace (domain A), or administered anti-Ace domain A polyclonal antibody, were less susceptible to E. faecalis endocarditis than sham-immunized controls. In this work, we demonstrated that a sub nanomolar monoclonal antibody (mAb), anti-Ace mAb70, significantly diminished E. faecalis binding to ECM collagen IV in in vitro adherence assays and that, in the endocarditis model, anti-Ace mAb70 pre-treatment significantly reduced E. faecalis infection of aortic valves. The effectiveness of anti-Ace mAb against IE in the rat model suggests it might serve as a beneficial agent for passive protection against E. faecalis infections.

The effect of gelatinase production of Enterococcus faecalis on adhesion to dentin after irrigation with various endodontic irrigants

Objectives: The aim of this study was to evaluate whether the gelatinase production ability of Enterococcus faecalis provides any advantage on adhesion of this bacterium to dentin treated with various irrigants and their combinations.

Materials and methods: Standardized dentin discs were randomly divided into five groups (n = 20): group 1: 2.5% sodium hypochlorite (NaOCl), group 2: 2% chlorhexidine (CHX), group 3: NaOCl + Saline + CHX, group 4: NaOCl + EDTA + NaOCl, group 5: QMix. After incubation of dentin discs with irrigants, each group was divided into two subgroups (n = 10) according to the bacterial strains used; a gelatinase-producing and a gelatinase-deficient strain of E. faecalis. After incubation of the discs with the bacterial suspensions aerobically for 48 h, XTT assay was conducted for bacterial adherence evaluation. Data were statistically analyzed by ANOVA and Tukey’s HSD tests (p = .05).

Results: Gelatinase-producing E. faecalis adhered to dentin was significantly more than gelatinase-deficient E. faecalis in all test groups (p < .05). Adherence to CHX-treated dentin was lower than to the surfaces treated with other irrigants, alone or in combination (p < .05). These differences were significant except for comparisons with QMix for gelatinase-producing bacteria (p < .05).

Conclusions: Gelatinase production of E. faecalis may be an important factor for bacterial adhesion. The addition of CHX to the irrigation regimen resulted in fewer adhered bacteria to dentin. QMix was not as effective as CHX in terms of bacterial adhesion prevention.

The Effect of Diode Laser on Planktonic Enterococcus faecalis in Infected Root Canals in an Ex Vivo Model

OBJECTIVE

This study examined the bactericidal effect of diode laser irradiation against intracanal Enterococcus faecalis.

METHODS AND MATERIALS

m total of 128 extracted single-rooted and single-canal teeth were treated with ProTaper instruments (Dentsply Maillefer, Ballaigues, Switzerland). A total of 120 root canals were inoculated with E. faecalis for 21 days, and the samples were randomly divided into five groups: Group 1 (n = 24) samples were irrigated with only saline solution (positive controls); Group 2 (n = 24) was treated with only 5.25% sodium hypochlorite; Group 3 (n = 24) was irrigated with saline solutions activated by diode laser; Group 4 (n = 24) was treated with 5.25% sodium hypochlorite activated by diode laser; and Group 5 (n = 24) was irrigated with saline solution with methylene blue dye activated by the diode laser Fox (Sweden & Martina, Padova, Italy); additionally, eight teeth were not contaminated and their canals were irrigated with saline solution and used as a negative control. The Uro-Quick system was used to determine the microbial residual charge. The data were analyzed using Pearson's chi-square test (p < 0.001).

RESULTS

A statistically significant reduction in bacterial count was observed in Group 2 and Group 4 (p < 0.001). There were no statistically significant differences among the other groups (p > 0.001).

CONCLUSIONS

Evidence indicates that the diode laser was not more effective than sodium hypochlorite in reducing free bacteria.

The two-component system GrvRS (EtaRS) regulates ace expression in Enterococcus faecalis OG1RF

Expression of ace (adhesin to collagen of Enterococcus faecalis), encoding a virulence factor in endocarditis and urinary tract infection models, has been shown to increase under certain conditions, such as in the presence of serum, bile salts, urine, and collagen and at 46 °C. However, the mechanism of ace/Ace regulation under different conditions is still unknown. In this study, we identified a two-component regulatory system GrvRS as the main regulator of ace expression under these stress conditions. Using Northern hybridization and β-galactosidase assays of an ace promoter-lacZ fusion, we found transcription of ace to be virtually absent in a grvR deletion mutant under the conditions that increase ace expression in wild-type OG1RF and in the complemented strain. Moreover, a grvR mutant revealed decreased collagen binding and biofilm formation as well as attenuation in a murine urinary tract infection model. Here we show that GrvR plays a major role in control of ace expression and E. faecalis virulence.

Etidronate from medicine to endodontics: effects of different irrigation regimes on root dentin roughness

An increase in dentin roughness, associated with surface composition, contributes to bacterial adherence in recontaminations. Surface roughness is also important for micromechanical interlocking of dental materials to dentin, and understanding the characteristics of the surface is essential to obtain the adhesion of root canal sealers that have different physico-chemical characteristics.

OBJECTIVES

To evaluate the effects of sodium hypochlorite (NaOCl), ethylenediaminetetraacetic (EDTA), etidronic (HEBP), and citric acid (CA) associated with different irrigation regimens on root dentin roughness.

MATERIAL AND METHODS

Forty-five root halves of anterior teeth were used. The root parts were sectioned in thirds, embedded in acrylic resin and polished to a standard surface roughness. Initially, the samples of each third were randomly assigned into 3 groups and treated as follows: G1 - saline solution (control); G2 - 5% NaOCl+18% HEBP mixed in equal parts; and G3 - 2.5% NaOCl. After initial measuments, the G3 samples were distributed into subgroups G4, G5 and G6, which were subjected to 17% EDTA, 10% CA and 9% HEBP, respectively. Following the new measuments, these groups received a final flush with 2.5% NaOCl, producing G7, G8 and G9. The dentin surface roughness (Ra) was determined before and after treatments using a profilometer. The Wilcoxon test (α<0.05) was used to compare the values before and after treatments, and the Friedman test (α<0.05) to detect any differences among root thirds.

RESULTS

(i) NaOCl did not affect the surface roughness; (ii) there was a significant increase in roughness after the use of chelating agents (P<0.01); and (iii) only the G3 group showed a difference in surface roughness between apical third and other thirds of the teeth (P<0.0043).

CONCLUSION

Only the irrigation regimens that used chelating agents altered the roughness of root dentin.

Effectiveness of curcumin against Enterococcus faecalis biofilm

OBJECTIVES

To evaluate the antimicrobial efficacy of curcumin against Enterococcus faecalis biofilm formed on tooth substrate in vitro. Sodium hypochlorite (NaOCl) and chlorhexidine (CHX) served as standards for comparison.

MATERIALS AND METHODS

Biofilms of E.faecalis were formed on instrumented, extracted human teeth (n = 96). At the end of the 2nd day, 2nd and 8th weeks, specimens were treated for 30 min with one of the test solutions or saline (control) and the surviving colony-forming units (CFU/mL) was recorded. Results were analyzed by Kruskal-Wallis test and Dunnet test for pair-wise comparison with Bonferroni correction (p = 0.05).

RESULTS

Only NaOCl showed complete eradication of bacteria at all time periods. In the 2-day and 2nd week biofilms, curcumin and NaOCl showed complete inhibition, which was significantly lower than the CFU recovered in the CHX and saline groups (p < 0.05). In 8 week biofilms, samples treated with curcumin showed 553 ± 137.6 CFU/mL, which was significantly higher than NaOCl (0 CFU/mL), but significantly lower than CHX (2551 ± 129.8) and saline control (1.42 × 1011 ± 2.12 × 1010; p < 0.05).

CONCLUSIONS

Sodium hypochlorite (3%) showed maximum antibacterial activity against E.faecalis biofilm formed on the tooth substrate, followed by curcumin and CHX. Considering the potential for undesirable properties of NaOCl, the use of herbal alternatives in endodontics might prove to be advantageous.

A new weak chelator in endodontics: effects of different irrigation regimens with etidronate on root dentin microhardness

This study investigated the effect of sodium hypochlorite (NaOCl), ethylenediaminetetraacetic (EDTA), etidronic (HEBP), and citric acid (CA) associated in different irrigation regimens on root dentin microhardness. Forty-five root halves of single-rooted teeth were sectioned into thirds that were embedded in acrylic resin, polished, randomly assigned into 3 groups, and treated as follows: G1: saline solution; G2: 5% NaOCl + 18% HEBP, mixed in equal parts; and G3: 2.5% NaOCl. After measurements, the G3 samples were distributed into subgroups G4, G5, and G6, which were submitted to 17% EDTA, 10% CA and 9% HEBP, respectively. Following the new measurements, these groups received a final flush with 2.5% NaOCl, producing G7, G8, and G9. Microhardness was measured with Knoop indenter under a 25 g load for 15 seconds, before and after treatments. The data were statistically analyzed using paired Student's t-test (α<0.05) to compare values before and after treatments and analysis of variance (ANOVA) (α<0.05) to detect any differences among thirds. Except G1, all tested irrigation regimens significantly decreased the microhardness. There were no differences between root thirds before treatments, and all root thirds exhibited equal responses to same treatment. Except saline, all tested irrigation regimens reduced the root dentin microhardness.

Streptococcus gordonii collagen-binding domain protein CbdA may enhance bacterial survival in instrumented root canals ex vivo

INTRODUCTION

The surface-associated collagen-binding protein Ace of Enterococcus faecalis has been implicated as a virulence factor that contributes to bacterial persistence in endodontic infections. The purpose of this study was to determine if proteins with amino acid sequence similarity to Ace found in more abundant oral streptococci could play a similar role in potentially enhancing endodontic infections.

METHODS

A Streptococcus gordonii gene similar to ace was identified by genome sequence searches in silico. An isogenic derivative of strain DL1 with a disruption in the identified gene was constructed by allelic replacement. Parent and mutant strains were characterized for their ability to bind immobilized collagen type 1 in a microtiter plate-binding assay. Survival of the strains in a human tooth ex vivo-instrumented root canal model was compared by inoculating canals with parental or mutant bacteria and determining the colony-forming units (CFUs) recovered at various time points over a 12-day period.

RESULTS

The S. gordonii gene, encoding a protein with a conserved collagen-binding domain similar to that of Ace, was designated cbdA. The cbdA-deficient cells were less able to bind collagen type 1 than parental cells (P < .0001). Genetic complementation of the cbdA-deficient strain restored the collagen-binding phenotype. By day 12, significantly fewer (P = .03) cbdA-deficient than parental CFUs were recovered from instrumented canals.

CONCLUSIONS

A gene encoding a putative collagen-binding protein was identified in S. gordonii. Fewer S. gordonii cbdA-deficient cells survived ex vivo compared with parental cells, suggesting that collagen-binding proteins may contribute to the persistence of oral streptococci in instrumented root canals.

Pathogenesis and immunity in enterococcal infections

Enterococcus faecalis and Enterococcus faecium have emerged as multi-resistant nosocomial pathogens in immunocompromised and critically ill patients. Multi-resistant strains have acquired virulence genes resulting in hospital-adapted clones. The following review summarizes several proteins and carbohydrate- or glycoconjugates that have been identified as putative virulence factors involved in the pathogenesis of enterococcal infections and may be used as targets for alternative therapies. Several studies describing the host immune response against enterococci are also summarized.

Comparative genomic analysis reveals significant enrichment of mobile genetic elements and genes encoding surface structure-proteins in hospital-associated clonal complex 2 Enterococcus faecalis

Background

Enterococci rank among the leading causes of nosocomial infections. The failure to identify pathogen-specific genes in Enterococcus faecalis has led to a hypothesis where the virulence of different strains may be linked to strain-specific genes, and where the combined endeavor of the different gene-sets result in the ability to cause infection. Population structure studies by multilocus sequence typing have defined distinct clonal complexes (CC) of E. faecalis enriched in hospitalized patients (CC2, CC9, CC28 and CC40).

Results

In the present study, we have used a comparative genomic approach to investigate gene content in 63 E. faecalis strains, with a special focus on CC2. Statistical analysis using Fisher's exact test revealed 252 significantly enriched genes among CC2-strains. The majority of these genes were located within the previously defined mobile elements phage03 (n = 51), efaB5 (n = 34) and a vanB associated genomic island (n = 55). Moreover, a CC2-enriched genomic islet (EF3217 to -27), encoding a putative phage related element within the V583 genome, was identified. From the draft genomes of CC2-strains HH22 and TX0104, we also identified a CC2-enriched non-V583 locus associated with the E. faecalis pathogenicity island (PAI). Interestingly, surface related structures (including MSCRAMMs, internalin-like and WxL protein-coding genes) implicated in virulence were significantly overrepresented (9.1%; p = 0.036, Fisher's exact test) among the CC2-enriched genes.

Conclusion

In conclusion, we have identified a set of genes with potential roles in adaptation or persistence in the hospital environment, and that might contribute to the ability of CC2 E. faecalis isolates to cause disease.

Importance of the collagen adhesin ace in pathogenesis and protection against Enterococcus faecalis experimental endocarditis

Ace is an adhesin to collagen from Enterococcus faecalis expressed conditionally after growth in serum or in the presence of collagen. Here, we generated an ace deletion mutant and showed that it was significantly attenuated versus wild-type OG1RF in a mixed infection rat endocarditis model (P<0.0001), while no differences were observed in a peritonitis model. Complemented OG1RFΔace (pAT392::ace) enhanced early (4 h) heart valve colonization versus OG1RFΔace (pAT392) (P = 0.0418), suggesting that Ace expression is important for early attachment. By flow cytometry using specific anti-recombinant Ace (rAce) immunoglobulins (Igs), we showed in vivo expression of Ace by OG1RF cells obtained directly from infected vegetations, consistent with our previous finding of anti-Ace antibodies in E. faecalis endocarditis patient sera. Finally, rats actively immunized against rAce were less susceptible to infection by OG1RF than non-immunized (P = 0.0004) or sham-immunized (P = 0.0475) by CFU counts. Similarly, animals given specific anti-rAce Igs were less likely to develop E. faecalis endocarditis (P = 0.0001) and showed fewer CFU in vegetations (P = 0.0146). In conclusion, we have shown for the first time that Ace is involved in pathogenesis of, and is useful for protection against, E. faecalis experimental endocarditis.

Enterococcus faecalis was recognized as a common cause of infective endocarditis (IE) by the early 1900s. It is still third in community-onset IE, but is the second most common cause of hospital-associated IE. Complications due to E. faecalis IE include congestive heart failure, septic emboli and death and current management involves a combination of antimicrobials, often with surgery. Emergence of antimicrobial resistance has created the need for alternative strategies (such as immunoprophylaxis) that target in vivo expressed virulence-associated surface proteins. One such E. faecalis protein is Ace, which is antigenic during human IE and mediates attachment of E. faecalis cells to host extracellular matrix proteins collagen and laminin. Using a rat model, we now show that ace contributes to E. faecalis IE pathogenesis and demonstrate that Ace is expressed at high levels during IE even though produced at low levels under laboratory conditions; both active and passive immunization based on the collagen-binding domain of Ace conferred significant protection against IE. These observations, along with data that human antibodies against Ace inhibit collagen adherence of E. faecalis, indicate that Ace is an important virulence-associated factor and a promising target for prophylactic and possibly therapeutic strategies against E. faecalis IE.

LPxTG surface proteins of enterococci

Enterococci have become an important cause of nosocomial infections since the late 1980s. Several surface proteins have been implicated in contributing to infections caused by Enterococcus faecalis and Enterococcus faecium. Understanding the in vivo function of enterococcal surface proteins, particularly their role in directing interactions with the host during infection, is essential to explain the success of enterococci as nosocomial pathogens. Here we review current knowledge of enterococcal LPxTG surface proteins, including aggregation substance, enterococcal surface protein, three collagen-binding microbial surface components that recognize adhesive matrix molecules (Ace, Acm, Scm) and pili (Ebp, PilA and PilB), their interactions with host molecules and their role in pathogenicity and biofilm development.

A model system to study antimicrobial strategies in endodontic biofilms

The purpose of this work was to develop a model system to study antimicrobial strategies in endodontic biofilms. Enterococcus faecalis suspension was colonized in 10 human root canals. Five milliliters of Brain Heart Infusion (BHI) were mixed with 5 mL of the bacterial inoculums (E. faecalis) and inoculated with sufficient volume to fill the root canal during 60 days. This procedure was repeated every 72 h, always using 24-h pure culture prepared and adjusted to No. 1 MacFarland turbidity standard. Biofilm formation was analyzed by scanning electron microscopy (SEM). E. faecalis consistently adhered to collagen structure, colonized dentin surface, progressed towards the dentinal tubules and formed a biofilm. The proposed biofilm model seems to be viable for studies on antimicrobial strategies, and allows for a satisfactory colonization time of selected bacterial species with virulence and adherence properties.

Possible role of the adhesin ace and collagen adherence in conveying resistance to disinfectants on Enterococcus faecalis

INTRODUCTION

This study aimed to evaluate whether the presence of the ace gene and Ace-mediated binding to collagen confers on Enterococcus faecalis resistance against common endodontic disinfectants.

METHODS

Isogenic strains of E. faecalis: OG1RF (wild-type) and TX5256 (ace insertion mutant of OG1RF) were grown in brain-heart infusion broth at 46 degrees C overnight. Standardized bacterial suspensions were pretreated for 1 h either with acid-soluble collagen or acidified phosphate-buffered saline (ac-PBS). Bacteria were challenged with chlorhexidine digluconate (CHX), iodine potassium-iodide (IKI), sodium hypochlorite (NaOCl), and calcium hydroxide [Ca(OH)(2)]. Samples were removed at 1, 3, and 6 h, and cultured on Todd-Hewitt agar plates. Colonies were counted, the absolute values were log transformed, and the data were statistically analyzed using Fisher's least significant differences test and t-test.

RESULTS

OG1RF was more resistant than TX5256 to IKI, NaOCl, and Ca(OH)(2) (P < 0.05). Collagen-exposed OG1RF was more resistant than the ac-PBS-pretreated OG1RF against CHX at 3 h and against IKI at 1 h (P < 0.05); no significant difference was found against NaOCl. As expected, the ace mutant strain, TX5256, pretreated with collagen or ac-PBS did not differ significantly in viability when challenged with CHX, IKI, and NaOCl. An unexpected result was found for Ca(OH)(2): collagen-pretreated OG1RF and TX5256 were both more susceptible than ac-PBS-pretreated OG1RF and TX5256, respectively (P < 0.05).

CONCLUSION

The presence of the ace gene confers resistance against IKI, NaOCl, and Ca(OH)(2) on E. faecalis. Exposure to collagen makes the wild-type bacterium more resistant against CHX and IKI; however, exposure to collagen apparently decreases resistance to Ca(OH)(2).

The resistance of collagen-associated, planktonic cells of Enterococcus faecalis to calcium hydroxide

This study examined whether collagen association by an endodontic isolate of Enterococcus faecalis conferred resistance to the bacterium against calcium hydroxide. E. faecalis A197A was grown at 46 degrees C until early stationary phase. Standardized bacterial suspensions were pretreated for 1 hour either with acid-soluble collagen or acidified phosphate-buffered saline (ac-PBS) and cultured to determine the baseline viable bacterial numbers. The bacterial suspensions were challenged with calcium hydroxide solution. Samples were removed at 6, 12, and 24 hours and cultured on tryptone soy agar plates. An adherence assay was performed to confirm that the collagen in the pretreatment medium was bound by the bacteria. Significantly more bacteria were cultivated at 12 hours in the collagen-pretreated group than the ac-PBS-pretreated group (p < 0.01). No bacteria could be cultivated at 24 hours in either group. Collagen association by E. faecalis A197A was found to increase the tolerance of the bacterium to calcium hydroxide.

Monoclonal antibodies recognizing the Enterococcus faecalis collagen-binding MSCRAMM Ace: conditional expression and binding analysis

Enterococci are opportunistic pathogens known to cause numerous clinical infections and complications in humans. Adhesin-mediated binding to extracellular matrix (ECM) proteins of the host is thought to be a crucial step in the pathogenesis of these bacterial infections. Adhesin of collagen from Enterococcus faecalis (Ace) is a cell-wall anchored protein of E. faecalis that has been shown to be important for bacterial binding to the ECM. In this report, we characterize the conditions for Ace expression and demonstrate Ace binding to mammalian epithelial and endothelial cells as well as to collagens found in the ECM. To further characterize Ace expression and function, we report the generation of a panel of monoclonal antibodies (mAbs) directed against this important E. faecalis virulence factor. Through the use of multiple in vitro assays, surface plasmon resonance and flow cytometry, we have characterized this panel of mAbs which may prove to be not only beneficial in studies that address the precise biological role of adhesion of E. faecalis, but may also serve as beneficial therapeutic agents against E. faecalis infections.

The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics

Bacteria have been implicated in the pathogenesis and progression of pulp and periapical diseases. The primary aim of endodontic treatment is to remove as many bacteria as possible from the root canal system and then to create an environment in which any remaining organisms cannot survive. This can only be achieved through the use of a combination of aseptic treatment techniques, chemomechanical preparation of the root canal, antimicrobial irrigating solutions and intracanal medicaments. The choice of which intracanal medicament to use is dependent on having an accurate diagnosis of the condition being treated, as well as a thorough knowledge of the type of organisms likely to be involved and their mechanisms of growth and survival. Since the disease is likely to have been caused by the presence of bacteria within the root canal, the use of an antimicrobial agent is essential. Many medicaments have been used in an attempt to achieve the above aims but no single preparation has been found to be completely predictable or effective. Commonly used medicaments include calcium hydroxide, antibiotics, non-phenolic biocides, phenolic biocides and iodine compounds. Each has advantages and disadvantages, and further research is required to determine which is best suited for root canal infections.