Guanidine derivative inhibits C. albicans biofilm growth on denture liner without promote loss of materials' resistance

Guanidine-Containing Antifungal Agents against Human-Relevant Fungal Pathogens (2004-2022)-A Review

The guanidine moiety is typically a highly basic group, and can be found in a wide variety of drugs, such as zanamivir (Relenza) and metformin (Fortamet), as well as in biologically active compounds for numerous disease areas, including central nervous system (CNS) diseases and chemotherapeutics. This review will focus on antifungal agents which contain at least one guanidine group, for the treatment of human-related fungal pathogens, described in the literature between 2004 and 2022. These compounds include small molecules, steroids, polymers, metal complexes, sesquiterpenes, natural products, and polypeptides. It shall be made clear that a diverse range of guanidine-containing derivatives have been published in the literature and have antifungal activity, including efficacy in in vivo experiments.

A combination therapy strategy for treating antibiotic resistant biofilm infection using a guanidinium derivative and nanoparticulate Ag(0) derived hybrid gel conjugate

Bacteria organized in biofilms show significant tolerance to conventional antibiotics compared to their planktonic counterparts and form the basis for chronic infections. Biofilms are composites of different types of extracellular polymeric substances that help in resisting several host-defense measures, including phagocytosis. These are increasingly being recognized as a passive virulence factor that enables many infectious diseases to proliferate and an essential contributing facet to anti-microbial resistance. Thus, inhibition and dispersion of biofilms are linked to addressing the issues associated with therapeutic challenges imposed by biofilms. This report is to address this complex issue using a self-assembled guanidinium-Ag(0) nanoparticle (AD-L@Ag(0)) hybrid gel composite for executing a combination therapy strategy for six difficult to treat biofilm-forming and multidrug-resistant bacteria. Improved efficacy was achieved primarily through effective biofilm inhibition and dispersion by the cationic guanidinium ion derivative, while Ag(0) contributes to the subsequent bactericidal activity on planktonic bacteria. Minimum Inhibitory Concentration (MIC) of the AD-L@Ag(0) formulation was tested against Acinetobacter baumannii (25 μg mL-1), Pseudomonas aeruginosa (0.78 μg mL-1), Staphylococcus aureus (0.19 μg mL-1), Klebsiella pneumoniae (0.78 μg mL-1), Escherichia coli (clinical isolate (6.25 μg mL-1)), Klebsiella pneumoniae (clinical isolate (50 μg mL-1)), Shigella flexneri (clinical isolate (0.39 μg mL-1)) and Streptococcus pneumoniae (6.25 μg mL-1). Minimum bactericidal concentration, and MBIC50 and MBIC90 (Minimum Biofilm Inhibitory Concentration at 50% and 90% reduction, respectively) were evaluated for these pathogens. All these results confirmed the efficacy of the formulation AD-L@Ag(0). Minimum Biofilm Eradication Concentration (MBEC) for the respective pathogens was examined by following the exopolysaccharide quantification method to establish its potency in inhibition of biofilm formation, as well as eradication of mature biofilms. These effects were attributed to the bactericidal effect of AD-L@Ag(0) on biofilm mass-associated bacteria. The observed efficacy of this non-cytotoxic therapeutic combination (AD-L@Ag(0)) was found to be better than that reported in the existing literature for treating extremely drug-resistant bacterial strains, as well as for reducing the bacterial infection load at a surgical site in a small animal BALB/c model. Thus, AD-L@Ag(0) could be a promising candidate for anti-microbial coatings on surgical instruments, wound dressing, tissue engineering, and medical implants.

Antifungal Polymeric Materials and Nanocomposites

Rising global populations due to medicinal advancements increases the patient population susceptible to superficial and severe fungal infections. Fungi often implicated in these diseases includes the dermatophytes (Microsporum spp., Epidermophtyon spp., Trichophyton spp.) as well as species of the Candida spp., Aspergillosis spp. and Cryptococcus spp. genera. In addition, increasing global populations leads to increasing agricultural demands. Thus, fungal infections of preharvested crops and stored food by plant pathogens such as Magnaporthe oryzae and Fusarium oxysporum can have detrimental socioeconomic effects due to food insecurity. Current antifungal strategies are based mainly on small molecule antifungal drugs. However, these drugs are limited by poor solubility and bioavailability. Furthermore, antifungal resistance against these drugs are on the rise. Thus, antimicrobial polymers offer an alternative antifungal strategy. Antifungal polymers are characterised by cationic and hydrophobic regions where the cationic regions have been shown to interact with microbial phospholipids and membranes. These polymers can be synthetic or natural and demonstrate distinct antifungal mechanisms ranging from fungal cell membrane permeabilisation, cell membrane depolarisation or cell entry. Although the relative importance of such mechanisms is difficult to decipher. Due to the chemical properties of these polymers, they can be combined with other antimicrobial compounds including existing antifungal drugs, charcoals, lipids and metal ions to elicit synergistic effects. In some cases, antifungal polymers and nanocomposites show better antifungal effects or reduced toxicity compared to the widely used small molecule antifungal drugs. This review provides an overview of antimicrobial polymers and nanocomposites with antifungal activity and the current understanding of their antifungal mechanisms.

Physicochemical and biological properties of experimental dental adhesives doped with a guanidine-based polymer: an in vitro study

OBJECTIVES

The objective of this study is to formulate experimental dental adhesives with different polyhexamethylene guanidine hydrochloride concentrations (PHMGH) and evaluate their physical, chemical, and biological properties.

MATERIALS AND METHODS

The experimental adhesives were formulated with 0 (control, G_CTRL), 0.5 (G_0.5%), 1 (G_1%), or 2 (G_2%) wt.% into the adhesive. The adhesives were analyzed for degree of conversion (DC%), softening in solvent (ΔKHN%), ultimate tensile strength (UTS), microtensile bond strength (μTBS) immediately and after 1 year of aging, antibacterial activity, and cytotoxicity.

RESULTS

There were no differences among groups for DC%, ΔKHN%, and UTS (p > 0.05%). There were no differences between each PHMGH-doped adhesive compared to G_CTRL in the immediate μ-TBS (p > 0.05). Adhesives with at least 1 wt.% of PHMGH presented better stability of μ-TBS. PHMGH-doped adhesives showed improved longitudinal μ-TBS compared to G_CTRL (p < 0.05). Lower Streptococcus mutans biofilm formation was observed for PHMGH-doped adhesives (p < 0.05). There was lower viability of planktonic S. mutans in the media in contact with the samples when at least 1 wt.% of PHGMGH was incorporated (p < 0.05). The formulated adhesives showed no cytotoxicity against pulp cells (p > 0.05).

CONCLUSIONS

The adhesive with 2 wt.% of PHMGH showed the highest antibacterial activity, without affecting the physicochemical properties and cytotoxicity, besides conferring stability for the dental adhesion.

CLINICAL RELEVANCE

PHMGH, a positively charged polymer, conveyed antibacterial activity to dental adhesives. Furthermore, it did not negatively affect the essential physicochemical and biocompatibility properties of the adhesives. More importantly, the incorporation of PHMGH provided stability for the μ-TBS compared to the control group without this additive.

3D cone-beam C.T. imaging used to determine the effect of disinfection protocols on the dimensional stability of full arch impressions

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Cone-beam computed tomography assessed the dimensional stability of impressions.

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The two common impression materials: alginate or polyvinylsiloxane were evaluated.

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Five commercial disinfectant agents were tested on materials’ stability.

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All disinfectant agents did not affect materials’ stability.

Aim

This study aimed to investigate the dimensional stability of irreversible hydrocolloid and polyvinylsiloxane (P.V.S.) impressions after exposure to four commercial disinfectants using cone-beam computed tomography (CBCT).

Materials and Methods

Two different impression materials were tested: irreversible hydrocolloid and P.V.S. Four disinfection solutions were applied: BirexSE, Opti-Cide3, COEfect MinuteSpray, and CaviCide Spray. Distilled water was used as a control group. Each solution remained in contact with the impression for 5 min. Additional contact time of 5 min compromises time for scanning. The materials were evaluated for dimensional stability after the impression of a maxillary complete edentulous template via CBCT before and after being in contact with the disinfectant agents. Measurements were assessed on the digital models from A-B, B-C, and C-A points. Paired analyses (Wilcoxon Signed Rank test or paired Student's t-test) were used to analyze each measurement before and after the contact with the disinfectant agents. The variance for each measurement was also analyzed via a one-way analysis of variance or Kruskal-Wallis.

Results

Overall, there were no statistical differences among the points measurements in the irreversible hydrocolloid or P.V.S. between initial and final assessments (p > 0.05). The used disinfectant agents in this study did not influence each measurement's variation on irreversible hydrocolloid or P.V.S. (p > 0.05). All agents showed an effect on the dimensional stability of both impression materials. The differences in the three dimensions ranged between 0.34 and 1.54%.

Conclusion

Within 10 min of removing the impression from the master cast, is study's findings indicated that the four commercially available disinfectants did not influence the dimensional stability of irreversible hydrocolloid or P.V.S. Further studies should be performed to elucidate the antimicrobial effect of these solutions applied as a spray on the surface of irreversible hydrocolloid and P.V.S. impressions.

Does microwave disinfection affect the dimensional stability of denture base acrylic resins? A systematic review

OBJECTIVE

To systematically evaluate the effect of microwave disinfection on the dimensional stability of denture base acrylic resins.

BACKGROUND

Microwave disinfection has been considered as an alternative method for disinfecting complete dentures to help prevent and treat denture stomatitis. However, data on the impact of microwave disinfection on the dimensional stability of acrylic resins are still scarce.

METHODS

The PubMed/Medline, SCOPUS and EMBASE databases were searched in order to assess articles published in English up to January 2021 (CRD42021212267). We included studies that have assessed the effect of microwave disinfection, on the dimensional stability of acrylic resins, comparing them with negative or positive controls.

RESULTS

A total of seven in vitro studies were included. The qualitative synthesis demonstrated that, in general, microwave disinfection produced more distortion on the materials than do immersion in sodium hypochlorite, chloride solution, chlorhexidine, and water immersion. However, considering the dimensional stability of the specimens, microwave disinfection at 500 W for 3 minutes, and at 450 W for 5 minutes, produced similar or better outcomes than did control groups.

CONCLUSION

In general, microwave disinfection promotes changes in the dimensional stability of denture base acrylic resins, and should thus be used with caution. However, microwave disinfection protocols at lower power settings (500 and 450 W) and exposure times (3 and 5 minutes) produces similar or less distortion than chemical disinfection. More studies are still required in order to evaluate the clinical and long-term implications of microwave disinfection.

Biomaterials for the Prevention of Oral Candidiasis Development

Thousands of microorganisms coexist within the human microbiota. However, certain conditions can predispose the organism to the overgrowth of specific pathogens that further lead to opportunistic infections. One of the most common such imbalances in the normal oral flora is the excessive growth of Candida spp., which produces oral candidiasis. In immunocompromised individuals, this fungal infection can reach the systemic level and become life-threatening. Hence, prompt and efficient treatment must be administered. Traditional antifungal agents, such as polyenes, azoles, and echinocandins, may often result in severe adverse effects, regardless of the administration form. Therefore, novel treatments have to be developed and implemented in clinical practice. In this regard, the present paper focuses on the newest therapeutic options against oral Candida infections, reviewing compounds and biomaterials with inherent antifungal properties, improved materials for dental prostheses and denture adhesives, drug delivery systems, and combined approaches towards developing the optimum treatment.

Antibiofilm and Protein-Repellent Polymethylmethacrylate Denture Base Acrylic Resin for Treatment of Denture Stomatitis

Candida albicans (C. albicans) biofilm is a common etiological factor in denture stomatitis. The purpose of this study was to investigate the effects of incorporating 2-methacryloyloxyethyl phosphorylcholine (MPC) as a protein repellent into a new high-impact denture acrylic (HIPA) resin on the surface roughness, solution pH, and C. albicans biofilm adhesion to the denture base. The new acrylic denture resin base was formulated by mixing MPC into HIPA resin at mass fractions of 1.5%, 3%, and 4.5%. Surface roughness was measured using a Mitutoyo surface roughness tester. C. albicans biofilm growth and viability were assessed via colony forming unit counts. The pH of the biofilm growth medium was measured using a digital pH meter. Adding MPC to the HIPA resin at percentages of 1.5% and 3% increased the roughness values significantly (p < 0.05), while adding 4.5% MPC resulted in no difference in roughness values to that of the control group (p > 0.05). All experimental groups demonstrated neutral pH values (pH ≅ 7) and were not significantly different from each other (p > 0.05). Incorporating 2-methacryloyloxyethyl phosphorylcholine at 4.5% resulted in a significant (≅1 log) colony-forming unit reduction compared with the control group with 0% MPC (p < 0.05). A fungal-retarding denture acrylic resin was developed through the incorporation of MPC for its protein-repelling properties. This newly developed denture acrylic material has the potential to prevent oral microbial infections, such as denture stomatitis.

Assessment of surface roughness changes on orthodontic acrylic resins by all-in-one spray disinfectant solutions

Background. The disinfection of orthodontic acrylic resins might change the physical and mechanical properties of these materials. We aimed to investigate the impact of four different commercially available disinfectants on the surface roughness of acrylic resins used for orthodontic appliances.

Methods. Four disinfectant solutions (BirexSE, Opti-Cide3, COEfect MinuteSpray, and CaviCide Spray) were used to disinfect orthodontic acrylic resins using the spraying method. The resins were subjected to repeated disinfection protocols. Distilled water, also applied via spraying method, was used as a control. Surface roughness was scrutinized to examine the extent of surface topography changes by stylus profilometry. Data normality was evaluated via the Shapiro–Wilk test, followed by the Wilcoxon Signed-Rank test for non-parametric data or paired Student’s t-test for parametric data to compare intra-group differences in roughness before and after the use of the disinfectant solutions.

Results. Some of the disinfectants (BirexSE and CaviCide) resulted in significant changes in surface roughness values before and after the disinfection compared to the controls (P<0.05). The groups that were in contact with distilled water, Opti-Cide, and Coeffect did not exhibit significant differences in surface roughness before and after the intervention (P>0.05). However, from a clinical perspective, the resulting variations in surface roughness (<%0.15) induced by these solutions might not reflect clinically significant differences.

Conclusion. The use of disinfectant solutions is unlikely to harm the surface of orthodontic acrylic resins. Oral care providers need to be attentive to the interpretation and implementation of clinically significant changes in their evidence-based approach regarding potential material damages by disinfection sprays.