Adherence inhibition of Streptococcus mutans: an assay reflecting a possible role of antibody in dental caries prophylaxis

Antibacterial potency and fluoride release of a glass ionomer restorative material containing different concentrations of natural and chemical products: An in-vitro comparative study

BACKGROUND

This study investigated the antibacterial efficacy against Streptococcus mutans and fluoride release of a conventional glass ionomer (GI) contained natural and chemical agents.

MATERIAL AND METHODS

Two hundred and ten GI specimens were divided into ten groups (n=21) according to the concentrations of the additives as; Propolis extract containing GI (Groups 1, 2, 3) with concentrations of 0.25%, 0.75% and 1.25% respectively, Miswak extract containing GI (Groups 4, 5, 6) and Chlorhexidine containing GI (Groups 7, 8, 9) with the same concentrations. The prepared specimens were subjected to antimicrobial activity by well diffusion, bacterial adherence, and fluoride release (from 2 to 72 hours) assessments.

RESULTS

A higher statistically significant antibacterial activity was found in (Groups 2, 3) compared to (Groups 8, 9), while (Groups 1, 4, 5, 6, 7, 10) no antibacterial efficacy was reported. For (Groups 2, 3) had a higher statistically significant anti-adherence effect compared to the other tested groups. Enhanced ascending increase in fluoride release was observed for (Groups 3, 4) compared to (GI).

CONCLUSIONS

The increased concentration of propolis extract had a synergistic effect on the antimicrobial activity of the tested GI. Additive concentrations of 0.25% Miswak and 1.25% propolis could enhance the fluoride-releasing ability of the tested GI. Key words:Propolis, miswak, chlorhexidine, glass ionomer, fluoride.

Identification of the Streptococcus gordonii glmM gene encoding phosphoglucosamine mutase and its role in bacterial cell morphology, biofilm formation, and sensitivity to antibiotics

Phosphoglucosamine mutase (EC 5.4.2.10) catalyzes the interconversion of glucosamine-6-phosphate into glucosamine-1-phosphate, an essential step in the biosynthetic pathway leading to the formation of peptidoglycan precursor uridine 5'-diphospho-N-acetylglucosamine. The gene (glmM) of Escherichia coli encoding the enzyme has been identified previously. We have now identified a glmM homolog in Streptococcus gordonii, an early colonizer on the human tooth and an important cause of infective endocarditis, and have confirmed that the gene encodes phosphoglucosamine mutase by assaying the enzymatic activity of the recombinant GlmM protein. Insertional glmM mutant of S. gordonii did not produce GlmM, and had a growth rate that was approximately half that of the wild type. Morphological analyses clearly indicated that the glmM mutation causes marked elongation of the streptococcal chains, enlargement of bacterial cells, and increased roughness of the bacterial cell surface. Furthermore, the glmM mutation reduces biofilm formation and increases sensitivity to penicillins relative to wild type. All of these phenotypic changes were also observed in a glmM deletion mutant, and were restored by the complementation with plasmid-borne glmM. These results suggest that, in S. gordonii, mutations in glmM appear to influence bacterial cell growth and morphology, biofilm formation, and sensitivity to penicillins.

Differential immunogenicity of a DNA vaccine containing the Streptococcus mutans wall-associated protein A gene versus that containing a truncated derivative antigen A lacking in the hydrophobic carboxyterminal region

Two plasmid DNA constructs were obtained by cloning separately into the eukaryotic expression vector pcDNA3.1/V5-His-TOPO the wall-associated protein A (wapA) gene of Streptococcus mutans GS-5 or its truncated derivative antigen A (agA) gene encoding a known candidate antigen for dental caries vaccine. The immunogenicity of the two constructs, designated pcDNA-wapA and pcDNA-agA, was compared by intranasal immunization of two groups of mice using the cationic DMRIE-C (1,2-dimyristyloxypropyl-3-dimethylhydroxy ethyl ammonium bromide-cholesterol) as an adjuvant. Immunization with pcDNA-wapA or pcDNA- agA resulted in specific salivary IgA and systemic IgG antibodies to the target antigens after two doses given at 3-week intervals. Higher salivary IgA level was observed in the mice immunized with the pcDNA-wapA vaccine compared to those immunized with the pcDNA-agA vaccine. Furthermore, anti-WapA antibody inhibited S. mutans sucrose-dependent adherence suggesting a potential protection against S. mutans colonization of the tooth, while anti-AgA had no significant effect. Indeed, prediction and analysis of protein epitopes showed that WapA contains highly promiscuous MHC-II binding motifs in addition to those found in AgA. Immunodot assay confirmed that WapA bound biotin-labeled dextran, whereas AgA did not. These data indicated that full-length WapA is a better candidate vaccine antigen than the soluble AgA, which is truncated in the hydrophobic membrane and wall-spanning region.

Dental plaque formation

Dental plaque is a complex biofilm that accumulates on the hard tissues (teeth) in the oral cavity. Although over 500 bacterial species comprise plaque, colonization follows a regimented pattern with adhesion of initial colonizers to the enamel salivary pellicle followed by secondary colonization through interbacterial adhesion. A variety of adhesins and molecular interactions underlie these adhesive interactions and contribute to plaque development and ultimately to diseases such as caries and periodontal disease.

Accumulation of Streptococcus mutans on light-cured composites and amalgam: an in vitro study

The aim of the in vitro study was to examine the accumulation of Streptococcus mutans on light-cured composite materials and amalgam. Bacteria cultures were grown in a brain heart infusion medium, and their growth rate was determined through turbidity measurements. The data, so obtained, were evaluated statistically by analysis of variance (ANOVA) followed by Scheffe test. Experiments on amalgam showed better results compared to those on composite materials. There were no statistically significant differences in plaque accumulation on different composite materials after finishing and polishing procedures, compared to plaque accumulation on composite materials against a Mylar strip.

Inactivation of the Streptococcus mutans wall-associated protein A gene (wapA) results in a decrease in sucrose-dependent adherence and aggregation

A 0.8-kb HindIII-BamHI internal fragment of the Streptococcus mutans wall-associated protein A gene (wapA) was ligated to the 5.1-kb HindIII-BamHI fragment of the chimeric Streptococcus-Escherichia coli plasmid pVA891 (Emr Cmr). The resulting construct was used to transform S. mutans GS-5, and erythromycin-resistant mutants were isolated and analyzed. Directed mutagenesis of the wapA gene by plasmid insertion through homologous recombination was demonstrated by Southern blot hybridization with the wapA and pVA891 probes. Stable mutants were obtained, and the alteration of the wapA gene by insertional inactivation was associated with a significant decrease in S. mutans sucrose-dependent aggregation and binding to smooth surfaces. Thus, WapA may play an important role in the colonization of the tooth surface by S. mutans and in the buildup of dental plaque. These findings provided an explanation for previous studies which indicated that WapA was effective in the prevention of dental caries in animal models. Thus, the use of recombinant WapA in the preparation of a safe and effective human dental vaccine should be investigated further.

The relationship between 48-h dental plaque accumulation in young human adults and the concentrations of hypothiocyanite, 'free' and 'total' lysozyme, lactoferrin and secretory immunoglobulin A in saliva

Samples of resting and stimulated whole saliva and stimulated parotid saliva were collected from 40 young adults. One week later, after 48 h on a standardized diet without oral hygiene, all available plaque was collected for dry weighing. An inverse relationship was found between the 'free' lysozyme concentration in stimulated parotid saliva and plaque dry weight (r = -0.46, p less than 0.01). There were no other statistically significant correlation coefficients between concentrations of individual salivary constituents and plaque dry weight. However, cluster analysis of constituents in resting whole saliva revealed three groups of subjects with different salivary profiles, and in particular with different concentrations of both IgA and hypothiocyanite. Subsequent analysis revealed differences in plaque dry weight between the groups, demonstrating the potential biological significance of cluster membership based on salivary factors.

Changes in strains of mutans streptococci induced by treatment with chlorhexidine varnish

Isolates of mutans streptococci were obtained from the dental plaque of ten subjects before and after the subjects had been free of detectable mutans streptococci for a mean period of 14.6 weeks (range, from two to 36 weeks). The mutans streptococci had been rendered undetectable by chlorhexidine varnish treatment. Examination of the restriction endonuclease analysis (REA) patterns of the isolates revealed that all ten subjects had one strain (REA type) after re-appearance of the mutans streptococci that was identical to one that had been present before the varnish treatment. In six of the ten subjects, only one strain was detected both before and after treatment. Each of the other four subjects appeared to gain a new strain after treatment; one of the four appeared to lose one strain, and another, four strains. The ability of strains to persist after the period of undetectability seemed unrelated to their resistance to chlorhexidine or to their ability to exhibit insoluble glucan-mediated adhesion. In the subjects harboring multiple REA types, one-seventh of the tooth surfaces sampled harbored two strains simultaneously, suggesting an inability of either strain to exclude the other aggressively. Overall, the study indicated that every subject receiving chlorhexidine varnish therapy had a primary strain of mutans streptococcus that re-emerged after treatment. In contrast, secondary strains were highly susceptible to being lost or gained.

Isolation and characterization of the Streptococcus mutans gtfC gene, coding for synthesis of both soluble and insoluble glucans

The intact gtfC gene from Streptococcus mutans GS-5 was isolated in Escherichia coli in plasmid vector pUC18. The glucosyltransferase activity expressed by the gene synthesized both low-molecular-weight water-soluble glucan and insoluble glucan in a primer-independent manner. Purification of the enzyme by procedures that minimize proteolytic digestion yielded a purified preparation with a molecular weight of 140,000. Insertional inactivation of the gtfC gene with a streptococcal erythromycin resistance gene fragment followed by transformation of strain GS-5 suggested that the gtfC gene product was required for sucrose-dependent colonization in vitro. In addition, evidence for the presence of a third gtf gene coding for soluble glucan synthesis was obtained following the construction of mutants containing deletions of both the gtfB and gtfC genes.

Anticariogenic activity of licorice and glycyrrhizine I: Inhibition of in vitro plaque formation by Streptococcus mutans

The effect of licorice and its active sweet component glycyrrhizin was tested on the growth and adherence to glass of the cariogenic Streptococcus mutans. Neither licorice nor glycyrrhizin promoted growth or induced plaque formation. In the presence of sucrose, glycyrrhizin did not affect bacterial growth, but the adherence (plaque formation) was markedly inhibited. At 0.5-1% glycyrrhizin, inhibition was almost complete. These results support our previous suggestions that glycyrrhizin might serve as an efficient vehicle for topical oral medications.

Effects of local immunization of hamsters with glucosyltransferase antigens on infection with Streptococcus sanguis

The effects of immunization with antigens of the Streptococcus mutans glucosyltransferase (GTF) complex on oral challenge with two Streptococcus sanguis strains (H7PR3 and 34) in hamsters were studied. Antisera to S. mutans GTF complex were able to inhibit one-third (strain H7PR3) to one-half (strain 34) of the S. sanguis GTF activity which could be inhibited when these S. sanguis GTFs were incubated with antisera to S. sanguis GTF. Washed, intact cells of strains H7PR3 and 34 were able to remove a significant amount of enzyme inhibitory activity and immunoglobulin G antibody activity from antisera to S. mutans GTF. These results established the existence of an antigenic relationship between S. sanguis and S. mutans GTFs. The effect of injection of S. mutans strain 6715 GTF or phosphate-buffered saline, incorporated into complete Freund adjuvant, on oral challenge with S. sanguis was compared in 243 hamsters in nine experiments. Salivary and serum GTF inhibitory activity was present in all GTF-injected animals before challenge. After a 2- or 3-day challenge with S. sanguis H7PR3 (seven experiments) or 34 (two experiments), fewer bacteria were recovered from GTF-injected hamsters in every experiment. Significant differences were observed in six of the nine experiments. During the 7- to 21-day period after challenge, 33% of the phosphate-buffered saline-injected sham group (group I) still had S. sanguis recoverable from the molar surfaces, whereas only 19% of the S. mutans GTF-injected group (group II) remained infected with S. sanguis (P less than 0.01). These results suggest that immunization with GTF from S. mutans may influence the colonization potential of S. sanguis in the oral cavity.

Humoral and cell-mediated responses to a ribosomal preparation from Streptococcus mutans

Streptococcus mutans 6715 ribosomes disrupted in a Braun homogenizer were isolated in sodium dodecyl sulfate by differential centrifugation. This preparation contained 80% RNA and 20% protein, and carbohydrate was not detected by phenol-sulfuric acid and methyl pentose assays. The sedimentation coefficient of the ribosomes was 70S. After dialysis in 0.01 M phosphate buffer containing 10(-4) M MgCl2, the ribosomes dissociated into 54S and 32S particles. Leukocytes from rabbits immunized intramuscularly with the ribosomal preparation showed transformation and migration indices of 13.0 and 0.71, which were significantly different (P less than 0.05) from the respective indices of 0.9 and 0.98 in nonimmunized animals. Hyperimmune serum from these rabbits agglutinated representative Formalin-killed strains of all seven serotypes of S. mutans, inhibited adherence of live S. mutans 6715 to glass, and agglutinated S. mutans 6715 ribosomes adsorbed upon erythrocytes. These findings suggested that animals immunized with S. mutans ribosomes may be protected from caries caused by any of the seven serotypes of this organism.

Evaluation of salivary IgA antibodies to cariogenic microorganisms in children. Correlation with dental caries activity

Children were examined for caries activity, and their salivary IgA was evaluated for reactivity to antigens of cariogenic bacteria by an enzyme-linked immunosorbent assay (ELISA). IgA levels to Streptococcus mutans were higher in children with no detectable caries. Analysis of IgA specific for Lactobacillus casei, teichoic acid, and glucan revealed no protective role for these specificities in children.

Synthesis of glucan on the cell surface of Streptococcus mutans: chemical and scanning electron microscopic studies

The appearance and continuing growth of extracellular material on Streptococcus mutans HS6 cells in sucrose-containing Merthiolated buffer was observed in a scanning electron microscope and was found to be related to the glucan synthesis on the cell and to adherence of the cell to a smooth surface. Cells grown in broth completely deprived of sucrose by invertase (HS6-IV) had a characteristic, slightly rugged surface structure. On incubation of HS6-IV in the sucrose-containing buffer, a few small globular particles appeared on the surface and grew to an irregular shape (globular to fibrilar) after several hours. The increase in the total glucan content of the cells paralleled the growth of the globular material, to which ferritin-conjugated anti-dextran globulin was found to bind. On the cell surface of cells harvested from conventional broth, both small globular and irregular structures, which possibly formed from sucrose in the broth, existed originally and continued to grow during incubation, along with the material newly appearing on the surface. The accumulation of glucan on the cells resulted in their adherence to a glass surface. The inhibition of growth of the extracellular material on the cells by trypsin, dextranase or anti-glucosyltransferase corresponded to the decrease in glucan synthesis and the loss of adhering ability. These results indicated that the material growing on the cell surface was glucan synthesized by glucosyltransferases.

Rapid quantitative determination of the effect of antiplaque agents and antisera on the growth, acid production, and adherence of Streptococcus mutans

A rapid quantitative in vitro assay measured the effects of antiplaque agents and antiserum on growth and sucrose-mediated adherence of radio-labeled S. mutans 6715. Acid production was measured by change in pH. In this assay the primary effect of chlorhexidine and fluoride was bacteriostasis and inhibition of acid production, respectively; the primary effect of dextran, dextranase, and specific antiserum was inhibition of sucrose-mediated adherence.

Interference of secretory immunoglobulin A with sorption of oral bacteria to hydroxyapatite

The potential of secretory immunoglobulin A (S-IgA) to interfere with the initial phase of dental plaque formation was studied by using an in vitro method which permits the quantitative determination of the sorption of radiolabeled oral bacterial cells to hydroxyapatite (HA) beads. The importance of specific S-IgA antibodies was evaluated by a comparison of the effect of pure preparations of colostral S-IgA, polymeric myeloma IgA, or preabsorbed S-IgA. Specific antibody molecules bound at the HA surface significantly enhanced the sorption of two Streptococcus sanguis strains. In contrast, HA-bound S-IgA antibodies inhibited the sorption of Streptococcus mitior and Streptococcus salivarius. The same was true for Streptococcus mutans cells, but only when they were propagated in the absence of sucrose. Suspended in saliva, cells of all streptococcal species adhered in significantly lower numbers to HA. Comparative experiments with bacteria suspended in solutions of various preparations of IgA or immunoglobulin-deficient salivas with S-IgA or myeloma IgA added indicated that the adherence inhibition seen with S. Sanguis, S. mitior, S. salivarius, and glucose-grown S. mutans was partly attributable to functions of S-IgA antibodies. Under the in vitro conditions of the study, S-IgA antibodies had no effect on the sorption of sucrose-grown S. mutans, Actinomyces viscosus, and Actinomyces naeslundii to HA. The results indicated that S-IgA can interfere with the sorption of some oral bacteria to HA by several different functions.

Common antigens of streptococcal and non-streptococcal oral bacteria: immunochemical studies of extracellular and cell-wall-associated antigens from Streptococcus sanguis, Streptococcus mutans, Lactobacillus salivarius, and Actinomyces viscosus

Soluble extracellular antigens (ESA) were prepared from the culture supernatant of exponential growing cells of Streptococcus sanguis OMZ 9 by a combination of ammonium sulfate precipitation and chromatography on a Bio-Gel P6 column. Soluble cell wall antigens (WEA) were obtained from the bacterial pellet by extraction with 1 M phosphate buffer (pH 6). Antisera against whole cells of S. sanguis and S. mutans of different serotypes, 10% trichloroacetic extracts of bacterial cell walls, dextran, ESA, and WEA were prepared by injecting the different antigens several times in rabbits. ESA and WEA were prepared from a representative strain of Bratthall's seven serological groups, Lactobacillus salivarius, and Actinomyces viscosus. All sera showed various agglutinin titers against heat-killed cells, and titers were generally higher with homologous cells. The comparison of the different antigens using agar gel diffusion and immunoelectrophoresis showed the presence of extracellular common antigens in both ESA and WEA between the different strains. Absorption of anti-ESA sera with WEA, and anti-WEA sera with ESA, showed the existence of a specific antigen common to all bacteria in each fraction. Enzymatic treatment of the antigen before immunodiffusion demonstrated the protein nature of the two antigens present in ESA and WEA.

Oral candidiasis: effects of antifungal therapy upon clinical signs and symptoms, salivary antibody, and mucosal adherence of Candida albicans

A human study of the effects of topical nystatin (Mycostatin) therapy of oral candidiasis showed that effects of treatment were limited to the time in which the drug was used. Two weeks of therapy resulted in significant reduction in number of organisms and marked improvement in signs and symptoms of candidiasis. The condition recurred rapidly following cessation of treatment. No change in specific anticandida antibody in saliva or in adherence of Candida albicans to mucosal epithelium (in vitro) was seen with treatment.

Demonstration of the adherence of Streptococcus pyogenes to the surface of human tonsillar tissue

One of the mechanisms by which bacteria become pathogenic on mucosal surfaces is their capacity to adhere to those surfaces. Although adherence of pathogens has been demonstrated on other mucosal surfaces, it has never been demonstrated on tonsillar tissue. A section of the surface of a pharyngeal tonsil was thoroughly washed with phosphate buffered saline and divided into fragments of Gram staining, scanning electron microscopy, and incubation with group A beta hemolytic Streptococcus pyogenes isolated from the upper respiratory tract. After 30 minutes and 24 hours of incubation the fragment was removed, washed thoroughly with phosphate buffered saline to remove any nonadherent S. pyogenes, and divided into three parts for Gram staining, scanning electron microscopy, and homogenization for tube and plate dilution. Adherence of S. pyogenes was demonstrated by Gram staining, scanning electron microscopy, and plate dilution. This first demonstration of bacterial adherence on tonsillar mucosa tract points to adhesion as a mechanism of pathogenesis in S. pyogenes infection in the tonsil.

Biology, immunology, and cariogenicity of Streptococcus mutans

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Purification and characterization of a rhamnose-containing cell wall antigen of Streptococcus mutans B13 (serotype d)

A rhamnose-containing polysaccharide (RCP) was extracted and purified from cell walls of Streptococcus mutans B13 (serotype d) and was chemically and immunologically characterized. Walls were initially extracted with 5% trichloroacetic acid at 4 degrees C to remove the serotype antigen and were then sequentially extracted with increasing concentrations of hot acid. Extracts lacking galactose were combined and chromatographed on a column of diethylaminoethyl--Sephadex A25. The purified RCP contained 90% carbohydrate, 1.4% protein, and 0.16% phosphorus. Analysis by gas chromatography indicated that the RCP was composed of rhamnose and glucose in a 1.6:1 ratio. RCP was immunogenic in rabbits when animals were immunized with whole cells or cell walls. Antisera prepared against partially extracted cell walls of B13 appeared specific for RCP. These sera were not reactive with purified serotype d antigen or lipoteichoic acid in passive hemagglutination assays or by agar gel diffusion. The RCP appeared to be a cell wall polysaccharide that was both chemically and immunologically distinct from the serotype d antigen.

Factors influencing adherence of group B streptococci to human vaginal epithelial cells

Factors affecting the adherence of group B streptococci to human vaginal epithelial cells in vitro were examined. Maximal adherence was achieved within 15 min of incubation of bacteria with epithelial cells. Adherence was temperature and pH dependent; maximal adherence occurred at 37 degrees C and pH 5.5. Killing of streptococci with ultraviolet light or penicillin did not affect adherence. Similarly, adherence was not altered by preincubating epithelial cells at 65 degrees C for 30 min. Thus neither bacterial nor epithelial cell viability appears to be a prerequisite for adherence. Preincubation of streptococci at 65 degrees C for 30 min resulted in a marked decrease in adherence, whereas preincubation of group B streptococci with neuraminidase was associated with a significant increase in adherence. The adherence of strains belonging to five different group B streptococcal serotypes was not altered by group-specific or type-specific rabbit antisera. These findings suggest that the site for adherence on the bacterial cell wall is heat sensitive and is marked by sialic acid, but is not related to either group-specific or type-specific antigens.

Passage of intact IgG from plasma to the oral cavity via crevicular fluid

The aim of this investigation was to determine whether IgG could pass from the blood to the oral cavity. Pure IgG was prepared from monkey serum, by ion exchange chromatography and gel filtration, and was radiolabelled with ¹²⁵I. This was injected intravenously into eight Rhesus monkeys. Radioactivity could be detected in crevicular fluid washings, and in mixed and parotid saliva samples 30 min after injection. Ultracentrifugation on sucrose density gradients revealed that most of the radioactivity in crevicular fluid washings was associated with proteins having a sedimentation coefficient similar to marker IgG. Radioactivity in parotid saliva was not found in the IgG zone, but was present in zones with sedimentation coefficients of approximately 4·5S and 1S. The results suggest that IgG passes as an intact molecule from plasma to crevicular fluid, and support the hypothesis that serum antibodies could play a role in protection against dental caries.

Characterization of glucosyltransferase-deficient, plasmid-containing mutants of Streptococcus mutans LM-7

The possibility that glucosyltransferase (GT)-mediated insoluble-glucan synthesis from sucrose is controlled by the 3-megadalton plasmid pAM7 in Streptococcus mutans LM-7 has been examined. A low-sucrose agar medium was developed to readily detect and quantitate presumptive GT-negative mutants. Such mutants were isolated from Todd-Hewitt broth cultures grown either with or without sodium dodecyl sulfate (10 microgram/ml) or acriflavine (0.5 microgram/ml) at frequencies ranging from about 0.01 to 1%. Independently isolated mutants had the following characteristics: (i) cells were virtually devoid of cell-associated GT and did not aggregate upon addition of sucrose; (ii) cell-free culture fluids synthesized 10X less insoluble glucan than those of the parent; and (iii) cultures grown with sucrose did not form adherent deposits on the wall of the culture tube, as is typical of S. mutans. Both parent and mutants formed relatively little soluble glucan in 1-h assays. Three independently isolated mutants and the parent were found to contain similar amounts of plasmid DNA. Analysis by sucrose density gradient centrifugation and agarose gel electrophoresis did not reveal a size difference between the plasmids from parent and mutants. These results show that (i) S. mutans LM-7 generates GT-deficient mutants at relatively high frequency that still contain a 3-megadalton plasmid; (ii) both cell-associated and extracellular GT levels are depressed in the mutants, which suggests that these activities are directly or indirectly controlled by the same gene or by genes that segregate as a unit.

Immunogenic properties of the glucosyltransferase from Streptococcus sanguis OMZ 9: kinetic study of inhibition by antibodies

An anti-glucosyltransferase serum was prepared against a pure enzyme preparation from Streptococcus sanguis OMZ 9, which synthesized both soluble and insoluble dextran. Sera, crude gamma globulins, and antibody fractions obtained after gel filtration on a Bio-Gel P200 column were used to study enzyme-antibody interactions. A strong inhibition of glucosyltransferase activity was obtained only with the purified antibody fraction. Kinetics studies showed that the anti-glucosyltransferase antibodies acted as noncompetitive inhibitors with respect to the substrate (sucrose). The addition of primer dextran in the reaction mixture during preincubation produced a diminution of the inhibition, and the antibodies acted as mixed type inhibitors with respect to dextran. The simultaneous addition of dextran and antibodies can protect the enxyme against antibody inhibition.

Bacterial adherence in the pathogenesis of endocarditis. Interaction of bacterial dextran, platelets, and fibrin

The role of dextran in the pathogenesis of bacterial endocarditis was investigated by studying the adherence of dextran producing oral streptococci to the constituents of nonbacterial thrombotic endocarditis (NBTE) in vitro and in vivo. The adherence of Streptococcus sanguis to fibrin and platelets was determined in an in vitro assay system simulating nonbacterial thrombotic endocarditis. Adherence was increased when the organisms were grown in sucrose-supplemented media (adherence ratio X 10(4), 177 +/- 6 in 5% sucrose vs. 140 +/- 7 in 0.5% sucrose, P less than 0.001), and decreased by incubating the organisms in dextranase (adherence ratio X 10(4), 117 +/- 16, P less than 0.001), an effect which was nullified by heat inactivating this enzyme (adherence ratio X 10(4), 192 +/- 7, P less than 0.001). The amount of dextran produced in broth by three different oral streptococci correlated directly with the adherence observed to fibrin and a fibrin-platelet matrix in vitro (P less than 0.001). These organisms adhered more readily to a fibrin-platelet matrix than to fibrin alone (adherence ratio X 10(4), 455 +/- 30 vs. 177 +/- 6, respectively, P less than 0.001). The role of dextran formation was also examined in vivo in rabbits with preexisting NBTE. After injection of 10(7) S. sanguis, 12 of 17 animals developed endocarditis. In contrast, when the organisms were pretreated with dextranase (an enzyme that removes dextran from the bacterial cell surface), the same inoculum resulted in endocarditis in only 5 of 19 animals (P less than 0.05). In addition, a fresh strain of S. sanguis that produced high levels of dextran (1,220 +/- 50 microgram/ml) and adhered avidly to fibrin (adherence ratio X 10(4), 220 +/- 11) produced endocarditis in 12 of 18 rabbits after injection of 10(7) organisms. Another isolate of the same strain that had been passed repeatedly in the laboratory produced less dextran (400 +/- 30 microgram/ml), adhered poorly to fibrin (adherence ratio X 10(4), 140 +/- 7), and produced endocarditis in only 3 of 14 rabbits under identical conditions (P less than 0.05). This study demonstrates that dextran production is important in the adherence of oral streptococci to the constituents of NBTE and may play a role in the pathogenesis of bacterial endocarditis by oral streptococci.

Dextran receptors as immunogens in caries prophylaxis

1) Immunization of rats with dextran receptors appears to confer resistance to development of caries. 2) A significant negative correlation between antiserum titers and caries scores is observed in immunized rats. 3) Antiserum specific for dextran receptors does not inhibit in vitro adherence of live bacteria in sucrose supplemented media. 4) Free receptors can bind to dextran, thereby inhibiting its ability to induce bacterial agglutination.

Therapeutics of caries prevention--concepts and prospects

Despite intensive research, water fluoridation and, where practiced, diet control, remain the most effective methods of preventing caries. In this paper, a number of approaches discussed appear to hold promise that they may enhance the caries preventive effect of fluoride, and others, when developed and applied, may hasten the day when dental caries will cease to be a public health problem.

Adherence of Veillonella species mediated by extracellular glucosyltransferase from Streptococcus salivarius

The effect of extracellular products from Streptococcus salivarius on sucrose-dependent adherence to smooth surfaces by other oral bacteria was studied in vitro. Strains of Streptococcus mitis, Streptococcus pyogenes, and Veillonella parvula without innate ability to adhere to a steel wire were able to do so when incubated with sucrose and cell-free culture fluid from S. salivarius strains 9759, 25975, CNII, and MEPI. These culture fluids synthesized more adherent material and water-insoluble glucan than those from Streptococcus mutans C67-1 and seven other S. salivarius strains. Among the S. salivarius strains, glucosyltransferase (GT; dextransucrase, EC 2.4.1.5) activity varied more than 100-fold. Cells of Veillonella and S. mitis S3 that had been incubated in culture fluids from S. salivarius 25975 and 9759, respectively, and then washed adhered upon subsequent incubation with sucrose. This was due to adsorbed GT because (i) the adherence was sensitive to dextranase; (ii) it was observed only with the high-GT culture fluids; (iii) it was dependent on sucrose; and (iv) the washed Veillonella cells synthesized glucan, but not fructan, from sucrose. These results suggest that sucrose-dependent adherence of bacteria without such innate ability can be mediated by (i) entrapment in insoluble glucan synthesized by S. salivarius culture fluids, and (ii) prior adsorption of GT from S. salivarius culture fluids. The possibility that GT formed by high-yield strains of S. salivarius is distributed through the mouth by the action of salivary flow and contributes to sucrose-dependent adherence and plaque formation is considered.

Molecular basis for the different sucrose-dependent adherence properties of Streptococcus mutans and Streptococcus sanguis

The enzymatic and adherence properties of Streptococcus mutans GS5 and S. sanguis ST3, both isolated from human carious lesions, have been compared. During growth in sucrose media, S. mutans GS5 adheres to smooth surfaces approximately three times more effectively than dose S. sanguis ST3. However, strain ST3 does not display sucrose-dependent adherence under nongrowth conditions, whereas strain GS5 displays significant adherence. Although both organisms synthesize both water-soluble and -insoluble glucans, the glucosyltransferases from S. mutans GS5 synthesize much more adherent glucan molecules than do the comparable enzymes from S. sanguis ST3. Both cell types bind exogenous glucosyltransferases synthesized by strain ST3 equally well, whereas cells of strain GS5 bind the comparable enzyme fraction that it synthesizes to a greater degree than do cell of S. sanguis ST3. However, in contrast to the results with cells of S. mutans GS5, the absorption of the glucosyltransferase activity synthesized by S. mutans GS5 to the surface of S. sanguis ST3 results in low levels of subsequent sucrose-dependent adherence. These results are discussed in terms of the molecular basis for the sucrose-dependent adherence of the oral streptococci to smooth surfaces.

Biochemical study of the relationship of extracellular glucan to adherence and cariogenicity in Streptococcus mutans and an extracellular polysaccharide mutant

A mutant of Streptococcus mutans, GS-5, which differed in extracellular polysaccharide (EPS) produced from sucrose, was used to study the role of EPS in the production of dental caries. The mutant proved to be identical to the parent strain in sugar fermentation, growth rate, and serotype. Strain GS-5 synthesized an EPS, which in electron micrographs appeared to be of fibrillar structure, whereas the mutant produced no fibrillar material but only a globular EPS. Analysis of the EPS revealed that about 30% of the glucose units in the GS-5 polymer carried (1-3)-like bonds either as branch points or as part of the linear backbone and that the mutant material contained only about 3% of these linkages. When grown in sucrose broth, the proportion of the mutant culture adherent to the glass vessel was dramatically less than that of the parent strain. Caries scores produced in conventional rats by the mutant were significantly lower than those obtained with the parent strain. Since the only difference discovered between strain GS-5 and the mutant was the inability of the mutant to synthesize either a fibrillar EPS or an EPS with more than about 3% (1-3)-like linkages, it was concluded that the fibrillar EPS of strain GS-5 contained about 30% (1-3)-like linkages and was necessary for adherence of the bacteria to surfaces and for production of dental caries in test animals.

Purification and some properties of free and cell-associated dextransucrase from Streptococcus sanguis

Dextransucrase of Streptococcus sanguis occurred in cell-free and cell-associated forms. Cell-free dextransucrase was purified by four successive chromatographies on Bio-Gel P 60, DEAE-cellulose, and Bio-Gel P 200 from the culture supernatant. The purification of cell-associated dextransucrase was made from the pellet of Streptococcus sanguis culture. Bacterial pellet was extracted with 1 M phosphate buffer (pH 6.0) and chromatographied by using an immunosorbent column. The two enzymes gave single bands in polyacrylamide gel electrophoresis. The molecular weight determined by sodium dodecyl sulfate polyacrylamide gel was about 100 000 daltons for the two forms of dextransucrases. The optimum pH of the cell-free and cell-associated enzymes was around 6 and the temperature optimum was broad for the two enzymes. The KM values for sucrose were respectively 2 mM and 3 mM for cell-free and cell-associated enzymes. When primer dextran was added, the reaction velocity increased but the KM for sucrose remained the same, and the KA for dextran was 200 muM for the two dextransucrases. Trehalose and maltose acted also as glucosyl residue acceptors. Purified enzymes had dextran synthesising activity and invertase-like activity. The same properties of the two forms of enzymes and the positive cross reaction against anti free and anti cell-associated globulins stongly suggest the identity of the two enzymes.

Inhibition of rat dental caries by dextranase from a strain of Spicaria violacea

Dextranase AD17 obtained from a culture liquor of a strain of Spicaria violacea was assessed for its ability to inhibit the development of dental caries in conventional Sprague-Dawley rats which had been infected with one of the Streptococcus mutans strains. MT6R (serotype c), OMZ 176R (d), or MT-703R (e). These experiments showed that caries was significantly inhibited when rats were given cariogenic diets No. 2000 and drinking water containing AD17 at a concentration of 10 units/g, as compared to control rats not given dextranase. The inhibitory effects of AD17 were more prominent in smooth surface caries than in total caries. AD17 had a tendency to retard both the establishment of inoculated S. mutans and plaque deposition on tooth surfaces. However, S. mutans could be implanted in the rat oral cavity after repeated inoculation of the bacteria, even in the presence of AD17. These results suggest that the anticaries activity of AD17 is due to not only inhibition of adherence of S. mutans cells on tooth surfaces but also to physiochemical changes of dental plaque formed under the enzymatic action of AD17. Preliminary histophatological examination showed that AD17 had no significant toxicity in rats.

Differential inhibition of Streptococcus mutans in vitro adherence by anti-glucosyltransferase antibodies

Antibodies prepared against an insoluble-soluble glucan-synthesizing fraction significantly inhibited in vitro adherence of Streptococcus mutans, whereas antibodies directed against a soluble glucan-synthesizing fraction were much less inhibitory.

Serum glucosyltransferase-inhibiting antibodies and dental caries in rhesus monkeys immunized against Streptococcus mutans

Serum antibodies to glucosyltransferase (GTF) of Streptococcus mutans serotype c were assayed sequentially by means of an enzyme inhibition radio-assay in twenty-six Rhesus monkeys immunized with S. mutans. Pre-immune and control sera had a GTP-enhancing effect which was shown also by albumin and non-immune immunoglobulin fractions. GTF-inhibitory activity was found in IgG fractions from some immune sera and could be absorbed by S. mutans cells possessing cell-bound GTF. Inhibitory antibodies to GTF developed in the sera of four monkeys immunized with hydroxylapatite extract of culture supernatant (HACS), and in four out of fifteen monkeys immunized with S. mutans cells, but in none of the seven sham-immunized control animals. The monkeys immunized with HACS showed no reduction in caries. A correlation has been demonstrated between protection against caries and the early development of serum IgG antibodies to antigens present in HACS but there was no consistent association between protection against caries and GTF-inhibitory antibodies. The results also suggest the possibility that other antibodies, possibly present in the IgM or IgA fractions and having an enhancing effect on GTF, may increase the incidence of caries.

Inhibition of streptococcal adherence by human oral secretions and its possible relationship to dental caries

Oral secretions were collected from 100 human volunteers, concentrated, and assayed for their ability to inhibit glucan-dependent adherence of S mutans strains to glass. Some samples were found to contain adherence inhibition activity. The inhibitor was heat labile and nondialyzable but dependent on the presence of a dialyzable molecule. Comparison of activities with the caries experience (DMFT) showed that individuals with the highest activity had significantly lower mean caries scores, but that cariesfree donors did not differ significantly from caries-positive donors in mean adherence inhibition activity. These results suggest that some persons may have substances in their oral secretions that play a role in resistance to dental caries.

Immunization experiments using the rodent caries model

Taken together, the immunization experiments which have been performed in the rat caries model system appear to suggest a correlation between the presence of salivary antibody to S mutans and reductions in caries caused by these bacteria. However, the multifactorial nature of this disease does not permit at present the conclusion that the presence of this antibody is both necessary and sufficient to give rise to the demonstrated effects on pathogenesis. To clarify the role of salivary antibody, several refinements may be required in the current model. Immunization procedures that elicit only a local antibody response would both simplify interpretations of effects and would be more desirable for use as a vaccine. Such procedures might include intraductal installation of antigen in the parotid gland which has been demonstrated to result in this type of response. An additional refinement stems from the knowledge that the kinds of immunization procedures currently used stimulated both cellular immune and soluble antibody systems, potentially giving rise to a rather broad spectrum of immune responses. Therefore, it might be useful to study the effects on S mutans pathogenesis in rats in which certain of these responses have been repressed, for example, by thymectomy, antilymphocyte serum, and so on. Also, each of these approaches would be measurably enhanced by more sensitive techniques to monitor immunological events in the oral cavity. Refinements in the selection and use of relevant antigens of S mutans also are necessary to delineate the in vivo mechanism of immunological interference in the pathogenesis of cariogenic streptococci. Approaches involve the use of purified GTF antigens or cell surface antigens both in the investigation of these mechanisms in in vitro models using antibody specifically directed to these antigens and in rat immunization experiments using immunogenic preparations of these materials. In addition, alterations in the diet and challenge dosage of infecting cariogenic organisms might permit more sensitive detection of effects in vivo. Clearly, the evidence suggests immunological interference with S mutans pathogenesis in the rat model system. However, several gaps exist in our basic understanding of this interference and of the appropriate system in which to observe these effects. The potential significance of this phenomenon should spur efforts to fill these gaps to establish definitively the role of immunity as an ecological determinant in the oral cavity.

Interactions of antisera, sera, and oral fluid with glucosyltransferases

Partially purified glucosyltransferases (GTF) isolated from Streptococcus mutans OMZ 176 and respective rabbit antisera were used to study enzyme-antibody interactions. A comparison between sensitive serological techniques and a functional inhibition test based on a radioenzyme assay demonstrated that the latter test system was the only one that discriminated between different antisera. Positive reactions in high dilutions in the former test systems were explained by the involvement of non-GTF contaminants and/or antibodies against enzyme regions distant to the catalytic site. The minute cross-reactions between two enzyme fractions and the respective antisera in the functional inhibition test indicated that the two immunogens contained mainly GTF that differed in the structure of their catalytic region. Control rabbit sera, rat oral fluid, and insoluble and soluble glucans considerably activated the GTF eluted with a 0.5 M phosphate buffer from hydroxapatite. It is suggested that these enzymes had additional binding sites for macromolecules inherent to rabbit sera and rat oral fluid, respectively, and that the observed increase in enzyme activity was due to a more stable enzyme conformation. Possibly the stimulation of GTF by the soluble glucan fraction was caused by a primer and/or acceptor function; however, this was not the case of the insoluble glucan. A stable complex was formed in the absence of the enzyme substrate, sucrose, the activity of which was not readily enhanced. It is concluded that the GTF of strain OMZ 176 are composed of multiple, multi-reactive molecules that enable these enzymes to act as cross-linking agents.

Immunologic basis for vaccination against dental caries in rhesus monkeys

The effects of immunization with Streptococcus mutans on the development of caries and the immune responses were investigated in 37 young rhesus monkeys (Macaca mulatta) during a period of up to 33 months. The monkeys were supplied a human type of carbohydrate-rich diet that contained about 15% sucrose. The monkeys were separated into seven groups, and the effects of two whole cell vaccines and an extracellular culture extract of S mutans in Freund's incomplete adjuvant were compared with a vaccine of a noncariogenic Streptococcus CHT, the adjuvant alone, and a sham immunized group. Sequential analysis of complement fixing, hemagglutinating and precipitating antibodies to the cell wall, and extracellular culture extract have shown that a significant reduction in smooth surface and fissure caries resulted from immunization with the S mutans vaccines, if antibodies reached an optimum level before caries development started. Protection was not elicited by the culture extract of S mutans or the noncariogenic Streptococcus CHT vaccines. A recently developed bacteriological sampling technique of crevicular fluid, plaque, and saliva showed that caries reduction in immunized animals was associated with a significantly decreased percentage of S mutans in crevicular fluid. Immunochemical studies showed IgG and IgM classes of antibodies in serum and secretory IgA antibodies in saliva, but it appears that reduction in caries was best associated with serum IgG antibodies to the culture extract of S mutans. The humoral and cellular mechanisms involved in the immunologic control of caries are discussed in terms of a central afferent mechanism required for antigen processing and cellular proliferation, and two peripheral effector mechanisms that function in the crevicular and salivary domains.

Effects of antibodies on adherence and cell-associated glucan production by Streptococcus mutans cells

Studies reported here show that hyperimmune rabbit serums can have profound inhibitory effects on adherence of S mutans to smooth surfaces and that this reduction in adherence is correlated with the reduction of CAG. The latter was measured by an assay developed in our laboratory that estimates CAG production by measuring the uptake of 14C glucose-labeled sucrose into components which can be extracted by dilute alkali. This is a direct demonstration of the effect of antibody on a metabolic function of S mutans that is important in virulence. The direct correlation bewteen inhibition of CAG production, and inhibition of adherence by an antibody, suggests that the inhibition of adherence is brought about by reduction of CAG synthesis. Further studies reported here show that the inhibition of adherence and of CAG synthesis is much more effective in homologous antiserums as compared to heterologous antiserums. These results point to the need for in vivo experiments to test the effects of vaccines on colonization by heterologous as well as homologous S mutans strains.

Immune components in dental plaque

Acquired pelicle appears to contain primarily IgA and other proteins of salivary origin. With the increased time necessary for plaque formation, gingival crevicular fluid contributes proteins to the growing plaque accumulation. However, secretory IgA is still the major intact immunoglobulin in plaque samples since appreciable portions of the molecules bearing IgG determinants appear to be degraded to small fragments. Nevertheless, the amount of IgA present in plaque, which could be considered antibody, is too little to account for most of the plaque interactions. Since secretory IgA appears to be resistant to proteolytic degradation by a mixture of plaque enzymes, and IgA fragments are not prominent in plaque extracts, degradation of secretory IgA probably cannot explain the relatively low IgA levels in plaque. It has been shown that salivary IgA antibody can interfere with enzymes responsible for the plaque-forming potential of certain organisms. All the preceding evidence is consistent with our current contention that secretory IgA functions as blocking antibody to interfere with the formation of dental plaque. This could occur by direct inhibition of bacterial polymer formation or by direct or indirect inhibition of bacterial interaction with salivary constituents by secretory IgA. Less than 1% of the plaque interactions can probably be attributed to secretory IgA antibody. IgG may contribute even less since it is degraded.

Purification, characterization, and immunogenicity of cell-associated glucan from Streptococcus mutans

Appropriate immunization with whole cell vaccines of S mutans appear to induce antibodies that inhibit implantation of S mutans on tooth surfaces and associated dental caries. To better understand the mechanisms by which vaccination prevents S mutans implantation and dental caries, and to prepare antigens whose effectiveness and safety can be tested in animal models of caries, we set out to purify and chemically characterize the CAG of S mutans. The CAG of S mutans strain 6715 was prepared by extracting cells with potasssium hydroxide at 100 C. After neutralization and extensive washing, the water-insoluble product was characterized by a battery of chemical analyses and found to be a relatively pure glucan. The CAG was weakly immunogenic in rabbits when administered in Freund's complete adjuvant. In monkeys (M irus) immunized via the parotid duct with an aqueous solution of CAG, a definite but weak serum IgG, IgM, IgA, and salivary IgA antibody response was observed. Absorption experiments showed that the CAG induced antibodies that cross reacted with Sephadex G-25 and others that reacted with unique determinants on CAG. Retention of native antigenic determinants through the purification procedures was verified by the observations that antiserums to CAG reacted with whole cells of S mutans and by the fact that antiserums to S mutans cells reacted with CAG.

Immunization of Macaca fascicularis (Macaca irus) monkeys with Streptococcus mutans: specificity of antibody responses in saliva

M fascicularis monkeys were immunized subcutaneously in the vicinity of the major salivary glands and by retrograde infusion into the parotid duct, with a vaccine containing Formalin-killed S mutans strain 6715 cells and culture-fluid antigens. Indirect immunofluorescent staining was used to titrate and classify antibodies. Subcutaneous immunization induced only a serum response, whereas intraductal infusion stimulated both an IgA antibody response in the parotid fluid and a serum response. Immunized and nonimmunized control groups were orally infected with S mutans strain 6715. The establishment in dental plaque was quantitated by recovery of the infecting organism on selective media and by immunofluorescent staining of plaque smears taken from individual tooth surfaces. The establishment of S mutans strain 6715 was noticeably inhibited in immune monkeys. Immunofluorescent assays for antibody also showed that serum and parotid fluid containing serum IgA antibodies cross reacted with other d serotype and a serotype strains but not representative b and c strains. Immune and control groups were then orally infected with S mutans strain GS-5, a c serotype strain, and no inhibition in establishment was detected of the non-cross-reacting type c organism in the immune group. A latter series of booster immunizations via the intraductal route resulted in a significant decrease in parotid fluid flow. Histological investigations showed inflammatory cell infiltration and replacement of epithelium by connective tissue in the glands from immunized monkeys. A separate group of monkeys, younger than the first, was immunized with the same vaccine via the duct only. In this group, immunizations were given at shorter intervals, but the immunization response was similar to that observed in the first group. The investigations reviewed here and new experiments reported show that immunization of monkeys with S mutan strain 6715 via the parotid duct elicited a reproducible IgA antibody response in the parotid fluid as well as a serum antibody response. Inhibition of colonization on tooth surfaces in immune monkeys showed specificity for the immunizing strain suggesting that inhibition was antibody mediated.