Analyses of Streptococcus mutans in saliva with species-specific monoclonal antibodies

Correlation between Streptococcus mutans levels in dental plaque and saliva of children

PURPOSE

This study was designed to compare the levels of Streptococcus mutans (S. mutans) in saliva with those in occlusal plaque on posterior teeth at different stages of dentition, and to explore the correlation with caries experience to determine the most suitable source of S. mutans for research.

METHODS

Samples of saliva and occlusal plaque were collected from 83 patients (aged 3-17 years) over three months. S. mutans levels were determined by culture-based selective plating, morphological identification, and S.mutans-specific monoclonal antibody labeling.

RESULTS

The mean age of the participants was 8.8 (±3.7) years, and 74.7% of them were Hispanic. Mean caries experience for children with primary, mixed, and permanent dentition was 5.2 (±4.7), 4.0 (±3.3), and 0.8 (±1.3), respectively. Children with primary and mixed dentition had a higher caries experience than children with permanent dentition (P < 0.01), despite having similar S. mutans levels and total bacteria. A positive correlation was observed between S. mutans levels in plaque and those in saliva, but not between S. mutans levels and caries experience. It was noteworthy that plaque samples harbored higher S. mutans levels (>10⁵ CFU/mL) than saliva samples.

CONCLUSION

Both plaque and saliva samples are useful sources for S. mutans isolation. S. mutans levels from both sources were not significantly correlated with caries experience, but occlusal plaque had greater sensitivity for quantification of high S. mutans levels.

Effect of CPP-ACP on Streptococcus mutans in saliva of high caries-risk preschool children: a randomized clinical trial

PURPOSE

The aim of this study was to assess the efficacy of CPP-ACP in reducing salivary S. mutans levels and compare its effect as a dentifrice to use of a fluoride dentifrice alone, or with the sequential use of a combination of both agents (fluoride, then CPP-ACP) in three groups of preschool children over a 6-month period.

METHODS

This was a double-blinded clinical trial, the sample (n = 127, age 4.6 ± 0.47 years), with high caries risk, was randomized into three groups which applied different agents twice daily; fluoride toothpaste (500 ppm, n = 50), CPP-ACP (10% w/v, n = 38), and combination group (n = 39) applied fluoride, then CPP-ACP. S. mutans salivary levels were measured by GC Saliva-Check Mutans^™.

RESULTS

Within groups, a significant decrease in S. mutans-positive children (SMPC) occurred in fluoride and combination groups at 3-months, (P < 0.05), and in all groups at 6-months, (P < 0.05). The highest reduction in SMPC occurred in the CPP-ACP group, however, there were no significant differences in SMPC between groups at all study intervals, (P > 0.05).

CONCLUSION

Although all agents were effective, CPP-ACP showed the highest reduction in SMPC over 6-months.

Lollipop containing Glycyrrhiza uralensis extract reduces Streptococcus mutans colonization and maintains oral microbial diversity in Chinese preschool children

The anticariogenic activity of the extract of Glycyrrhiza uralensis (licorice) has been well documented. We recently developed an herbal lollipop containing licorice extracts with Glycyrrhizol A, the compound displaying strong antimicrobial activity against Streptococcus mutans. Preliminary testing showed that the herbal lollipop reduced salivary S. mutans counts in vivo. In this study, we aimed to further test the efficacy of this herbal lollipop for reducing salivary S. mutans levels, and investigate its impact on salivary microbiome. Using a well-established in vitro oral microbiome model, we showed that licorice extract displays targeted killing against S. mutans without affecting the biodiversity of the community. In vivo study corroborated in vitro findings, showing for high caries-risk children aged 3–6 with salivary S. mutans levels >5x10⁵ cells/ml, daily use of 2 licorice-containing lollipops for 3 weeks significantly reduced salivary S. mutans levels compared to the control group. Salivary microbiome analysis showed either no change or even increase in phylogenetic diversity of the oral community following herbal lollipop usage. Although further study with longer term observation is needed, these results suggest that use of licorice extract-containing lollipops can be as a simple and effective way to reduce the risk of dental caries in children.

Biofilm formation by the oral pioneer colonizer Streptococcus gordonii: an experimental and numerical study

For decades, extensive research efforts have been conducted to improve the functionality and stability of implants. Especially in dentistry, implant treatment has become a standard medical practice. The treatment restores full dental functionality, helping patients to maintain high quality of life. However, about 10% of the patients suffer from early and late device failure due to peri-implantitis, an inflammatory disease of the tissues surrounding the implant. Peri-implantitis is caused by progressive microbial colonization of the device surface and the formation of microbial communities, so-called biofilms. This infection can ultimately lead to implant failure. The causative agents for the inflammatory disease, periodontal pathogenic biofilms, have already been extensively studied, but are still not completely understood. As numerical simulations will have the potential to predict oral biofilm formation precisely in the future, for the first time, this study aimed to analyze Streptococcus gordonii biofilms by combining experimental studies and numerical simulation. The study demonstrated that numerical simulation was able to precisely model the influence of different nutrient concentration and spatial distribution of active and inactive biomass of the biofilm in comparison with the experimental data. This model may provide a less time-consuming method for the future investigation of any bacterial biofilm.

Application of Monoclonal Antibodies to Detect and Compare the Levels of Streptococcus mutans in Adolescents Undergoing Orthodontic Treatment with Those Not Undergoing Treatment

The purpose of this study was to detect Streptococcus mutans by using monoclonal antibodies (mAbs) against S. mutans that cause dental caries and compare the levels of the bacterium between the saliva of adolescents undergoing orthodontic treatment (OT) and those not undergoing treatment (NT). Saliva samples, collected from 25 OT adolescents (with a mean age of 12.84 years) and 25 NT adolescents (mean age of 12.4 years), were analyzed by Dentocult-SM and enzyme-linked immunosorbent assay using mAbs against Ag I/II (ckAg I/II) and GTF B (ckGTF B), GTF C (ckGTF C), and GTF D (ckGTF D) of S. mutans. The DMFT index was slightly higher in the OT group (5.12 in OT and 4.96 in NT) and the level of S. mutans (≥10⁵ CFU/mL) was higher in OT (72%) than in NT (56%). The detected levels of ckAg I/II, ckGTF B, ckGTF C, and ckGTF D were slightly higher in OT than in NT. The results of this study indicate that use of mAbs against S. mutans yields sensitive detection for the bacterium in saliva samples and shows that it has a reliable connection to the number of S. mutans and decayed, missing, filled teeth (DMFT), suggesting that the levels of S. mutans in saliva can be defined and compared by the application of the mAbs.

Fluorescent Detection of Oral Pathogens by a Solid-Phase Immunoassay on PDMS

We have developed an array of sensors for the oral pathogen Streptococcus mutans (S. mutans) using an enzymelinked linked immunosorbent assay (ELISA) on a polydimethylsiloxane (PDMS) device. The model bacterial analyte, S. mutans, has been implicated in the initiation and progression of dental caries. The PDMS was modified with 3-aminopropyltriethoxysilance (APTS) and glutaraldehyde to covalently crosslink monoclonal anti-S. mutans immunoglobulin G (IgG) to the sensor surface. Successful IgG immobilization was verified by AFM and fluorescence imaging. Colloidal bacteria were captured on the sensor surface and labeled with immuno-active quantum dots (QDs), whose fluorescence was excited by an LED and detected by a CCD. The system was capable of detecting S. mutans concentrations as low as 6 10⁶cells/ml in a 20 &#956;l sample. This work represents a stable foundation for the development of a chair side diagnostic system capable of specific and sensitive detection of pathogens directly from oral fluid.

Clinical efficacy of a specifically targeted antimicrobial peptide mouth rinse: targeted elimination of Streptococcus mutans and prevention of demineralization

BACKGROUND/AIMS

Streptococcus mutans, the major etiological agent of dental caries, has a measurable impact on domestic and global health care costs. Though persistent in the oral cavity despite conventional oral hygiene, S. mutans can be excluded from intact oral biofilms through competitive exclusion by other microorganisms. This suggests that therapies capable of selectively eliminating S. mutans while limiting the damage to the normal oral flora might be effective long-term interventions to fight cariogenesis. To meet this challenge, we designed C16G2, a novel synthetic specifically targeted antimicrobial peptide with specificity for S. mutans. C16G2 consists of a S. mutans-selective 'targeting region' comprised of a fragment from S. mutans competence stimulation peptide (CSP) conjoined to a 'killing region' consisting of a broad-spectrum antimicrobial peptide (G2). In vitro studies have indicated that C16G2 has robust efficacy and selectivity for S. mutans, and not other oral bacteria, and affects targeted bacteria within seconds of contact.

METHODS

In the present study, we evaluated C16G2 for clinical utility in vitro, followed by a pilot efficacy study to examine the impact of a 0.04% (w/v) C16G2 rinse in an intra-oral remineralization/demineralization model.

RESULTS AND CONCLUSIONS

C16G2 rinse usage was associated with reductions in plaque and salivary S. mutans, lactic acid production, and enamel demineralization. The impact on total plaque bacteria was minimal. These results suggest that C16G2 is effective against S. mutans in vivo and should be evaluated further in the clinic.

Clinical reduction of S. mutans in pre-school children using a novel liquorice root extract lollipop: a pilot study

AIM

To determine the clinical effect of a simple herbal caries-prevention protocol aimed at reduction of Streptococcus mutans (SM) in young children in a pre-school setting.

STUDY DESIGN

Proof-of-principle pilot study.

METHODS

To prove the concept this pilot study delivered a clinical intervention using sugar-free lollipops containing liquorice root extract. Regimen: Supervised herbal lollipops, twice daily for 3 weeks. Species-specific monoclonal antibody testing of saliva provided SM counts. Children were grouped in high, medium and low caries-risk using baseline SM-levels as risk-indicator. Bacterial numbers at baseline, during intervention, and for 9 weeks post-intervention were compared.

STATISTICS

SM levels were analysed using GEE modelling.

RESULTS

High-risk children showed the steepest early decrease in mean log-SM (P<.001). At end of a follow-up period, the log-SM decrease moved the high-risk group down to moderate-risk level. High-risk children showed a decrease in fitted mean SM% not seen in other groups (P<.001). The decrease reached a nadir around 22-days post-intervention. Twice-daily use of herbal lollipop significantly reduced both number and relative percent of SM in high-risk children. SM numbers were reduced for 22 days after the last lollipop, stabilized and then began to rebound.

CONCLUSION

A potential for simple effective caries-prevention for high-risk children has been demonstrated. Encouraging results warrant randomised clinical trials (RCT) of liquorice root in herbal lollipops or alternative modes of delivery.

Spit: Saliva in Nursing Research, Uses and Methodological Considerations in Older Adults

Over the last 10 years, interest in the analysis of saliva as a biomarker for a variety of systemic diseases or for potential disease has soared. There are numerous advantages to using saliva as a biological fluid, particularly for nurse researchers working with vulnerable populations, such as frail older adults. Most notably, it is noninvasive and easier to collect than serum or urine. The authors describe their experiences with the use of saliva in research with older adults that examined (a) osmolality as an indicator of hydration status and (b) cortisol and behavioral symptoms of dementia. In particular, the authors discuss the timing of data collection along with data analysis and interpretation. For example, it is not enough to detect levels or rely solely on summary statistics; rather it is critical to characterize any rhythmicity inherent in the parameter of interest. Not accounting for rhythmicity in the analysis and interpretation of data can limit the interpretation of associations, thus impeding advances related to the contribution that an altered rhythm may make to individual vulnerability.

Systematic approach to optimizing specifically targeted antimicrobial peptides against Streptococcus mutans

Previously we reported a novel strategy of "targeted killing" through the design of narrow-spectrum molecules known as specifically targeted antimicrobial peptides (STAMPs) (R. Eckert et al., Antimicrob. Agents Chemother. 50:3651-3657, 2006; R. Eckert et al., Antimicrob. Agents Chemother. 50:1480-1488, 2006). Construction of these molecules requires the identification and the subsequent utilization of two conjoined yet functionally independent peptide components: the targeting and killing regions. In this study, we sought to design and synthesize a large number of STAMPs targeting Streptococcus mutans, the primary etiologic agent of human dental caries, in order to identify candidate peptides with increased killing speed and selectivity compared with their unmodified precursor antimicrobial peptides (AMPs). We hypothesized that a combinatorial approach, utilizing a set number of AMP, targeting, and linker regions, would be an effective method for the identification of STAMPs with the desired level of activity. STAMPs composed of the Sm6 S. mutans binding peptide and the PL-135 AMP displayed selectivity at MICs after incubation for 18 to 24 h. A STAMP where PL-135 was replaced by the B-33 killing domain exhibited both selectivity and rapid killing within 1 min of exposure and displayed activity against multispecies biofilms grown in the presence of saliva. These results suggest that potent and selective STAMP molecules can be designed and improved via a tunable "building-block" approach.

Comparative analysis of a monoclonal antibody-based Streptococcus mutans detection method with selective culture assays using polymerase chain reaction as a gold standard

The aim of this study was to compare a recently developed monoclonal antibody (MAb)-based salivary Streptococcus mutans detection method with various selective media using polymerase chain reaction (PCR) as the gold standard. Salivary S. mutans cells were enumerated with a MAb-based method, along with three commonly used selective media, mitis-salivarius-bacitracin agar (MSB), trypticase yeast-extract cystine sucrose bacitracin agar (TYCSB), and glucose-sucrose-potassium tellurite-bacitracin (GSTB) agar. Statistical analysis showed no significant correlations between each method. With PCR as the standard, a MAb-based detection method was found to provide the highest sensitivity (91%) and specificity (96%) among these four methods. This study demonstrates that the MAb-based detection method may provide more accurate enumeration of salivary S. mutans than selective media.

Use of quantum dot luminescent probes to achieve single-cell resolution of human oral bacteria in biofilms

Oral biofilms are multispecies communities, and in their nascent stages of development, numerous bacterial species engage in interspecies interactions. Better insight into the spatial relationship between different species and how species diversity increases over time can guide our understanding of the role of interspecies interactions in the development of the biofilms. Quantum dots (QD) are semiconductor nanocrystals and have emerged as a promising tool for labeling and detection of bacteria. We sought to apply QD-based primary immunofluorescence for labeling of bacterial cells with in vitro and in vivo biofilms and to compare this approach with the fluorophore-based primary immunofluorescence approach we have used previously. To investigate QD-based primary immunofluorescence as the means to detect distinct targets with single-cell resolution, we conjugated polyclonal and monoclonal antibodies to the QD surface. We also conducted simultaneous QD conjugate-based and fluorophore conjugate-based immunofluorescence and showed that these conjugates were complementary tools in immunofluorescence applications. Planktonic and biofilm cells were labeled effectively by considering two factors: the final nanomolar concentration of QD conjugate and the amount of antibody conjugated to the QD, which we define as the degree of labeling. These advances in the application of QD-based immunofluorescence for the study of biofilms in vitro and in vivo will help to define bacterial community architecture and to facilitate investigations of interactions between bacterial species in these communities.

In situ and non-invasive detection of specific bacterial species in oral biofilms using fluorescently labeled monoclonal antibodies

Noninvasive in situ detection of suspected cariogenic bacterial species within dental biofilms could facilitate monitoring of the dynamic change of oral microbial flora and assist in the assessment of the treatment efficacy of therapeutic agents. In this study, we explore the possibility to use three well-characterized monoclonal antibodies (MAbs) against Streptococcus mutans, Actinomyces naeslundii, and Lactobacillus casei to identify these three important members of the oral microbial community in the complex environment of oral biofilms. These MAbs, which were conjugated to different fluorescent labels and visualized with confocal laser scanning microscopy (CLSM), proved to be an useful tool to identify the three species of interest (S. mutans, A. naeslundii, and L. casei) under various experimental conditions including in vitro and in vivo derived oral biofilms. Manifold addition of the MAbs on consecutive days did not alter the biofilm structure thus allowing monitoring of the same biofilm over extended time periods. Using this MAb-based method the effect of sucrose challenge on the biofilm composition and the distribution of S. mutans, A. naeslundii, and L. casei were examined. S. mutans was found to be the predominant species under the various biofilm conditions tested. These studies indicate that MAbs based bacterial detection with CLSM is a versatile tool which permits new insights into the ecology of oral biofilm development.

Production and characterization of species-specific monoclonal antibodies against Actinomyces naeslundii and Lactobacillus casei

Dental caries is a disease induced by a few cariogenic bacterial species. Quantitative detection of these cariogenic bacteria could provide useful information for caries risk assessment. In this study, we developed highly species-specific monoclonal antibodies (MAbs) against the type strains of Actinomyces naeslundii ATCC 12104 and Lactobacillus casei ATCC 11578. Assayed with immunoprecipitation and immunofluorescent microscopy, these antibodies showed high sensitivities and specificities in detecting A. naeslundii and L. casei in saliva. Examining 100 saliva samples using these MAb-based techniques, we found that the number of A. naeslundii in saliva ranges from 0.5 x 10(4) to 4.8 x 10(5) and that the number of L. casei in saliva ranges from 1 x 10(4) to 1.2 x 10(6). With fluorescent imaging techniques and confocal laser scanning microscopy (CLSM), these antibodies were used to visualize A. naeslundii and L. casei within dental plaques derived from stimulated whole human saliva in vitro. The study demonstrated that these MAbs were also able to effectively detect A. naeslundii and L. casei in plaque.