Candida albicans adherence to resin-composite restorative dental material: influence of whole human saliva

Adesão de biofilmes monoespécie de Streptococcus mutans e Candida albicans em diferentes superfícies de resinas compostas convencionais e bulk fill

Resumo Introdução As resinas compostas são alternativas restauradoras, porém sua superfície pode favorecer o acúmulo de biofilme. Objetivo Analisar in vitro a adesão de biofilmes de Streptococcus mutans (UA159) e Candida albicans (ATCC 90028) em superfícies de resinas compostas convencionais e bulk fill. Material e método Foram utilizadas quatro marcas de resinas compostas e bulk fill: Aura Bulk Fill - SDI®; Premisa - Kerr®; Opallis- FGM®, e Filtek bulk fill flow - 3M®. Utilizou-se saliva artificial para formação da película salivar, por 60 min a 37 °C. O inóculo foi padronizado em 1×108 UFC/mL para S. mutans e 1×106 UFC/mL para C. albicans. Os espécimes (n=8/grupo) foram acondicionados em placas de 24 poços, com BHI suplementado com sacarose para as bactérias, e RPMI 1640, para os fungos. A formação do biofilme foi avaliada considerando as unidades formadoras de colônia (UFC/mL).Os dados foram analisados por ANOVA e Tukey (p<0,05). Resultado Para os biofilmes de S. mutans, não houve diferença significativa na contagem de UFC/mL entre os diferentes tipos de resina (p=0,119). Na contagem de UFC/mL para biofilme de Candida, as médias variaram entre 7,78 e 8,34. Houve diferença significativa entre as marcas, especialmente entre as resinas convencionais e bulk fill. Conclusão O presente estudo demonstra que não há diferença na adesão para biofilmes de S. mutans. Porém, há diferença na adesão da C. albicans na superfície de diferentes resinas compostas.

Susceptibility to Oral Antiseptics and Virulence Factors Ex Vivo Associated with Candida spp. Isolated from Dental Prostheses

PURPOSE

To isolate Candida spp. from dental prosthesis users' saliva and to evaluate the isolates for the presence of several virulence factors. This research also aimed to investigate the antifungal activity of 3 commercial mouthwashes/oral antiseptic formulations containing 0.12% chlorhexidine, 0.07% cetylpyridinium, or 0.075% cetylpyridinium against planktonic and sessile (biofilm mode) yeast cells.

MATERIALS AND METHODS

Forty-three Candida yeasts were isolated from 32 of 70 selected patients, and the virulence factors of C. albicans, C. krusei, C. glabrata, C. tropicalis, and C. parapsilosis species were investigated by polymerase chain reaction (PCR) and proteinase in plates. Minimum inhibitory concentration (MIC), and in vitro biofilm assay evaluated the antifungal activity of antiseptics.

RESULTS

C. albicans, C. krusei, C. glabrata, C. tropicalis, and C. parapsilosis were detected in mono and mixed cultures. Only C. albicans displayed genes related to adhesion and proteinases (ALS2, ALS3, SAP1, and SAP3). The aspartate proteinase activity was found in 60.46% of isolates. The tested antiseptic formulations exhibited a MIC less than 1.25% toward yeasts in the planktonic mode. According to XTT ((2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide) assay results, most Candida isolates and all mixed cultures formed biofilms within 24 hours. The evaluated antiseptic formulations were also active against biofilms.

CONCLUSION

Most virulence factors investigated here (ALS2, ALS3, SAP1, and SAP3) occurred in the majority of the Candida spp. isolates, especially in C. albicans. The tested mouthwash formulations were effective against all the yeast isolates in both the planktonic and sessile growth modes. Developing alternative therapies that can avoid or control biofilm formation is necessary to prevent oral candidiasis and other Candida spp. infections.

The Role of Oral Cavity Biofilm on Metallic Biomaterial Surface Destruction-Corrosion and Friction Aspects

Metallic biomaterials in the oral cavity are exposed to many factors such as saliva, bacterial microflora, food, temperature fluctuations, and mechanical forces. Extreme conditions present in the oral cavity affect biomaterial exploitation and significantly reduce its biofunctionality, limiting the time of exploitation stability. We mainly refer to friction, corrosion, and biocorrosion processes. Saliva plays an important role and is responsible for lubrication and biofilm formation as a transporter of nutrients for microorganisms. The presence of metallic elements in the oral cavity may lead to the formation of electro-galvanic cells and, as a result, may induce corrosion. Transitional microorganisms such as sulfate-reducing bacteria may also be present among the metabolic microflora in the oral cavity, which can induce biological corrosion. Microorganisms that form a biofilm locally change the conditions on the surface of biomaterials and contribute to the intensification of the biocorrosion processes. These processes may enhance allergy to metals, inflammation, or cancer development. On the other hand, the presence of saliva and biofilm may significantly reduce friction and wear on enamel as well as on biomaterials. This work summarizes data on the influence of saliva and oral biofilms on the destruction of metallic biomaterials.

Secretory component mediates Candida albicans binding to epithelial cells

OBJECTIVES

Candida albicans attaches to oral surfaces via a number of mechanisms including adherence mediated by salivary components adsorbed to the C. albicans cell surface. Our goal was to identify the salivary molecules involved.

MATERIALS AND METHODS

Biotinylated salivary polypeptides that were bound by C. albicans were detected in extracts from washed, saliva-treated yeast cells by polyacrylamide gel electrophoresis and electroblot or immunoblot transfer analysis and purified by electroelution. Purified material was tested for the ability to promote the adherence of radiolabelled C. albicans yeast cells to cultured epithelial monolayers.

RESULTS

Three of the polypeptides bound by C. albicans cells were identified as components of secretory IgA, including secretory component. Using non-denaturing polyacrylamide gel electrophoresis, we demonstrated that secretory component could be detected in its free form in saliva, and was bound by yeast cells. Secretory component which was purified by electroelution from non-denaturing PAGE-separated saliva, without detectable complete IgA, promoted adherence of yeast cells to cultured epithelial monolayers in a dose-dependent fashion.

CONCLUSION

These results indicate that despite the inhibitory effect on adherence of IgA specific to C. albicans, IgA components, in particular secretory component, also promote binding to cultured epithelial monolayers.

Candida albicans adherence to denture base material: chemical disinfection and the effect of acquired salivary pellicle formation

PURPOSE

The aim of this study was to evaluate the effect of 1% sodium hypochlorite (H1%) and 4% chlorhexidine gluconate (CG4%) on the adhesion of Candida albicans to denture base acrylic resins, as well as to verify the effect of the acquired salivary pellicle (ASP) formation on this process.

MATERIALS AND METHODS

A total of 300 acrylic specimens were immersed in distilled water (control) (n = 100), H1% (n = 100), or CG4% (n = 100) for 30 days. Twenty specimens were used in each experimental period (0, 1, 7, 15, 30 days). At the end of disinfection testing periods, 10 specimens of each group were exposed to human whole saliva to simulate ASP formation, and then all specimens were incubated with C. albicans ATTC 90028. Microorganism adhesion was analyzed by fluorescence microscopy, after staining with Acridine orange.

RESULTS

In the 30(th) disinfection cycle in relation to baseline, the H1% or CG4%, without ASP formation, reduced the C. albicans adhesion by approximately 80%; however, with ASP, this reduction after disinfection with H1% was higher (88%). The presence of ASP resulted in higher reduction of adhered fungal cells in comparison to resin without ASP, at the 1(st) H1% or CG4% disinfection cycle, as well as at 30(th) H1% disinfection cycles.

CONCLUSIONS

Our results suggest that the presence of saliva might influence the adhesion of C. albicans and improve the effectiveness of methods to reduce fungal adhesion.

Are self-ligating brackets related to less formation of Streptococcus mutans colonies? A systematic review

OBJECTIVE

To verify, by means of a systematic review, whether the design of brackets (conventional or self-ligating) influences adhesion and formation of Streptococcus mutans colonies.

METHODS

SEARCH STRATEGY

four databases (Cochrane Central Register of Controlled Trials, Ovid ALL EMB Reviews, PubMed and BIREME) were selected to search for relevant articles covering the period from January 1965 to December 2012.

SELECTION CRITERIA

in first consensus by reading the title and abstract. The full text was obtained from publications that met the inclusion criteria.

DATA COLLECTION AND ANALYSIS

Two reviewers independently extracted data using the following keywords: conventional, self-ligating, biofilm, Streptococcus mutans, and systematic review; and independently evaluated the quality of the studies. In case of divergence, the technique of consensus was adopted.

RESULTS

The search strategy resulted in 1,401 articles. The classification of scientific relevance revealed the high quality of the 6 eligible articles of which outcomes were not unanimous in reporting not only the influence of the design of the brackets (conventional or self-ligating) over adhesion and formation of colonies of Streptococcus mutans, but also that other factors such as the quality of the bracket type, the level of individual oral hygiene, bonding and age may have greater influence. Statistical analysis was not feasible because of the heterogeneous methodological design.

CONCLUSIONS

Within the limitations of this study, it was concluded that there is no evidence for a possible influence of the design of the brackets (conventional or self-ligating) over colony formation and adhesion of Streptococcus mutans.

The effect of eating sea cucumber jelly on Candida load in the oral cavity of elderly individuals in a nursing home

We conducted a double-blind randomized controlled study of elderly individuals in a nursing home to investigate the effect of the consumption of jelly containing sea cucumber on their oral Candida load. The jelly contained a hydrolysate of the sea cucumber Stichopus japonicus, which contained triterpene glycosides called holotoxins. The holotoxins worked as a fungicide, and their minimum inhibitory concentrations for Candida albicans were 7 µg/mL. Eight individuals in the nursing home took the sea cucumber jelly for a week and their oral Candida were counted before and after the intervention. Nine individuals took a control jelly without S. japonicus. The sea cucumber jelly showed inhibitory effects on the oral Candida. Thus, daily consumption of the S. japonicus jelly has the potential to reduce the oral Candida load in the elderly in nursing homes.

Evaluation of Candida albicans adherence on the surface of various maxillofacial silicone materials

OBJECTIVES

Fungal infection resulting from Candida adherence on material surface is one of the most important medical risks for maxillofacial prosthesis wearers. Despite wide usage, there is a sparse data evaluating C. albicans adherence on various commercial maxillofacial silicone materials that have different surface contact angles. The objective of this study was to investigate the relationship between surface contact angle and fungal adherence on widely used maxillofacial silicone materials.

MATERIALS AND METHODS

Three maxillofacial silicone materials titled VST-50, A-2006, and A-2186F were used for fabrication of disc-shaped specimens. Surface contact angle of specimens were measured by the goniometric method. Adhesion quantity of two different C. albicans strains was evaluated with a colorimetric method using XTT/Coenzyme Q0. The Kruskal-Wallis and Mann-Whitney U tests were used for statistical analysis of data.

RESULTS

The lowest surface contact angle values with the highest Candida adhesion quantity were measured on the specimens fabricated with A-2006 silicone material. Statistically significant differences were found among three maxillofacial silicone materials in terms of both surface contact angle values and adhesion quantity (P<0.01).

CONCLUSION

There is a close relationship between surface contact angle and quantity of Candida adherence. However, it should be noted that various factors arising from material properties may affect the complex nature of the Candida adhesion process.

Investigating biofilm production, coagulase and hemolytic activity in Candida species isolated from denture stomatitis patients

OBJECTIVE

Oral candidiasis, in the form of Candida-associated denture stomatitis, represents a common disease in a large percentage of denture wearers, and Candida albicans remains the most commonly isolated species. In this study, we aimed to evaluate biofilm production, coagulase and hemolytic activity of Candida species isolated from denture stomatitis patients.

MATERIALS AND METHODS

This study included 70 patients (31 female, 39 male). Forty-eight of the patients were found to have a positive culture. A total of 48 Candida isolates representing five species, C. albicans (n=17), C. glabrata (n=10), C. krusei (n=9), C. kefyr (n=7) and C. parapsilosis (n=5), were tested. Their coagulase activities were evaluated by a classical tube coagulase test with rabbit plasma. A blood plate assay on 3% enriched sheep blood Sabouraud-dextrose agar (SDA) was used to determine their in vitro hemolytic activities. Biofilm production was determined by a visual tube method.

RESULTS

Twenty-one Candida isolates exhibited coagulase activity, and the coagulase activities of the C. albicans (64.7%) isolates were higher than other species. C. albicans, C. glabrata, C. kefyr and C. krusei species demonstrated beta hemolysis. C. parapsilosis strains failed to demonstrate any hemolytic activities. Fifteen (88.0%) of the C. albicans strains were biofilm positive. Six (35.2%) of these strains were strongly positive, 8 (47.0%) C. albicans strains were moderately positive and 1 (5.8%) C. albicans strain was weakly positive. Sixteen (51.6%) of the non-albicans Candida strains were biofilm positive while 15 (48.3%) did not produce biofilms.

CONCLUSION

The results of this present study indicate coagulase, hemolytic activity and biofilm production by Candida spp. isolated from patients with denture stomatitis. Investigations of these virulence factors might be helpful in gaining information about the possible virulence of oral Candida species related to denture stomatitis.

Candida albicans: genotyping methods and clade related phenotypic characteristics

Several molecular methods, such as Southern blotting hybridization, Multilocus Sequence Typing, and DNA microsatellite analysis, have been employed to genotype Candida albicans. The genotype analysis allows to group strains in clades, that is, a group composed of one ancestor and its descendants. These genotype studies demonstrate that clades distribution is influenced by geographic area as well as that antifungal resistance is associated with particular clades. These findings suggested that C. albicans reproduces mainly in a clonal manner, with certain degree of DNA microevolution. Additionally, virulence factors and site of isolation have also been associated with clade specificity. The present article is a brief review about the methods used for Candida genotyping and the correlated clade systems established. Special emphasis is given to Ca3 hybridization, MLST, and Microsatellites. The present work is also focused on the phenotypic and physiological traits associated with Candida clades.

Monoclonal antibody-mediated inhibition of adhesion of Candida albicans and Candida dubliniensis to human epithelial cells

The aim of this study was to assess the role of whole saliva, four saliva-derived preparations, and six monoclonal antibodies (mAbs), directed against components of the cell wall of Candida albicans, on the adhesion of C. albicans and Candida dubliniensis to human epithelial cells (HEC). C. albicans serotype A NCPF 3153 and C. albicans serotype B ATCC 90028 showed higher adhesion to HEC than C. dubliniensis NCPF 3949. Pooled whole saliva was more efficient than salivary secretory immunoglobulin A, partially purified by chromatography, at inhibiting the adhesion of C. albicans serotype A NCPF 3153 to HEC. Monoclonal antibodies C7, 14-8, and 26G7 were the most potent inhibitors of adhesion. Our results show that mAbs can mimic the inhibition of adhesion of C. albicans to HEC that is mediated by human saliva.

Prevalence of Candida species in the oral cavity of patients undergoing head and neck radiotherapy

Background and aims

Candidiasis is a common opportunistic infection in immunocompromised patients. Radiation to the head and neck affects the oral mucous membrane and produces xerostomia. Xerostomia alters the oral mucosa and predisposes them to colonization by Candida species. The aim of this study was evaluation of Candida species before and after radiotherapy.

Materials and methods

Twenty patients undergoing radiation therapy were selected. None of the patients had taken any antibiotics and antifungals during the 3-month period prior to the study and did not take any during the study; in addition, they did not have any systemic conditions predisposing them to Candida infections. Swabs were collected from all the patients for Candida species culturing procedures 3±1 days before treatment and 2 and 4 weeks after radiotherapy. Swabs were inoculated on 2% Sabouraud’s dextrose agar. Different types of Candida species are specified by colony color. Analysis of variance was used to assess the difference between the periods before and after treatment.

Results

Mean age of the patients were 59.4 years. Ten patients were Candida-positive before the initiation of radiotherapy. Eighteen and 20 patients were Candida-positive after two and four weeks of radiotherapy, respectively. The most frequent type of Candida in this study was Candida albicans both before and after radiotherapy.

Conclusion

The present study suggests that patients undergoing head and neck radiotherapy should take antifungal agents, especially sugar-free agents, topical fluoride and salivary substitutes. The most commonly found Candida in this study was Candida albicans, which might be attributed to its high pathogenecity.

Candida albicans Adherence to Glass Ionomer Restorative Dental Material

Background and aims

It is believed that adherence of Candida albicans to oral surfaces is a critical event in the coloni-zation and development of oral diseases such as candida-associated denture stomatitis. Although there is considerable infor-mation about the adherence of Candida albicans to buccal epithelial cells and prosthetic materials, there is very little infor-mation available about the adherence of Candida albicans to glass ionomer materials. The purpose of this study was to investigate the degree of Candida albicans adherence to glass ionomer restorative material.

Materials and methods

In this experimental study adherence of Candida albicans strains was studied with and without human whole saliva. First, glass ionomer fragments were prepared; then yeast cells were inoculated and incubated with differ-ent incubation times. After incubation, the fragments were removed from the wells and stained with 0.1% calcofluor white. Adhesion was quantified by counting the total number of cells at 40, 80 and 120 minutes. The analysis of variance and Stu-dent's test were used to assess the significance of differences between the means.

Results

In the absence of saliva, the adherence of Candida albicans showed an increase, reaching a maximum at the end of the experiment (120 minutes). However, in the presence of saliva, the adherence of Candida albicans to glass ionomer significantly decreased.

Conclusion

The presence of human whole saliva is an important factor in the adherence of Candida albicans to glass ion-omer restorative material.

Development of Candida-associated denture stomatitis: new insights

Despite therapeutic progress, opportunistic oral fungal infectious diseases have increased in prevalence, especially in denture wearers. The combination of entrapment of yeast cells in irregularities in denture-base and denture-relining materials, poor oral hygiene and several systemic factors is the most probable cause for the onset of this infectious disease. Hence colonization and growth on prostheses by Candida species are of clinical importance. The purpose of this review is to critically discuss several key factors controlling the adhesion of Candida species which are relevant to denture-associated stomatitis. Although there is some consensus on the role of surface properties, studies on several other factors, as the use of denture liners, salivary properties and yeast-bacterial interactions, have shown contradictory findings. A comprehensive fundamental understanding is hampered by conflicting findings due to the large variations in experimental protocols, while other factors have never been thoroughly studied. Surface free energy and surface roughness control the initial adherence, but temporal changes have not been reported. Neither have in vivo studies shown if the substratum type is critical in dictating biofilm accumulation during longer periods in the oral environment. The contribution of saliva is unclear due to factors like variations in its collection and handling. Initial findings have disclosed that also bacteria are crucial for the successful establishment of Candida in biofilms, but the clinical significance of this observation is yet to be confirmed. In conclusion, there is a need to standardize experimental procedures, to bridge the gap between laboratory and in vivo methodologies and findings and – in general – to thoroughly investigate the factors that modulate the initial attachment and subsequent colonization of denture-base materials and the oral mucosa of patients subjected to Candida infections. Information on how these factors can be controlled is required and this may help to prevent the disease. The societal impact of such information is significant given the magnitude of the candidosis problem worldwide.

Efficacy of denture disinfection methods in controlling Candida albicans colonization in vitro

OBJECTIVE

The aim of this study was to rank 10 denture disinfection methods according to their efficacy in reducing Candida albicans (C. albicans) colonization on soft denture relining material.

MATERIAL AND METHODS

Circular specimens (diameter 8 mm) were made of soft denture relining material (Mucopren E, Kettenbach) and thermally aged. Specimens were incubated with C. albicans (strain 1386, DSMZ) followed by 1 of 10 disinfection procedures (6 soaks, 2 microwave irradiation regimes, 1 effervescent commercial cleansing product, and denture left dry overnight). Incubation with phosphate buffered saline (PBS) served as a control. Adhering fungi were quantified using a bioluminometric assay in combination with an automated plate reader for cell quantification. Scanning electron micrographs (SEMs) were made for validation.

RESULTS

Low median luminescence intensities indicated the presence of a few viable fungi after the soaking of specimens in sodium hypochlorite (10 relative luminescence units (rlu)), microwave irradiation immersed in water (8 rlu), and application of effervescent cleansing tabs (22 rlu). No statistically significant difference (p>0.05) to control PBS (200 rlu) was found after immersion in hydrogen peroxide (172 rlu), glutaraldehyde (103 rlu), household vinegar (196 rlu), Listerine coolmint (194 rlu), Plax (222 rlu), dry microwave irradiation (221 rlu) and specimens left dry overnight (165 rlu). SEM displayed C. albicans monolayers with different morphologic forms on each surface investigated.

CONCLUSIONS

Only soaking in sodium hypochlorite (1%; 10 min), microwave irradiation immersed in water (800 W; 6 min), and application of effervescent cleansing tabs (Blend-a-dent tabs; 10 min) proved to be effective against C. albicans colonization on soft denture relining material.

Comparison between E-test and CLSI broth microdilution method for antifungal susceptibility testing of Candida albicans oral isolates

Thirty Candida albicans isolated from oral candidosis patients and 30 C. albicans isolated from control individuals were studied. In vitro susceptibility tests were performed for amphotericin B, fluconazole, 5-flucytosine and itraconazole through the Clinical and Laboratorial Standards Institute (CLSI) reference method and E test system. The results obtained were analyzed and compared. MIC values were similar for the strains isolated from oral candidosis patients and control individuals. The agreement rate for the two methods was 66.67% for amphotericin B, 53.33% for fluconazole, 65% for flucytosine and 45% for itraconazole. According to our data, E test method could be an alternative to trial routine susceptibility testing due to its simplicity. However, it can not be considered a substitute for the CLSI reference method.

Whole Saliva has a Dual Role on the Adherence of Candida albicans to Polymethylmetacrylate

Adhesion of Candida albicans to acrylic of dental prostheses or to salivary macromolecules adsorbed on their surface is believed to be a critical event in the development of denture stomatitis. In previous studies our group has shown that adhesion of C. albicans germ tubes to polystyrene is decreased by saliva whereas C. albicans yeast cells adhesion to the same material is enhanced. The results presented in this study confirm this dual role played by whole saliva, since it decreased the adhesion of germ tubes but increased the adhesion of yeast cells to polymethylmetacrylate (PMMA). These effects mediated by whole saliva do not seem to be related to an inhibition of the germination of C. albicans, since similar levels of filamentation were observed in presence and absence of saliva. These results may give new insights into the conflicting role of saliva in the adhesion of C. albicans to acrylic resins of dental prostheses.

Denture-related stomatitis: identification of aetiological and predisposing factors - a large cohort

The aim of this study was to identify and characterize aetiological and predisposing factors in denture-related stomatitis (DRS), by means of a case-control, transversal study, in a large cohort of 140 persons wearing removable maxillary polymethylamethacrylate prostheses. Data were obtained by (1) a questionnaire that included the identification of the subject, demographic and social data, medical history and behaviour; (2) intra-oral examination; (3) evaluation of the prosthesis; (4) microbiological examination; (5) yeast identification and analyses using Epi-info and the chi-square test. Results showed significant associations between DRS and yeasts, gender, age and alcohol consumption. We also found a significant relationship between the presence of yeasts and hyposalivation and decreased salivary pH. We found a highly significant difference between groups with and without DRS concerning the presence or absence of yeasts, regardless of the sample origin. Most cases of DRS showed the presence of Candida albicans. The results confirm a highly significant difference between groups with and without DRS concerning the presence or absence of yeasts.

In vitro candidacidal activity of a synthetic killer decapeptide (KP) against Candida albicans cells adhered to resin acrylic discs

BACKGROUND

Oral Candida spp., and C. albicans in particular, are considered as important aetiological agents in the pathogenesis of denture-induced stomatitis. Several studies have reported that C. albicans is able to easily adhere to different medical devices, such as vascular and urinary catheters or acrylic denture surfaces, and that adhesion is a fundamental step in the initial pathogenic process of colonization and further possible infection. Recently, a synthetic decapeptide (KP) derived from the sequence of a single-chain recombinant anti-idiotypic antibody, acting as a functional internal image of a microbicidal, broad spectrum yeast killer toxin, has been reported to kill in vitro C. albicans cells and to exert a therapeutic activity against experimental mucosal and systemic candidiasis.

METHODS

The aim of this study was to evaluate, through a CFU assay, the candidacidal activity of KP on sanded acrylic resin discs, previously colonized by C. albicans cells.

RESULTS AND CONCLUSIONS

At 100 microg/ml KP showed over 90% of killing activity on C. albicans cells adhered to resin discs, when compared with a scramble peptide used as control. The results of this study suggest a potential effect of KP on C. albicans cells adhered on the surface of resin materials, such as prosthetic dentures.

Synthesis and in vitro activity of 2-thiazolylhydrazone derivatives compared with the activity of clotrimazole against clinical isolates of Candida spp

In this paper, we report on the synthesis of a novel series of 2-thiazolylhydrazone derivatives and the influence of the substituents on the thiazole ring on antifungal activity. All synthesized compounds were screened for their in vitro activities against 22 clinical isolates of Candida spp., representing six different species, compared to clotrimazole as a reference compound. Some of the tested compounds were found to possess significant antifungal activity when compared to clotrimazole, in particular compound 14 which exhibited higher potency against most of the Candida spp. considered. The compounds that were most active as anti-Candida agents were also submitted to cytotoxic screening by the Trypan Blue dye exclusion assay and in general they were shown to induce low cytotoxic effects.

Influence of Different Orthodontic Brackets on Adherence of Microorganisms In Vitro

OBJECTIVE

To define the capacity of different bracket materials to modify the growth and adherence of microorganisms.

METHODS

Three types of brackets from the right upper central incisor were used: metallic, ceramic, and composite. Streptococcus mutans and Candida albicans were studied. The association of both species was also evaluated. The brackets were placed in flat-bottomed vials containing basal medium with 20% sucrose added; the flasks were inoculated with each of the microbial suspensions. The samples were incubated at 37 degrees C for 48 hours, after which the brackets were removed. The supernatant was removed from the flasks, the cells adhering to the glass were counted, and the brackets were studied with electron microscopy.

RESULTS

The adherence of Streptococcus mutans was not modified by the different brackets. The adherence of Candida albicans was increased by the composite bracket, whereas the use of metallic brackets decreased the number of colony-forming units (CFUs). By electron microscopy we demonstrated that the adherence of Streptococcus mutans plus Candida albicans together varied according to the bracket materials with composite > ceramic > metallic.

CONCLUSIONS

Orthodontic appliances serve as different impact zones and modify microbial adherence and colonization, acting as foreign reserves and possible sources of infection.

Prevalence and antifungal susceptibility of yeasts obtained from the oral cavity of elderly individuals

Infections caused by Candida yeasts are common in elderly individuals. Seventy-five isolates of Candida spp. were obtained from saliva samples of 136 institutionalized elderly individuals resident in six retirement homes of Belo Horizonte, Brazil. Forty-seven isolates (62.66%) were identified as Candida albicans, 15 (20%) as C. tropicalis, 7 (9.33%) as C. glabrata, 4 (5.33) as C. parapsilosis, and 2 (2.67%) as C. guilliermondii. Among the 136 elderly individuals studied, 49 (36%) were male and 87 (64%) were female. Ages ranged from 60 to 90 years old. Sixty-three (46.3%) of the institutionalized individuals were denture wearers and, among them, 53 (84.1%) carried Candida yeasts in the oral cavity. Forty-four subjects presented lesions in the oral mucosa and among these, 36 (82%), had positive culture for Candida spp. The samples were tested for the in vitro susceptibility to amphotericin B, itraconazole, fluconazole and 5-flucytosin, and great variations were observed in the minimum inhibitory concentrations (MIC) of these drugs according to the species.

Correlation between adhesion, enzyme production, and susceptibility to fluconazole in Candida albicans obtained from denture wearers

OBJECTIVE

The aim of this study was to assess the contribution and the correlation between the virulence factors of Candida albicans in denture stomatitis.

STUDY DESIGN

Thirty C. albicans strains obtained from the oral cavity of patients with denture stomatitis and 30 C. albicans obtained from the oral cavity of denture wearers with normal palatal mucosa were compared for adhesion ability to buccal epithelial cells (BEC), reduction in adhesion after exposure to fluconazole, and enzyme production. The correlation between these virulence factors was assessed by Pearson's correlation coefficient.

RESULTS

C. albicans obtained from denture stomatitis patients were more adherent to BEC and higher enzyme producers than those obtained from healthy patients. Our results demonstrated that exposure to fluconazole reduces C. albicans adherence to BEC. This study could also provide evidence of correlation between virulence factors.

CONCLUSION

Our results suggest that adhesion and enzyme production could be factors that, along with predisposing conditions related to the host, determine if an individual will develop disease or remain as a healthy carrier and confirm that fluconazole has an impact on the adherence ability and enzyme production in C. albicans.

In vitro evaluation of virulence attributes of Candida spp. isolated from patients affected by diabetes mellitus

BACKGROUND

Diabetes mellitus is a common disease found worldwide and it has been previously suggested that oral candidal infections may be more frequent or severe in patients with this disease. Systemic and local factors may influence the balance between the host and yeasts, and favour the transformation of Candida isolates from commensal to pathogenic microorganisms. Candida species have developed specific virulence mechanisms that confer the ability to colonise host surfaces, to invade deeper host tissue, or to evade host defences. Few studies have investigated the expression of the virulence attributes of oral Candida isolates in patients with diabetes mellitus.

MATERIAL AND METHODS

The in vitro extracellular proteinase production and the in vitro ability to adhere to fibronectin of 229 Candida isolates of two geographic different groups of patients with diabetes mellitus and of healthy subjects were assessed.

RESULTS

Candida isolates of patients with diabetes mellitus expressed a higher ability to adhere than those of healthy subjects. Higher levels of adhesion were also recorded in patients with a lower oral Candida colonisation. No differences were observed in the in vitro expression of extracellular proteinase of Candida isolates of patients with diabetes mellitus and those of non-diabetic subjects. Isolates of patients with type 2 diabetes mellitus expressed greater levels of proteinase than isolates of type 1 diabetes mellitus.

CONCLUSIONS

Diabetes mellitus could be considered as an additional variable that may influence not only oral Candida carriage but also the ability of isolates to enhance the expression of virulence attributes.

Virulence factors and antifungal susceptibility of Candida albicans isolates from oral candidosis patients and control individuals

Sixty isolates of Candida albicans, 30 obtained from the oral cavity of denture wearers presenting signs of candidosis and 30 obtained from the oral cavity of denture wearers with normal palatal mucosa were assayed for phospholipase and proteinase production, as well as for adherence to buccal epithelial cells. Likewise, susceptibility of the isolates to antifungals was determined by the NCCLS reference method and the E-test method. Proteinase activity was increased among the strains obtained from oral candidosis patients. In contrast, no significant differences between the two groups of isolates were observed in their adherence ability in vitro, in phospholipase production, and susceptibility to antifungal drugs.

Predisposing conditions forCandidaspp. carriage in the oral cavity of denture wearers and individuals with natural teeth

Candida species are a normal commensal present in a large percentage of healthy individuals. Denture wearers are predisposed to the development of candidosis and to the presence of Candida spp. The presence of the yeast, even in healthy subjects, should be considered more carefully. We investigated the prevalence of Candida spp. in 112 denture wearers and 103 individuals with natural teeth, patients from the clinic of total prosthesis of the Dental School of the Federal University of Minas Gerais, Brazil, and from the School of Pharmacy and Dentistry of Alfenas, Brazil. Factors like gender, age over 60 years, low education, and xerostomia were directly associated with the presence of Candida yeasts at a significance level of 5% (p > 0.05). However, the major predisposing factor for the carrier state was wearing dentures (p = 0.001). Candida isolates were identified using morphological and biochemical profiles. Seventy-one isolates were identified as C. albicans (65.1%), 15 as C. glabrata (13.7%), 8 as C. parapsilosis (7.3%), 3 as C. krusei (2.7%), and 12 as C. tropicalis (11.0%). Susceptibility testing to fluconazole and itraconazole was also performed with the strains obtained. Both drugs showed a strong inhibition against most oral isolates.Key words: yeast infection, prosthetic devices, oral cavity.

Minimum inhibitory concentration of adherence of Punica granatum Linn (pomegranate) gel against S. mutans, S. mitis and C. albicans

The purpose of this study was to investigate the antimicrobial effect of a Punica granatum Linn (pomegranate) phytotherapeutic gel and miconazole (Daktarin® oral gel) against three standard streptococci strains (mutans ATCC 25175, sanguis ATCC 10577 and mitis ATCC 9811), S. mutans clinically isolated and Candida albicans either alone or in association. The effect of minimum inhibitory concentrations of the gels on the adherence of these microorganisms to glass was assessed in the presence of 5% sucrose, using increasing and doubled concentrations of the diluted solution of the gels ranging from 1:1 to 1:1024. The minimum inhibitory concentrations of adherence of Punica granatum L. gel against the test organisms were: 1:16 for S. mutans (ATCC), S. mutans (CI) and S. sanguis; 1:128 for S. mitis and 1:64 for C. albicans. The minimum inhibitory concentrations of adherence of miconazole against the same organisms were: 1:512, 1:64, 1:4, 1:128 and 1:16, respectively. In experiments with three and four associated microorganisms, the Punica granatum L. gel had greater efficiency in inhibiting microbial adherence than the miconazole. The results of this study suggest that this phytotherapeutic agent might be used in the control of adherence of different microorganisms in the oral cavity.

Inhibition of adherence of Candida albicans and Candida dubliniensis to a resin composite restorative dental material by salivary secretory IgA and monoclonal antibodies

OBJECTIVE

The attachment of Candida to oral surfaces is a crucial step in the colonization of the oral cavity and the eventual development of oral diseases caused by this microorganism. Inhibition of adhesion is one of the strategies currently studied to prevent Candida infections. The main objective of this study was to investigate the inhibitory effect of the human salivary components on the adherence of Candida albicans and C. dubliniensis to Herculite, a widely used resin composite restorative dental material. We have also investigated the influence on the adherence of three monoclonal antibodies (mAbs) directed against C. albicans cell wall antigens.

DESIGN

The adhesion of three strains of C. albicans and one strain of C. dubliniensis was studied by a visual method after incubating the fungus and the resin in presence and in absence of human whole saliva, secretory immunoglobulin A (sIgA) and three mAbs directed against C. albicans cell wall surface antigens.

RESULTS

Adherence of C. albicans was inhibited by whole saliva (41.7%), salivary sIgA (55.7%) and the salivary components that bind to the cell wall (36.7%). Whole saliva significantly reduced the adhesion of C. dubliniensis to Herculite to 45.3% of the control level. Saliva previously adsorbed with fungal cells or sIgA depleted saliva had no effect on adherence. An inhibition in the adhesion of C. albicans and C. dubliniensis to Herculite similar to that shown by whole saliva was also observed when mAbs C7 and 26G7 were used. However, mAb 21E6 increased adhesion of all the strains to Herculite.

CONCLUSIONS

The results suggest that sIgA, as well as whole saliva, are important in blocking adherence of C. albicans and C. dubliniensis to Herculite and that this effect can be reproduced with mAbs directed against the cell wall surface of C. albicans.

A monoclonal antibody directed against a Candida albicans cell wall mannoprotein exerts three anti-C. albicans activities

Antibodies are believed to play a role in the protection against Candida albicans infections by a number of mechanisms, including the inhibition of adhesion or germ tube formation, opsonization, neutralization of virulence-related enzymes, and direct candidacidal activity. Although some of these biological activities have been demonstrated individually in monoclonal antibodies (MAbs), it is not clear if all these anti-C. albicans activities can be displayed by a single antibody. In this report, we characterized a monoclonal antibody raised against the main target of salivary secretory immunoglobulin A in the cell wall of C. albicans, which exerts three anti-C. albicans activities: (i) inhibition of adherence to HEp-2 cells, (ii) inhibition of germination, and (iii) direct candidacidal activity. MAb C7 reacted with a proteinic epitope from a mannoprotein with a molecular mass of >200 kDa predominantly expressed on the C. albicans germ tube cell wall surface as well as with a number of antigens from Candida lusitaniae, Cryptococcus neoformans, Aspergillus fumigatus, and Scedosporium prolificans. MAb C7 caused a 31.1% inhibition in the adhesion of C. albicans to HEp-2 monolayers and a 55.3% inhibition in the adhesion of C. albicans to buccal epithelial cells, produced a 38.5% decrease in the filamentation of C. albicans, and exhibited a potent fungicidal effect against C. albicans, C. lusitaniae, Cryptococcus neoformans, A. fumigatus, and S. prolificans, showing reductions in fungal growth ranging from 34.2 to 88.7%. The fungicidal activity showed by MAb C7 seems to be related to that reported by antibodies mimicking the activity of a killer toxin produced by the yeast Pichia anomala, since one of these MAbs also reacted with the C. albicans mannoprotein with a molecular mass of >200 kDa. Results presented in this study support the concept of a family of microbicidal antibodies that could be useful in the treatment of a wide range of microbial infections when used alone or in combination with current antimicrobial agents.