Muhammad
Shahzad
a,
Emma
Millhouse
b,
Shauna
Culshaw
b,
Christine A.
Edwards
a,
Gordon
Ramage
b and
Emilie
Combet
*a
aHuman Nutrition, School of Medicine, Glasgow Royal Infirmary, College of Medical, Veterinary and Life Sciences, The University of Glasgow, Glasgow G31 2ER, UK. E-mail: Emilie.CombetAspray@glasgow.ac.uk; Tel: +44 (0) 141 201 8527
bInfection and Immunity Research Group, Glasgow Dental School, College of Medical, Veterinary and Life Sciences, The University of Glasgow, Glasgow G2 3JZ, UK
First published on 24th December 2014
Periodontitis (PD) is a chronic infectious disease mediated by bacteria in the oral cavity. (Poly)phenols (PPs), ubiquitous in plant foods, possess antimicrobial activities and may be useful in the prevention and management of periodontitis. The objective of this study was to test the antibacterial effects of selected PPs on periodontal pathogens, on both planktonic and biofilm modes of growth. Selected PPs (n = 48) were screened against Streptococcus mitis (S. mitis), Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Fusobacterium nucleatum (F. nucleatum) and Porphyromonas gingivalis (P. gingivalis). The antibacterial potential of each compound was evaluated in terms of planktonic minimum inhibitory concentration (PMIC) and planktonic minimum bactericidal concentration (PMBC) using standardized broth microdilution assays. The most active PPs were further tested for their effect on mono-species and multi-species biofilms using a colorimetric resazurin-based viability assay and scanning electron microscopy. Of the 48 PPs tested, 43 showed effective inhibition of planktonic growth of one or more test strains, of which curcumin was the most potent (PMIC range = 7.8–62.5 μg mL−1), followed by pyrogallol (PMIC range = 2.4–2500 μg mL−1), pyrocatechol (MIC range = 4.9–312.5 μg mL−1) and quercetin (PMIC range = 31.2–500 μg mL−1). At this concentration, adhesion of curcumin and quercetin to the substrate also inhibited adhesion of S. mitis, and biofilm formation and maturation. While both curcumin and quercetin were able to alter architecture of mature multi-species biofilms, only curcumin-treated biofilms displayed a significantly reduced metabolic activity. Overall, PPs possess antibacterial activities against periodontopathic bacteria in both planktonic and biofilm modes of growth. Further cellular and in vivo studies are necessary to confirm their beneficial activities and potential use in the prevention and or treatment of periodontal diseases.
In humans, PD is commonly associated with a dental plaque biofilm that accumulates on the tooth surfaces. It is one of the most complex and diverse microbial ecosystems within the human body, encompassing some 700 different reported bacterial species.7 However, initiation and causation of periodontitis is associated with a few pathogenic species, including P. gingivalis and P. intermedia, and A. actinomycetemcomitans in aggressive periodontitis.8
Current management approaches include periodontal surgery, scaling and root planning along with adjunctive antibiotic therapy.9 However, these treatment options not only have limited effectiveness in high risk populations and in those with advanced periodontal disease,10 but can also be associated with adverse side effects and antibiotic resistance.11 Therefore, alternative therapeutic and preventive measures which are safe, effective and free of side effects, are highly desirable.12
In recent years, an increasing interest has been observed in the use of natural compounds (of dietary origin) for the management of oral infectious diseases, including caries,13 oral candidosis14 and periodontitis.15 While plant-derived phytochemicals, especially the (poly)phenols (PPs), have been studied for their antioxidant and anti-inflammatory properties,16 the antimicrobial properties of PPs have received limited exposure in the context of prevention and treatment of PD.17 Nevertheless, several studies have reported the inhibitory activities of certain PP extracts, including cranberries, lotus, seaweed and perilla seeds against a range of planktonic periodontal pathogens.18–21 Moreover, the antibacterial activity of flavan-3-ol-rich green tea extracts has been reported against planktonic S. mitis, P. gingivalis and F. nucleatum.22–25 Others have quantified the antibacterial activity of specific PP molecules (including gallic acid, naringin and quercetin) on planktonic P. gingivalis and F. nucleatum.21,26–28 In addition, there are reports that the antimicrobial potential of PPs depends on their chemical structure.29,30 Given that periodontal pathogens in dental plaque exist in the form of biofilm, there has been very limited research investigating the effect of PPs on biofilm development and formation. Therefore, the aim of the present study was to evaluate the potential of a panel of PPs in inhibiting growth and biofilm formation of PD pathogens, with emphasis on structure–function relationship, if any.
To assess ultra-structural change of biofilms following PP treatment, scanning electron microscopy (SEM) was performed on PP-treated, mature, multispecies biofilms and untreated controls. Briefly, cells were standardised as described above, and grown directly onto Thermanox™ coverslips (Nunc, Roskilde, Denmark) to allow biofilm formation. Following maturation, biofilms were carefully washed with PBS and treated with PMIC concentrations of the selected PPs for 24 h. Following treatment, biofilms were again washed with PBS and then fixed in 2% para-formaldehyde, 2% gluteraldehyde and 0.15 M sodium cacodylate, and 0.15% w/v Alcian Blue, pH 7.4, and prepared for SEM as previously described.39 The specimens were sputter-coated with gold and viewed under a JEOL JSM-6400 scanning electron microscope. Images were assembled using Photoshop (Adobe, San Jose, CA, USA).
Range testeda | S. mitis | A. actinom. | P. gingivalis | F. nucleatum | |||||
---|---|---|---|---|---|---|---|---|---|
MIC | MBC | MIC | MBC | MIC | MBC | MIC | MBC | ||
a Range of test concentration, All MIC values are in μg mL−1. A actinom. = A. actinomycetemcomitans. | |||||||||
Hydroxybenzoic acids | |||||||||
Benzoic acid | 4.88–2500 | 1250 | >2500 | 625 | 1250 | 625 | >2500 | 625 | 625 |
3-Hydroxybenzoic acid | 4.88–2500 | 2500 | 2500 | 625 | 1250 | 1250 | >2500 | 1250 | >2500 |
4-Hydroxybenzoic acid | 4.88–2500 | 1250 | 2500 | 625 | 1250 | 2500 | >2500 | 1250 | >2500 |
3,4-Dihydroxybenzoic acid | 4.88–2500 | 1250 | 2500 | 312.5 | 312.5 | 1250 | 2500 | 1250 | 1250 |
Gallic acid | 4.88–2500 | 312.5 | 1250 | 9.6 | 9.6 | 1250 | 2500 | 2500 | 2500 |
Hippuric acid | 4.88–2500 | 2500 | 2500 | 1250 | 1250 | 1250 | >2500 | 2500 | >2500 |
Syringic acid | 1.46–750 | >750 | >750 | 750 | 750 | 375 | >750 | 750 | 1500 |
Vanillic acid | 2.92–1500 | 750 | >1500 | 325 | 650 | 1500 | >1500 | 1500 | 1500 |
Hydroxycinnamic acids | |||||||||
Chlorogenic acid | 4.88–2500 | >2500 | >2500 | 312.5 | 312.5 | 312.5 | >2500 | 525 | >2500 |
Coumaric acid | 2.92–1500 | 1500 | 1500 | 375 | 375 | 750 | >1500 | 750 | 1500 |
Ferulic acid | 1.46–750 | >750 | >750 | 375 | 750 | 750 | >750 | 375 | >750 |
Caffeic acid | 0.97–500 | >500 | >500 | 62.5 | 62.5 | 62.5 | >500 | 62.5 | 500 |
Hydroxyphenylacetic acid | |||||||||
Phenylacetic acid | 4.88–2500 | 1250 | 2500 | 625 | 1250 | 2500 | 2500 | 1250 | >2500 |
3-Dihydroxyphenylacetic acid | 4.88–2500 | 2500 | 2500 | 1250 | 1250 | 2500 | 2500 | 2500 | >2500 |
3,4-Dihydroxyphenylacetic acid | 4.88–2500 | 312.5 | 2500 | 4.88 | 4.88 | 2500 | 2500 | 2500 | 2500 |
3-Methoxy-4-hydroxyphenylacetic acid | 4.88–2500 | 2500 | 2500 | 1250 | 1250 | 2500 | 2500 | 2500 | >2500 |
Flavonols | |||||||||
Quercetin | 0.97–500 | 250 | >500 | 31.25 | 31.25 | 62.5 | >500 | 500 | >500 |
Quercetin 3-O-glucoside | 0.488–250 | >250 | >250 | 325 | 325 | 125 | >250 | 250 | >250 |
Quercetin 3-O-glucuronide | 0.488–250 | >250 | >250 | >250 | >250 | >250 | >250 | 250 | >250 |
Kaempferol 3-O-rutinoside | 0.24–125 | >125 | >125 | >125 | >125 | 125 | >125 | 125 | >125 |
Kaempferol 3-O-glucuronide | 0.488–250 | >250 | >250 | >250 | >250 | >250 | >250 | >250 | >250 |
Kaempferol 7-O-neohesperidoside | 0.24–125 | >125 | >125 | >125 | >125 | 125 | >125 | 125 | >125 |
Flavanols | |||||||||
Theaflavin extract | 0.488–250 | >250 | >250 | >250 | >250 | >250 | >250 | >250 | >250 |
Procyanidin B2 | 0.488–250 | >250 | >250 | >250 | >250 | >250 | >250 | >250 | >250 |
Catechin | 0.488–250 | >250 | >250 | 250 | 250 | 250 | >250 | >250 | >250 |
Epicatechin | 0.488–250 | >250 | >250 | >250 | >250 | >250 | >250 | >250 | >250 |
Epigallocatechin | 0.488–250 | 250 | >250 | 31.25 | 31.25 | 250 | >250 | 125 | >250 |
Epigallocatechin 3-O-gallate | 4.88–2500 | 312.5 | 625 | 39.06 | 39.06 | 156.25 | 156.25 | 312.5 | 312.5 |
Epicatechin 3-O-gallate | 0.488–250 | >250 | >250 | 250 | 250 | 125 | 250 | >250 | >250 |
Catechin 3-O-gallate | 0.24–125 | >250 | >250 | >250 | >250 | 125 | 125 | >250 | >250 |
Flavanones | |||||||||
Naringenin | 2.92–1500 | 162.5 | 325 | 162.5 | 162.5 | 46.87 | 375 | 162.5 | 325 |
Naringin | 2.92–1500 | >1500 | >1500 | >1500 | >1500 | 750 | 1500 | 1500 | >1500 |
Rutin hydrate | 0.97–500 | 500 | >500 | 250 | >500 | >500 | >500 | 500 | >500 |
Hesperitin | 0.97–500 | 125 | 125 | 62.5 | 62.5 | 15.62 | >500 | 125 | 125 |
Hesperidin | 0.97–500 | >500 | >500 | 31.25 | 31.25 | 500 | >500 | >500 | >500 |
Anthocyanins | |||||||||
Malvidin | 0.488–250 | >250 | >250 | 62.5 | 62.5 | 31.25 | 62.5 | 125 | >250 |
Malvin | 0.488–250 | >250 | >250 | >250 | >250 | >250 | >250 | >250 | >250 |
Malvidin 3-O-galactoside | 0.488–250 | >250 | >250 | 125 | 125 | 125 | >250 | >250 | >250 |
Pelargonidin | 0.97–500 | >500 | >500 | 62.5 | 62.5 | 62.5 | >500 | >500 | >500 |
Oenin | 0.488–250 | >250 | >250 | 125 | 125 | >250 | >250 | >250 | >250 |
Pelargonin | 0.488–250 | >250 | >250 | >250 | >250 | 125 | >250 | >250 | >250 |
Flavones | |||||||||
Apigenin | 0.488–250 | >250 | >250 | >250 | >250 | 15.62 | >250 | 125 | >250 |
Isoflavonoids | |||||||||
Daidzein | 0.488–250 | >250 | >250 | >250 | >250 | 500 | >250 | 500 | >250 |
Phenolics | |||||||||
Pyrocatechol | 4.88–2500 | 312.5 | 312.5 | 4.88 | 4.88 | 312.5 | 312.5 | 312.5 | 312.5 |
Resorcinol | 4.88–2500 | 2500 | 2500 | 1250 | 1250 | 1250 | 2500 | 2500 | 2500 |
Phloroglucinol | 2.92–1500 | 1500 | >1500 | 137.50 | 137.50 | 375 | 750 | 750 | 750 |
Pyrogallol | 4.88–2500 | 9.76 | 19.5 | 2.4 | 2.4 | 312.5 | 312.5 | 2500 | 2500 |
Curcumin | 0.390–200 | 62.5 | >200 | 15.62 | 15.62 | 7.81 | 15.62 | 31.25 | 62.5 |
The PMBC for the majority of PPs was either the same or 2×PMIC. Wide variations in the susceptibility (mean MIC ± SD) to PPs were observed among the test strains (Table 2 and Fig. 1). A. actinomycetemcomitans showed highest susceptibility (p < 0.05) to test PPs, with a mean PMIC of 341 ± 393 μg mL−1 compared with S. mitis (1027 ± 916 μg mL−1, p < 0.001), P. gingivalis (691 ± 811 μg mL−1, p < 0.05) and F. nucleatum (941 ± 895 μg mL−1, p < 0.001) (Table 2). The order of PPs susceptibility of the test strain was A. actinomycetemcomitans > P. gingivalis > F. nucleatum > S. mitis.
Parameter | Test strain | |||
---|---|---|---|---|
S. mitis | A. actinomycetemcomitans | P. gingivalis | F. nucleatum | |
a All MIC Values are given as Mean ± S.D. (μg mL−1). Significant difference between MIC of A. actinomycetemcomitans compared with other test strains. *p < 0.05, ***p < 0.001 (T test). | ||||
No of effective PPs | 23/48 | 35/48 | 40/48 | 35/48 |
Range | 9.76–2500 | 2.4–1250 | 7.81–2500 | 31.25–2500 |
MIC | 1027 ± 916*** | 341 ± 393 | 691 ± 811* | 941 ± 895*** |
Antimicrobial activity increased considerably (lower MICs) with increasing number of OH groups attached to the benzene ring (Table 3). The antibacterial activity was also dependent on the location of the OH group. This was reflected in the higher antibacterial potential (lower PMICs) of pyrogallol (1,2,3-trihydroxybenzene; PMIC 2.4 μg mL−1) and pyrocatechol (1,2-dihydroxybenzene; PMIC 4.8 μg mL−1), having the same structure as phloroglucinol (1,3,5-trihydroxybenzene; PMIC 137.5 μg mL−1) and resorcinol (1,3-dihydroxybenzene; PMIC 1250 μg mL−1) respectively, but different hydroxylation pattern and higher PMIC values. A similar trend was observed for other PPs (Table 3). The presence of pyrogallol (3,4,5-trihydroxybenzoyl) group in the chemical structure of PPs also increased the antibacterial activity. For example, flavan-3-ols containing a pyrogallol (1,2,3-trihydroxybenzene) moiety in their structure (epigallocatechin, epigallocatechin 3-O-gallate, epicatechin 3-O-gallate) had lower PMICs (31.2, 39.0, 250 μg mL−1 respectively) and higher antibacterial activity than epicatechin and procyanidin B2 containing catechol group (1,2-dihydroxybenzene) which possessed higher PMICs (>250 μg mL−1).
Basic structure of non-flavonoids | ||||
---|---|---|---|---|
PP Compound (chemical name) | Common name | Hydroxylation pattern | Substitutions R | MIC (μg mL−1) |
1,2-Dihydroxybenzene | Pyrocatechol | 1,2 | OH | 4.88 |
1,3-Dihydroxybenzene | Resorcinol | 1,3 | OH | 1250 |
1,2,3-Trihydroxybenzene | Pyrogallol | 1,2,3 | OH | 2.4 |
1,3,5-Trihydroxybenzene | Phloroglucinol | 1,3,5 | OH | 137.50 |
4-Hydroxybenzoic acid | 4 | COOH | 625 | |
3,4-Dihydroxybenzoic acid | Protocatechuic acid | 3,4 | COOH | 312.5 |
3,4,5-Trihydroxybenzoic acid | Gallic acid | 3,4,5 | COOH | 9.6 |
3-Hydroxyphenylacetic acid | 3 | CH3COOH | 1250 | |
3,4-Dihydroxyphenylacetic acid | Homoprotocatechuic acid | 3,4 | CH3COOH | 4.88 |
4-Hydroxycinnamic acid | Coumaric acid | 4 | CH–CH–COOH | 375 |
3,4-Dihydroxy-cinnamic acid | Caffeic acid | 3,4 | CH–CH–COOH | 62.5 |
Aglycones (PP with no sugar group attached) were stronger (lower MICs) at inhibiting the growth of A. actinomycetemcomitans than corresponding glycosides (PPs with attached glucose moiety). An example is quercetin, an aglycone, which had a much lower MIC (31.25 μg mL−1) than its glycoside, quercetin-3-O-glucoside (MIC = 325 μg mL−1). The same was true for other aglycones and corresponding glycosides (Table 4).
Basic structure of flavonoids | ||||
---|---|---|---|---|
PP compound (chemical name) | Common name | Hydroxylation pattern | Substitutions R | MIC (μg mL−1) |
Quercetin 3-O-glucoside | Isoquercetin | 5,7,3,4 | 3-O-Glucoside | 325 |
Quercetin-3-O-rutinoside | Rutin | 5,7,4′,5′ | 3-O-Rutinoside | 250 |
3,5,7,3′,4′-Penta-hydroxyXavone | Quercetin | 3,5,7,3′,4′ | Nil | 31.25 |
Naringenin 7-O-neohesperidoside | Naringin | 5,7,4′ | 7-Rhamnoglucoside | >1500 |
5,7,4′-Trihydroxyflavanone | Naringenin | 5,7,4′ | Nil | 162.5 |
Malvidin 3,5-O-diglucoside | Malvin | 7,4′ | 3,5-Diglucoside | >250 |
Malvidin 3-O-glucoside | Oenin | 5,7,4′ | 3-O-Glucoside | 125 |
Malvidin 3-O-galactoside | 5,7,4′ | 3-O-Galactocoside | 125 | |
3,5,7,4′-Tetrahydroxy-3′,5′-dimethoxyflavylium | Malvidin | 3,5,7,4′ | Nil | 62.5 |
Pelargonidin 3,5-O-diglucoside | Pelargonin | 7,4′ | 3,5-Diglucoside | >250 |
3,5,7,4′-Tetrahydroxyflavylium | Pelargonidin | 3,5,7,4′ | Nil | 62.5 |
Hesperetin 7-O-rutinoside | Hesperidin | 5,3′ | 7-O-Rutinoside | 62.5 |
5,7,3′-Trihydroxy-4′-methoxyflavanone | Hesperetin | 5,7,3′ | Nil | 31.25 |
The PMIC data was thoroughly reviewed and only a subset of the most effective PPs (those with PMIC values of <100 μg mL−1 against one or more of the test strains) were carried forward for subsequent assays. Selected PPs (n = 10) included curcumin, quercetin, EGC, EGCG, pyrogallol, gallic acid, 3,4-dihydroxyphenyl acetic acid, naringenin, hesperetin and pyrocatechol.
The potential for PPs to adsorb onto HA, a key constituent of tooth enamel was tested. After 1 h incubation, the amount of PP adsorbed ranged from 1–66.5 μg g−1 HA. Compared with the control, a significant adsorption was observed for curcumin (p < 0.001), EGC (p < 0.05), EGCG (p < 0.001), and pyrogallol (p < 0.01) (Fig. 2). Other PPs (gallic acid, 3,4-dihydroxyphenyl acetic acid, naringenin, quercetin, hesperetin and pyrocatechol) did not show any significant adsorption onto HA.
Adsorption of PP onto substrate (HA coated, 96-well plate) with the ten selected PPs (at PMIC) resulted in differential suppression of S. mitis biofilms (Fig. 3). Biofilm suppression ranged from 1 to 12% of the untreated control, with significant (p < 0.05) inhibitory activity shown by quercetin only (12%).
The ten selected PPs were also tested at their PMIC against maturation of S. mitis biofilms. Decreased viability (3–10%) in biofilms was observed following treatment with gallic acid (p < 0.01), curcumin (p < 0.001), hesperetin (p < 0.001), and pyrocatechol (p < 0.001) compared with untreated controls (Fig. 4). Other PPs (3,4-dihydroxyphenylacetic acid, quercetin, EGC, EGCG and pyrogallol) showed no significant effect on biofilm maturation.
A summary of the levels at which the ten selected PPs were effective in relation to adsorption to substrate and inhibition of biofilm formation or maturation is given in Table 5. It is interesting to note that none of the ten PPs were significantly involved in all three steps (adsorption, inhibition of formation or maturation).
PP | Adsorption | Biofilm formation | Biofilm maturation |
---|---|---|---|
a 3,4-diOH PAA = 3,4-dihydroxyphenylacetic acid, EGC = epigallocatechin, EGCG = epigallocatechin 3-O-gallate. | |||
Gallic acid | ✓ | ||
3,4-DiOH PAA | |||
Quercetin | |||
Curcumin | ✓ | ✓ | |
Hesperitin | ✓ | ||
Naringenin | |||
EGC | ✓ | ✓ | |
EGCG | ✓ | ||
Pyrogallol | ✓ | ||
Pyrocatechol | ✓ |
An important consideration for cell-based assays involving PPs is their solubility. Many PPs are water insoluble and solvents such as dimethyl sulfoxide (DMSO), methanol or ethanol are often used. However, the antibacterial activity of these solvents can often interfere with the interpretation of the data.42 Keeping these limitations in mind, we first confirmed that DMSO in the concentration of 2.5% (v/v) was the most suitable solvent, having no discernible effect on the growth of the test strain (data not shown). Previously reported PMICs of PPs against P. gingivalis were noticeably different from our data (Table 1), i.e. gallic acid (MIC = 1 mg mL−1), quercetin (250 mg mL−1), naringin (250 mg mL−1), EGCG (500 μg mL−1) and EGC (1000 μg mL−1).21,23,26–28 This is, most probably, due to variations in the methods used for susceptibility testing, some authors have used the agar dilution method, different test strains, and sources of PP (commercial or natural).
A species-dependent susceptibility of periodontal pathogens to PPs was observed, where the PMIC for Gram negative test strains (A. actinomycetemcomitans, P. gingivalis & F. nucleatum) was lower than for the Gram positive test strain S. mitis (Table 2). Similar results have been obtained by Bakri and Douglas43 where Gram negative oral bacteria (A. actinomycetemcomitans, P. gingivalis & F. nucleatum) were more susceptible to the action of allicin (present in garlic extract) than streptococci. This differential activity of PPs was further reflected in the time kill curves performed on Gram positive S. mutans and Gram negative P. gingivalis.43 Among Gram-negative bacterial strains tested in our study, F. nucleatum was the least susceptible to the action of PPs and in some cases the PMIC value was approaching that for the Gram-positive strain (S. mitis). Interestingly, in addition to an outer membrane, F. nucleatum has a large periplasmic space surrounded by peptidoglycan layers, in-between the outer and inner cytoplasmic membranes.44 Therefore, it is reasonable to speculate that decreased sensitivity of the bacterium could be partly due to its membrane structure, which could hamper access of PPs to the target enzymes in cytoplasmic and perioplasmic space. Similarly, the diminished sensitivity of S. mitis may be explained by the presence of a thick peptidoglycan layer in the cell wall of Gram-positive bacteria.45 The difference between PMIC and PMBC values reflect that the PPs tested in this study were bactericidal in their activity against the test strains. These result were in agreement with a recently published study.46
Our study also reported for the first time the relationship between the chemical structure of PPs and antibacterial activity against A. actinomycetemcomitans, the most susceptible of the test strains. We have shown that increased hydroxylation of the benzene ring in phenolic acids and benzene alcohols is associated with increases antibacterial activity. The opposite association was reported previously for E. coli.29 This difference could be due to the use of different antimicrobial susceptibility assay, in addition to test strains (E. coli) and growth conditions. We showed that PPs containing a 3,4,5-trihydroxyphenyl (pyrogallol) group in their chemical structure were more potent inhibitors (possessing lower PMICs) of the growth of A. actinomycetemcomitans than PPs containing 1,2 dihydroxyphenyl (pyrocatechol) groups. These findings are in agreement with Taguri et al.47,48 who report an increased antibacterial potential of PPs containing a pyrogallol moiety against a number of food-borne pathogenic bacteria (n = 96) including both Gram positive and Gram negative strains. We also observed a stronger antibacterial activity of aglycones than their corresponding PP glycosides. PPs present in foods are mainly found in the glycosylated form however, reports indicate that PP glycosides can be hydrolysed into aglycones by salivary enzymes and the oral microflora.49,50 This further raises the possibility of increased antimicrobial activity of PPs in the oral cavity following dietary consumption that can also contribute to the prevention of oral infectious diseases including periodontitis.
The primary aetiological factor in PD is biofilm formation and its dynamic complexity. Theoretically, inhibition of the early steps in this process can result in the prevention of periodontal diseases, as has been the focus in developing vaccines against the pioneer species.51 An important property of PPs is their ability to adhere to oral hard and soft tissues, microbes and salivary proteins.52,53 Our study has confirmed that PPs, especially curcumin, possess high adsorptive affinity for HA that can be employed in increasing the local (oral) availability of PPs. This can further help in preventing and inhibiting biofilm formation on tooth surface, either through physical inhibition54 or high antimicrobial properties observed in this study and elsewhere.55 Both curcumin and quercetin can also affect the metabolic activity and architecture of mature, multi-species, pathogenic biofilm. The activity of both curcumin and quercetin appeared to be selective based on imaging of the biofilms; depleting only specific pathogens in mature biofilms, leaving a biofilm composed mainly S. mitis. This finding is interesting because S. mitis is a part of the normal oral flora, and biofilms containing only streptococci are inert and pose no threat per se to oral health. Also, swelling and rupture of P. gingivalis cells following treatment with quercetin may be a mechanism for the observed killing activity by quercetin.
Along with key strengths (the large screening, use of published guidelines, use of planktonic and biofilm assays, and single and multispecies models), this study presents some limitations. Adsorption of PPs onto HA-coated 96-well plates or commercial HA discs might be different than adsorption onto HA powder; due to differences in the available surface area and details (HA discs are more polished). Quantification of PPs adsorption onto HA discs using an ellipsometer would be helpful in this regards, and further studies combining HA with simulated salivary pellicle as a more complex surface are warranted. In addition, the antimicrobial susceptibilities and relationship between PPs structure and antimicrobial activity need to be further evaluated by using other species and clinical strains. Multispecies biofilm models have been extensively used in our group;38 their construction however can differ, and ours is completely different (both in term of the number of bacterial species and the sequence of addition of bacterial strains to produce a biofilm) from other recent work56 reporting death of S. mitis in biofilm following addition of P. gingivalis.
Collectively our observations provide evidence that the PPs tested in this study may be important in preventing oral microbial diseases and maintaining oral health. Potential routes for exploitation of PPs beneficial activities (antibacterial potential) include dietary intervention and pharmaceutical preparations. For the most active PPs, the PMICs were less than 100 μg mL−1 which can be achieved through diet as they are present in commonly consumed foods. For example, tea (green, black, oolong), turmeric and onions are rich sources of curcumin, EGCG and quercetin.57 It is estimated that one cup of tea (240 mL) contain 240 mg of EGCG.58 Moreover, the estimated daily intake of turmeric in Nepal and India is approximately 1500–2500 mg per day corresponding to 50–100 mg of curcumin.59 In the Dutch population, the estimated flavonoid intake, of which 70% is quercetin, is about 34 mg per day.60 Oral availability of PP can be potentiated by their ability to adsorb onto the tooth surface.
Where adequate intake cannot be achieved by diet alone, there are opportunities to use PPs for pharmaceutical development of oral healthcare products. Indeed, PPs containing toothpaste and dental gel are available in the market (AO ProToothpaste, AO ProVantage dental gel and Antioxidant Oral Care System marketed by PERIOSCIENCES©) containing natural (poly)phenols (phloretin & ferrulic acid) with no clinical data so far supporting a PP-specific effect on oral health. A key consideration for oral healthcare is the potential for tooth staining, which was demonstrated for tea polyphenolic extracts.33,61 Preparation of synthetic analogues with superior or optimal therapeutic properties without staining risk may be more suitable.62 We have demonstrated the antibacterial potential of PPS in vitro, further cellular and in vivo studies are required for successful use of PPs in the prevention and treatment of periodontal diseases.
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