Role of pH in salivary histidine-rich polypeptide antifungal germ tube inhibitory activity

Effect of donor age on the concentrations of histatins in human parotid and submandibular/sublingual saliva

Histatins are small proteins of human glandular saliva that have antifungal properties. Recent studies show that oral candidal infections increase with age, suggesting an age-associated compromise in oral host defence. Here, the effect of age and of physiological gland stimulation on the concentration and secretion of salivary histatins was investigated. Parotid and submandibular/sublingual salivas were collected from six young adults under unstimulated, mechanical (chewing) and gustatory (0.025 M and 0.1 M citric acid) stimulation, and the concentration and secretion of histatins was measured by cationic polyacrylamide gel electrophoresis with subsequent densitometric scanning of the stained gels. With gland stimulation, parotid saliva showed no significant increase in histatin concentration (microg/ml); however, histatin secretion (microg/min) increased up to 26-fold (p<0.005; ANOVA). Stimulation of submandibular/sublingual saliva resulted in significant increases in both histatin concentration (p<0.005) and secretion (p<0.0005). Ageing effects on salivary histatins were determined in citric acid (0.1 M)-stimulated parotid and submandibular/sublingual saliva samples collected from 80 individuals (divided into four age groups having approximately equal numbers of males and females: 35-44 years; 45-54 years; 55-64 years and 65-76 years). None of the patients was taking medications or wore dentures. ANOVA showed no sex differences in histatins. Regression analysis showed significant age-associated decreases for parotid saliva histatin concentration (p<0.002) and secretion (p<0. 002) as well as for submandibular/sublingual saliva histatin concentration (p<0.0001) and secretion (p<0.0001). Both saliva types showed significant (p<0.0001) decreases in the histatin concentration per mg of total protein, suggesting a preferential decrease in salivary histatins compared to total salivary protein. These results suggest that the salivary histatin component of the oral host defence system is compromised with increasing age.

Antifungal peptides: potential candidates for the treatment of fungal infections

Many diversely produced natural peptides, as well as those produced semisynthetically and synthetically, have been found to inhibit the growth or even be lethal to a wide range of fungi. Some of these have the potential to aid mankind in combating mycoses caused by emerging pathogens or as a result of the increasing number of antibiotic-resistant fungi. Antifungal peptides may also assist in non-medical fields such as agriculture. For example, introduction by transgenic research of antifungal peptides could improve crop production yields by increasing host resistance to fungal invasion. The aim of this review is to provide information on research on these important peptides.

Further characterization of human salivary anticandidal activities in a human immunodeficiency virus-positive cohort by use of microassays

Salivary anticandidal activities play an important role in oral candidal infection. R. P. Santarpia et al. (Oral Microbiol. Immunol. 7:38-43, 1992) developed in vitro anticandidal assays to measure the ability of saliva to inhibit the viability of Candida albicans blastoconidia and the formation of germ tubes by C. albicans. In this report, we describe modifications of these assays for use with small volumes of saliva (50 to 100 microl). For healthy subjects, there is strong inhibition of blastoconidial viability in stimulated parotid (75%), submandibular-sublingual (74%), and whole (97%) saliva, as well as strong inhibition of germ tube formation (>80%) for all three saliva types. The susceptibility of several Candida isolates to inhibition of viability by saliva collected from healthy subjects is independent of body source of Candida isolation (blood, oral cavity, or vagina) or the susceptibility of the isolate to the antifungal drug fluconazole. Salivary anticandidal activities in human immunodeficiency virus (HIV)-infected patients were significantly lower than those in healthy controls for inhibition of blastoconidial viability (P < 0.05) and germ tube formation (P < 0. 001). Stimulated whole-saliva flow rates were also significantly lower (P < 0.05) for HIV-infected patients. These results show that saliva of healthy individuals has anticandidal activity and that this activity is reduced in the saliva of HIV-infected patients. These findings may help explain the greater incidence of oral candidal infections for individuals with AIDS.

Histatin 3-mediated killing of Candida albicans: effect of extracellular salt concentration on binding and internalization

Human saliva contains histidine-rich proteins, histatins, which have antifungal activity in vitro. The mechanism by which histatins are able to kill Candida albicans may have clinical significance but is currently unknown. Using radiolabeled histatin 3, we show that the protein binds to C. albicans spheroplasts in a manner that is dependent on time and concentration. Binding to the spheroplasts was saturable and could be competed with unlabeled histatin 3. A single histatin 3 binding site with a K(d) = 5.1 microM was detected. Histatin 3 binding resulted in potassium and magnesium efflux, predominantly within the first 30 min of incubation. Studies with fluorescent histatin 3 demonstrate that the protein is internalized by C. albicans and that translocation of histatin inside the cell is closely associated with cell death. Histatin binding, internalization, and cell death are accelerated in low-ionic-strength conditions. Indeed, a low extracellular salt concentration was essential for cell death to occur, even when histatin 3 was already bound to the cell. The interaction of histatin 3 with C. albicans, and subsequent cell death, is inhibited at low temperature. These results demonstrate that the candidacidal activity of histatin 3 is not due exclusively to binding at the cell surface but also involves subsequent interactions with the cell.

Salivary histatins in patients with recurrent oral candidiasis

The level of salivary histatins was evaluated in 20 patients with a history of recurrent oral candidiasis and in age-, sex-matched healthy controls. Salivary pH, flow rate, total protein and histatins were compared. Results of this study indicated that salivary pH was significantly lower among patients than controls (5.9 vs. 6.3, respectively, P = 0.002). No significant difference was observed in the mean flow rate and total protein between patients and controls (0.39 ml/min/gland vs. 0.46 ml/min/gland and 112.4 mg% vs. 113.0 mg%, respectively). However, the mean salivary histatin levels were significantly higher among patients than controls, both in terms of concentration (16.8 mg% vs. 11.1 mg%, P = 0.016) as well as a ratio of total protein (15 mg/g vs. 10 mg/g, P = 0.018). These findings indicate that oral candidiasis is associated with increased levels of salivary histatin. Such a finding suggests that oral candidiasis may modulate the levels of salivary histatin.

Human salivary histatins: promising anti-fungal therapeutic agents

Histatins constitute a group of small, cationic multifunctional proteins present in the saliva of human and some non-human primates. The most significant function of histatins may be their anti-fungal activity against Candida albicans and Cryptococcus neoformans. Histatins have been extensively studied at both the protein and gene levels. The structure-function relationship of histatins with respect to their candidacidal activity has also been studied by means of recombinant histatin variants, as well as by chemically synthesized histatin fragments. The mechanism of histatins' action on Candida albicans is not clear, but it appears to be different from that of azole-based anti-fungal drugs which interrupt ergosterol synthesis. During the past 20 years, fungal infections have become more prevalent as a result of the emergence of AIDS, as well as, paradoxically, modern medical advances. The toxicity of current anti-fungal medicine, the emergence of drug-resistant strains, and the availability of only a few types of anti-fungal agents are the major disadvantages of current anti-fungal therapy. Therefore, the importance of the search for new, broad-spectrum anti-fungals with little or no toxicity cannot be overemphasized. The following properties make histatins promising anti-fungal therapeutic agents: (1) They have little or no toxicity; (2) they possess high cidal activities against azole-resistant fungal species and most of the fungal species tested; and (3) their candidacidal activity is similar to that of azole-based antifungals. Current research efforts focus on the development of improved histatins with enhanced cidal activity and stability, and of suitable and effective histatin delivery systems. These and other approaches may help to outpace the growing list of drug-resistant and opportunistic fungi causing life-threatening, disseminating diseases. The histatins with improved protective properties may also be used as components of artificial saliva for patients with salivary dysfunction.

Synthetic histatin analogues with broad-spectrum antimicrobial activity

Histatins are salivary histidine-rich cationic peptides, ranging from 7 to 38 amino acid residues in length, that exert a potent killing effect in vitro on Candida albicans. Starting from the C-terminal fungicidal domain of histatin 5 (residues 11-24, called dh-5) a number of substitution analogues were chemically synthesized to study the effect of amphipathicity of the peptide in helix conformation on candidacidal activity. Single substitutions in dh-5 at several positions did not have any effect on fungicidal activity. However, multi-site substituted analogues (dhvar1 and dhvar2) exhibited a 6-fold increased activity over dh-5. In addition, dhvar1 and dhvar2 inhibited the growth of the second most common yeast found in clinical isolates, Torulopsis glabrata, of oral- and non-oral pathogens such as Prevotella intermedia and Streptococcus mutans, and of a methicillin-resistant Staphylococcus aureus. In their broad-spectrum activity, dhvar1 and dhvar2 were comparable to magainins (PGLa and magainin 2), antimicrobial peptides of amphibian origin. Both the fungicidal and the haemolytic activities of dhvar1, dhvar2 and magainins increased at decreasing ionic strength.

Effect of saliva composition on growth of Candida albicans and Torulopsis glabrata

Candida albicans and Torulopsis glabrata are the most prevalent yeasts in humans. The majority harbor C. albicans in the oral cavity, but only a few develop oral candidiasis. We have sought a possible relationship between indigenous salivary constituents, including antimicrobial and nutritive factors, and the growth rate and/or viability of inoculated fungi in glucose-supplemented sterilized saliva. Stimulated whole saliva was collected from 30 healthy donors. Saliva samples were sterilized, supplemented with glucose and inoculated with C. albicans or T glabrata. After incubation of the inoculates for 20 h, the number of viable cells were counted. All saliva samples were analyzed for different indigenous salivary components and Candida before as well as after sterilization. Besides a 4% reduction in calcium (Ca2+) and thiocyanate (SCN-) concentrations, sterilization did not affect the concentrations of saliva electrolytes, but the proteins were significantly reduced (19-85%). Indigenous candidal carriage (n=19) correlated with neither the growth of inoculated fungi nor any of the analyzed components in saliva. The growth of C. albicans and T. glabrata was similar at pH 5 but, at pH 6, C. albicans had a remarkably slower growth rate than T. glabrata. Statistical analysis showed that the 5-h growth of C. albicans at pH 5 was associated with water and electrolyte secretion, whereas the growth after 20 h was associated with variations in protein-glycoprotein content. The growth of T. glabrata was not related to variations in the salivary variables analyzed.

Salivary proteolysis of histidine-rich polypeptides and the antifungal activity of peptide degradation products

Incubation of purified synthetic histidine-rich polypeptides, HRP-2, -3, -4, -5, -6 (histatins), with diluted human parotid saliva yielded a series of peptide degradation products whose structures could be determined by gas-phase sequencing of cationic polyacrylamide gel electroblots. Sequencing indicated that two and sometimes three peptides were present in the same Coomassie blue-stained band. By comparing different individuals' salivas it was observed that structural variation occurs, perhaps due to differences in the concentrations or specific activities of salivary proteases. Based on the structural data, four proteolytic enzyme activities are proposed. A trypsin-like and chymotrypsin-like enzymatic activity(s) appear to represent the most active salivary protease; however, both an alanine-lysine endopeptidase and a histidine peptidase activity are also present in parotid saliva. In comparison to HRP-4 or HRP-6, degraded products were less active as antifungal agents against Candida albicans both in blastospore and germ-tube assays.

Inhibition of Candida albicans by the Peroxidase/SCN-/H2O2 system

Effects of the salivary peroxidase (SPO) system on the growth, glucose uptake and metabolic activities of oral bacteria are well documented but the effects on oral fungi are virtually unknown. Therefore, the viability of Candida albicans (ATCC 28366) exposed to the peroxidase/SCN-/H2O2 system was studied in sterilized saliva, in phosphate-buffered saline (PBS) and in potassium chloride. The growth of C. albicans in glucose-supplemented saliva was faster at pH 5.5 than at pH 7. The addition of the complete SPO (or lactoperoxidase) system to either sterilized saliva, KCl (50 microM) or PBS at pH 5.5 inhibited dose-dependently the viability of C. albicans in KCl, but no inhibition was found in PBS or saliva. Maximal inhibition was achieved in 2 h and with > 320 microM of peroxidase-generated HOSCN/OSCN-. However, physiological salivary concentrations of phosphate (> or = 1.0 mM) and PBS blocked the antifungal effect of HOSCN/OSCN-. The relative proportions of SCN- and H2O2 were critical to the antifungal effects. With 0.2 mM KSCN, a complete loss of viability was achieved, though the HOSCN/OSCN- concentrations did not exceed 100 microM. It is concluded that C. albicans is sensitive to HOSCN/OSCN- but salivary concentrations of phosphate block the antifungal effect of the peroxidase systems.

Longitudinal study of parotid saliva in HIV-1 infection

Parotid flow rate and chemistry of 78 HIV + gay/bisexual men and 27 HIV-gay/bisexual controls were compared on a longitudinal basis at 4-month intervals over a 1 yr period for changes indicative of inflammatory or autoimmune diseases of the salivary glands, or reduced protective capacity toward oral opportunistic infection. Parotid saliva was examined for concentrations of sodium, chloride, phosphate, total protein, lysozyme, lactoferrin, secretory IgA, salivary peroxidase, histatin and albumin. Chloride, lysozyme and peroxidase were significantly higher in HIV + at all 3 examinations and increased in concentration over time. Although mean values for stimulated flow rate were not significantly different in the two groups over the year, there was a significant increase in the number of HIV + with reduced flow over time. In 6% of HIV + there was a marked reduction in flow rate and Sjögren's syndrome-like elevations in parotid chemistry but no enlargement. At all examinations low flow rate was significantly related to oral candidiasis; T4 levels were inversely related to oral candidiasis, but not to concentration of salivary components or flow rate; nor was AZT use. As a group the HIV + patients maintained normal flow rate and secreted normal or elevated concentrations of protective proteins. A subgroup, however, exhibited diminished flow over time and an increasing tendency to oral candidiasis and a diminution in output of histatins.

One-step purification of histidine-rich polypeptides form human parotid saliva and determination of anti-candidal activity

Immunoadsorption affinity chromatography was used to selectively purify the family of the histidine-rich polypeptides (HRPs) from human parotid saliva. The immunoadsorbent was prepared by coupling an enriched preparation of horse anti-(HRPs 2, 3, 4, 5 and 6) IgG to protein G. Both freshly collected stimulated untreated and acidified boiled salivas (5 ml) were applied to the affinity column. When native saliva was used it appeared that all of the components of saliva, with the exception of the HRPs, were present in the fraction nonadsorbed to the affinity column; however, recovery of the HRPs with 0.2 M sodium acetate-HCl, pH 1.8, was poor. Yields of HRPs desorbed from the column with the pH 1.8 treatment were significantly improved if salivary HRP proteolysis was delayed immediately after collection by acidifying the saliva to pH 4.5 followed by a short boiling time period, which neither affected HRP quantification nor biological activity. Affinity chromatography results were checked both by cationic polyacrylamide gel and by capillary electrophoresis. Antifungal activity was found to reside only in the low pH HRP fraction of the immunoadsorbent column, suggesting that it is the histidine-rich family of polypeptides that is responsible for salivary antifungal action.

Salivary anti-candidal assays

Inhibition of Candida albicans blastospore viability by parotid, submandibular-sublingual and whole salivas could not be determined by direct assay of yeast cells in each respective saliva. Determination of antifungal activity could, however, be carried out if saliva was first preincubated with Candida cells and this was immediately followed by removal of saliva and resuspension of yeast cells in nonenriched buffers of pH 5-7 for appropriate incubation periods. To attain accurate reproducible quantitative data, parotid, submandibular-sublingual and whole salivas each required different preincubation times with C. albicans as well as prior acidification and boiling. Acidification was also necessary for optimizing the germ tube assay although, in contrast to blastospore viability, inhibition of blastospore-germ tube conversion could be determined directly in saliva. Salivary antifungal effects on blastospore division were negligible at yeast cell concentrations greater than 10(6) colony-forming units per ml and were found to be independent of pH, whereas salivary inhibition of germ tube formation was significant only at pH 5 in the assay systems employed. The requirement for acidification and an observed enhancement of antifungal activity on aqueous dilution of the saliva suggested that only a fraction of the salivary antifungal components present in saliva were available in the free form to exert their biological activity. These results open up the possibility of investigating salivary antifungal activity in human health and disease.

Antifungal activities of salivary histidine-rich polypeptides against Candida albicans and other oral yeast isolates

Twenty-six oral yeast isolates from 26 donors were tested for their susceptibility to salivary histidine-rich polypeptide-4 (HRP-4) in blastospore viability assays. HRP-4 was observed to inhibit blastospore division in all of the yeast isolates, although inhibition was variable depending upon both species and strain tested. Nine species of Candida and 2 strains of Trichosporon pullulans were included in the study. No significant differences in susceptibility to HRP-4 could be seen, irrespective of where in the oral cavity the yeast isolate was obtained.

The use of capillary electrophoresis to identify cationic proteins in human parotid saliva

Eight proteins, HRPs 1, 2, 3, 4, 5 and 6, lysozyme and histatin 6, are the major cationic components of the parotid salivas of normal healthy individuals. Histatins 2 and 4 appear to be further degradation products of the HRPs. Capillary electrophoresis separates all of these eight components, thus allowing future studies to correlate protein concentration with antimicrobial activity in health and disease.