Deirdre A. Devine

Dental plaque biofilms: communities, conflict and control

From the very beginning of the discipline of microbiology, the dogma has been to isolate bacteria in pure culture in order to be able to define their individual properties. This process also involved the use of conventional broth (planktonic) culture to prepare biomass and to determine the phenotype of particular species. This approach provided a sound foundation for contemporary investigations of classical infectious diseases. Recently, however, there has been a renaissance in our understanding of microbial behaviour in natural habitats, and a recognition that chronic diseases can have a complex aetiology. It is now accepted that, in nature, bacteria exist for the most part attached to a surface as a biofilm, often as a member of a polymicrobial community (or consortium) of interacting species. If biofilms were merely planktonic-like cells that had adhered to a surface and the properties of a multi-species microbial community were just the sum of the constituent populations, then the scientific and clinical imperative for their study would be low. However, application of novel imaging (confocal or epifluorescence microscopy, fluorescence in situ hybridization, live ⁄ dead stains, etc.) and molecular techniques (16S rRNA gene amplification and sequence comparison, proteomics, transcriptomics, reporter gene technology, etc.) has radically altered our understanding of the biology of multi-species biofilms (Table 1), and key developments that are pertinent to the control of dental plaque are highlighted in this review. Another major shift in our understanding of microbial behaviour has come from our increased knowledge of microbial ecology (3), and recognition of the intimate relationship between the resident human microflora and the host. Changes in the host environment have a direct impact on gene expression, and thereby influence the metabolic activity, competitiveness and composition of the microflora, while the action of resident microorganisms can have consequences for the host. An appreciation of this dynamic relationship is critical to fully understand the relationship between the oral microflora and the host in health or disease.

The Commensal Streptococcus salivarius K12 Downregulates the Innate Immune Responses of Human Epithelial Cells and Promotes Host-Microbe Homeostasis

ABSTRACT Streptococcus salivarius is an early colonizer of human oral and nasopharyngeal epithelia, and strain K12 has reported probiotic effects. An emerging paradigm indicates that commensal bacteria downregulate immune responses through the action on NF-κB signaling pathways, but additional mechanisms underlying probiotic actions are not well understood. Our objective here was to identify host genes specifically targeted by K12 by comparing their responses with responses elicited by pathogens and to determine if S. salivarius modulates epithelial cell immune responses. RNA was extracted from human bronchial epithelial cells (16HBE14O- cells) cocultured with K12 or bacterial pathogens. cDNA was hybridized to a human 21K oligonucleotide-based array. Data were analyzed using ArrayPipe, InnateDB, PANTHER, and oPOSSUM. Interleukin 8 (IL-8) and growth-regulated oncogene alpha (Groα) secretion were determined by enzyme-linked immunosorbent assay. It was demonstrated that S. salivarius K12 specifically altered the expression of 565 host genes, particularly those involved in multiple innate defense pathways, general epithelial cell function and homeostasis, cytoskeletal remodeling, cell development and migration, and signaling pathways. It inhibited baseline IL-8 secretion and IL-8 responses to LL-37, Pseudomonas aeruginosa, and flagellin in epithelial cells and attenuated Groα secretion in response to flagellin. Immunosuppression was coincident with the inhibition of activation of the NF-κB pathway. Thus, the commensal and probiotic behaviors of S. salivarius K12 are proposed to be due to the organism (i) eliciting no proinflammatory response, (ii) stimulating an anti-inflammatory response, and (iii) modulating genes associated with adhesion to the epithelial layer and homeostasis. S. salivarius K12 might thereby ensure that it is tolerated by the host and maintained on the epithelial surface while actively protecting the host from inflammation and apoptosis induced by pathogens.

How is the development of dental biofilms influenced by the host

BACKGROUND The host provides environmental conditions that support diverse communities of microorganisms on all environmentally-exposed surfaces of the body. MATERIALS AND METHODS To review the literature to determine which properties of the host substantially influence the development of dental biofilms. RESULTS The mouth facilitates the growth of a characteristic resident microbiota. The composition of the oral microbiota is influenced by temperature, pH, and atmosphere, as well as by the host defences and host genetics. In addition, the host supplies endogenous nutrients and a variety of surfaces for biofilm formation. In health, the resident oral microbiota forms a symbiotic relationship with the host, regulated by active host-microbe cross talk. This resident microbiota is sensitive to perturbations in the host environment, especially to changes in nutrient supply and pH, so that previously minor components of the microbiota can become more competitive (and vice versa), resulting in reorganization of biofilm community structure. CONCLUSION The host environment dictates the composition and gene expression of the resident microbiota. Changes in oral environmental conditions can disrupt the normal symbiotic relationship between the host and its resident microbes, and increase the risk of disease.

Penetration of Fluoride into Natural Plaque Biofilms

Caries occurs at inaccessible stagnation sites where plaque removal is difficult. Here, the penetration through plaque of protective components, such as fluoride, is likely to be crucial in caries inhibition. We hypothesized that topically applied fluoride would readily penetrate such plaque deposits. In this study, plaque biofilms generated in vivo on natural enamel surfaces were exposed to NaF (1000 ppm F−) for 30 or 120 sec (equivalent to toothbrushing) or for 30 min. Biofilms were then sectioned throughout their depth, and the fluoride content of each section was determined with the use of a fluoride electrode. Exposure to NaF for 30 or 120 sec increased plaque fluoride concentrations near the saliva interface, while concentrations near the enamel surface remained low. Fluoride penetration increased with duration of NaF exposure. Removal of exogenous fluoride resulted in fluoride loss and redistribution. Penetration of fluoride into plaque biofilms during brief topical exposure is restricted, which may limit anti-caries efficacy.

Antimicrobial peptides in defence of the oral and respiratory tracts

Antimicrobial peptides (AMPs) are components of complex host secretions, acting synergistically with other innate defence molecules to combat infection and control resident microbial populations throughout the oral cavity and respiratory tract. AMPs are directly antimicrobial, bind lipopolysaccharide (LPS) and lipoteichoic acid, and are immunomodulatory signals. Pathogenic and commensal organisms display a variety of resistance mechanisms, which are related to structure of cell wall components (e.g. LPS) and cytoplasmic membranes, and peptide breakdown mechanisms. For example, LPS of the AMP-resistant cystic fibrosis pathogen Burkholderia cepacia is under-phosphorylated and highly substituted with charge-neutralising 4-deoxy-4-aminoarabinose. Additionally, host mimicry by addition of phosphorylcholine contributes to resistance in oral and respiratory organisms. Porphyromonas gingivalis, Pseudomonas aeruginosa and other pathogens produce extracellular and membrane-bound proteases that degrade AMPs. Many of these bacterial properties are environmentally regulated. Their modulation in response to host defences and inflammation can result in altered sensitivity to AMPs, and may additionally change other host-microbe interactions, e.g. binding to Toll-like receptors. The diversity and breadth of antimicrobial cover and immunomodulatory function provided by AMPs is central to the ability of a host to respond to the diverse and highly adaptable organisms colonising oral and respiratory mucosa.

SPLUNC1 (PLUNC) is expressed in glandular tissues of the respiratory tract and in lung tumours with a glandular phenotype

Short PLUNC1 (SPLUNC1) is the founding member of a novel family of proteins (PLUNC) expressed in the upper respiratory tract that may function in host defence. It is one of the most highly expressed genes in the upper airways and the protein has been detected in sputum and nasal secretions. This study describes, for the first time, the precise cellular localization of SPLUNC1 in human tissues from the respiratory tract. Although SPLUNC1 is found in some epithelial cells of the upper airways and coats the surface epithelial cell lining of the major airways, the most significant site of protein localization is in mucous cells and ducts of submucosal glands. Intense staining is also seen in minor glands of the nose, sinuses, posterior tongue and tonsil, suggesting that the protein is secreted into mucoid secretions of these tissues, where it probably functions in host defence. No staining was seen in peripheral lung tissue. As SPLUNC1 has been suggested to be a novel lung cancer marker, a limited panel of lung cancers was also studied. The findings suggest that SPLUNC1 is commonly expressed in adenocarcinomas, muco‐epidermoid carcinoma, and bronchio‐alveloar carcinoma, and is absent from small‐cell carcinoma and squamous cell carcinoma. This expression pattern is consistent with the presumed phenotypic origin of these tumours and suggests that SPLUNC1 may be a useful marker for lung cancer. Copyright

Prospects for the development of probiotics and prebiotics for oral applications

There has been a paradigm shift towards an ecological and microbial community-based approach to understanding oral diseases. This has significant implications for approaches to therapy and has raised the possibility of developing novel strategies through manipulation of the resident oral microbiota and modulation of host immune responses. The increased popularity of using probiotic bacteria and/or prebiotic supplements to improve gastrointestinal health has prompted interest in the utility of this approach for oral applications. Evidence now suggests that probiotics may function not only by direct inhibition of, or enhanced competition with, pathogenic micro-organisms, but also by more subtle mechanisms including modulation of the mucosal immune system. Similarly, prebiotics could promote the growth of beneficial micro-organisms that comprise part of the resident microbiota. The evidence for the use of pro or prebiotics for the prevention of caries or periodontal diseases is reviewed, and issues that could arise from their use, as well as questions that still need to be answered, are raised. A complete understanding of the broad ecological changes induced in the mouth by probiotics or prebiotics will be essential to assess their long-term consequences for oral health and disease.

Ecological approaches to oral biofilms: control without killing.

Humans have co-evolved with micro-organisms and have a symbiotic or mutualistic relationship with their resident microbiome. As at other body surfaces, the mouth has a diverse microbiota that grows on oral surfaces as structurally and functionally organised biofilms. The oral microbiota is natural and provides important benefits to the host, including immunological priming, down-regulation of excessive pro-inflammatory responses, regulation of gastrointestinal and cardiovascular systems, and colonisation by exogenous microbes. On occasions, this symbiotic relationship breaks down, and previously minor components of the microbiota outcompete beneficial bacteria, thereby increasing the risk of disease. Antimicrobial agents have been formulated into many oral care products to augment mechanical plaque control. A delicate balance is needed, however, to control the oral microbiota at levels compatible with health, without killing beneficial bacteria and losing the key benefits delivered by these resident microbes. These antimicrobial agents may achieve this by virtue of their recommended twice daily topical use, which results in pharmacokinetic profiles indicating that they are retained in the mouth for relatively long periods at sublethal levels. At these concentrations they are still able to inhibit bacterial traits implicated in disease (e.g. sugar transport/acid production; protease activity) and retard growth without eliminating beneficial species. In silico modelling studies have been performed which support the concept that either reducing the frequency of acid challenge and/or the terminal pH, or by merely slowing bacterial growth, results in maintaining a community of beneficial bacteria under conditions that might otherwise lead to disease (control without killing).

Temperature-Dependent Modulation of Porphyromonas gingivalis Lipid A Structure and Interaction with the Innate Host Defenses

ABSTRACT Lipid A structure is a critical determinant of the interaction between pathogens and the innate immune system. Previously, we demonstrated the presence of non- and monophosphorylated tetra-acylated lipid A structures in the outer membrane of Porphyromonas gingivalis, an agent of human periodontal disease. These modifications to lipid A structure lead to evasion and suppression of innate defenses mediated by Toll-like receptor 4 (TLR4) and cationic antimicrobial peptides. In this investigation, we examined the influence of growth temperature on P. gingivalis lipid A structure and recognition by TLR4 as an example of an environmental influence which is known to vary between healthy and diseased sites in the periodontium. We demonstrate that P. gingivalis grown at a normal body temperature produces mainly nonphosphorylated and monophosphorylated tetra-acylated lipid A structures, whereas bacteria grown at 39°C and 41°C intended to mimic increasing levels of inflammation, producing increasing proportions of monophosphorylated, penta-acylated lipid A. The temperature-dependent alteration in lipid A renders the bacterium significantly more potent for activating TLR4 and more susceptible to killing by β-defensins 2 and 3. This is the first report of a lipid A remodeling system linked to temperature shifts associated with a deregulated inflammatory response. Temperature elevation at sites of inflammation in the periodontium may be a significant environmental regulator of the lipid A modification systems of P. gingivalis, which will influence the interaction of this organism with the innate host defense.

Modulation of antibacterial peptide activity by products of Porphyromonas gingivalis and Prevotella spp.

This study investigated the ability of anaerobic periodontal bacteria to inactivate and resist killing by antimicrobial peptides through production of extracellular proteases. Antibacterial activities of peptides were assessed in a double-layer agarose diffusion assay, and MICs and MBCs were determined in broth microdilution assays. Culture supernates of Porphyromonas gingivalis and Prevotella spp. inactivated mastoparan, magainin II and cecropin B whilst Gram-positive oral supragingival bacteria had no effect. Inactivation was prevented by protease inhibitors and was unaffected by 45% human serum. Purified proteases from the periodontopathogen Porph. gingivalis inactivated peptides [cecropin B, brevinin, CAMEL (cecropin A 1-7 + melittin 2-9), mastoparan] as would be predicted from the amino acid sequences of the peptides and the known bond specificities of these Arg-x and Lys-x enzymes. MALDI-TOF MS revealed that inactivation of cecropin B by Porph. gingivalis protease was due to specific cleavage of the molecule. Inactivation of cecropin B by proteases took 10-15 min. Paradoxically, MICs of cecropin B against Porph. gingivalis and Prevotella intermedia were low, while Prevotella nigrescens was resistant, suggesting that production of proteases alone is insufficient to protect Porph. gingivalis and Prev. intermedia from the action of antimicrobial peptides. Thus, antimicrobial peptides could be developed as therapeutic agents targeted against specific periodontal pathogens.