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Bernardi S, Gerardi D, Bartsch S, Macchiarelli G, Hellwig E, Al-Ahmad A. Antimicrobial therapy using VIS plus water-filtered infrared-A as an alternative method to treat oral diseases. Future Microbiol 2024; 19:241-254. [PMID: 38294280 DOI: 10.2217/fmb-2023-0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/25/2023] [Indexed: 02/01/2024] Open
Abstract
Oral biofilm is the main cause of pathologies affecting the hard and soft oral tissues around teeth. Its main components are the periodontal pathogens and other bacteria of the supragingival and subgingival biofilm. Different alternative strategies that could be adjuvants to the usual periodontal treatments used to eliminate biofilms are available. One of these methods is antimicrobial photodynamic therapy using VIS and water-filtered infrared-A combined with a photosensitizer. In this review, different recent studies were collected to evaluate the antimicrobial effects of antimicrobial photodynamic therapy and the effectiveness of different types of photosensitizers.
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Affiliation(s)
- Sara Bernardi
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, 67100, Italy
| | - Davide Gerardi
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, 67100, Italy
- Department of Innovative Technologies in Medicine & Dentistry, Dental School, 'G D'Annunzio' University of Chieti-Pescara, Chieti, 66100, Italy
| | - Sibylle Bartsch
- Department of Operative Dentistry & Periodontology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, 79106666, Germany
| | - Guido Macchiarelli
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, 67100, Italy
| | - Elmar Hellwig
- Department of Operative Dentistry & Periodontology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, 79106666, Germany
| | - Ali Al-Ahmad
- Department of Operative Dentistry & Periodontology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, 79106666, Germany
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Rux C, Wittmer A, Stork A, Vach K, Hellwig E, Cieplik F, Al-Ahmad A. Optimizing the use of low-frequency ultrasound for bacterial detachment of in vivo biofilms in dental research-a methodological study. Clin Oral Investig 2023; 28:19. [PMID: 38141103 DOI: 10.1007/s00784-023-05397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Low-frequency, low-intensity ultrasound is commonly utilized in various dental research fields to remove biofilms from surfaces, but no clear recommendation exists in dental studies so far. Therefore, this study aims to optimize the sonication procedure for the dental field to efficiently detach bacteria while preserving viability. MATERIALS AND METHODS Initial biofilm was formed in vivo on bovine enamel slabs (n = 6) which were worn by four healthy participants for 4 h and 24 h. The enamel slabs covered with biofilm were then ultrasonicated ex vivo for various time periods (0, 1, 2, 4, 6 min). Colony-forming units were determined for quantification, and bacteria were identified using MALDI-TOF. Scanning electron microscopic images were taken to also examine the efficiency of ultrasonications for different time periods. RESULTS Ultrasonication for 1 min resulted in the highest bacterial counts, with at least 4.5-fold number compared to the non-sonicated control (p < 0.05). Most bacteria were detached within the first 2 min of sonication, but there were still bacteria detached afterwards, although significantly fewer (p < 0.0001). The highest bacterial diversity was observed after 1 and 2 min of sonication (p < 0.03). Longer sonication periods negatively affected bacterial counts of anaerobes, Gram-negative bacteria, and bacilli. Scanning electron microscopic images demonstrated the ability of ultrasound to desorb microorganisms, as well as revealing cell damage and remaining bacteria. CONCLUSIONS With the use of low-frequency, low-intensity ultrasound, significantly higher bacterial counts and diversity can be reached. A shorter sonication time of 1 min shows the best results overall. CLINICAL RELEVANCE This standardization is recommended to study initial oral biofilms aged up to 24 h to maximize the outcome of experiments and lead to better comparability of studies.
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Affiliation(s)
- Cassandra Rux
- Department of Operative Dentistry and Periodontology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Annette Wittmer
- Institute of Medical Microbiology and Hygiene, Faculty of Medicine, University of Freiburg, Hermann-Herder- Str. 11, 79104, Freiburg, Germany
| | - Anja Stork
- Department of Operative Dentistry and Periodontology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Kirstin Vach
- Institute for Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
| | - Elmar Hellwig
- Department of Operative Dentistry and Periodontology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Fabian Cieplik
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Ali Al-Ahmad
- Department of Operative Dentistry and Periodontology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
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Klein M, Al-Ahmad A, Follo M, Hellwig E, Vach K, Chrubasik-Hausmann S. In Vitro Eradication of Planktonic, Saliva and Biofilm Bacteria Using Lingonberry Extract as a Photosensitizer for Visible Light Plus Water-Filtered Infrared-A Irradiation. Nutrients 2023; 15:4988. [PMID: 38068846 PMCID: PMC10708215 DOI: 10.3390/nu15234988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Antimicrobial photodynamic treatment (aPDT) with visible light plus water-filtered infrared-A irradiation (VIS-wIRA) and natural single- or multi-component photosensitizers (PSs) was shown to have potent antimicrobial activity. The aim of this study was to obtain information on the antimicrobial effects of aPDT-VIS-wIRA with lingonberry extract (LE) against bacteria that play a role in oral health. Planktonic bacterial cultures of the Gram-positive E. faecalis T9, S. mutans DSM20523, S. oralis ATCC 35037 and S. sobrinus PSM 203513, the Gram-negative N. oralis 14F2 FG-15-7B, F. nucleatum ATCC 25586, and V. parvula DSM, the anaerobic F. nucleatum ATCC 25586 and V. parvula DSM 2008, and the total mixed bacteria from pooled saliva and supra- and subgingival plaques of volunteers were all treated and compared. aPDT-VIS-wIRA with LE as PS significantly (p < 0.008) reduced the growth of all tested Gram-positive, Gram-negative, as well as aerobic and anaerobic bacterial strains, whereas without irradiation no reductions were seen (p < 0.0001). NaCl, with or without irradiation, was ineffective. After treatment with CHX 0.2%, the highest killing rate (100%) was observed, and no bacteria (0 log10 CFU) were cultivable. The method also significantly reduced all of the bacteria present in saliva and in the gingival biofilms. Three-dimensional visualization of viable and non-viable microorganisms revealed that LE penetrated deeper into the cell wall layers than CHX 0.2%. LE was an appropriate PS for eradicating microorganisms with VIS-wIRA, either in their planktonic form or in saliva and gingival plaque biofilms. These results encourage further investigation in order to determine which LE compounds contribute to the photosensitizing effect and to evaluate the size of the effect on maintaining oral health.
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Affiliation(s)
- Mia Klein
- Department of Operative Dentistry and Periodontology, Medical Center of the University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (M.K.); (E.H.)
| | - Ali Al-Ahmad
- Department of Operative Dentistry and Periodontology, Medical Center of the University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (M.K.); (E.H.)
| | - Marie Follo
- Lighthouse Core Facility, Department of Medicine I, Medical Center of the University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 115, 79106 Freiburg, Germany;
| | - Elmar Hellwig
- Department of Operative Dentistry and Periodontology, Medical Center of the University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (M.K.); (E.H.)
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Straße 26, 79104 Freiburg, Germany;
| | - Sigrun Chrubasik-Hausmann
- Institute of Forensic Medicine, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany;
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Antimicrobial Behavior and Cytotoxicity of Indocyanine Green in Combination with Visible Light and Water-Filtered Infrared A Radiation against Periodontal Bacteria and Subgingival Biofilm. Biomedicines 2022; 10:biomedicines10050956. [PMID: 35625693 PMCID: PMC9138561 DOI: 10.3390/biomedicines10050956] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 01/10/2023] Open
Abstract
The widespread increase of antibiotic resistance highlights the need for alternative treatments such as antimicrobial photodynamic therapy (aPDT). This study aimed to evaluate the antimicrobial behavior and cytotoxicity of aPDT with indocyanine green (ICG) in combination with visible light (Vis) and water-filtered infrared A (wIRA). Representative periodontal bacteria (Parvimonas micra, Atopobium riame, Slackia exigua, Actinomyces naeslundii, Porphyromonas gingivalis, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans, and Prevotella nigrescens) and subgingival in situ biofilms from periodontal patients were treated with aPDT for 5 min. ICG was used at different concentrations (50–500 µg/mL) and the number of viable cells was determined in colony forming units (CFU). Untreated negative controls and 0.2% chlorhexidine as a positive control were also prepared. The cytotoxicity test on human keratinocytes in vitro was analyzed with the AlamarBlue assay after 5, 10, and 20 min, with four ICG concentrations, and at two temperatures (room temperature and 37 °C). The tested periodontal pathogens treated with aPDT were eliminated in a range between 1.2 and 6.7 log10 CFU, except for A. naeslundii, which was killed at a lower range. The subgingival biofilm treated with aPDT expressed significant differences to the untreated controls except for at 300 µg/mL ICG concentration. The cytotoxicity was directly related to the concentration of ICG and irradiation time. These observations raise questions concerning the use of this specific aPDT as an adjuvant to periodontal treatments due to its possible toxicity towards human gingival cells.
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Günther M, Karygianni L, Argyropoulou A, Anderson AC, Hellwig E, Skaltsounis AL, Wittmer A, Vach K, Al-Ahmad A. The antimicrobial effect of Rosmarinus officinalis extracts on oral initial adhesion ex vivo. Clin Oral Investig 2022; 26:4369-4380. [PMID: 35138461 PMCID: PMC9203371 DOI: 10.1007/s00784-022-04400-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/29/2022] [Indexed: 11/07/2022]
Abstract
Objective In the last few decades, there has been a growing worldwide interest in the use of plant extracts for the prevention of oral diseases. The main focus of this interest lies in the identification and isolation of substances that limit the formation of microbial biofilm which plays a major role in the development of caries, periodontitis, and peri-implantitis. In this clinical ex vivo study, we investigated the antimicrobial effects of Rosmarinus officinalis extract against oral microorganisms within in situ initial oral biofilms. Materials and methods Initial in situ biofilm samples (2 h) from six healthy volunteers were treated ex vivo with R. officinalis extract at concentrations of 20 mg/ml and 30 mg/ml. The number of viable bacterial cells was determined by counting the colony-forming units. All surviving bacteria were isolated in pure cultures and identified using MALDI-TOF and biochemical testing procedures. Additionally, live/dead staining in combination with epifluorescence microscopy was used for visualizing the antimicrobial effects in the initial biofilms. Results The number of colony-forming units in the R. officinalis–treated biofilms was significantly lower than in the untreated controls (p < 0.001). The reduction range of log10 was 1.64–2.78 and 2.41–3.23 for aerobic and anaerobic bacteria, respectively. Regarding the bacterial composition, large intra- and interindividual variability were observed. Except for Campylobacter spp., the average amount of all bacterial taxa was lower after treatment with R. officinalis than in the untreated biofilms. A total of 49 different species were detected in the untreated biofilms, while only 11 bacterial species were detected in the R. officinalis–treated biofilms. Live/dead staining confirmed that the R. officinalis–treated biofilms had significantly lower numbers of surviving bacteria than the untreated biofilms. Conclusions The treatment with R. officinalis extract has a significant potential to eliminate microbial oral initial biofilms. Clinical relevance The results of this study encourage the use of R. officinalis extracts in biofilm control and thus in the treatment of caries and periodontitis as a herbal adjuvant to synthetic substances.
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Affiliation(s)
- Mira Günther
- Department of Operative Dentistry and Periodontology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Lamprini Karygianni
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Aikaterini Argyropoulou
- Department of Pharmacognosy and Natural Products Chemistry, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Annette Carola Anderson
- Department of Operative Dentistry and Periodontology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Elmar Hellwig
- Department of Operative Dentistry and Periodontology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Alexios Leandros Skaltsounis
- Department of Pharmacognosy and Natural Products Chemistry, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Annette Wittmer
- Institute of Medical Microbiology and Hygiene, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kirstin Vach
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Ali Al-Ahmad
- Department of Operative Dentistry and Periodontology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
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Pattem J, Davrandi M, Aguayo S, Slak B, Maev R, Allan E, Spratt D, Bozec L. Dependency of hydration and growth conditions on the mechanical properties of oral biofilms. Sci Rep 2021; 11:16234. [PMID: 34376751 PMCID: PMC8355335 DOI: 10.1038/s41598-021-95701-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/21/2021] [Indexed: 11/21/2022] Open
Abstract
Within the oral cavity, dental biofilms experience dynamic environments, in part due to changes in dietary content, frequency of intake and health conditions. This can impact bacterial diversity and morpho-mechanical properties. While phenotypic properties of oral biofilms are closely related to their composition, these can readily change according to dynamic variations in the growth environment and nutrient availability. Understanding the interlink between phenotypic properties, variable growth conditions, and community characterization is an essential requirement to develop structure–property relationships in oral-biofilms. In this study, the impact of two distinct growth media types with increasing richness on the properties of oral biofilms was assessed through a new combination of in-vitro time-lapse biophysical methods with microbiological assays. Oral biofilms grown in the enriched media composition presented a decrease in their pH, an increase in soluble EPS production, and a severe reduction in bacterial diversity. Additionally, enriched media conditions presented an increase in biofilm volumetric changes (upon hydration) as well as a reduction in elastic modulus upon indentation. With hydration time considered a major factor contributing to changes in biofilm mechanical properties, we have shown that it is less associated than media richness. Future investigations can now use this time-lapse approach, with a clearer focus on the extracellular matrix of oral biofilms dictating their morpho-mechanical properties.
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Affiliation(s)
- J Pattem
- Division of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK. .,National Centre for Molecular Hydrodynamics, and Soft Matter Biomaterials and Bio-Interfaces, University of Nottingham, The Limes Building, Sutton Bonington Campus, Sutton Bonington, Leicestershire, LE12 5RD, UK.
| | - M Davrandi
- Division of Microbial Diseases, UCL Eastman Dental Institute, University College London, London, UK
| | - S Aguayo
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - B Slak
- Department of Electrical and Computer Engineering, University of Windsor, Windsor, Canada
| | - R Maev
- Department of Electrical and Computer Engineering, University of Windsor, Windsor, Canada
| | - E Allan
- Division of Microbial Diseases, UCL Eastman Dental Institute, University College London, London, UK
| | - D Spratt
- Division of Microbial Diseases, UCL Eastman Dental Institute, University College London, London, UK
| | - L Bozec
- Division of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK.,Faculty of Dentistry, University of Toronto, Toronto, Canada
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Bernardi S, Anderson A, Macchiarelli G, Hellwig E, Cieplik F, Vach K, Al-Ahmad A. Subinhibitory Antibiotic Concentrations Enhance Biofilm Formation of Clinical Enterococcus faecalis Isolates. Antibiotics (Basel) 2021; 10:antibiotics10070874. [PMID: 34356795 PMCID: PMC8300655 DOI: 10.3390/antibiotics10070874] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/08/2021] [Accepted: 07/14/2021] [Indexed: 12/15/2022] Open
Abstract
Enterococcus faecalis is a microorganism that can be found in the oral cavity, especially in secondary endodontic infections, with a prevalence ranging from 24-70%. The increase in the ability to form biofilms in the presence of subinhibitory antibiotic concentrations is a phenomenon that is observed for a wide variety of bacterial pathogens and is associated with increased resistance. In this study, therefore, six E. faecalis isolates from an endodontic environment and two control strains were exposed to subinhibitory concentrations of Penicillin G, Amoxicillin, Doxycycline, Fosfomycin, Tetracycline and Vancomycin and examined for their biofilm formation abilities. The minimum inhibitory concentration (MIC) was determined for all E. faecalis isolates. A culture of the isolate was mixed with a serial dilution series of the respective antibiotic, incubated overnight and the biofilm formation was analyzed using a microtiter plate assay. All isolates were able to form biofilms in the absence of an antibiotic. A significant increase in biofilm formation of up to more than 50% was found in the isolates exposed to subinhibitory concentrations of various antibiotics. Most isolates showed a significant increase in Fosfomycin (7/8), Doxycycline (6/8) and Tetracycline (6/8). Three endodontic isolates showed a significant increase in five of the antibiotics examined at the same time. On exposure to Vancomycin, three endodontic isolates and the two control strains showed an increase. The increase in the ability to form biofilms extended over a concentration range from 1/2 to 1/64 of the MIC concentration. Antibiotics may reach certain niches in the oral cavity at subinhibitory concentrations only. This can increase the biofilm formation by enterococci, and in turn lead to decreased susceptibility of these taxa to antibiotics.
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Affiliation(s)
- Sara Bernardi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
- Centre of Microscopy, University of L'Aquila, 67100 L'Aquila, Italy
| | - Annette Anderson
- Department of Operative Dentistry & Periodontology, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Guido Macchiarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Elmar Hellwig
- Department of Operative Dentistry & Periodontology, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Fabian Cieplik
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine, 79104 Freiburg, Germany
| | - Ali Al-Ahmad
- Department of Operative Dentistry & Periodontology, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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Chrubasik-Hausmann S, Hellwig E, Müller M, Al-Ahmad A. Antimicrobial Photodynamic Treatment with Mother Juices and Their Single Compounds as Photosensitizers. Nutrients 2021; 13:nu13030710. [PMID: 33668205 PMCID: PMC7995975 DOI: 10.3390/nu13030710] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/12/2021] [Accepted: 02/19/2021] [Indexed: 01/09/2023] Open
Abstract
The potent antimicrobial effects of antimicrobial photodynamic therapy (aPDT) with visible light plus water-filtered infrared-A irradiation and natural compounds as photosensitizers (PSs) have recently been demonstrated. The aim of this study was to obtain information on the antimicrobial effects of aPDT with mother juices against typical cariogenic oral Streptococcus pathogens in their planktonic form and determine its eradication potential on total human salivary bacteria from volunteers. Mother juices of pomegranate, bilberry, and chokeberry at different concentrations were used as PSs. The unweighted (absolute) irradiance was 200 mW cm−2, applied five minutes. Planktonic cultures of Streptococcus mutans and Streptococcus sobrinus and total mixed bacteria from pooled saliva of volunteers were treated with aPDT. Up to more than 5 log10 of S. mutans and S. sobrinus were killed by aPDT with 0.4% and 0.8% pomegranate juice, 3% and 50% chokeberry juice, and 12.5% bilberry juice (both strains). Concentrations of at least 25% (pomegranate) and >50% (chokeberry and bilberry) eradicated the mixed bacteria in saliva samples. This pilot study has shown that pomegranate mother juice is superior to the berry juices as a multicomponent PS for killing pathogenic oral bacteria with aPDT.
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Affiliation(s)
- Sigrun Chrubasik-Hausmann
- Institute of Forensic Medicine, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany;
| | - Elmar Hellwig
- Department of Operative Dentistry and Periodontology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Michael Müller
- Institute of Pharmaceutical Sciences, Pharmaceutical and Medicinal Chemistry, University of Freiburg, 79104 Freiburg, Germany;
| | - Ali Al-Ahmad
- Department of Operative Dentistry and Periodontology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
- Correspondence: ; Tel.: +49-761-270-48940
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Karygianni L, Ruf S, Hellwig E, Follo M, Vach K, Al-Ahmad A. Antimicrobial Photoinactivation of In Situ Oral Biofilms by Visible Light Plus Water-Filtered Infrared A and Tetrahydroporphyrin-tetratosylate (THPTS). Microorganisms 2021; 9:microorganisms9010145. [PMID: 33440906 PMCID: PMC7827502 DOI: 10.3390/microorganisms9010145] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/05/2021] [Accepted: 01/09/2021] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to examine the effect of aPDT with visual light (VIS) + water-filtered infrared A (wIRA) as a light source, and tetrahydroporphyrin-tetratosylate (THPTS) as a photosensitizer on in situ initial and mature oral biofilms. The samples were incubated, ex situ, with THPTS for two minutes, followed by irradiation with 200 mW cm − 2 VIS + wIRA for five minutes at 37 °C. The adherent microorganisms were quantified, and the biofilm samples were visualized using live/dead staining and confocal laser scanning microscopy (CLSM). The THPTS-mediated aPDT resulted in significant decreases in both the initially adherent microorganisms and the microorganisms in the mature oral biofilms, in comparison to the untreated control samples (>99.99% each; p = 0.018 and p = 0.0066, respectively). The remaining vital bacteria significantly decreased in the aPDT-treated biofilms during initial adhesion (vitality rate 9.4% vs. 71.2% untreated control, 17.28% CHX). Of the mature biofilms, 25.67% remained vital after aPDT treatment (81.97% untreated control, 16.44% CHX). High permeability of THPTS into deep layers could be shown. The present results indicate that the microbial reduction in oral initial and mature oral biofilms resulting from aPDT with VIS + wIRA in combination with THPTS has significant potential for the treatment of oral biofilm-associated diseases.
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Affiliation(s)
- Lamprini Karygianni
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine University of Zurich, CH-8032 Zürich, Switzerland;
| | - Sandra Ruf
- Department of Operative Dentistry and Periodontology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (S.R.); (E.H.)
| | - Elmar Hellwig
- Department of Operative Dentistry and Periodontology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (S.R.); (E.H.)
| | - Marie Follo
- Lighthouse Core Facility, Department of Hematology, Oncology & Stem Cell Transplantation, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany;
| | - Kirstin Vach
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, 79104 Freiburg, Germany;
| | - Ali Al-Ahmad
- Department of Operative Dentistry and Periodontology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (S.R.); (E.H.)
- Correspondence: ; Tel.: +49-761-27048940
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10
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Microbial Composition of Oral Biofilms after Visible Light and Water-Filtered Infrared a Radiation (VIS+wIRA) in Combination with Indocyanine Green (ICG) as Photosensitizer. Antibiotics (Basel) 2020; 9:antibiotics9090532. [PMID: 32842511 PMCID: PMC7558517 DOI: 10.3390/antibiotics9090532] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
In view of increasing antibiotic resistance, antimicrobial photodynamic therapy (aPDT) is an alternative treatment method used to eradicate the microbial community of oral biofilms that can be responsible for different oral infections. In order to investigate changes in the microbial composition after application of aPDT with visible light and water-filtered infrared A (VIS+wIRA) in combination with indocyanine green (ICG), oral microorganisms of the initial and mature biofilm were evaluated by mass spectrometry (MALDI-TOF-MS). To determine surviving microorganisms using MALDI-TOF-MS, an in situ biofilm was irradiated with VIS+wIRA for five minutes in the presence of ICG (300 and 450 µg/mL, respectively). Treatment with chlorhexidine (0.2%) served as positive control. Identified microorganisms of the initial biofilm treated with ICG showed a clear reduction in diversity. The microbial composition of the mature oral biofilm also showed changes after the implementation of aPDT, which mainly resulted in a shift in the percentage of bacterial species. The resulting destruction of the microbial balance within the oral biofilm by aPDT using VIS+wIRA and ICG can be seen as an advantageous supplementary approach in the adjunctive treatment of periodontitis and peri-implantitis.
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Effects of subgingival air-polishing with trehalose powder on oral biofilm during periodontal maintenance therapy: a randomized-controlled pilot study. BMC Oral Health 2020; 20:123. [PMID: 32321490 PMCID: PMC7178568 DOI: 10.1186/s12903-020-01111-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/12/2020] [Indexed: 12/18/2022] Open
Abstract
Background This pilot study was part of a larger study which compared the effect of subgingival air-polishing using trehalose powder with sonic scaling on clinical parameters during supportive periodontal therapy. Within this microbiological part of the investigation subgingival samples were taken from 10 participants to analyze the survival of different bacterial species after the two different treatments as a proof of principle. Methods In 10 participants two non-adjacent, single-root teeth requiring treatment (PD =5 mm with bleeding on probing (BOP) or > 5 mm) were selected following a split-mouth design and were treated either with a sonic scaler or air-polishing device and trehalose powder. For persistent pockets (PD =4 mm and BOP or > 4 mm), treatment was repeated after 3 months. Subgingival biofilm samples were taken at baseline (BL), subsequently and three and six months after treatment. After determination of the bacterial counts (TBL), isolated bacteria were identified by MALDI-TOF-MS. If unsuccessful, PCR and 16S rDNA sequencing were performed. Results In both treatment groups, TBL decreased immediately after treatment remaining at a lower level. This confirms the findings of the larger study regarding clinical parameters showing a comparable effect on PD, BOP and CAL. Immediately after treatment, the diversity of detected species decreased significantly more than in the sonic group (p = 0.03). After 3 months, the proportion of Gram-positive anaerobic rods was lower in the air-polishing group (powder/ sonic 7%/ 25.9%, p = 0.025). Also, there was a greater reduction of Gram-negative aerobic rods for this group at this time (air-polishing/ sonic − 0.91 / -0.23 Log10 cfu/ ml, p = 0.020). Conclusion Within the limitations of this study air-polishing and sonic treatment seem to have a comparable effect on the subgingival oral biofilm during supportive periodontal treatment. Trial registration The study was registered in an international trial register (German Clinical Trial Register number DRKS 00006296) on 10th of June 2015. HTML&TRIAL_ID = DRKS00006296.
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Anane YA, Apalata T, Vasaikar S, Okuthe GE, Songca SP. In vitro antimicrobial photodynamic inactivation of multidrug-resistant Acinetobacter baumannii biofilm using Protoporphyrin IX and Methylene blue. Photodiagnosis Photodyn Ther 2020; 30:101752. [PMID: 32289462 DOI: 10.1016/j.pdpdt.2020.101752] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/19/2020] [Accepted: 03/27/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acinetobacter baumannii is a challenging pathogen due to the rapid development of antimicrobial resistance and biofilm formation. The objective of this study was to evaluate the effect of antimicrobial photodynamic inactivation against biofilms of multidrug-resistant A. baumannii isolated from clinical, abattoir and aquatic sources. METHODS The isolates were tested for susceptibility to imipenem, meropenem, tigecycline and colistin using autoSCAN-4 automated system and rechecked by the E-test. Methylene blue, Protoporphyrin IX, and a halogen lamp were used in the in vitro assay against biofilms of the isolates. The antimicrobial photodynamic inactivation was assessed by counting colony-forming units (CFU). RESULTS The isolates from abattoir and aquatic sources were resistant to carbapenems (>64 μg/mL) but susceptible to tigecycline (2 μg/mL) and colistin (Abattoir, 0.35 μg/mL and Aquatic, 0.24 μg/mL), whereas the clinical isolate was susceptible to only colistin (0.5 μg/mL) using the E-test. The log survival percentages of the control group at a concentration of 20 μM were 5 × 10-6 % for Protoporphyrin IX and 2 × 10-6 % for Methylene blue. Therefore, Methylene blue showed higher bacterial reduction of 7.0 log10 colony forming units than 6.0 log10 for Protoporphyrin IX. No significant difference was observed with respect to the origin of isolates and the minimum inhibitory concentrations. CONCLUSION The results indicate that antimicrobial photodynamic inactivation could be an alternative strategy for the control of infections caused by multi-drug resistant A. baumannii by significantly reducing biofilm growth at a sub-lethal concentrations.
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Affiliation(s)
- Yaw Adjei Anane
- Division of Medical Microbiology, Department of Laboratory Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University, Private Bag: X1, Mthatha, 5117 Eastern Cape Province, South Africa.
| | - Teke Apalata
- Division of Medical Microbiology, Department of Laboratory Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University, Private Bag: X1, Mthatha, 5117 Eastern Cape Province, South Africa; Division of Medical Microbiology, National Health Laboratory Services (NHLS), Nelson Mandela Central Hospital, Mthatha 5100, South Africa.
| | - Sandeep Vasaikar
- Division of Medical Microbiology, Department of Laboratory Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University, Private Bag: X1, Mthatha, 5117 Eastern Cape Province, South Africa; Division of Medical Microbiology, National Health Laboratory Services (NHLS), Nelson Mandela Central Hospital, Mthatha 5100, South Africa
| | - Grace Emily Okuthe
- Department of Biological & Environmental Sciences, Walter Sisulu University, Private Bag: X1, Mthatha, 5117 Eastern Cape Province, South Africa.
| | - Sandile Phinda Songca
- School of Chemistry and Physics, College of Agriculture Engineering and Science, University of KwaZulu-Natal, 2nd Floor, Francis Stock Building, Howard College Campus, UKZN, Durban, 4041, South Africa.
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Vollmer A, Al-Ahmad A, Argyropoulou A, Thurnheer T, Hellwig E, Attin T, Vach K, Wittmer A, Ferguson K, Skaltsounis AL, Karygianni L. Antimicrobial Photoinactivation Using Visible Light Plus Water-Filtered Infrared-A (VIS + wIRA) and Hypericum Perforatum Modifies In Situ Oral Biofilms. Sci Rep 2019; 9:20325. [PMID: 31889168 PMCID: PMC6937260 DOI: 10.1038/s41598-019-56925-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/19/2019] [Indexed: 12/24/2022] Open
Abstract
Due to increasing antibiotic resistance, the application of antimicrobial photodynamic therapy (aPDT) is gaining increasing popularity in dentistry. The aim of this study was to investigate the antimicrobial effects of aPDT using visible light (VIS) and water-filtered infrared-A (wIRA) in combination with a Hypericum perforatum extract on in situ oral biofilms. The chemical composition of H. perforatum extract was analyzed using ultra-high-performance liquid chromatography coupled with high resolution mass spectrometry (UPLC-HRMS). To obtain initial and mature oral biofilms in situ, intraoral devices with fixed bovine enamel slabs (BES) were carried by six healthy volunteers for two hours and three days, respectively. The ex situ exposure of biofilms to VIS + wIRA (200 mWcm-2) and H. perforatum (32 mg ml-1, non-rinsed or rinsed prior to aPDT after 2-min preincubation) lasted for five minutes. Biofilm treatment with 0.2% chlorhexidine gluconate solution (CHX) served as a positive control, while untreated biofilms served as a negative control. The colony-forming units (CFU) of the aPDT-treated biofilms were quantified, and the surviving microorganisms were identified using MALDI-TOF biochemical tests as well as 16 S rDNA-sequencing. We could show that the H. perforatum extract had significant photoactivation potential at a concentration of 32 mg ml-1. When aPDT was carried out in the presence of H. perforatum, all biofilms (100%) were completely eradicated (p = 0.0001). When H. perforatum was rinsed off prior to aPDT, more than 92% of the initial viable bacterial count and 13% of the mature oral biofilm were killed. Overall, the microbial composition in initial and mature biofilms was substantially altered after aPDT, inducing a shift in the synthesis of the microbial community. In conclusion, H. perforatum-mediated aPDT using VIS + wIRA interferes with oral biofilms, resulting in their elimination or the substantial alteration of microbial diversity and richness. The present results support the evaluation of H. perforatum-mediated aPDT for the adjunctive treatment of biofilm-associated oral diseases.
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Affiliation(s)
- Andreas Vollmer
- Department of Operative Dentistry and Periodontology, Center for Dental Medicine, Albert-Ludwigs-University, Freiburg, Germany
| | - Ali Al-Ahmad
- Department of Operative Dentistry and Periodontology, Center for Dental Medicine, Albert-Ludwigs-University, Freiburg, Germany
| | - Aikaterini Argyropoulou
- Department of Pharmacognosy and Chemistry of Natural Products, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Thurnheer
- Clinic for Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Elmar Hellwig
- Department of Operative Dentistry and Periodontology, Center for Dental Medicine, Albert-Ludwigs-University, Freiburg, Germany
| | - Thomas Attin
- Clinic for Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Kirstin Vach
- Institute for Medical Biometry and Statistics, Center for Medical Biometry and Medical Informatics, Albert-Ludwigs-University, Freiburg, Germany
| | - Annette Wittmer
- Institute of Medical Microbiology and Hygiene, Albert-Ludwigs-University, Freiburg, Germany
| | - Kerry Ferguson
- Botanical Innovation, Unit 2, 390 Clergate Road, Orange, NSW, 2800, Australia
| | - Alexios Leandros Skaltsounis
- Department of Pharmacognosy and Chemistry of Natural Products, Faculty of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Lamprini Karygianni
- Clinic for Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
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Inactivation of oral biofilms using visible light and water-filtered infrared A radiation and indocyanine green. Future Med Chem 2019; 11:1721-1739. [PMID: 31368351 DOI: 10.4155/fmc-2018-0522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aim: To investigate the antimicrobial photodynamic therapy (aPDT) of visible light and water-filtered infrared A radiation in combination with indocyanine green (ICG) on planktonic oral microorganisms as well as on oral biofilm. Methods: The irradiation was conducted for 5 min in combination with ICG. Treatment with chlorhexidine served as a positive control. The number of colony forming units and bacterial vitality were quantified. Results: All tested bacterial strains and salivary bacteria were killed at a level of 3log10. The colony forming units of the initial mature oral biofilms were strongly reduced. The high bactericidal effect of aPDT was confirmed by live/dead staining. Conclusion: The aPDT using visible light and water-filtered infrared A radiation and ICG has the potential to treat periodontitis and peri-implantitis.
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15
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V T A, Paramanantham P, S B SL, Sharan A, Syed A, Bahkali NA, Alsaedi MH, K K, Busi S. Antimicrobial photodynamic activity of toluidine blue-carbon nanotube conjugate against Pseudomonas aeruginosa and Staphylococcus aureus - Understanding the mechanism of action. Photodiagnosis Photodyn Ther 2019; 27:305-316. [PMID: 31228562 DOI: 10.1016/j.pdpdt.2019.06.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/09/2019] [Accepted: 06/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The emergence of drug-resistant bacterial strains has raised the need to develop alternative treatment modalities to combat infectious diseases. Antimicrobial photodynamic therapy (aPDT) is an alternative to conventional treatment modalities. aPDT integrates a photosensitizer, which, after exposure to light of an appropriate wavelength, leads to the generation of cytotoxic reactive oxygen species (ROS). METHODS The aim of the present study was to synthesize a toluidine blue/multiwalled carbon nanotube conjugate (TBCNT) for enhanced photoinactivation of Pseudomonas aeruginosa and Staphylococcus aureus. Synthesized TBCNT conjugate was characterized and its antibacterial and antibiofilm activity was determined. RESULTS During TBCNT synthesis, dye loading, and entrapment efficiency of the CNT were 12.04 ± 0.55% and 48.99 ± 2.33%, respectively. The photo-destruction of planktonic cells of the test bacteria was performed by exposure to a 125 mW red laser with a wavelength of 670 nm (radiant exposure of 58.49 J/cm2) for 3 min. Photoinactivation using TBCNT resulted in a 4.91- and 5.47-log10 reduction in P. aeruginosa and S. aureus, respectively. The mechanism of this aPDT was studied by measuring intracellular ROS generation, protein leakage, and lipid peroxidation in the test bacteria after light irradiation. The antibiofilm activity of TBCNT after light exposure was 69.94% and 75.54% for P. aeruginosa and S. aureus, respectively. Photoinactivation of test bacteria treated with TBCNT reduced cell viability and exopolysaccharide production. Confocal laser-scanning microscopy revealed a significant biofilm inhibition efficacy of the TBCNT conjugate. CONCLUSION Therefore, TBCNT conjugates may be used for the eradication of P. aeruginosa and S. aureus biofilms.
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Affiliation(s)
- Anju V T
- Department of Microbiology, School of Life Sciences, Pondicherry University, Puducherry, 605014, India
| | - Parasuraman Paramanantham
- Department of Microbiology, School of Life Sciences, Pondicherry University, Puducherry, 605014, India
| | - Sruthil Lal S B
- Department of Physics, School of Physical, Chemical &, Applied Sciences, Pondicherry University, Puducherry, 605014, India
| | - Alok Sharan
- Department of Physics, School of Physical, Chemical &, Applied Sciences, Pondicherry University, Puducherry, 605014, India
| | - Asad Syed
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Needa A Bahkali
- Biological Sciences Department, Wagner College, 1 Campus Rd, Staten Island, NY, 10301, USA
| | - Marzouq H Alsaedi
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Kaviyarasu K
- UNESCO-UNISA Africa Chair in Nanoscience's/Nanotechnology Laboratories, College of Graduate Studies, University of South Africa (UNISA), Muckleneuk Ridge, P O Box 392, Pretoria, South Africa; Nanosciences African Network (NANOAFNET), Materials Research Group (MRG), iThemba LABS-National Research Foundation (NRF), 1 Old Faure Road, 7129, P O Box 722, Somerset West, Western Cape Province, South Africa.
| | - Siddhardha Busi
- Department of Microbiology, School of Life Sciences, Pondicherry University, Puducherry, 605014, India.
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Kuratli J, Borel N. Perspective: Water-Filtered Infrared-A-Radiation (wIRA) - Novel Treatment Options for Chlamydial Infections? Front Microbiol 2019; 10:1053. [PMID: 31134043 PMCID: PMC6522854 DOI: 10.3389/fmicb.2019.01053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/26/2019] [Indexed: 11/13/2022] Open
Abstract
Water-filtered infrared-A-radiation (wIRA) is a promising therapeutic method, which is particularly used as supportive treatment for wound closure, and wound infection treatment and prevention. High penetration properties of the heat field and beneficial effects on wound healing processes predispose wIRA irradiation to be a non-invasive treatment method for bacterial infections in superficial tissues. Since Chlamydia trachomatis still represents the leading cause of infectious blindness in third world countries (WHO http://www.who.int/topics/trachoma/en/) and wIRA displays beneficial effects on chlamydial infections in vitro without inducing cellular damage in ex vivo eye models and also shows beneficial effects on wound healing, this irradiation technique might represent a promising future treatment for trachoma patients. To this end, further studies investigating shorter irradiation times or irradiation of Chlamydia in chronic infections [the chlamydial stress response (Bavoil, 2014)] as well as safety studies in animal models should clearly be performed.
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Affiliation(s)
- Jasmin Kuratli
- Institute of Veterinary Pathology, University of Zurich, Zurich, Switzerland
| | - Nicole Borel
- Institute of Veterinary Pathology, University of Zurich, Zurich, Switzerland
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17
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Cieplik F, Jakubovics NS, Buchalla W, Maisch T, Hellwig E, Al-Ahmad A. Resistance Toward Chlorhexidine in Oral Bacteria - Is There Cause for Concern? Front Microbiol 2019; 10:587. [PMID: 30967854 PMCID: PMC6439480 DOI: 10.3389/fmicb.2019.00587] [Citation(s) in RCA: 195] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/07/2019] [Indexed: 12/20/2022] Open
Abstract
The threat of antibiotic resistance has attracted strong interest during the last two decades, thus stimulating stewardship programs and research on alternative antimicrobial therapies. Conversely, much less attention has been given to the directly related problem of resistance toward antiseptics and biocides. While bacterial resistances toward triclosan or quaternary ammonium compounds have been considered in this context, the bis-biguanide chlorhexidine (CHX) has been put into focus only very recently when its use was associated with emergence of stable resistance to the last-resort antibiotic colistin. The antimicrobial effect of CHX is based on damaging the bacterial cytoplasmic membrane and subsequent leakage of cytoplasmic material. Consequently, mechanisms conferring resistance toward CHX include multidrug efflux pumps and cell membrane changes. For instance, in staphylococci it has been shown that plasmid-borne qac ("quaternary ammonium compound") genes encode Qac efflux proteins that recognize cationic antiseptics as substrates. In Pseudomonas stutzeri, changes in the outer membrane protein and lipopolysaccharide profiles have been implicated in CHX resistance. However, little is known about the risk of resistance toward CHX in oral bacteria and potential mechanisms conferring this resistance or even cross-resistances toward antibiotics. Interestingly, there is also little awareness about the risk of CHX resistance in the dental community even though CHX has been widely used in dental practice as the gold-standard antiseptic for more than 40 years and is also included in a wide range of oral care consumer products. This review provides an overview of general resistance mechanisms toward CHX and the evidence for CHX resistance in oral bacteria. Furthermore, this work aims to raise awareness among the dental community about the risk of resistance toward CHX and accompanying cross-resistance to antibiotics. We propose new research directions related to the effects of CHX on bacteria in oral biofilms.
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Affiliation(s)
- Fabian Cieplik
- Department of Conservative Dentistry and Periodontology, University Medical Center Regensburg, Regensburg, Germany
| | - Nicholas S Jakubovics
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Wolfgang Buchalla
- Department of Conservative Dentistry and Periodontology, University Medical Center Regensburg, Regensburg, Germany
| | - Tim Maisch
- Department of Dermatology, University Medical Center Regensburg, Regensburg, Germany
| | - Elmar Hellwig
- Department of Operative Dentistry and Periodontology, Center for Dental Medicine, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ali Al-Ahmad
- Department of Operative Dentistry and Periodontology, Center for Dental Medicine, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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18
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Cieplik F, Zaura E, Brandt BW, Buijs MJ, Buchalla W, Crielaard W, Laine ML, Deng DM, Exterkate RAM. Microcosm biofilms cultured from different oral niches in periodontitis patients. J Oral Microbiol 2018; 11:1551596. [PMID: 30598734 PMCID: PMC6263112 DOI: 10.1080/20022727.2018.1551596] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: Periodontal diseases are triggered by dysbiotic microbial biofilms. Therefore, it is essential to develop appropriate biofilm models. Aim of the present study was to culture microcosm biofilms inoculated from different niches in periodontitis patients and compare their microbial composition to those inoculated from subgingival plaque. Methods: Saliva, subgingival plaque, tongue and tonsils were sampled in five periodontitis patients to serve as inocula for culturing biofilms in vitro in an active attachment model. Biofilms were grown for 14 or 28 d and analyzed for their microbial composition by 16S rDNA sequencing. Results: As classified by HOMD, all biofilms were dominated by periodontitis-associated taxa, irrespective which niche had been used for inoculation. There was a low similarity between 14 d biofilms and their respective inocula (Bray-Curtis similarity 0.26), while biofilms cultured for 14 and 28 d shared high similarity (0.69). Principal components analysis showed much stronger clustering per patient than per niche indicating that the choice of patients may be more crucial than choice of the respective niches in these patients. Conclusion: Saliva, tongue scrapings or tonsil swabs may represent sufficient alternative inocula for growing microcosm biofilms resembling periodontitis-associated microbial communities in cases when sampling subgingival plaque is not possible.
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Affiliation(s)
- Fabian Cieplik
- Department of Conservative Dentistry and Periodontology, University Medical Center Regensburg, Regensburg, Germany.,Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Egija Zaura
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bernd W Brandt
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mark J Buijs
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wolfgang Buchalla
- Department of Conservative Dentistry and Periodontology, University Medical Center Regensburg, Regensburg, Germany
| | - Wim Crielaard
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marja L Laine
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dong Mei Deng
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rob A M Exterkate
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Kuratli J, Pesch T, Marti H, Leonard CA, Blenn C, Torgerson P, Borel N. Water Filtered Infrared A and Visible Light (wIRA/VIS) Irradiation Reduces Chlamydia trachomatis Infectivity Independent of Targeted Cytokine Inhibition. Front Microbiol 2018; 9:2757. [PMID: 30524392 PMCID: PMC6262300 DOI: 10.3389/fmicb.2018.02757] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 10/29/2018] [Indexed: 11/13/2022] Open
Abstract
Chlamydia trachomatis is the major cause of infectious blindness and represents the most common bacterial sexually transmitted infection worldwide. Considering the potential side effects of antibiotic therapy and increasing threat of antibiotic resistance, alternative therapeutic strategies are needed. Previous studies showed that water filtered infrared A alone (wIRA) or in combination with visible light (wIRA/VIS) reduced C. trachomatis infectivity. Furthermore, wIRA/VIS irradiation led to secretion of pro-inflammatory cytokines similar to that observed upon C. trachomatis infection. We confirmed the results of previous studies, namely that cytokine secretion (IL-6, IL-8, and RANTES/CCL5) upon wIRA/VIS treatment, and the subsequent reduction of chlamydial infectivity, are independent of the addition of cycloheximide, a host protein synthesis inhibitor. Reproducible cytokine release upon irradiation indicated that cytokines might be involved in the anti-chlamydial mechanism of wIRA/VIS. This hypothesis was tested by inhibiting IL-6, IL-8, and RANTES secretion in C. trachomatis or mock-infected cells by gene silencing or pharmaceutical inhibition. Celastrol, a substance derived from Trypterygium wilfordii, used in traditional Chinese medicine and known for anti-cancer and anti-inflammatory effects, was used for IL-6 and IL-8 inhibition, while Maraviroc, a competitive CCR5 antagonist and anti-HIV drug, served as a RANTES/CCL5 inhibitor. HeLa cell cytotoxicity and impact on chlamydial morphology, size and inclusion number was evaluated upon increasing inhibitor concentration, and concentrations of 0.1 and 1 μM Celastrol and 10 and 20 μM Maraviroc were subsequently selected for irradiation experiments. Celastrol at any concentration reduced chlamydial infectivity, an effect only observed for 20 μM Maraviroc. Triple dose irradiation (24, 36, 40 hpi) significantly reduced chlamydial infectivity regardless of IL-6, IL-8, or RANTES/CCL5 gene silencing, Celastrol or Maraviroc treatment. Neither gene silencing nor pharmaceutical cytokine inhibition provoked the chlamydial stress response. The anti-chlamydial effect of wIRA/VIS is independent of cytokine inhibition under all conditions evaluated. Thus, factors other than host cell cytokines must be involved in the working mechanism of wIRA/VIS. This study gives a first insight into the working mechanism of wIRA/VIS in relation to an integral component of the host immune system and supports the potential of wIRA/VIS as a promising new tool for treatment in trachoma.
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Affiliation(s)
- Jasmin Kuratli
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Theresa Pesch
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Hanna Marti
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Cory Ann Leonard
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Christian Blenn
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Paul Torgerson
- Section of Veterinary Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Nicole Borel
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Cieplik F, Deng D, Crielaard W, Buchalla W, Hellwig E, Al-Ahmad A, Maisch T. Antimicrobial photodynamic therapy - what we know and what we don't. Crit Rev Microbiol 2018; 44:571-589. [PMID: 29749263 DOI: 10.1080/1040841x.2018.1467876] [Citation(s) in RCA: 454] [Impact Index Per Article: 75.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Considering increasing number of pathogens resistant towards commonly used antibiotics as well as antiseptics, there is a pressing need for antimicrobial approaches that are capable of inactivating pathogens efficiently without the risk of inducing resistances. In this regard, an alternative approach is the antimicrobial photodynamic therapy (aPDT). The antimicrobial effect of aPDT is based on the principle that visible light activates a per se non-toxic molecule, the so-called photosensitizer (PS), resulting in generation of reactive oxygen species that kill bacteria unselectively via an oxidative burst. During the last 10-20 years, there has been extensive in vitro research on novel PS as well as light sources, which is now to be translated into clinics. In this review, we aim to provide an overview about the history of aPDT, its fundamental photochemical and photophysical mechanisms as well as photosensitizers and light sources that are currently applied for aPDT in vitro. Furthermore, the potential of resistances towards aPDT is extensively discussed and implications for proper comparison of in vitro studies regarding aPDT as well as for potential application fields in clinical practice are given. Overall, this review shall provide an outlook on future research directions needed for successful translation of promising in vitro results in aPDT towards clinical practice.
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Affiliation(s)
- Fabian Cieplik
- a Department of Conservative Dentistry and Periodontology , University Medical Center Regensburg , Regensburg , Germany.,b Department of Preventive Dentistry , Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
| | - Dongmei Deng
- b Department of Preventive Dentistry , Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
| | - Wim Crielaard
- b Department of Preventive Dentistry , Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
| | - Wolfgang Buchalla
- a Department of Conservative Dentistry and Periodontology , University Medical Center Regensburg , Regensburg , Germany
| | - Elmar Hellwig
- c Department of Operative Dentistry and Periodontology, Faculty of Medicine , Center for Dental Medicine, University of Freiburg , Freiburg , Germany
| | - Ali Al-Ahmad
- c Department of Operative Dentistry and Periodontology, Faculty of Medicine , Center for Dental Medicine, University of Freiburg , Freiburg , Germany
| | - Tim Maisch
- d Department of Dermatology , University Medical Center Regensburg , Regensburg , Germany
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The in vitro effect of Antimicrobial Photodynamic Therapy on dental microcosm biofilms from partially erupted permanent molars: A pilot study. Photodiagnosis Photodyn Ther 2018; 21:163-167. [DOI: 10.1016/j.pdpdt.2017.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 11/21/2022]
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Antimicrobial efficacy of irradiation with visible light on oral bacteria in vitro: a systematic review. Future Med Chem 2017; 9:1557-1574. [PMID: 28792235 DOI: 10.4155/fmc-2017-0051] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIM Resistances to antibiotics employed for treatment of infectious diseases have increased to alarming numbers making it more and more difficult to treat diseases caused by microorganisms resistant to common antibiotics. Consequently, novel methods for successful inactivation of pathogens are required. In this instance, one alternative could be application of light for treatment of topical infections. Antimicrobial properties of UV light are well documented, but due to its DNA-damaging properties use for medical purposes is limited. In contrast, irradiation with visible light may be more promising. METHODS Literature was systematically screened for research concerning inactivation of main oral bacterial species by means of visible light. RESULTS Inactivation of bacterial species, especially pigmented ones, in planktonic state showed promising results. There is a lack of research examining the situation when organized as biofilms. CONCLUSION More research concerning situation in a biofilm state is required.
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Cieplik F, Buchalla W, Hellwig E, Al-Ahmad A, Hiller KA, Maisch T, Karygianni L. Antimicrobial photodynamic therapy as an adjunct for treatment of deep carious lesions—A systematic review. Photodiagnosis Photodyn Ther 2017; 18:54-62. [DOI: 10.1016/j.pdpdt.2017.01.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 12/29/2016] [Accepted: 01/13/2017] [Indexed: 11/15/2022]
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Tavares LJ, Pavarina AC, Vergani CE, de Avila ED. The impact of antimicrobial photodynamic therapy on peri-implant disease: What mechanisms are involved in this novel treatment? Photodiagnosis Photodyn Ther 2016; 17:236-244. [PMID: 27939958 DOI: 10.1016/j.pdpdt.2016.11.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/27/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
Abstract
According to the American Academy of Implant Dentistry, 3 million Americans have dental implants, and this number is growing by 500,000 each year. Proportionally, the number of biological complications is also increasing. Among them, peri-implant disease is considered the most common cause of implant loss after osseointegration. In this context, microorganisms residing on the surfaces of implants and their prosthetic components are considered to be the primary etiologic factor for peri-implantitis. Some research groups have proposed combining surgical and non-surgical therapies with systemic antibiotics. The major problem associated with the use of antibiotics to treat peri-implantitis is that microorganisms replicate very quickly. Moreover, inappropriate prescription of antibiotics is not only associated with potential resistance but also and most importantly with the development of superinfections that are difficult to eradicate. Although antimicrobial photodynamic therapy (aPDT) was discovered several years ago, aPDT has only recently emerged as a possible alternative therapy against different oral pathogens causing peri-implantitis. The mechanism of action of aPDT is based on a combination of a photosensitizer drug and light of a specific wavelength in the presence of oxygen. The reaction between light and oxygen produces toxic forms of oxygen species that can kill microbial cells. This mechanism is crucial to the efficacy of aPDT. To help us understand conflicting data, it is necessary to know all the particularities of the etiology of peri-implantitis and the aPDT compounds. We believe that this review will draw attention to new insights regarding the impact of aPDT on peri-implant disease.
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Affiliation(s)
- Lívia Jacovassi Tavares
- Department of Dental Materials and Prosthodontics, School of Dentistry at Araraquara, Univ Estadual Paulista-UNESP, Rua Humaitá, 1680, 14801-903 Araraquara, SP, Brazil
| | - Ana Claudia Pavarina
- Department of Dental Materials and Prosthodontics, School of Dentistry at Araraquara, Univ Estadual Paulista-UNESP, Rua Humaitá, 1680, 14801-903 Araraquara, SP, Brazil
| | - Carlos Eduardo Vergani
- Department of Dental Materials and Prosthodontics, School of Dentistry at Araraquara, Univ Estadual Paulista-UNESP, Rua Humaitá, 1680, 14801-903 Araraquara, SP, Brazil
| | - Erica Dorigatti de Avila
- Department of Dental Materials and Prosthodontics, School of Dentistry at Araraquara, Univ Estadual Paulista-UNESP, Rua Humaitá, 1680, 14801-903 Araraquara, SP, Brazil.
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Al-Ahmad A, Walankiewicz A, Hellwig E, Follo M, Tennert C, Wittmer A, Karygianni L. Photoinactivation Using Visible Light Plus Water-Filtered Infrared-A (vis+wIRA) and Chlorine e6 (Ce6) Eradicates Planktonic Periodontal Pathogens and Subgingival Biofilms. Front Microbiol 2016; 7:1900. [PMID: 27965635 PMCID: PMC5124645 DOI: 10.3389/fmicb.2016.01900] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/14/2016] [Indexed: 12/15/2022] Open
Abstract
Alternative treatment methods for pathogens and microbial biofilms are required due to the widespread rise in antibiotic resistance. Antimicrobial photodynamic therapy (aPDT) has recently gained attention as a novel method to eradicate pathogens. The aim of this study was to evaluate the antimicrobial effects of a novel aPDT method using visible light (vis) and water infiltrated infrared A (wIRA) in combination with chlorine e6 (Ce6) against different periodontal pathogens in planktonic form and within in situ subgingival oral biofilms. Eight different periodontal pathogens were exposed to aPDT using vis+wIRA and 100 μg/ml Ce6 in planktonic culture. Additionally, pooled subgingival dental biofilm was also treated by aPDT and the number of viable cells determined as colony forming units (CFU). Live/dead staining was used in combination with confocal laser scanning microscopy to visualize and quantify antimicrobial effects within the biofilm samples. Untreated negative controls as well as 0.2% chlorhexidine-treated positive controls were used. All eight tested periodontal pathogens including Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Eikenella corrodens, Actinomyces odontolyticus, Fusobacterium nucleatum, Parvimonas micra, Slackia exigua, and Atopobium rimae and the aPDT-treated subgingival biofilm were eliminated over the ranges of 3.43–8.34 and 3.91–4.28 log10 CFU in the log10 scale, respectively. Thus, aPDT showed bactericidal effects on the representative pathogens as well as on the in situ subgingival biofilm. The live/dead staining also revealed a significant reduction (33.45%) of active cells within the aPDT-treated subgingival biofilm. Taking the favorable tissue healing effects of vis+wIRA into consideration, the significant antimicrobial effects revealed in this study highlight the potential of aPDT using this light source in combination with Ce6 as an adjunctive method to treat periodontitis as well as periimplantitis. The present results encourage also the evaluation of this method for the treatment of caries and apical periodontitis.
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Affiliation(s)
- Ali Al-Ahmad
- Department of Operative Dentistry and Periodontology, Center for Dental Medicine, Albert Ludwigs University of Freiburg Freiburg, Germany
| | - Aleksander Walankiewicz
- Department of Operative Dentistry and Periodontology, Center for Dental Medicine, Albert Ludwigs University of Freiburg Freiburg, Germany
| | - Elmar Hellwig
- Department of Operative Dentistry and Periodontology, Center for Dental Medicine, Albert Ludwigs University of Freiburg Freiburg, Germany
| | - Marie Follo
- Department of Medicine I, Medical Center, Faculty of Medicine, Albert Ludwigs University of Freiburg Freiburg, Germany
| | - Christian Tennert
- Department of Operative Dentistry and Periodontology, Center for Dental Medicine, Albert Ludwigs University of Freiburg Freiburg, Germany
| | - Annette Wittmer
- Institute of Medical Microbiology and Hygiene, Albert Ludwigs University of Freiburg Freiburg, Germany
| | - Lamprini Karygianni
- Department of Operative Dentistry and Periodontology, Center for Dental Medicine, Albert Ludwigs University of Freiburg Freiburg, Germany
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