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Alves D, Pereira MO, Lopes SP. Co-immobilization of Ciprofloxacin and Chlorhexidine as a Broad-Spectrum Antimicrobial Dual-Drug Coating for Poly(vinyl chloride) (PVC)-Based Endotracheal Tubes. ACS APPLIED MATERIALS & INTERFACES 2024; 16:16861-16879. [PMID: 38507790 PMCID: PMC10995906 DOI: 10.1021/acsami.4c01334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/23/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024]
Abstract
The endotracheal tube (ETT) affords support for intubated patients, but the increasing incidence of ventilator-associated pneumonia (VAP) is jeopardizing its application. ETT surfaces promote (poly)microbial colonization and biofilm formation, with a heavy burden for VAP. Devising safe, broad-spectrum antimicrobial materials to tackle the ETT bioburden is needful. Herein, we immobilized ciprofloxacin (CIP) and/or chlorhexidine (CHX), through polydopamine (pDA)-based functionalization, onto poly(vinyl chloride) (PVC) surfaces. These surfaces were characterized regarding physicochemical properties and challenged with single and polymicrobial cultures of VAP-relevant bacteria (Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus, Staphylococcus epidermidis) and fungi (Candida albicans). The coatings imparted PVC surfaces with a homogeneous morphology, varied wettability, and low roughness. The antimicrobial immobilization via pDA chemistry was still evidenced by infrared spectroscopy. Coated surfaces exhibited sustained CIP/CHX release, retaining prolonged (10 days) activity. CIP/CHX-coated surfaces evidencing no A549 lung cell toxicity displayed better antibiofilm outcomes than CIP or CHX coatings, preventing bacterial attachment by 4.1-7.2 Log10 CFU/mL and modestly distressingC. albicans. Their antibiofilm effectiveness was endured toward polymicrobial consortia, substantially inhibiting the adhesion of the bacterial populations (up to 8 Log10 CFU/mL) within the consortia in dual- and even inP. aeruginosa/S. aureus/C. albicans triple-species biofilms while affecting fungal adhesion by 2.7 Log10 CFU/mL (dual consortia) and 1 Log10 CFU/mL (triple consortia). The potential of the dual-drug coating strategy in preventing triple-species adhesion and impairing bacterial viability was still strengthened by live/dead microscopy. The pDA-assisted CIP/CHX co-immobilization holds a safe and robust broad-spectrum antimicrobial coating strategy for PVC-ETTs, with the promise laying in reducing VAP incidence.
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Affiliation(s)
- Diana
Filipa Alves
- CEB
- Centre of Biological Engineering, University
of Minho, 4710-057 Braga, Portugal
- LABBELS—Associate
Laboratory, 4710-057 Braga/Guimarães, Portugal
| | - Maria Olívia Pereira
- CEB
- Centre of Biological Engineering, University
of Minho, 4710-057 Braga, Portugal
- LABBELS—Associate
Laboratory, 4710-057 Braga/Guimarães, Portugal
| | - Susana Patrícia Lopes
- CEB
- Centre of Biological Engineering, University
of Minho, 4710-057 Braga, Portugal
- LABBELS—Associate
Laboratory, 4710-057 Braga/Guimarães, Portugal
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Zhang J, Jiang X, Li X, Sun H, Wang M, Zhang W, Li H, Wang H, Zhuang M, Zhang L, Lu L, Tang J. Pulmonary Toxicity Assessment after a Single Intratracheal Inhalation of Chlorhexidine Aerosol in Mice. TOXICS 2023; 11:910. [PMID: 37999562 PMCID: PMC10675078 DOI: 10.3390/toxics11110910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Guanidine disinfectants are important chemical agents with a broad spectrum of activity that are effective against most microorganisms. Chlorhexidine, one of the most used guanidine disinfectants, is added to shampoo and mouthwash and applied in medical device sterilization. During the use of chlorhexidine, aerosols with micron particle size may be formed, which may cause inhalation toxicity. To assess the toxicity of inhaled chlorhexidine aerosol, mice underwent the intratracheal instillation of different concentrations of chlorhexidine (0, 0.125%, 0.25%, 0.5%, and 1%) using a MicroSprayer Aerosolizer. The mice were exposed for eight weeks and then sacrificed to obtain lung tissue for subsequent experiments. Histopathology staining revealed damaged lung tissues and increased collagen exudation. At the same time, pulmonary function tests showed that chlorhexidine exposure could cause restrictive ventilatory dysfunction, consistent with pulmonary fibrosis. The results of transcriptome analyses suggest that chlorhexidine may trigger an inflammatory response and promote the activation of pathways related to extracellular matrix deposition. Further, we identified that chlorhexidine exposure might enhance mucus secretion by up-regulating Muc5b and Muc5ac genes, thereby inducing fibrosis-like injury. These findings underscore the need for standardized use of disinfectants and the assessment of their inhalation toxicity.
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Affiliation(s)
- Jianzhong Zhang
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan 250001, China; (J.Z.); (X.J.); (L.Z.)
- Department of Environmental and Occupational Health, School of Public Health, Qingdao University, Qingdao 266071, China; (X.L.); (H.S.); (M.W.); (W.Z.); (H.L.)
| | - Xinmin Jiang
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan 250001, China; (J.Z.); (X.J.); (L.Z.)
- Department of Environmental and Occupational Health, School of Public Health, Qingdao University, Qingdao 266071, China; (X.L.); (H.S.); (M.W.); (W.Z.); (H.L.)
| | - Xin Li
- Department of Environmental and Occupational Health, School of Public Health, Qingdao University, Qingdao 266071, China; (X.L.); (H.S.); (M.W.); (W.Z.); (H.L.)
| | - He Sun
- Department of Environmental and Occupational Health, School of Public Health, Qingdao University, Qingdao 266071, China; (X.L.); (H.S.); (M.W.); (W.Z.); (H.L.)
| | - Mingyue Wang
- Department of Environmental and Occupational Health, School of Public Health, Qingdao University, Qingdao 266071, China; (X.L.); (H.S.); (M.W.); (W.Z.); (H.L.)
| | - Wanjun Zhang
- Department of Environmental and Occupational Health, School of Public Health, Qingdao University, Qingdao 266071, China; (X.L.); (H.S.); (M.W.); (W.Z.); (H.L.)
| | - Haonan Li
- Department of Environmental and Occupational Health, School of Public Health, Qingdao University, Qingdao 266071, China; (X.L.); (H.S.); (M.W.); (W.Z.); (H.L.)
| | - Hongmei Wang
- Department of Respiratory Medicine, Affiliated Hospital of Medical College of Qingdao University, Qingdao 266021, China; (H.W.); (M.Z.)
| | - Min Zhuang
- Department of Respiratory Medicine, Affiliated Hospital of Medical College of Qingdao University, Qingdao 266021, China; (H.W.); (M.Z.)
| | - Lin Zhang
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan 250001, China; (J.Z.); (X.J.); (L.Z.)
- Department of Environmental and Occupational Health, School of Public Health, Qingdao University, Qingdao 266071, China; (X.L.); (H.S.); (M.W.); (W.Z.); (H.L.)
| | - Lin Lu
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan 250001, China; (J.Z.); (X.J.); (L.Z.)
- Department of Environmental and Occupational Health, School of Public Health, Qingdao University, Qingdao 266071, China; (X.L.); (H.S.); (M.W.); (W.Z.); (H.L.)
| | - Jinglong Tang
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan 250001, China; (J.Z.); (X.J.); (L.Z.)
- Department of Environmental and Occupational Health, School of Public Health, Qingdao University, Qingdao 266071, China; (X.L.); (H.S.); (M.W.); (W.Z.); (H.L.)
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3
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Alaiya MA, Odeniyi MA. Utilisation of Mangifera indica plant extracts and parts in antimicrobial formulations and as a pharmaceutical excipient: a review. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2023; 9:29. [PMID: 37035527 PMCID: PMC10074368 DOI: 10.1186/s43094-023-00479-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/27/2023] [Indexed: 04/11/2023] Open
Abstract
Background Antimicrobial resistance and the environmental threat posed by some synthetic antimicrobial agents necessitate more research into development of novel pharmaceutical products that are environmentally friendly. Also, the use of plant derived excipients is growing and opening up new avenue to solve current drug delivery issues in the pharmaceutical industry. Main body This review summarizes studies related to the antimicrobial property of Mangifera indica extracts, possible mechanisms of antimicrobial action and antimicrobial formulations from the plant and overview of researches relating to the use of M. indica as a pharmaceutical excipient. Electronic searches were conducted on databases such as Pub Med, Wiley Online Library (WOL) and Google Scholar with focus on published articles relating to M. indica. Inclusion and exclusion criteria include publications relating to antimicrobial properties of M. indica extracts, its antimicrobial formulations and its use as a pharmaceutical excipient. The electronic searches yielded about 190 articles. From the studies reviewed, the mechanisms of action of phytochemicals described corroborate the antimicrobial activity exhibited by M. indica extracts and its selected formulations. In addition, mango pectin was observed to possess potential as a pharmaceutical excipient. Very few previous review articles based their focus on incorporating mechanism of action of phytochemicals with antimicrobial activity.This review examined antimicrobial properties of M. indica extracts and formulations, major phytochemicals in the plant parts and their possible modes of action. In addition, the study assessed the use of natural polymer derived from mango plant as excipients in pharmaceutical and pharmacological preparations. Conclusion The study concluded that effective antimicrobial activity of mango plant extracts and formulations requires synergy of actions among various phytochemical constituents of the extract or formulation. It is recommended that more researches focused on discovery of new phytochemicals in M. indica, their mechanisms of action and effective utilization of the plant in the pharmaceutical industry should be further explored.
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Affiliation(s)
- Mojisola Atinuke Alaiya
- grid.448723.eDepartment of Environmental Management and Toxicology, Federal University of Agriculture, Abeokuta, Nigeria
| | - Michael A. Odeniyi
- grid.9582.60000 0004 1794 5983Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
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Chuprom J, Sangkanu S, Mitsuwan W, Boonhok R, Mahabusarakam W, Singh LR, Dumkliang E, Jitrangsri K, Paul AK, Surinkaew S, Wilairatana P, Pereira MDL, Rahmatullah M, Wiart C, Oliveira SMR, Nissapatorn V. Anti- Acanthamoeba activity of a semi-synthetic mangostin derivative and its ability in removal of Acanthamoeba triangularis WU19001 on contact lens. PeerJ 2022; 10:e14468. [PMID: 36523474 PMCID: PMC9745913 DOI: 10.7717/peerj.14468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/06/2022] [Indexed: 12/13/2022] Open
Abstract
Garcinia mangostana L., also known as the mangosteen tree, is a native medicinal plant in Southeast Asia having a wide variety of pharmacologically active compounds, including xanthonoid mangostin. In this study, we examined the pharmacological activities of the selected semi-synthetic mangostin derivative, namely, amoebicidal activity, encystation inhibition, excystation activity, and removal capacity of adhesive Acanthamoeba from the surface of contact lens (CL). Among the three derivatives, C1 exhibited promising anti-Acanthamoeba activity against Acanthamoeba triangularis WU19001 trophozoites and cysts. SEM images displayed morphological changes in Acanthamoeba trophozoites, including the loss of acanthopodia, pore formation in the cell membrane, and membrane damage. In addition, the treated cyst was shrunken and adopted an irregular flat cyst shape. Under a fluorescence microscope, acridine orange and propidium iodide (AO/PI) staining revealed C1 induced condensation of cytoplasm and chromatin with the loss of cell volume in the treated trophozoites, while calcofluor white staining demonstrated the leakage of cell wall in treated cysts, leading to cell death. Interestingly, at the concentration ranges in which C1 showed the anti-Acanthamoeba effects (IC50 values ranging from 0.035-0.056 mg/mL), they were not toxic to Vero cells. C1 displayed the highest inhibitory effect on A. triangularis encystation at 1/16×MIC value (0.004 mg/mL). While C1 demonstrated the excystation activity at 1/128×MIC value with a high rate of 89.47%. Furthermore, C1 exhibited the removal capacity of adhesive Acanthamoeba from the surface of CL comparable with commercial multipurpose solutions (MPSs). Based on the results obtained, C1 may be a promising lead agent to develop a therapeutic for the treatment of Acanthamoeba infections and disinfectant solutions for CL.
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Affiliation(s)
- Julalak Chuprom
- School of Allied Health Sciences, Southeast Asia Water Team (SEA Water Team) and World Union for Herbal Drug Discovery (WUHeDD), Walailak University, Nakhon Si Thammarat, Thailand,School of Languages and General Education (SOLGEN), Walailak University, Nakhon Si Thammarat, Thailand
| | - Suthinee Sangkanu
- School of Allied Health Sciences, Southeast Asia Water Team (SEA Water Team) and World Union for Herbal Drug Discovery (WUHeDD), Walailak University, Nakhon Si Thammarat, Thailand
| | - Watcharapong Mitsuwan
- Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat, Thailand
| | - Rachasak Boonhok
- Department of Medical Technology, School of Allied Health Sciences, Research Excellence Center for Innovation and Health Products (RECIHP), Walailak University, Nakhon Si Thammarat, Thailand
| | - Wilawan Mahabusarakam
- Division of Physical Science, Faculty of Science, Prince of Songkla University, Songkhla, Thailand
| | - L. Ravithej Singh
- Fluoro-Agrochemicals Division, CSIR–Indian Institute of Chemical Technology, Tarnaka, Hyderabad, India,Chemical Sciences Division, Academy of Scientific and Innovative Research, Ghaziabad, India
| | - Ekachai Dumkliang
- Faculty of Pharmacy, Silpakorn University, Pharmaceutical Development of Green Innovations Group (PDGIG), Nakhon Pathom, Thailand
| | - Kritamorn Jitrangsri
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | - Alok K. Paul
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Sirirat Surinkaew
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
| | - Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Maria de Lourdes Pereira
- CICECO-Aveiro Institute of Materials & Department of Medical Sciences, University of Aveiro, Aveiro, Portugal,Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Mohammed Rahmatullah
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Lalmatia, Dhaka, Bangladesh
| | - Christophe Wiart
- The Institute for Tropical Biology and Conservation, University Malaysia Sabah, Kota Kin-abalu, Sabah, Malaysia
| | - Sonia Marlene Rodrigues Oliveira
- CICECO-Aveiro Institute of Materials & Department of Medical Sciences, University of Aveiro, Aveiro, Portugal,Hunter Medical Research Institute, New Lambton, Australia
| | - Veeranoot Nissapatorn
- School of Allied Health Sciences, Southeast Asia Water Team (SEA Water Team) and World Union for Herbal Drug Discovery (WUHeDD), Walailak University, Nakhon Si Thammarat, Thailand
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Bapat RA, Parolia A, Chaubal T, Dharamadhikari S, Abdulla AM, Sakkir N, Arora S, Bapat P, Sindi AM, Kesharwani P. Recent update on potential cytotoxicity, biocompatibility and preventive measures of biomaterials used in dentistry. Biomater Sci 2021; 9:3244-3283. [PMID: 33949464 DOI: 10.1039/d1bm00233c] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Dental treatment is provided for a wide variety of oral health problems like dental caries, periodontal diseases, periapical infections, replacement of missing teeth and orthodontic problems. Various biomaterials, like composite resins, amalgam, glass ionomer cement, acrylic resins, metal alloys, impression materials, bone grafts, membranes, local anaesthetics, etc., are used for dental applications. The physical and chemical characteristics of these materials influence the outcome of dental treatment. It also impacts on the biological, allergic and toxic potential of biomaterials. With innovations in science and their positive results, there is also a need for awareness about the biological risks of these biomaterials. The aim of dental treatment is to have effective, yet safe, and long-lasting results for the benefit of patients. For this, it is important to have a thorough understanding of biomaterials and their effects on local and systemic health. Materials used in dentistry undergo a series of analyses before their oral applications. To the best of our knowledge, this is the first and original review that discusses the reasons for and studies on the toxicity of commonly used biomaterials for applications in dentistry. It will help clinicians to formulate a methodical approach for the selection of dental biomaterials, thus providing an awareness for forecasting their risk of toxic reactions.
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Affiliation(s)
- Ranjeet Ajit Bapat
- Faculty, Division of Clinical Dentistry, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Abhishek Parolia
- Faculty, Division of Clinical Dentistry, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Tanay Chaubal
- Faculty, Division of Clinical Dentistry, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | | | - Anshad Mohamed Abdulla
- Faculty, Department of Pediatric Dentistry and Orthodontic Sciences, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Nasil Sakkir
- Registrar Endodontist, Central Security Hospital, Abha, Kingdom of Saudi Arabia
| | - Suraj Arora
- Faculty, Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Prachi Bapat
- Dentist, Modern Dental College, Indore 453112, Madhya Pradesh, India
| | - Amal M Sindi
- Faculty, Oral Diagnostic Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Prashant Kesharwani
- Faculty, Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India.
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Alves D, Borges P, Grainha T, Rodrigues CF, Pereira MO. Tailoring the immobilization and release of chlorhexidine using dopamine chemistry to fight infections associated to orthopedic devices. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 120:111742. [PMID: 33545884 DOI: 10.1016/j.msec.2020.111742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 11/03/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
A crucial factor in the pathogenesis of orthopedics associated infections is that bacteria do not only colonize the implant surface but also the surrounding tissues. This study aimed to engineer an antimicrobial release coating for stainless steel (SS) surfaces, to impart them with the ability to prevent Staphylococci colonization. Chlorhexidine (CHX) was immobilized using two polydopamine (pDA)-based approaches: a one-pot synthesis, where CHX is dissolved together with dopamine before its polymerization; and a two-step methodology, comprising the deposition of a pDA layer to which CHX is immobilized. To modulate CHX release, an additional layer of pDA was also added for both strategies. Immobilization of CHX using a one-step approach yielded surfaces with a more homogenous coating and less roughness than the other strategies. The amount of released CHX was lower for the one-step approach, as opposed to the two-step approach yielding the higher release, which could be decreased by applying an outward layer of pDA. Both one and two-step approaches provided the surfaces with the ability to prevent bacterial colonization of the surface itself and kill most of bacteria in the bulk phase up to 10 days. This long-term antimicrobial performance alluded a stable and enduring immobilization of CHX. In terms of biocompatibility, the amount of CHX released from the one-step approach did not compromise the growth of mammalian cells, contrary to the two-step strategy. Additionally, the few bacteria that managed to adhere to surfaces modified with one-step approach did not show evidence of resistance towards CHX. Overall data underline that one-step immobilization of CHX holds great potential to be further applied in the fight against orthopedic devices associated infections.
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Affiliation(s)
- Diana Alves
- CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal.
| | - Patrick Borges
- CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Tânia Grainha
- CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Célia F Rodrigues
- CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Maria Olívia Pereira
- CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
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Lactobacillus plantarum lipoteichoic acid disrupts mature Enterococcus faecalis biofilm. J Microbiol 2020; 58:314-319. [DOI: 10.1007/s12275-020-9518-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
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Kramer A, Eberlein T, Müller G, Dissemond J, Assadian O. Re-evaluation of polihexanide use in wound antisepsis in order to clarify ambiguities of two animal studies. J Wound Care 2019; 28:246-255. [PMID: 30975054 DOI: 10.12968/jowc.2019.28.4.246] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Due to classification of the agent polihexanide (PHMB) in category 2 'may cause cancer' by the Committee for Risk Assessment of the European Chemicals Agency in 2011, the users of wound antiseptics may be highly confused. In 2017, this statement was updated, defining PHMB up to 0.1% as a preservative safe in all cosmetic products. In the interest of patient safety, a scientific clarification of the potential carcinogenicity of PHMB is necessary. METHODS A multidisciplinary team (MDT) of microbiologists, surgeons, dermatologists and biochemists conducted a benefit-risk assessment to clarify the hazard of antiseptic use of PHMB. RESULTS In two animal studies, from which the assessment of a carcinogenic risk was derived, PHMB was administered orally over two years in extremely high concentrations far above the NO(A)EL (no-observed-(adverse-) effect level) in rats and mice. Feeding in the NO(A)EL range resulted in no abnormal effects. In one male in the highest dose group of 4000ppm PHMB, an adenocarcinoma was found, which the author attributed to chronic inflammation of the colon with systemic atypical exposure. The increasing incidence of hemangiosarcomas highly probably resulted from increased endothelial proliferation, triggered by the exceedingly high dosage fed, because PHMB is not genotoxic and there is no evidence for epigenetic effects. DISCUSSION It is well known that PHMB is not absorbed when applied topically. Considering the absence of genotoxicity and epigenetic effects together with the interpretation of the animal studies, it is the consensus of the multidisciplinary experts that a carcinogenic risk from PHMB-use for wound antisepsis can be ruled out. CONCLUSION On this basis and considering their effectiveness, tolerability and clinical evidence, the indications for PHMB based wound antiseptics are justified.
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Affiliation(s)
- Axel Kramer
- Consultant Clinical Microbiology and Infection Control, Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Thomas Eberlein
- Consultant Wound Management, College of Medicine and Medical Science, Arabian Gulf University Manama, Kingdom of Bahrain
| | - Gerald Müller
- Biochemist, Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Joachim Dissemond
- Medical Dermatologist, Department of Dermatology, Venerology and Allergology, University Hospital Essen, Germany
| | - Ojan Assadian
- Consultant Clinical Microbiology and Infection Control, Consultant Infectious Diseases and Tropical Medicine, Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Austria.,Consultant Clinical Microbiology and Infection Control, Consultant Infectious Diseases and Tropical Medicine, Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
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Kim AR, Ahn KB, Yun CH, Park OJ, Perinpanayagam H, Yoo YJ, Kum KY, Han SH. Lactobacillus plantarum Lipoteichoic Acid Inhibits Oral Multispecies Biofilm. J Endod 2019; 45:310-315. [PMID: 30803538 DOI: 10.1016/j.joen.2018.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/27/2018] [Accepted: 12/04/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Apical periodontitis is an inflammatory disease in the periradicular region of teeth that results from infection by multispecies bacterial biofilm residing in the root canal system. In this study, we investigated whether Lactobacillus plantarum lipoteichoic acid (Lp.LTA) could inhibit multispecies oral pathogenic bacterial biofilm formation. METHODS Highly pure and structurally intact Lp.LTA was purified from L. plantarum. Actinomyces naeslundii, Lactobacillus salivarius, Streptococcus mutans, and Enterococcus faecalis were co-cultured to form oral multispecies biofilm in the presence or absence of Lp.LTA on culture plates or human dentin slices. Preformed biofilm was treated with or without Lp.LTA, followed by additional treatment with intracanal medicaments such as calcium hydroxide or chlorhexidine digluconate. Confocal microscopy and crystal violet assay were performed to determine biofilm formation. Biofilm on human dentin slices was visualized with a scanning electron microscope. RESULTS Biofilm formation of multispecies bacteria on the culture dishes was dose-dependently reduced by Lp.LTA compared with the nontreatment control group. Lp.LTA also inhibited multispecies biofilm formation on the dentin slices in a dose-dependent manner. Interestingly, Lp.LTA was shown to reduce preformed multispecies biofilm compared with the nontreatment group. Moreover, Lp.LTA potentiated the effectiveness of the intracanal medicaments in the removal of preformed multispecies biofilm. CONCLUSIONS These results suggest that Lp.LTA is a potential anti-biofilm agent for treatment or prevention of oral infectious disease, including apical periodontitis, which is mainly caused by multispecies bacterial biofilm.
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Affiliation(s)
- A Reum Kim
- Department of Oral Microbiology and Immunology, DRI, and BK21 Plus Program, School of Dentistry, Seoul National University, Seoul 08826, Republic of Korea
| | - Ki Bum Ahn
- Department of Oral Microbiology and Immunology, DRI, and BK21 Plus Program, School of Dentistry, Seoul National University, Seoul 08826, Republic of Korea; Research Division for Biotechnology, Korea Atomic Energy Research Institute, Jeongeup 56212, Republic of Korea
| | - Cheol-Heui Yun
- Department of Agricultural Biotechnology and Research Institute for Agriculture and Life Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Ok-Jin Park
- Department of Oral Microbiology and Immunology, DRI, and BK21 Plus Program, School of Dentistry, Seoul National University, Seoul 08826, Republic of Korea
| | - Hiran Perinpanayagam
- Division of Restorative Dentistry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Yeon-Jee Yoo
- Department of Conservative Dentistry, School of Dentistry, Seoul National University, Seoul 03080, Republic of Korea
| | - Kee-Yeon Kum
- Department of Conservative Dentistry, School of Dentistry, Seoul National University, Seoul 03080, Republic of Korea.
| | - Seung Hyun Han
- Department of Oral Microbiology and Immunology, DRI, and BK21 Plus Program, School of Dentistry, Seoul National University, Seoul 08826, Republic of Korea.
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Osmanov A, Wise A, Denning DW. In vitro and in vivo efficacy of miramistin against drug-resistant fungi. J Med Microbiol 2019; 68:1047-1052. [PMID: 31169488 DOI: 10.1099/jmm.0.001007] [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: 12/17/2022] Open
Abstract
INTRODUCTION Miramistin is a topical antiseptic with broad antimicrobial activity that was developed in the Soviet Union during the Cold War. AIM To investigate the antifungal activity of miramistin against clinically relevant drug-resistant fungi. METHODOLOGY The in vitro activity of miramistin was determined following Clinical and Laboratory Standards Institute (CLSI) guidelines. Mammalian cell toxicity was tested using a McCoy cell line and topical and systemic tolerability, and in vivo efficacy was tested using Galleria mellonella models. RESULTS The minimal inhibitory concentration (MIC) range against fungi was 1.56-25 mg l-1 (GM 3.13 mg l-1 ). In the G. mellonella model, miramistin provided potent survival benefits for Candida albicans and Aspergillus fumigatus infection. Miramistin was tolerated by McCoy cell lines at concentrations up to 1000 mg l-1 and was systemically safe in G. mellonella at 2000 mg kg-1. Topical administration at 32 000 mg l-1 was well tolerated with no adverse effects. CONCLUSION These findings support further investigation of miramistin and suggest its possible use for treatment of superficial fungal infections.
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Affiliation(s)
- Ali Osmanov
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Andrew Wise
- Evotec UK Ltd, Block 23 Alderley Park, Macclesfield SK10 4TG, UK
| | - David W Denning
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,National Aspergillosis Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Southmoor Road, Manchester M23 9LT, UK
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Patel E, Pradeep P, Kumar P, Choonara YE, Pillay V. Oroactive dental biomaterials and their use in endodontic therapy. J Biomed Mater Res B Appl Biomater 2019; 108:201-212. [PMID: 30957440 DOI: 10.1002/jbm.b.34379] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 03/11/2019] [Accepted: 03/20/2019] [Indexed: 01/14/2023]
Abstract
Dental biomaterials have revolutionized modern therapies. Untreated dental caries remains the major etiological factor for endodontic treatment, and together with a decreasing rate of tooth loss escalates the importance of continuously improving the materials used for endodontic therapies. Endodontic biomaterials are used for vital pulp therapies, irrigation, intracanal medicaments, obturation and regenerative procedures. These materials offer several functions including: antimicrobial activity, mechanical reinforcement, aesthetics, and therapeutic effects. Vital pulp therapies have seen an improvement in clinical results with an incremental approach to build on the strengths of past materials such as calcium hydroxide and calcium silicates. While sodium hypochlorite remains the gold standard for canal irrigation, numerous nanoparticle formulations have been developed to promote sustained antimicrobial action. Gutta-percha based bulk fillers remain the most common materials for root filling. However, while multiple studies focus on the development of novel formulations containing drugs, glass derivatives or ionic-, polymeric-, or drug- loaded nanoparticles, a lack of reliable and long-term clinical evidence obligates further study as experienced clinicians prefer to use what has worked for decades. This review delves in to the biochemistry of the materials to scrutinize their shortcomings, and where opportunity lies to further enhance their efficacy in endodontic practice. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 108B:201-212, 2020.
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Affiliation(s)
- Ebrahim Patel
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Priyamvada Pradeep
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pradeep Kumar
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yahya E Choonara
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Viness Pillay
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Antimicrobial and cytotoxic effects of denture base acrylic resin impregnated with cleaning agents after long-term immersion. Toxicol In Vitro 2018; 52:8-13. [PMID: 29807097 DOI: 10.1016/j.tiv.2018.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 11/20/2022]
Abstract
The coadjutant method for denture cleansing most used by denture wearers is immersion in chemical agents, which are toxic when in direct contact with cells. However, clinically, the contact between these chemical agents and prosthetic tissues does not occur directly, but rather with what remained impregnated into acrylic bases, even after rinsing the disinfected dentures. This study evaluated the antimicrobial and cytotoxic effects of a denture acrylic resin after successive cycles of daily overnight immersion in 1% sodium hypochlorite (1%NaClO) and 2% chlorhexidine digluconate (2%CHX), simulating the periods of 9 months or 1.5 year. Microbiological and cytotoxic assays were performed, respectively, by broth microdilution method (Candida albicans or Staphylococcus aureus) and MTT assay. Chemical residues of 2%CHX impregnated into the denture acrylic resin had an antimicrobial effect on both immersion periods, which was not observed with those of 1%NaClO. However, residues of 2%CHX were severely cytotoxic to human gingival fibroblasts compared to those of 1%NaClO and acrylic resin (not submitted to the denture cleansers), which were slightly cytotoxic. Even at low concentrations recommended for overnight soaking of removable dentures, the chemical residues of CHX may result in some degree of toxicity to the denture-bearing mucosa after long-term daily immersion.
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The synthetic human beta-defensin-3 C15 peptide exhibits antimicrobial activity against Streptococcus mutans, both alone and in combination with dental disinfectants. J Microbiol 2017; 55:830-836. [PMID: 28956355 DOI: 10.1007/s12275-017-7362-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 09/03/2017] [Indexed: 02/06/2023]
Abstract
Streptococcus mutans is a major etiologic agent of human dental caries that forms biofilms on hard tissues in the human oral cavity, such as tooth and dentinal surfaces. Human β-defensin-3 (HBD3) is a 45-amino-acid natural antimicrobial peptide that has broad spectrum antimicrobial activity against bacteria and fungi. A synthetic peptide consisting of the C-terminal 15 amino acids of HBD3 (HBD3-C15) was recently shown to be sufficient for its antimicrobial activity. Thus, clinical applications of this peptide have garnered attention. In this study, we investigated whether HBD3-C15 inhibits the growth of the representative cariogenic pathogen Streptococcus mutans and its biofilm formation. HBD3-C15 inhibited bacterial growth, exhibited bactericidal activity, and attenuated bacterial biofilm formation in a dose-dependent manner. HBD3-C15 potentiated the bactericidal and anti-biofilm activity of calcium hydroxide (CH) and chlorhexidine digluconate (CHX), which are representative disinfectants used in dental clinics, against S. mutans. Moreover, HBD3-C15 showed antimicrobial activity by inhibiting biofilm formation by S. mutans and other dentinophilic bacteria such as Enterococcus faecalis and Streptococcus gordonii, which are associated with dental caries and endodontic infection, on human dentin slices. These effects were observed for HBD3-C15 alone and for HBD3-C15 in combination with CH or CHX. Therefore, we suggest that HBD3-C15 is a potential alternative or additive disinfectant that can be used for the treatment of oral infectious diseases, including dental caries and endodontic infections.
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Mohieldin EAM, Muddathir AM, Mitsunaga T. Inhibitory activities of selected Sudanese medicinal plants on Porphyromonas gingivalis and matrix metalloproteinase-9 and isolation of bioactive compounds from Combretum hartmannianum (Schweinf) bark. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:224. [PMID: 28427461 PMCID: PMC5399347 DOI: 10.1186/s12906-017-1735-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 04/08/2017] [Indexed: 12/26/2022]
Abstract
Background Periodontal diseases are one of the major health problems and among the most important preventable global infectious diseases. Porphyromonas gingivalis is an anaerobic Gram-negative bacterium which has been strongly implicated in the etiology of periodontitis. Additionally, matrix metalloproteinases-9 (MMP-9) is an important factor contributing to periodontal tissue destruction by a variety of mechanisms. The purpose of this study was to evaluate the selected Sudanese medicinal plants against P. gingivalis bacteria and their inhibitory activities on MMP-9. Methods Sixty two methanolic and 50% ethanolic extracts from 24 plants species were tested for antibacterial activity against P. gingivalis using microplate dilution assay method to determine the minimum inhibitory concentration (MIC). The inhibitory activity of seven methanol extracts selected from the 62 extracts against MMP-9 was determined by Colorimetric Drug Discovery Kit. In search of bioactive lead compounds, Combretum hartmannianum bark which was found to be within the most active plant extracts was subjected to various chromatographic (medium pressure liquid chromatography, column chromatography on a Sephadex LH-20, preparative high performance liquid chromatography) and spectroscopic methods (liquid chromatography-mass spectrometry, Nuclear Magnetic Resonance (NMR)) to isolate and characterize flavogalonic acid dilactone and terchebulin as bioactive compounds. Results About 80% of the crude extracts provided a MIC value ≤4 mg/ml against bacteria. The extracts which revealed the highest potency were: methanolic extracts of Terminalia laxiflora (wood; MIC = 0.25 mg/ml) followed by Acacia totrtilis (bark), Ambrosia maritima (aerial part), Argemone mexicana (seed), C. hartmannianum (bark), Terminalia brownii (wood) and 50% ethanolic extract of T. brownii (bark) with MIC values of 0.5 mg/ml. T. laxiflora (wood) and C. hartmannianum (bark) which belong to combretaceae family showed an inhibitory activity over 50% at the concentration of 10 μg/ml against MMP-9. Additionally, MMP-9 was significantly inhibited by terchebulin with IC50 value of 6.7 μM. Conclusions To the best of our knowledge, flavogalonic acid dilactone and terchebulin were isolated from C. hartmannianium bark for the first time in this study. Because of terchebulin and some crude extracts acting on P. gingivalis bacteria and MMP-9 enzyme that would make them promising natural preference for preventing and treating periodontal diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12906-017-1735-y) contains supplementary material, which is available to authorized users.
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do Vale LR, Delbem A, Arias LS, Fernandes RA, Vieira A, Barbosa DB, Monteiro DR. Differential effects of the combination of tyrosol with chlorhexidine gluconate on oral biofilms. Oral Dis 2017; 23:537-541. [PMID: 28142218 DOI: 10.1111/odi.12648] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/18/2017] [Accepted: 01/25/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study assessed the effect of tyrosol and chlorhexidine gluconate in combination against Candida albicans, Candida glabrata, and Streptococcus mutans in the planktonic state or forming biofilms in vitro. MATERIALS AND METHODS Checkerboard assays were performed for determination of minimum inhibitory concentration. Biofilms were cultivated during 24 h on specimens of acrylic resin and hydroxyapatite and treated with the drugs alone or in combination twice a day for 1 min, during 3 days. The antibiofilm effect was determined by quantification of the metabolic activity and cultivable cells. The drug combination was also applied on C. albicans to investigate its action on the number of hyphae. Data were statistically examined by two-way ANOVA and Holm-Sidak test (P < 0.05). RESULTS The effect of drug combination on planktonic cells was classified as antagonistic for C. albicans and indifferent for the other strains. Also, the drugs were ineffective against the tested biofilms. However, the drug combination showed a synergistic effect in reducing the number of hyphae by C. albicans. CONCLUSION The combination of tyrosol with chlorhexidine gluconate was only effective in reducing the number of hyphae by C. albicans, a relevant virulence factor of this species.
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Affiliation(s)
- L R do Vale
- Department of Pediatric Dentistry and Public Health, School of Dentistry, São Paulo State University (Unesp), Araçatuba, São Paulo, Brazil
| | - Acb Delbem
- Department of Pediatric Dentistry and Public Health, School of Dentistry, São Paulo State University (Unesp), Araçatuba, São Paulo, Brazil
| | - L S Arias
- Department of Pediatric Dentistry and Public Health, School of Dentistry, São Paulo State University (Unesp), Araçatuba, São Paulo, Brazil
| | - R A Fernandes
- Department of Pediatric Dentistry and Public Health, School of Dentistry, São Paulo State University (Unesp), Araçatuba, São Paulo, Brazil.,Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (Unesp), Araçatuba, São Paulo, Brazil
| | - Apm Vieira
- Department of Pediatric Dentistry and Public Health, School of Dentistry, São Paulo State University (Unesp), Araçatuba, São Paulo, Brazil
| | - D B Barbosa
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (Unesp), Araçatuba, São Paulo, Brazil
| | - D R Monteiro
- Department of Pediatric Dentistry and Public Health, School of Dentistry, São Paulo State University (Unesp), Araçatuba, São Paulo, Brazil.,Graduate Program in Dentistry (GPD - Master's Degree), University of Western São Paulo (UNOESTE), Presidente Prudente, São Paulo, Brazil
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Abstract
Prosthetic joint infection (PJI) is a serious complication after total joint arthroplasty (TJA). Chlorhexidine is a widely used antiseptic because of its rapid and persistent action. It is well tolerated and available in different formulations at various concentrations. Chlorhexidine can be used for pre-operative skin cleansing, surgical site preparation, hand antisepsis of the surgical team and intra-articular irrigation of infected joints. The optimal intra-articular concentration of chlorhexidine gluconate in irrigation solution is 2%, to provide a persistent decrease in biofilm formation, though cytotoxicity might be an issue. Although chlorhexidine is relatively cheap, routine use of chlorhexidine without evidence of clear benefits can lead to unnecessary costs, adverse effects and even emergence of resistance. This review focuses on the current applications of various chlorhexidine formulations in TJA. As the treatment of PJI is challenging and expensive, effective preparations of chlorhexidine could help in the prevention and control of PJI.
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Affiliation(s)
- Jaiben George
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
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Kramer A, Assadian O, Koburger-Janssen T. Antimicrobial efficacy of the combination of chlorhexidine digluconate and dexpanthenol. GMS HYGIENE AND INFECTION CONTROL 2016; 11:Doc24. [PMID: 27999767 PMCID: PMC5156840 DOI: 10.3205/dgkh000284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective: The objective of this standardised experimental study was to investigate the antimicrobial efficacy of the combination of chlorhexidine digluconate (CHX) and the anti-inflammatory pro-vitamin dexpanthenol, which stimulates wound-healing, in the form of Bepanthen® Antiseptic Wound Cream, in order to rule out possible antagonistic combination effects of CHX and the alcohol analogue of pantothenic acid (vitamin B5) dexpanthenol. Method: Testing was carried out using the quantitative suspension test at conditions simulating wound bio-burden. Test strains included Enterococcus hirae (ATCC 10541) and Candida albicans (ATCC 10231) in accordance with the standard methods of the German Hygiene and Microbiology Society with the following three organic challenges: i) cell culture medium MEM with Earle’s salts, L-glutamine and 10% foetal calf serum (CCM); ii) 10% sheep’s blood; iii) or a mixture of 4.5% albumin, 4.5% sheep’s blood and 1% mucin. For methodological reasons, the wound cream was tested as a 55% dilution, prepared with 1% Tween 80 (equivalent to a content of 0.275% CHX instead of 0.5% as in the original preparation). CHX 0.275% was tested as control in an aqueous solution and in 1% Tween 80. Additionally, 1% Tween 80 was tested in order to rule out an interfering effect of the dilution medium. A combination of 3% Tween 80, 3% saponin, 0.1% histidine, 0.3% lecithin, 0.5% Na-thiosulphate and 1% ether sulphate was identified as the most appropriate neutraliser during the experiments. Results: Exposed to CCM or 10% sheep’s blood, the tested wound cream fulfilled the requirements for a wound antiseptic against both test species with ≥3 log reduction at 10 minutes. Even at the the worst-case challenge test with 4.5% albumin, 4.5% sheep’s blood and 1% mucin, the requirement for a ≥3 log reduction was met after 24 hours of exposure. Interestingly, the aqueous solution of 0.275% CHX tested as control did not achieve the antimicrobial efficacy of the combination of CHX and 5% dexpanthenol. 1% Tween 80 was ineffective against both test species. Conclusion: Bepanthen® Antiseptic Wound Cream achieves the in vitro bactericidal and fungicidal efficacy required for a wound antiseptic under three different challenges, despite dilution to 55% of the original preparation. So far, the addition of dexpanthenol was intended to support wound healing. However, our results indicate that the antiseptic efficacy of CHX is synergistically increased by adding 5% dexpanthenol. Acknowledging the antimicrobial and residual efficacy of CHX, and bearing in the mind the contraindications to CHX (allergy and anaphylaxis), the tested wound cream should be regarded as better suitable to be used as wound antiseptic than preparations on basis of CHX alone.
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Affiliation(s)
- Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Ojan Assadian
- Institute for Skin Integrity and Infection Prevention, University of Huddersfield, UK
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Below H, Assadian O, Baguhl R, Hildebrandt U, Jäger B, Meissner K, Leaper DJ, Kramer A. Measurements of chlorhexidine, p-chloroaniline, and p-chloronitrobenzene in saliva after mouth wash before and after operation with 0.2% chlorhexidine digluconate in maxillofacial surgery: a randomised controlled trial. Br J Oral Maxillofac Surg 2016; 55:150-155. [PMID: 27789177 DOI: 10.1016/j.bjoms.2016.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/07/2016] [Indexed: 11/29/2022]
Abstract
Chlorhexidine gluconate is used to prevent the accumulation of dental plaque and gingivitis, infection of the surgical site, and ventilator-associated pneumonia in maxillofacial surgery, but it is not clear whether the metabolites of chlorhexidine are detectable in the patient's saliva at clinically relevant concentrations. Forty-three patients who had orofacial operations were randomised to use a 0.2% chlorhexidine gluconate (n=23), or an octenidine-based, chlorhexidine-free (n=20), mouthwash once preoperatively and three times daily for five postoperative days. After the first, 8.7 (23.3) mg/L chlorhexidine (0.7%-2.5% of the total amount used) was measured in saliva. The concentration increased to 15.2 (6.2) mg/L after the second rinse (first postoperative day), and peaked at 29.4 (11.2) mg/L on the fourth postoperative day. It remained detectable for up to 12hours after the last one, but was not detectable in serum or urine at any time. The potentially carcinogenic metabolite p-chloroaniline was detectable in saliva at higher concentrations in the chlorhexidine group (0.55mg/L) than the octenidine group (0.21mg/L), and p-chloronitrobenzene was detected in both groups in only minimal concentrations (0.001-0.21mg/L). Chlorhexidine gluconate mouthwashes do increase the concentration of p-chloroaniline, but a single use seems to be safe. Whether prolonged exposure over many years may have carcinogenic potential is still not clear. Based on the hitherto unknown kinetics of p-chloroaniline in saliva, the recent recommendation of the Federal Drug Administration (FDA) in the USA to limit the use of a chlorhexidine gluconate mouthwash to a maximum of six months seems to be justified.
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Affiliation(s)
- H Below
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - O Assadian
- Institute of Skin Integrity and Infection Prevention, School of Human & Health Sciences, University of Huddersfield, United Kingdom.
| | - R Baguhl
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - U Hildebrandt
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - B Jäger
- Institute of Biometry and Medical Computer Science, University Medicine Greifswald, Germany
| | - K Meissner
- Department of Anaesthesiology and Intensive Medicine, University Medicine Greifswald, Germany
| | - D J Leaper
- Institute of Skin Integrity and Infection Prevention, School of Human & Health Sciences, University of Huddersfield, United Kingdom
| | - A Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
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Barreras US, Méndez FT, Martínez REM, Valencia CS, Rodríguez PRM, Rodríguez JPL. Chitosan nanoparticles enhance the antibacterial activity of chlorhexidine in collagen membranes used for periapical guided tissue regeneration. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 58:1182-7. [PMID: 26478419 DOI: 10.1016/j.msec.2015.09.085] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 09/14/2015] [Accepted: 09/23/2015] [Indexed: 01/12/2023]
Abstract
Endodontic failure is mainly associated with the persistence of microbial infection in the root canal system and/or the periradicular area. Microorganisms and their toxins located in the root canal system may trigger apical periodontitis and tissue destruction. Tissue regeneration in periapical surgery by using membrane barriers has shown an improved healing and bone closure. However, bacterial membrane contamination is a main reason of failure. In this in vitro study, different brands of chlorhexidine, a combination of chitosan nanoparticles containing chlorhexidine were tested against Enterococcus faecalis on agar plate's cultures and infected collagen membranes. Our results indicated that chitosan nanoparticles acted synergistically with chlorhexidine, inhibiting and eliminating significantly a greater amount of colony former units in both BHI-agar cultures and infected collagen membranes. These results suggested that chitosan nanoparticles could be used to improve regenerative procedures in periapical surgery.
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Ajay Rao HT, Bhat SS, Hegde S, Jhamb V. Efficacy of garlic extract and chlorhexidine mouthwash in reduction of oral salivary microorganisms, an in vitro study. Anc Sci Life 2015; 34:85-8. [PMID: 25861142 PMCID: PMC4389398 DOI: 10.4103/0257-7941.153465] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: To assess and compare the antimicrobial effect of garlic extract and chlorhexidine (CHX) mouthwash solution against oral salivary microorganisms. Materials and Methods: Thirty six salivary samples were obtained in dry plastic vials. Collected saliva samples were centrifuged. Each vial was mixed completely on a shaker after which 1 ml of saliva was added to 9 ml of ethanol by a sterile pipette and mixed. A volume of 1 ml of garlic hydro-alcoholic extract and 1 ml of mouthwash was added to 1 ml each case specimen and was transferred to culture medium of Trypticase Soy Agar. Agar plates were incubated at 37°C for 48 h to allow for microbial growth. Microbial colonies were counted by independent interpreter to evaluate the result. Statistical Analysis: Data obtained were analyzed using one-way ANOVA test. P < 0.001 was considered statistically significant. Result: Result of the study shows that mean colony count of salivary microbial population was (1984 ± 400) 1127 in saline group (negative control), (50 ± 4) 27 in (0.12%) CHX group (positive control), (700 ± 200) 469 in garlic extract (5%) group (case control). Conclusion: Mouthwash containing garlic extract can be used as an alternative to CHX mouthwash.
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Affiliation(s)
- H T Ajay Rao
- Department of Paedodontics and Preventive Dentistry, Yenepoya Dental College, Yenepoya University, Deralakatte, Mangalore, Karnataka, India
| | - Sham S Bhat
- Department of Paedodontics and Preventive Dentistry, Yenepoya Dental College, Yenepoya University, Deralakatte, Mangalore, Karnataka, India
| | - Sundeep Hegde
- Department of Paedodontics and Preventive Dentistry, Yenepoya Dental College, Yenepoya University, Deralakatte, Mangalore, Karnataka, India
| | - Vikram Jhamb
- Department of Paedodontics and Preventive Dentistry, Yenepoya Dental College, Yenepoya University, Deralakatte, Mangalore, Karnataka, India
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Carvacrol codrugs: a new approach in the antimicrobial plan. PLoS One 2015; 10:e0120937. [PMID: 25859852 PMCID: PMC4393269 DOI: 10.1371/journal.pone.0120937] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 02/09/2015] [Indexed: 01/10/2023] Open
Abstract
Objective The increasing prevalence of antibiotic-resistant bacterial infections led to identify alternative strategies for a novel therapeutic approach. In this study, we synthesized ten carvacrol codrugs – obtained linking the carvacrol hydroxyl group to the carboxyl moiety of sulphur-containing amino acids via an ester bond – to develop novel compounds with improved antimicrobial and antibiofilm activities and reduced toxicity respect to carvacrol alone. Method All carvacrol codrugs were screened against a representative panel of Gram positive (S. aureus and S. epidermidis), Gram negative (E. coli and P. aeruginosa) bacterial strains and C. albicans, using broth microdilution assays. Findings Results showed that carvacrol codrug 4 possesses the most notable enhancement in the anti-bacterial activity displaying MIC and MBC values equal to 2.5 mg/mL for all bacterial strains, except for P. aeruginosa ATCC 9027 (MIC and MBC values equal to 5 mg/mL and 10 mg/mL, respectively). All carvacrol codrugs 1-10 revealed good antifungal activity against C. albicans ATCC 10231. The cytotoxicity assay showed that the novel carvacrol codrugs did not produce human blood hemolysis at their MIC values except for codrugs 8 and 9. In particular, deepened experiments performed on carvacrol codrug 4 showed an interesting antimicrobial effect on the mature biofilm produced by E. coli ATCC 8739, respect to the carvacrol alone. The antimicrobial effects of carvacrol codrug 4 were also analyzed by TEM evidencing morphological modifications in S. aureus, E. coli, and C. albicans. Conclusion The current study presents an insight into the use of codrug strategy for developing carvacrol derivatives with antibacterial and antibiofilm potentials, and reduced cytotoxicity.
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Abstract
PURPOSE OF REVIEW Neonates in intensive care are more susceptible to sepsis. Infection is commonly acquired via the transcutaneous portal. It is necessary to identify the most effective yet safest topical antiseptics for use in neonates to reduce nosocomial sepsis. RECENT FINDINGS Recent national surveys indicate that a wide range of topical antiseptic preparations are used in the neonatal nursery. There are very few comparative studies in neonates and no robust evidence in favour of any particular antiseptic. There are significant safety and potential toxicity issues for neonates with all the commonly used antiseptics, particularly in very small immature babies. There are no convincing roles for routine application of emollient creams on the skin, topical antiseptics on the umbilical stump, or maternal vaginal washes with chlorhexidine for the prevention of neonatal infection. SUMMARY Large multicentre trials are needed to determine the optimal antiseptic to use for neonates undergoing intensive care, especially for extremely preterm infants.
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Ros-Llor I, Lopez-Jornet P. Cytogenetic analysis of oral mucosa cells, induced by chlorhexidine, essential oils in ethanolic solution and triclosan mouthwashes. ENVIRONMENTAL RESEARCH 2014; 132:140-145. [PMID: 24769563 DOI: 10.1016/j.envres.2014.03.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/08/2014] [Accepted: 03/11/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate DNA damage and cytokinetic defects, proliferative potential and cell death caused by the frequent use of mouthrinses containing chlorhexidine, triclosan and essential oils in ethanolic solution, compared to a placebo mouthwash. STUDY DESIGN This double-blind, prospective, randomized clinical trial included 80 Caucasian patients. Subjects were divided into four groups: Group I used a mouthrinse, Triclosan; Group II used physiological saline; Group III used chlorhexidine; Group IV a mouthrinse with essential oils in ethanolic solution. All subjects used the mouthrinses for two weeks (15 ml, twice a day, rinsing for 30s). Two cell samples per subject were collected, before and after mouthrinse use (on day 0 and day 15). Samples were processed as follows: cell collection from cheeks with a cytobrush; cell centrifuge; slide preparation, fixation and staining; and fluorescent microscope analysis. 2000 exfoliated cells were screened for nuclear abnormalities, particularly the presence of micronuclei by means of cytome assay. RESULTS No significant differences between study times (before and after use of mouthwash) were identified for any of the variables studied (p>0.05). Differences between mouthrinse groups were also compared but no significant differences were found (p>0.05). CONCLUSIONS This study did not observe any genotoxic effect resulting from mouthrinse use.
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Affiliation(s)
- Irene Ros-Llor
- Department of Oral Medicine, Faculty of Medicine and Dentistry. Ageing Research Institute, University of Murcia, Murcia, Spain
| | - Pia Lopez-Jornet
- Department of Oral Medicine, Faculty of Medicine and Dentistry. Ageing Research Institute, University of Murcia, Murcia, Spain.
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