Starvation survival,growth and recovery of Enterococcus faecalis in human serum

The ability of Enterococcus faecalis to survive starvation for long periods in the obturated root canal is likely to be an important factor in the pathogenesis and maintenance of a persistent infection after endodontic treatment. The response of E. faecalis to starvation survival in water and glucose-, phosphate- or amino acid-limited chemically defined medium was studied, along with the capacity for growth and recovery of starved cells of E. faecalis in pooled human serum. After an initial rapid fall in cell numbers, a small remaining population of E. faecalis was able to survive in water for over 4 months and in nutrient-limited media for extended periods. A high cell density at the onset of starvation was critical for the ability of E. faecalis to endure prolonged nutrient limitation. Upon starvation, a static population of starved cells developed and were apparently in a minimal metabolic state, since blocking cell wall synthesis with penicillin G or inhibiting DNA synthesis with norfloxacin during starvation resulted in limited change in the rate of loss of viable cells. In 50% serum, E. faecalis grew, then stabilized at a relatively constant population of 106 colony-forming units/ml for 4 months, irrespective of the initial cell density. In summary, E. faecalis is capable of withstanding prolonged periods of starvation in a minimal metabolic state provided that there is a high cell density at the onset of starvation. Starved cells were capable of recovery upon addition of human serum.     

饥饿状态的粪肠球菌的研究进展

作为顽固性或继发性根管内感染的主要致病菌,粪肠球菌可以饥饿状态在恶劣的环境中长期生存。在饥饿状态下,粪肠球菌可保持较低的代谢水平并形成生物膜,从而提高其对外界刺激的耐受水平。本文就饥饿状态与活的不可培养状态,饥饿状态下的粪肠球菌的生长状况,饥饿状态下的粪肠球菌的生物膜形成能力,饥饿状态下的粪肠球菌对外界刺激的耐受水平等研究进展作一综述。     

根管治疗后疾病与粪肠球菌

根管治疗后疾病中最常发现的细菌是粪肠球菌,有效清除粪肠球菌与提高根管治疗治疗术成功率存在着联系。本文就这方面的研究现状进行综述。     

根管内粪肠球菌感染的研究进展

粪肠球菌（E.faecalis）在治疗失败根管内的检出率较高,是根管持续感染和再感染的重要微生物之一。粪肠球菌在治疗前后根管内的感染特点不同,并且对抗菌药物有较强耐药性。目前的根管清理和消毒方法难以将定植于根管中的粪肠球菌彻底清除。本文就有关根管内粪肠球菌的感染特点及其对抗菌剂的敏感性研究进展作一综述。     

粪肠球菌及其在牙本质小管内的检测和鉴定

粪肠球菌的抗饥饿能力较强,可在非常苛刻的环境下生存。在根管内的不同部位,粪肠球菌的定植密度不同。粪肠球菌具有的多种毒力因子,可在肠球菌菌种之间转移扩散,耐受宿主的非特异性免疫应答,增强其致病性和生存能力。本文就粪肠球菌的特点,牙本质小管内粪肠球菌的检测与鉴定等研究进展作一综述。     

持续性根尖周炎优势菌粪肠球菌生物膜形成能力的体外研究

目的：比较持续性根尖周炎优势细菌粪肠球菌( Enterococcus faecalis,E． faecalis)标准菌株与临床菌株生物膜体外形成能力。方法 E． faecalis 标准菌株 ATCC 29212及持续性根尖周炎分离的 E． faecalis 临床株lcl1709,体外形成生物膜,采用激光扫描共聚焦荧光显微镜(LSCM)观察并对比在12、24、36、48h时2种生物膜形成面积;使用96微孔板结晶紫染色法检测并比较在12、24、36、48h时两者生物膜形成量。结果 ATCC 29212菌株培养12、24、36、48h在离体牙根尖表面生物膜形成面积(μm2)分别为47．577±45．221,206．935±122．596,558．782±330．877,1865．023±702．539;lcl1709的为62．227±33．040,461．578±285．281,1211．077±515．262,2632．515±1332．914。36h与48h lcl1709形成的生物膜面积显著高于ATCC 29212(P<0．05)。12、24、36、48h的生物膜OD590值ATCC 29212菌株分别为0．048±0．001,0．130±0．025,0．148±0．022,0．137±0．021;lcl1709菌株分别为0．096±0．029,0．162±0．015,0．201±0．042,0．235±0．078。 lcl1709生物膜OD590值显著高于ATCC 29212(P<0．05),随时间延长,各组OD590值显著增大( P<0．05)。结论 E． faecalis可形成生物膜,持续性根尖周炎分离的E． faecalis菌株生物膜形成能力强于标准菌株,可能与其致病性密切相关。     

Dentinal tubule invasion and adherence by Enterococcus faecalis

Aim To investigate dentinal tubule invasion and the predilection of Enterococcus faecalis for dentinal tubule walls. Methodology The invasion of dentinal tubules in extracted human teeth by E. faecalis was measured ex vivo after 8 weeks of incubation. The canal walls of 16 root sections were either intact or instrumented with or without smear layer present. Extent and maximum depth of tubule invasion were assessed histologically and compared between groups. In the adherence study, 44 vertically split root samples were prepared to expose longitudinally aligned dentinal tubules and fractured orthodentine (OD). Surfaces were exposed to E. faecalis (erythromycin resistant strain, JH2‐2 carrying plasmid pGh9:ISS1) and incubated aerobically for 2 h. Samples were processed for analysis using scanning electron microscopy. Bacterial adhesion to tubule walls versus fractured OD was calculated as number of cells per 100 μm². Results The strain of E. faecalis used in this study showed moderate to heavy tubule invasion after 8 weeks. In the adhesion studies, significantly more bacteria adhered to fractured OD than to dentinal tubule walls (anova , P < 0.001). With respect to the tubule wall, adherence was greater in inner versus outer dentine (P = 0.02) and greater when bacterial adhesion was tested in chemically defined medium than in phosphate‐buffered saline (anova , P < 0.001). Conclusions Although E. faecalis readily invaded tubules, it did not adhere preferentially to tubule walls. Initial colonization of dentinal tubules by E. faecalis may depend primarily on other factors.     

Bacteriophages induced from lysogenic root canal isolates of Enterococcus faecalis

Introduction:  Bacterial viruses play crucial roles in the pathogenesis of many systemic diseases. They are known to inhabit the oral cavity, both as free virions and as prophages in lysogenic bacterial strains; however, there has been no report of bacteriophages in endodontic infections. In this study, we sought to detect, isolate, and describe temperate bacteriophages harbored by Enterococcus faecalis strains isolated from endodontic infections.
Methods:  Ten E. faecalis strains were isolated from root canals of teeth undergoing retreatment following unsuccessful endodontic therapy. Mitomycin C was used to induce any prophages present in the bacterial isolates. The induced phages were purified and examined using electron microscopy. The DNA extracted from one of the phage isolates was subjected to restriction endonuclease digestion and agarose electrophoresis analysis.
Results:  Lysogeny was demonstrated in 4 of the 10 E. faecalis strains. Three of the lysogenic strains yielded phages exhibiting a Siphoviridae morphology, with long, non-contractile tails 130 nm in length, and spherical/icosahedral heads 41 nm in diameter. The virus induced from the fourth lysogenic E. faecalis strain had a contractile tail characteristic of Myoviridae. Restriction endonuclease analysis of Nsi I and Nde I DNA fragments from one of the Siphoviridae phage isolates (phage φEf11) indicated a genome size of approximately 41 kbp.
Conclusion:  This is the first report of lysogenic bacteria and their inducible viruses in infected root canals.     

Resistance to acidic and alkaline environments in the endodontic pathogen Enterococcus faecalis

BACKGROUND/AIMS: This study aimed to investigate the biochemical mechanisms employed by the endodontic pathogen Enterococcus faecalis to confer acid- and alkali-resistance and to compare these with the mechanisms of representative oral streptococci. METHODS: E. faecalis JCM8728, Streptococcus mutans NCTC10449 and Streptococcus sanguinis ATCC10556 were used to assess both acid- and alkali-resistance by examining: (i) growth in complex media; (ii) stability of intracellular pH (pH(in)); (iii) cell durability to leakage of preloaded BCECF (2',7'-bis-(2-carboxyethyl)-5,6-carboxy-fluorescein); and (iv) cell permeability to SYTOX-Green. RESULTS: Growth was initiated by E. faecalis at pH 4.0-11.0, by S. mutans at pH 4.0-9.0 and by S. sanguinis at pH 5.0-9.0. The pH(in) was similar to the extracellular pH in S. mutans and S. sanguinis at pH 5-10, while the pH(in) of E. faecalis was maintained at approximately 7.5-8.5 when extracellular pH was 7.5-10 and was maintained at levels equivalent to the extracellular pH when pH < 7.5. Cell membranes of E. faecalis were resistant to BCECF leakage when extracellular pH was 2.5-12 and to SYTOX-Green permeability at pH 4-10. The cell membrane durability to extracellular pH in E. faecalis was higher than that observed in the Streptococcus strains. CONCLUSION: Compared to S. mutans, E. faecalis was found to be equally resistant to acid and more resistant to alkalis. The results suggest that pH-resistance in E. faecalis is attributed to membrane durability against acid and alkali, in addition to cell membrane-bound proton-transport systems. These characteristics may account for why E. faecalis is frequently isolated from acidic caries lesions and from persistently infected root canals where calcium hydroxide medication is ineffective.     

再感染根管内粪肠球菌生物膜的研究进展

粪肠球菌是顽固性和继发性根管感染中最易分离到的细菌,其主要致病机制之一是形成生物膜.笔者下面就再感染根管内粪肠球菌的分离与鉴定、影响粪肠球菌生物膜形成的相关因素等作一综述.     

碱性pH对浮游状态和生物膜状态粪肠球菌活性的影响

目的:比较生物膜状态与浮游状态下粪肠球菌对碱的耐受性。方法:制备浮游状态和生物膜状态的粪肠球菌细胞,用pH值分别为7、8、9、10、11和12的培养液作用2h,利用MTT比色法比较2种状态下细菌细胞活性变化。采用SAS6.12软件包对数据进行统计学分析。结果:低碱性环境(pH值7～9)对粪肠球菌的生长无明显影响,高碱性环境(pH值>10)下存活细菌的比例明显减少;高pH环境下,生物膜状态的粪肠球菌存活细菌比例显著高于浮游状态下细菌的存活比例。结论:粪肠球菌对碱性环境具有强耐受性,形成生物膜是粪肠球菌抵抗高碱性环境的一个重要原因。     

An in vitro evaluation of the ability of ozone to kill a strain of Enterococcus faecalis

AIM: To evaluate the potential of ozone as an antibacterial agent using Enterococcus faecalis as the test species. METHODOLOGY: Ozone was produced by a custom-made bench top generator and its solubility in water determined by ultraviolet (258 nm) spectrophotometric analysis of solutions through which ozone was sparged for various time-periods. The antibacterial efficacy of ozone was tested against both broth and biofilm cultures. Ozone was sparged for 30, 60, 120 and 240 s, through overnight broth cultures of a strain of E. faecalis (E78.2) and compared with those that were centrifuged, washed and resuspended in water. Enterococcus faecalis (E78.2) biofilms were grown on cellulose nitrate membrane filters for 48 h and suspended in water through which ozone gas was sparged with stirring for 60, 120 and 240 s in a standard fashion. In a separate test, biofilms were also exposed to gaseous ozone. Sodium hypochlorite (NaOCl) was used as a positive control. All experiments were repeated four times. RESULTS: There were significant (P < 0.05) reductions of bacteria in the unwashed (2 log(10) reductions) and washed (5 log(10) reductions) broth cultures following 240 s applications. Biofilms incubated for 240 s with ozonated water showed no significant reduction in cell viability attributable to ozone alone, whereas with NaOCl no viable cells were detected over the same time. Gaseous ozone applied for 300 s had no effect on these biofilms. CONCLUSIONS: Ozone had an antibacterial effect on planktonic E. faecalis cells and those suspended in fluid, but little effect when embedded in biofilms. Its antibacterial efficacy was not comparable with that of NaOCl under the test conditions used.     

In vitro treatment of Enterococcus faecalis with calcium hydroxide impairs phagocytosis by human macrophages

Objective: Monocyte-derived macrophages (MDMs) ability to phagocytize and produce nitric oxide (NO) was tested against root-canal strains of Enterococcus faecalis submitted to alkaline stress. Root-canal strains were also compared with urine Enterococci.

Materials and Methods: Enterococcus faecalis were stressed with alkaline-BHI broth and incubated in vitro at a cell/bacteria ratio of 1:5. Phagocytosis was analyzed by fluorescence microscopy using acridine orange stain, and NO concentration was measured in supernatants.

Results and Conclusions: Alkaline-stress significantly impaired MDMs phagocytosis of E. faecalis strains analyzed, except in ATCC4083 isolated from a pulpless tooth, but NO production was unchanged. Comparison of different strains showed the urine isolate had higher NO levels than root canal strains. Alterations in the bacterial cell wall structures after alkaline-stress possibly made bacteria less recognizable and phagocytized by MDMs but did not affect their ability to activate NO production. Furthermore, root canal strains elicited different responses by immune cells compared with strains from urine. Clinically, impaired phagocytosis of E. faecalis could contribute to their persistence in root canal systems previously treated with calcium hydroxide.     

持续性根尖周炎中粪肠球菌临床株的分离与鉴定

目的 优化持续性根尖周炎优势菌粪肠球菌临床株的分离、培养、鉴定方法,分离获得粪肠球菌临床菌株.方法 选择30例持续性根尖周炎患者,严格无菌行根尖手术,从切除的根尖及根尖周病变组织中分离培养粪肠球菌临床株,通过形态学观察、生化鉴定及16SrRNA基因扩增测序分析特异性片段扩增方法进行鉴定,获得粪肠球菌菌株.结果 临床样本中培养出乳白色、边缘光滑、隆起的菌落、革兰氏染色阳性的球菌17例,生化检测该菌株耐低温、高温、盐、碱特性及糖代谢特点符合粪肠球菌生化特点,16SrRNA基因扩增测序,经过与NCBI数据库比对,与粪肠球菌致病菌16SrRNA基因序列相似度近99％菌株15例,特异性引物扩增可得到目标条带菌株15例.结论 从30例持续性根尖周炎中分离获得粪肠球菌临床株15株.     

Antibacterial efficacy of casein-derived peptides against Enterococcus faecalis

Background : The aim of this study was to test a casein peptide in its glycosylated form (kappa‐casein glycopeptide, KCGP) and its non‐glycosylated form (kappa‐casein peptide, KCP) for antibacterial efficacy against Enterococcus faecalis in planktonic and biofilm cultures. Methods : E. faecalis strain JKD 15036 was exposed to different concentrations of KCGP and KCP in a 96‐well culture plate. The effect of the peptides on the growth of E. faecalis in planktonic culture was monitored by measuring optical density over 7 hours. Biofilm formation was measured after 24 hours using a crystal violet assay. All experiments were performed in triplicate. Results : KCGP and KCP inhibited growth of E. faecalis in planktonic culture with no significant difference in activity between the peptides. KCGP at 0.16% w/v was significantly better at inhibiting E. faecalis biofilm formation than KCP at the same concentration and significantly better than NaOCl at 1.0% w/v. Conclusions : KCGP effectively inhibited E. faecalis biofilm formation and may have potential to augment the efficacy of traditional antiseptic agents.