Development of an enzyme-linked immunosorbent assay for determination of lysozyme in human parotid and submandibular-sublingual salivas

Dose‑dependent effect of lysozyme upon Candida albicans biofilm

The present study investigated the in vitro effect of lysozyme (0-1,000 µg/ml) on Candida albicans (C. albicans) biofilm development. Investigations were conducted on C. albicans ATCC 10231 and on 10 clinical isolates from dentures. Strains were cultured aerobically at 37˚C in Sabouraud broth. Yeast growth was evaluated by turbidimetry. Biofilm biomass was quantified on a polystyrene support by crystal violet staining and on acrylic surfaces by counts of colony forming units. Lysozyme affected biofilm formation to a greater extent than it affected growth. For the ATCC 10231 reference strain, lysozyme acted as a biofilm promotor on polystyrene at the highest concentration tested (1,000 µg/ml, non‑physiological). When the reference strain was investigated on acrylic resin support, lysozyme acted as a significant biofilm promotor on rough resin, but less on smooth resin. The attached biomass in the presence of physiological concentrations of lysozyme (10‑30 µg/ml) was significantly decreased compared with the hypothetical value of 100% using a one‑sample t‑test, but a comparison between the different lysozyme conditions using analysis of variance and post hoc tests did not reveal significant differences. In 10 wild strains, different patterns of biofilm formation on polystyrene were observed in the presence of lysozyme. Some strains, characterized by large amounts of biofilm formation in the presence of 1,000 µg/ml lysozyme, were poor biofilm producers at low concentrations of lysozyme. In contrast, some strains that were poor biofilm producers with a high lysozyme concentration were more inhibited by low concentrations of lysozyme. The present study emphasizes the need to develop strategies for biofilm control based on in vitro experiments, and to implement these in clinical trials prior to approval of hygiene products enriched with exocrine proteins, such as lysozyme. Further studies will extend these investigations to other Candida species, and to fungi and bacteria present in oral biofilms.

Carbachol-induced in vitro secretion of certain human submandibular proteins investigated by mass-spectrometry

OBJECTIVE

To investigate protein content of saliva produced in vitro by samples of human submandibular gland following stimulation with the muscarinic agent carbachol.

DESIGN

Tissue samples, obtained at surgery from seven patients and showing normal morphological appearance, were tested for 30 min: in absence of carbachol and atropine; in presence of carbachol (10 microM); in presence of carbachol (10 microM) and atropine (20 microM); or in presence of just atropine (20 microM). Medium was analysed by high-performance liquid chromatography-mass-spectrometry. Neither before nor during surgery were the patients exposed to drug treatments that were likely to influence the in vitro secretion.

RESULTS

Proline-rich proteins (PRP)-1 and -3, peptide PC and PB, statherin, cystatins SN, S1 and S2 were invariably found in control gland tissue medium. Mean concentrations of these proteins/peptides in the medium were non-proportionally elevated following carbachol exposure to the gland tissues. Difference between basal release and carbachol-induced secretion achieved statistical significance as to all the proteins/peptides under study but for statherin. Atropine alone or atropine plus carbachol caused no significant changes compared to the basal release of proteins/peptides.

CONCLUSIONS

In vitro studies on salivary glands make it possible to study protein secretion from individual glands and thus, to reveal the contribution of the various types of gland to protein/peptide content of whole saliva. The disproportional responses to carbachol may imply that the proteins/peptides are not confined to the same cells or to the same intracellular locations and are therefore not secreted as packages at parasympathetic cholinergic activity.

Total antioxidant levels of saliva in children related to caries, age, and gender

AIM

The purpose of this study was to evaluate the relationship between the physicochemical properties of saliva such as flow rate, buffering capacity, pH, calcium level, total protein, total antioxidant status, and dental caries, age, and gender.

MATERIAL AND METHODS

The antioxidant activity of saliva was investigated in 80 healthy children aged 7-15 years. They were divided into subgroups according to gender, age (7-10 years and 11-15 years), and caries activity (caries active=CA and caries free=CF). Unstimulated saliva samples were collected from all groups. Flow rates were determined, and samples analysed for pH, buffer capacity, calcium, total proteins, and total antioxidant status. Salivary total antioxidant activity (TAA) was estimated by an adaptation of the ABTS (2,2-azino-di (3-ethylbenzthiazoline-6-sulphonate)) assay.

RESULTS

The results indicated that in general, although there was no linear association between salivary flow rate pH and buffering capacity values obtained from different groups, salivary calcium concentration values were found to be higher in caries free groups. Total protein and total antioxidant values were higher in caries active groups except those in the 11- to 15-year-old girls group.

CONCLUSION

In general, total protein and total antioxidant insaliva were increased with caries activity. Calcium concentrations in saliva were higher in caries-free children. In addition, calcium concentration increased with age. Thus, it can be concluded that a linear association exists between calcium concentration age and caries activity. More clinical and laboratory studies are needed to determine the exact relationship between the physicochemical properties of saliva such as flow rate, buffering capacity, pH, calcium level, total protein, total antioxidant status, and dental caries, age, and gender.

Health benefits of saliva: a review

OBJECTIVE

The aim is to present a review of the literature on human saliva composition, flow rates and some of the health benefits of saliva, with emphasis on studies from our laboratory that have looked at effects of age and age-related diseases on saliva output and composition.

DATA

Saliva influences oral health both through its non-specific physico-chemical properties, as well as through more specific effects. The proline-rich proteins, statherin and the histatins are salivary proteins that influence calcium phosphate chemistry, initial plaque formation and candida infection. Increases or decreases in mastication may affect saliva output. Our cross-sectional studies of saliva in a large population-based study cohort (N=1130) indicate that there is an age-related decline in saliva output for unstimulated whole, stimulated parotid, unstimulated submandibular/sublingual and stimulated submandibular/sublingual saliva, as well as some compositional alterations in anti-microbial and other proteins. Some of these alterations also appear to be specific for certain age-related medical conditions, such as diabetes mellitus.

CONCLUSIONS

These studies and data presented confirm the importance of saliva in maintaining a healthy oral environment; the practitioner is encouraged to consider saliva output and medical conditions that may compromise it as part of routine dental treatment planning.

Submandibular and sublingual salivary gland function in familial dysautonomia

OBJECTIVE

Drooling in familial dysautonomia (FD) has been attributed to denervation supersensitivity. The aim of this study was to investigate submandibular and sublingual (SM/SL) gland function in FD.

STUDY DESIGN

SM/SL saliva was collected from 15 children with FD and from 31 healthy control subjects. The protein and electrolyte content and the salivary flow rate were determined in each subject.

RESULTS

Children with FD displayed significantly elevated outputs of chloride, potassium, calcium, phosphorous, magnesium, and total protein. Salivary flow rates were significantly increased. Phosphorous concentration was statistically low. These results imply SM/SL hyperfunction at the acinar and ductal levels. The concentration of lysozyme, the activity of amylase, and the output of both were similar in patients and control subjects.

CONCLUSION

SM/SL gland hyperactivity is a newly described abnormality in FD. At the acinar level, this hyperactivity is expressed with increased fluid, electrolyte, and protein output, and at the ductal level, with increased ion secretion and absorption rate. These changes may be the result of ongoing parasympathetic denervation characteristic in FD.

Salivary anticandidal activity and saliva composition in an HIV-infected cohort

This study investigated salivary anticandidal activity and salivary composition in stimulated whole saliva of 18 advanced HIV-infected patients and compared these values to healthy controls. Stimulated whole saliva from HIV-infected patients showed decreased anticandidal activity. The flow rate was reduced by 40% as compared with controls. The saliva flow rate for HIV-infected patients who had recoverable yeast in their saliva was reduced as compared to HIV-infected patients without recoverable yeast. For HIV-infected patients, the saliva concentrations of lactoferrin, secretory IgA and Cl- were increased while the secretion rate of lysozyme, total protein and K+ were reduced. There was no difference in any parameter as a function of taking the antifungal drug fluconazole. There was no association between salivary anticandidal activity and any salivary component. This study shows reduced anticandidal activity and salivary flow rate in HIV-infected patients. These alterations may contribute to their increased incidence of oral candidal infections.

Parotid saliva protein profiles in caries-free and caries-active adults

OBJECTIVE

The objective of this study was to determine if there were any differences in the parotid saliva output and composition related to caries activity.

STUDY DESIGN

Stimulated parotid saliva samples were collected from 85 healthy young adults, caries-active or caries-free. Flow rates were determined, and samples were analyzed for pH and buffer capacity, total protein, electrolytes, proteins with a high performance liquid chromatography method, and histatins.

RESULTS

There were no differences in flow rates or pH, but buffer capacity was higher in women than in men, and K+ and Cl- were both slightly higher in the caries-active group. The women had a significantly higher total protein concentration, as well as higher concentrations of each of the individual protein components assayed. There were no differences attributable to caries activity.

CONCLUSIONS

Significant sex differences in salivary protein concentrations exist. Caries activity may be related to some salivary electrolyte alterations, but not to protein composition.

A population-based study of salivary lysozyme concentrations and candidal counts

The relationship between salivary lysozyme concentration and oral candida load was examined in 595 adults. Unstimulated whole saliva, and citrate-stimulated parotid and submandibular/sublingual saliva were collected from each participant. Candida colony-forming units (c.f.u.) in unstimulated whole saliva were determined. An enzyme-linked immunosorbent assay for lysozyme using commercially available antibodies was developed. This assay showed a linear relation of salivary lysozyme concentrations from 0.5 to 4.0 ng/ml. Significant negative relations were observed between lysozyme concentration and flow rate: r = -0.16 (p < 0.001) for stimulated parotid and r = -0.22 (p < 0.0001) for stimulated submandibular/sublingual saliva. The lysozyme concentration in stimulated submandibular/sublingual saliva was higher in males than in female, but no sex difference was observed for stimulated parotid saliva. The lysozyme concentration of stimulated parotid saliva was positively correlated with candida counts (r = 0.18: p < 0.005). Further study of groups according to their levels of candida in whole saliva revealed that lysozyme concentrations were higher in the high candida (> or = 1000 c.f.u./ml) group than in the zero and moderate candida categories in stimulated parotid saliva (p < 0.001): there were no concentration differences in stimulated submandibular/sublingual saliva. These results suggest that parotid lysozyme concentration increases as candida load increases.

Does variability in salivary protein concentrations influence oral microbial ecology and oral health?

Salivary protein interactions with oral microbes in vitro include aggregation, adherence, cell-killing, inhibition of metabolism, and nutrition. Such interactions might be expected to influence oral ecology. However, inconsistent results have been obtained from in vivo tests of the hypothesis that quantitative variation in salivary protein concentrations will affect oral disease prevalence. Results may have been influenced by choices made during study design, including saliva source, stimulation status, control for flow rate, and assay methods. Salivary protein concentrations also may be subject to circadian variation. Values for saliva collected at the same time of day tend to remain consistent within subjects, but events such as stress, inflammation, infection, menstruation, or pregnancy may induce short-term changes. Long-term factors such as aging, systemic disease, or medication likewise may influence salivary protein concentrations. Such sources of variation may increase the sample size needed to find statistically significant differences. Clinical studies also must consider factors such as human population variation, strain and species differences in protein-microbe interactions, protein polymorphism, and synergistic or antagonistic interaction between proteins. Salivary proteins may form heterotypic complexes with unique effects, and different proteins may exert redundant effects. Patterns of protein-microbe interaction also may differ between oral sites. Future clinical studies must take those factors into account. Promising approaches might involve meta-analysis or multi-center studies, retrospective and prospective longitudinal designs, short-term measurement of salivary protein effects, and consideration of individual variation in multiple protein effects such as aggregation, adherence, and cell-killing.

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.

Antimicrobial systems of human whole saliva in relation to dental caries, cariogenic bacteria, and gingival inflammation in young adults

The association of salivary antibody (total IgA, IgG, and IgM and antibodies reactive with Streptococcus mutans) and non-antibody (lysozyme, lactoferrin, salivary peroxidase, myeloperoxidase, hypothiocyanite, thiocyanate) defense factors with oral health (past and present dental caries, gingival bleeding, the number of salivary S. mutans and lactobacilli) were studied in 50 naval recruits. Dental caries was significantly associated with large amounts of S. mutans, lactobacilli, and total salivary immunoglobulins and with low salivary flow rate and buffer capacity. Salivary anti-S. mutans antibodies did not correlate with dental caries or S. mutans levels. Moreover, none of the salivary non-antibody factors alone had any strong relationship to dental caries or S. mutans levels. Gingival inflammation was associated with elevated levels of lysozyme in whole saliva. It is concluded that in adults the associations between single-point measurements of most salivary antimicrobial constituents and the factors describing oral health are weak.

Antimicrobial factors in saliva: ontogeny and relation to oral health

Antimicrobial agents (antibody and non-antibody) present in human saliva protect oral tissues by a variety of mechanisms, such as prevention of bacterial adhesion, agglutination of micro-organisms, and inhibition of multiplication and metabolism. However, studies in which the concentrations of various salivary antimicrobial agents have been correlated to the presence and severity of oral diseases--of dental caries, in particular--have produced controversial data, and it seems evident, also on the basis of the present study, that no single salivary antimicrobial factor (except flow rate) affects oral health to a significant degree. In the present study, we report the levels of some selected salivary antimicrobial agents in predentate and dentate human infants, with a comparison to the levels found in young adults' saliva. Salivary lysozyme, peroxidase, and hypothiocyanite concentrations were already at the adult level at the time when the primary teeth erupt, whereas immunoglobulin (IgA, IgG, and IgM), lactoferrin, myeloperoxidase, and thiocyanate concentrations were significantly lower in children than in adults. Dentate children had more IgG, thiocyanate, and protein in whole saliva than did predentate children.