Limiting factors for the generation of hypothiocyanite ion, an antimicrobial agent, in human saliva

Excess iodine exposure acutely increases salivary iodide and antimicrobial hypoiodous acid concentrations in humans

The lactoperoxidase (LPO)-hydrogen peroxide-halides reaction (LPO system) converts iodide and thiocyanate (SCN-) into hypoiodous acid (HOI) and hypothiocyanite (OSCN-), respectively. Since this system has been implicated in defense of the airways and oropharynx from microbial invasion, in this proof-of-concept study we measured the concentrations of these analytes in human saliva from a convenience clinical sample of 40 qualifying subjects before and after acute iodine administration via the iodinated contrast medium used in coronary angiography to test the hypothesis that an iodide load increases salivary iodide and HOI concentrations. Saliva was collected and salivary iodide, SCN-, HOI and OSCN- were measured using standard methodology. The large iodine load delivered by the angiographic dye, several 100-fold in excess of the U.S. Recommended Daily Allowance for iodine (150 µg/day), significantly increased salivary iodide and HOI levels compared with baseline levels, whereas there was no significant change in salivary SCN- and OSCN- levels. Iodine load and changes of salivary iodide and HOI levels were positively correlated, suggesting that higher iodide in the circulation increases iodide output and salivary HOI production. This first of its kind study suggests that a sufficient but safe iodide supplementation less than the Tolerable Upper Limit for iodine set by the U.S. Institute of Medicine (1,100 µg/day) may augment the generation of antimicrobial HOI by the salivary LPO system in concentrations sufficient to at least in theory protect the host against susceptible airborne microbial pathogens, including enveloped viruses such as coronaviruses and influenza viruses.

Antibacterial and antiplaque efficacy of a lactoperoxidase-thiocyanate-hydrogen-peroxide-system-containing lozenge

Background

Antimicrobial agents are considered valuable adjuncts to mechanical methods of plaque control. However, their long-term use can be limited because of side effects.

Therefore, using physiological substances is promising due to no risk of development, for example, of microbial resistances, allergies or DNA damaging. The lactoperoxidase-thiocyanate-hydrogen peroxide system (LPO-system) is a highly effective antimicrobial system. This study aimed to evaluate in a randomized study with a four-replicate cross-over design the effectiveness of two oral hygiene lozenges containing LPO-system in oral hygiene.

Results

After using the mouth rinse as positive control (A) and allocated test lozenges (B) (0.083% H₂O₂) & (C) (0.04% H₂O₂) for 4 days instead of the normal oral hygiene procedures (tooth brushing etc.), Listerine rinse (A) was statistically significantly more effective than the LPO-system-lozenge with 0.083% H₂O₂, the LPO-system-lozenge with 0.04% H₂O₂, and the placebo lozenge (D) in inhibiting plaque. Lozenges B and C were statistically significantly more effective than the placebo lozenge, but no statistically significant differences could be observed between them.

The LPO-system-lozenge (B) reduced statistically significantly more S. mutans than the LPO-system-lozenge with (C) and the placebo lozenge (D). The LPO-system-lozenge (C) reduced statistically significantly more Lactobacilli than Listerine (A), the LPO-system-lozenge (B) and the placebo lozenge (D). There were no statistically significant differences in the total CFUs between Listerine rinse, the LPO-system-lozenge with 0.083% H₂O₂ (B), the LPO-system-lozenge with 0.04% H₂O₂ (C), and the placebo lozenge (D). On day 5 there were no differences of the OSCN⁻-values between all A, B, C, and D. However, the SCN⁻-values increased over the days in both LPO-system-lozenges (B/C). The statistically significant differences between B/C and A/D on day 5 were as followed: A to B p = 0.0268; A to C p = 0.0035; B to D p = 0.0051; C to D p = 0.0007. Only in the group of Listerine (A) increased the NO₃⁻/NO₂⁻-quotient over the test time, which indicates a reduction of nitrate-reducing bacteria. On Day 5 the statistically significant difference between A and B was p = 0.0123.

Conclusions

The results indicate that lozenges containing a complete LPO-system, inhibiting plaque regrowth and reducing cariogenic bacteria, may be used in the daily oral hygiene.

Oral peroxidases: From antimicrobial agents to ecological actors (Review)

Sialoperoxidase and myeloperoxidase are the two main peroxidase enzymes found in the oral cavity. Sialoperoxidase is present in salivary secretions and in the biofilms that line the oral surfaces, while myeloperoxidase is abundant in the dento-gingival sulcus area. In the presence of hydrogen peroxide (H₂O₂), oral peroxidases catalyze the oxidation of the pseudohalide anion thiocyanate (SCN⁻) to hypothiocyanite (OSCN⁻), a strong oxidant that serves an antimicrobial role. Furthermore, oral peroxidases consume bacteria-produced H₂O₂ and could help inactivate toxic carcinogenic and genotoxic substances. Numerous in vitro studies have reported the antibacterial, antimycotic and antiviral role of peroxidases, suggesting possible applications in oral therapy. However, the use of oral hygiene products incorporating peroxidase systems has not yet been shown to be beneficial for the treatment or prevention of oral infections. This paradox reflects our incomplete knowledge of the physiological role of peroxidases in a complex environment, such as the oral region. While hygiene is crucial for restoring oral microbiota to a symbiotic state, there are no data to suggest that the addition of a peroxidase per se can create a dysbiotic state. Recent investigations have associated the presence of peroxidase activity with gram-positive cocci microbial flora, and its insufficiency with dysbiosis has been linked to pathologies, such as caries, periodontitis or infections of the oral mucosa. Therefore, oxidants generated by oral peroxidases appear to be an essential ecological determinant for oral health through the selection of a symbiotic microbiota capable of resisting oxidative stress. The objective of the present review was to update the current knowledge of the physiological aspects and applications of oral peroxidases in clinical practice.

Specific and robust ion chromatographic determination of hypothiocyanite in saliva samples

The enzymatic system in saliva, consisting of salivary peroxidase (SPO), hydrogen peroxide (H₂O₂), and thiocyanate (SCN^-), produces hypothiocyanite (OSCN^-) as a high effective antibacterial compound. OSCN^- is of great importance for the natural non-specific antibacterial resistance in the oral cavity. However, no analytical method currently exists to selectively quantify OSCN^- in saliva samples. A robust and specific analytical method for the determination of OSCN^- was developed based on ion chromatography with combined UV and electrochemical detection. Calibration was achieved by calculating a derived calibration factor based on the known ratio of molar extinction coefficients of SCN^- and OSCN^-. Thus, the specific quantification of OSCN^- in saliva samples is possible, as demonstrated here. The median value of 200 saliva samples was determined to be 0.56 mg L^-1 (median), with a maximum of 3.9 mg L^-1; the minimum value was below the detection limit (< 0.09 mg L^-1). The recovery rate in individual saliva samples was 95 ± 8%.

Association of salivary peroxidase activity and concentration with periodontal health: A validity study

AIM

Whereas the relationship between myeloperoxidase and periodontitis has been widely examined that between salivary peroxidase and periodontitis has received little attention. We examined how periodontitis depends on both salivary peroxidase activity and concentration.

MATERIALS AND METHODS

A full mouth, clinical assessment of probing depth was performed in a sample of 46 participants aged 25-54 years. To minimise bias, these data were corrected by data from the general population (Study of Health in Pomerania). Using five repeated measurements of activity and concentration over 1 day, we assessed daily biological variability and increased the reliability of salivary peroxidase measurements.

RESULTS

Salivary peroxidase activity was associated with probing depth (interquartile range effect = -0.48; robust estimates of 95% confidence interval: -0.90 to -0.31; p = .0052), and its effect was not confounded by salivary peroxidase concentration. In turn, the effect of salivary peroxidase concentration was confounded by salivary peroxidase activity, and it was smaller than that of activity.

CONCLUSIONS

We found an inverse association between salivary peroxidase activity and probing depth. Thus, our results imply that salivary peroxidase activity could be a protective factor against periodontitis. However, large, well-designed studies are needed to explore the causal mechanisms of this association.

Enzymes in therapy of biofilm-related oral diseases

Biofilm-related infections of the oral cavity, including dental caries and periodontitis, represent the most prevalent health problems. For years, the treatment thereof was largely based on antibacterial chemical agents. Recently, however, there has been growing interest in the application of more preventive and minimally invasive biotechnological methods. This review focuses on the potential applications of enzymes in the treatment and prevention of oral diseases. Dental plaque is a microbial community that develops on the tooth surface, embedded in a matrix of extracellular polymeric substances of bacterial and host origin. Both cariogenic microorganisms and the key components of oral biofilm matrix may be the targets of the enzymes. Oxidative salivary enzymes inhibit or limit the growth of oral pathogens, thereby supporting the natural host defense system; polysaccharide hydrolases (mutanases and dextranases) degrade important carbohydrate components of the biofilm matrix, whereas proteases disrupt bacterial adhesion to oral surfaces or affect cell-cell interactions. The efficiency of the enzymes in in vitro and in vivo studies, advantages and limitations, as well as future perspectives for improving the enzymatic strategy are discussed.

Innate Humoral Defense Factors

Although innate immunity came into the research spotlight in the late 1990s when its instructive role in the adaptive immune response was recognized, innate humoral defense factors have a much older history. The exocrine secretions of the body contain a plethora of distinct soluble factors (lysozyme, lactoferrin, peroxidases, proline-rich proteins, histatins, etc.) that protect the body from mucosal microbial pathogens. More recent studies have established that the humoral arm of innate immunity contains a heterogeneous group of pattern-recognition molecules (e.g., pentraxins, collectins, and ficolins), which perform diverse host-defense functions, such as agglutination and neutralization, opsonization, control of inflammation, and complement activation and regulation. These pattern-recognition molecules, which act as functional predecessors of antibodies (“ante-antibodies”), and the classic soluble innate defense factors form an integrated system with complementary specificity, action, and tissue distribution, and they are the subject of this chapter.

Effect of lactoperoxidase on the antimicrobial effectiveness of the thiocyanate hydrogen peroxide combination in a quantitative suspension test

BACKGROUND

The positive antimicrobial effects of increasing concentrations of thiocyanate (SCN-) and H2O2 on the human peroxidase defence system are well known. However, little is known about the quantitative efficacy of the human peroxidase thiocyanate H2O2 system regarding Streptococcus mutans and sanguinis, as well as Candida albicans. The aim of this study was to evaluate the effect of the enzyme lactoperoxidase on the bactericidal and fungicidal effectiveness of a thiocyanate-H2O2 combination above the physiological saliva level. To evaluate the optimal effectiveness curve, the exposure times were restricted to 1, 3, 5, and 15 min.

RESULTS

The bactericidal and fungicidal effects of lactoperoxidase on Streptococcus mutans and sanguinis and Candida albicans were evaluated by using two test mixtures of a 2.0% (w/v; 0.34 M) thiocyanate and 0.4% (w/v; 0.12 M) hydrogen peroxide solution, one without and one with lactoperoxidase. Following the quantitative suspension tests (EN 1040 and EN 1275), the growth of surviving bacteria and fungi in a nutrient broth was measured. The reduction factor in the suspension test without lactoperoxidase enzyme was < 1 for all three tested organisms. Thus, the mixtures of 2.0% (w/v; 0.34 M) thiocyanate and 0.4% (w/v; 0.12 M) hydrogen peroxide had no in vitro antimicrobial effect on Streptococcus mutans and sanguinis or Candida albicans. However, the suspension test with lactoperoxidase showed a high bactericidal and fungicidal effectiveness in vitro.

CONCLUSION

The tested thiocyanate and H2O2 mixtures showed no relevant antimicrobial effect. However, by adding lactoperoxidase enzyme, the mixtures became not only an effective bactericidal (Streptococcus mutans and sanguinis) but also a fungicidal (Candida albicans) agent.

Determination of salivary peroxidase activity in human mixed whole saliva

Mixed whole saliva contains salivary peroxidase (SPX) and myeloperoxidase (MPO), thus it is important to discriminate between the two peroxidases in order to understand their functions in the oral cavity. We developed a method to measure SPX activity in mixed whole saliva using an oxygen electrode. According to our results, when 50% of the peroxidase activity in saliva was due to MPO, determined using a typical substrate for peroxidase guaiacol, almost all oxygen evolved was due to SPX. We propose that measurement of H(2)O(2)-dependent oxygen evolution is a useful method for determining SPX activity in whole saliva.

The effect of a SCN-/H2O2 toothpaste compared to a commercially available triclosan-containing toothpaste on oral hygiene and gingival health -- a 6-month home-use study

OBJECTIVES

The aim of the study was to compare the gingival health benefits of a thiocyanate/carbamide peroxide toothpaste to that of a triclosan toothpaste in home use.

MATERIALS AND METHODS

The study was a two-centre, randomised, double-blind, parallel-group clinical trial, and consisted of a 2-week pre-experimental phase, followed by an experimental period of 6 months. A total of 140 healthy male and female volunteers (70 per group) who had at least 20 natural teeth with no probing depths greater than 5 mm and a mean gingival index (GI) of 1 or more at screening were admitted to the study. The two products were the test toothpaste (RCP) containing 0.5% SCN- (rhodanide), carbamide peroxide (equivalent 0.1% H2O2), and 1450 p.p.m. fluoride, and a control toothpaste (Colgate Total) containing 0.3% triclosan, 2.0% polyvinyl methyl ether maleic acid (PVM/MA), and 1450 p.p.m. fluoride (Triclosan). In the pre-experimental phase, all subjects used a fluoride toothpaste. Plaque (Turesky et al. 1970) and gingivitis (Löe & Silness 1963) were scored prior to beginning the pre-experimental phase, at baseline, and after 6 weeks and 3 and 6 months.

RESULTS

In both the RCP and the Triclosan group, gingival health improved significantly between baseline and the following examinations. Plaque scores decreased significantly between baseline and 6 months in both groups. There were, however, no significant differences between the groups for either gingival index or plaque index.

CONCLUSION

To conclude, this study seems to verify that in normal home use, a toothpaste containing a combination of thiocyanate and carbamide peroxide is as effective in reducing gingival inflammation and supragingival plaque formation as a benchmark control product.

Effects of SCN-/H2O2 combinations in dentifrices on plaque and gingivitis

OBJECTIVES

A 10-week, double-blind, placebo-controlled clinical study on 140 male subjects was conducted to determine the effect on plaque and gingivitis of 5 dentifrices containing various thiocyanate (SCN-)/hydrogen peroxide (H2O2) combinations.

MATERIALS AND METHODS

The dentifrices consisted of a gel base without any detergents or abrasives (placebo, group A) to which SCN- and/or H2O2 were added as follows: 0.1% SCN- (group B), 0.5% SCN- (group C), 0.1% SCN-/0.1% H2O2 (group D), 0.5% SCN-/0.1% H2O2 (group E) and 0.1% H2O2 (group F). A baseline examination was performed in which the Silness and Löe Plaque Index (PI), the Mühlemann and Son Sulcus Bleeding Index (SBI), and the amount of gingival crevicular fluid (GCF) were recorded using the Periotron 6,000 on teeth 16, 12, 24, 36, 32, and 44. The subjects were randomly assigned to either the placebo group (n = 40) or one of the test groups (n = 20) and used their respective dentifrices over a period of 8 weeks. Finally, each group used the placebo for another 2 weeks (wash-out). Re-examinations were performed after 1, 4, and 8 weeks and the 2-week wash-out period employing the clinical parameters used at baseline. Intragroup changes were analyzed with the Wilcoxon signed-ranks test, using the baseline and wash-out points as references. The Mann-Whitney U test was used for comparisons between the treatment groups and the placebo group.

RESULTS

At the 8-week examination, the plaque index in group E (p = 0.017) and group F (p = 0.032) was lower than in the placebo group. The Sulcus Bleeding Index in group F after 1 week was increased (p = 0.023) and the SBI in group E after 8 weeks was reduced (p = 0.047) as compared to the placebo group.

CONCLUSION

The results demonstrated that a dentifrice containing 0.5% SCN- and 0.1% H2O2 but no detergents or abrasives inhibited plaque and decreased gingivitis.

Combined inhibitory effect of bovine immune whey and peroxidase-generated hypothiocyanite against glucose uptake by Streptococcus mutans

Immune whey product was obtained from Streptococcus mutans- and Streptococcus sobrinus-immunized cows. Hypothiocyanite (HOSCN/OSCN-) was generated in VMG-buffer, pH 5.5 or 6.5, by bovine milk lactoperoxidase, KSCN and hydrogen peroxide. The glucose incorporation by late-log cells of S. mutans 10449, serotype c, was followed by measuring the uptake of 14C-glucose at 37 degrees C. At pH 5.5 and 6.5 both immune whey product and HOSCN/OSCN- dose-dependently inhibited glucose uptake. The inhibition by their combination was additive if bacterial cells were treated with HOSCN/OSCN- before exposed to immune whey product. In contrast to immune whey product, the control product from sham-immunized cows increased the glucose uptake even when added simultaneously with HOSCN/OSCN-. However, when bacterial cells were pretreated with HOSCN/OSCN- an enhanced inhibitory effect was observed also with control product. The results indicate that colostral proteins from S. mutants- or S. sobrinus-immunized cows inhibit glucose uptake and that the effect is enhanced by pretreatment with lactoperoxidase-generated HOSCN/OSCN-.

Antimicrobial function of human saliva--how important is it for oral health?

Human saliva contains a number of physical physicochemical, and chemical agents that protect oral tissues against noxious compounds, in particular those produced by various microorganisms. Among such protective factors, the flushing effect of saliva flow is the most important one, not only because it so effectively removes exogenous and endogenous microorganisms and their products into the gut but also because a steady supply of saliva guarantees continuous presence of both non-immune and immune factors in the mouth. A great number of studies with controversial results have been published regarding various individual agents and their possible association to oral health, particularly to dental caries. It appears that no single chemical agent is far more important than the others. For example, patients with selective IgA deficiency have normal levels of non-immune defense factors and often display a compensatory increase in the other immunoglobulin isotypes. The concerted action of all agents in whole saliva, both saliva- and serum-derived, provides a multifunctional protective network that is collapsed only if salivary flow rate is substantially reduced. In this mixture of defense factors, many show additive or even synergistic interactions against oral pathogens. Increased knowledge of the molecular functions of various agents has made it possible to prepare oral hygiene product that include host-derived antimicrobial agents instead of synthetic agents. Although the clinical efficacy of such products is still unsatisfactory and poorly described, new technologies, for example in the production of specific antibodies against oral pathogens, may considerably improve the antimicrobial power of these products.

Combined inhibitory effect of fluoride and hypothiocyanite on the viability and glucose metabolism of Streptococcus mutans, serotype c

The separate and combined effects of peroxidase-generated hypothiocyanite (HOSCN/OSCN-) and F- ions on glucose uptake and growth of Streptococcus mutans ATCC 25175 were investigated. S. mutans cells were grown to late exponential or stationary growth phase, harvested, washed and suspended in 2.0 ml of sterilized human whole saliva supplemented with 10 mM D-glucose. This saliva-bacteria mixture was supplemented with 5-150 microM H2O2 at pH 5.0 or 6.5. At pH 5.0, up to 103 +/- 21 microM HOSCN/OSCN- was generated. After 20 h of incubation at 37 degrees C, the saliva-bacteria suspension exposed to HOSCN/OSCN- were plated on mitis salivarius agar plates and incubated anaerobically for 2 days. Identical experiments were made with F- ions (0.5, 1.0 and 5.0 mM). Both HOSCN/OSCN- and F- caused a significant dose-dependent growth inhibition at pH 5.0, whereas no inhibition was observed at pH 6.5. When F- and HOSCN/OSCN- were added simultaneously at pH 5.0, an additive effect of growth inhibition was observed. In glucose incorporation experiments the bacteria-saliva mixture was exposed to 1 microM HOSCN/OSCN-, 0.5 mM F- or both. F-, HOSCN/OSCN- or their combination in sterilized whole saliva at pH 5.0 caused 14.2, 67.8 and 74.2% inhibition, respectively. These observations indicate that F- and HOSCN/OSCN- ions have an additive inhibitory effect on S. mutans and therefore their combination is likely to be more antibacterial than either agent alone.

Effects of oral hygiene products containing lactoperoxidase, lysozyme, and lactoferrin on the composition of whole saliva and on subjective oral symptoms in patients with xerostomia

This study evaluates the effects of two oral hygiene products containing nonimmunoglobulin antimicrobial agents on whole saliva and on subjective oral symptoms in patients with xerostomia. Twenty patients used a lactoperoxidase-system-containing toothpaste (Biotene) combined with the use of a mouthrinse (Biotene), comprising also lysozyme and lactoferrin, for 4 weeks. Saliva samples were collected at base line, after 4 weeks' use of the products, and at the end of a 4-week washout period. Samples were analyzed for selected biochemical and microbiologic factors. The effects on subjective oral symptoms were also recorded. A 4-week daily use of toothpaste and mouthrinse relieved the symptoms of oral dryness in 16 patients. The levels of salivary hypothiocyanite, lysozyme, lactoferrin, or myeloperoxidase activity did not change, but there was a significant decrease in salivary pH (P < 0.05), total peroxidase activity (P < 0.05), and total protein content (P = 0.01). In patients with the lowest salivary flow rates (n = 5) a significant (P > or = 0.04) increase was detected in salivary hypothiocyanite concentrations. No major changes occurred in salivary microflora. The products relieved subjective oral symptoms in most xerostomic patients, but this was not necessarily related to the presence of antimicrobial agents.

An evaluation of a dentifrice containing salivary peroxidase elements for the control of gingival disease in patients with irradiated head and neck cancer

Patients who have undergone irradiation for head and neck tumors commonly have xerostomia. Loss of the protective constituents normally found in saliva leaves patients at greater risk for development of significant dental pathologic disorders, including gingival and periodontal disease. Periodontal disease and tooth extractions are currently accepted as etiologic factors for the development of osteoradionecrosis. This double-blind crossover trial was conducted to assess the efficacy of a dentifrice containing salivary peroxidase elements in the reduction of gingivitis in a population of patients with irradiated cancer. Subjects were instructed to brush with the dentifrice provided. Plaque and gingival index values were obtained and statistically compared with baseline values. A weak positive effect was found between use of the dentifrice and a reduction in gingival inflammation. Patient compliance was a limiting factor in this treatment effect. The results suggest possible efficacy for the dentifrice in augmenting traditional measures of postradiation oral health maintenance.

Effects of delmopinol on antimicrobial peroxidase systems and lysozyme in vitro and in human whole saliva

Delmopinol is a new surface-active agent which can reduce plaque formation and gingivitis. This study was aimed to analyze whether delmopinol (0.0032-0.65 mM) interferes with the activity of two surface-active oral antimicrobial enzymes, salivary peroxidase and lysozyme. In addition to human whole saliva (pH 5.0 and 6.0), the experiments were done in 0.1 M phosphate buffer (pH 6.0) with purified lactoperoxidase (LPO) and myeloperoxidase (MPO). LPO and MPO were significantly inhibited in buffer by delmopinol concentrations > 6.5 mM and > or = 3.2 mM, respectively. No such inhibition was found for total peroxidase activity in mixed saliva. In vitro, delmopinol was found to desorb surface-bound peroxidases in an active form to the liquid phase. In further analyses, the possible effect of delmopinol on peroxidase-generated hypothiocyanite (HOSCN/OSCN-) was studied in saliva and buffer. No effect was found in buffer, but salivary HOSCN/OSCN- declined significantly with 6.5 mM delmopinol. This was obviously due to an enhanced decay of hypothiocyanite, rather than its reduced rate of formation. No delmopinol-related inhibition of lysozyme occurred in saliva or buffer. The results suggest that high concentration (6.4 mM -0.2%) of delmopinol may lower the concentrations of antimicrobial HOSCN/OSCN- in saliva but has no effect on human lysozyme.

Inhibition by thiocyanate of muscarinic-induced cytosolic acidification and Ca2+ entry in rat sublingual acini

Thiocyanate (SCN-) plays a critical part in an oral antimicrobial system by acting as a substrate for peroxidases. Salivary glands concentrate SCN- from blood up to 5 mM in saliva; however, the influence of SCN- on salivary acinar-cell function is unknown. The present study examined the effects of SCN- on the regulation of cytosolic pH (pHi) and free Ca2+ concentration ([Ca2+]i) in rat sublingual mucous acini using the pH- and Ca(2+)-sensitive fluorescent indicators, 2',7'-bis-(2-carboxyethyl)-5,6-carboxyfluorescein and fura-2, respectively. SCN- induced a concentration-dependent inhibition of the carbachol-stimulated cytosolic acidification (K1/2, approx. 1.4 mM SCN-). Cytosolic pH recovery from an acid load was not changed by substitution of Cl- by SCN-, suggesting that Na+/H+ exchange activity was not affected by SCN-. SCN- did not alter the initial carbachol-stimulated increase in [Ca2+]i; however, the sustained [Ca2+]i increase was inhibited by > 65% (K1/2, approx. 1.0 mM SCN-). Furthermore, SCN- prevented the carbachol-stimulated Mn2+ influx, indicating that it inhibits the divalent-cation entry pathway. Consistent with decreased Ca2+ mobilization being involved in the blockade of the agonist-induced acidification by SCN-, only total replacement of Cl- with SCN- significantly inhibited the acidification induced by the Ca2+ ionophore ionomycin. The permeability to SCN- through the Ca(2+)-dependent Cl- channels was 5.2-fold higher than the permeability to Cl-. These results suggest that inhibition of the agonist-induced cytosolic acidification by high-concentration SCN- may be mediated by both competitive inhibition of HCO3- efflux and by blockade of Ca2+ influx.

Effects of a lactoperoxidase-system-containing toothpaste on dental plaque and whole saliva in vivo

The effects of a lactoperoxidase-system-containing toothpaste. Biotene, on saliva and dental plaque were studied. In a double-blind crossover study 20 healthy volunteers used an experimental (comprising the complete peroxidase system) or a placebo (without lactoperoxidase, KSCN, and glucose oxidase) toothpaste twice daily for 2 weeks separated by a 2-week washout period. At base lines and at the end of both test periods saliva and plaque samples were collected, and plaque pH changes were monitored. Saliva was analyzed for hypothiocyanite (HOSCN/OSCN-) and thiocyanate (SCN-) concentrations and salivary peroxidase activity. The amount of total streptococci, mutans streptococci, lactobacilli, and total anaerobic flora was determined both in saliva and in plaque samples. The accumulation and the acidogenicity of plaque were also quantitated. A 2-week daily use of Biotene had no effect on salivary flow rate, peroxidase activity, HOSCN/OSCN-, SCN-, or any of the monitored bacterial counts compared with the placebo toothpaste. The accumulation of dental plaque was not affected by the lactoperoxidase-system-containing toothpaste. The acidogenicity of plaque did not change significantly, nor did the two test dentifrices differ in their ability to inhibit the plaque pH drop caused by sucrose in subjects with normal salivary flow rate.

Salivary defense factors and oral health in patients with common variable immunodeficiency

Studies of oral health in patients with common variable immunodeficiency have given controversial results. Obviously, one major factor modifying the oral health of these patients is saliva, in which the antibody-mediated defense is remarkably impaired compared to that of healthy subjects. However, the occurrence of nonimmunoglobulin (innate) antimicrobial agents in saliva of these patients is virtually unknown. Therefore, we analyzed both immune (total IgA, IgG, IgM, anti-Streptococcus mutans IgA, IgG, and IgM antibodies) and nonimmune (lysozyme, lactoferrin, salivary peroxidase, myeloperoxidase, hypothiocyanite, thiocyanate, and agglutinins) factors in whole saliva of 15 patients with common variable immunodeficiency. All patients were on Ig-replacement therapy (median duration, 10 years; range, 2-25 years), which had normalized their IgG but not their IgA or IgM levels both in serum and in saliva. Also, comprehensive clinical and microbiological analyses were made. The control group comprised 15 age- and sex-matched immunologically healthy subjects. The results showed no notable differences in dental caries, periodontal diseases, or salivary microorganisms but the patients had a history of more frequent oral mucosal lesions and respiratory infections. All innate, nonimmune salivary defense factors were equally abundant in the patients as in the controls, in many cases even at somewhat higher concentrations. These findings suggest that in spite of immunodeficiency, patients with common variable immunodeficiency display normal, perhaps even slightly elevated, levels of nonimmunoglobulin defense factors in whole saliva.(ABSTRACT TRUNCATED AT 250 WORDS)

Leukocyte myeloperoxidase and salivary lactoperoxidase: identification and quantitation in human mixed saliva

Human salivary lactoperoxidase (HS-LP) is synthesized and secreted by the salivary glands, whereas myeloperoxidase (MPO) is found in PMN leukocytes, which migrate into the oral cavity at gingival crevices. HS-LP levels vary with changes in salivary gland function, but increased numbers of MPO-containing leukocytes indicate infection or inflammation of oral tissues. To determine the contribution of each enzyme to the peroxidase activity of mixed-saliva samples, activity was assayed at pH 5.4 with tetramethylbenzidine as the substrate, with and without the inhibitor dapsone (4,4'-diaminodiphenylsulfone). Dapsone blocked the activity of HS-LP but not MPO. The enzymes were also separated and partially purified from the soluble portion of saliva samples and from detergent extracts of the saliva sediment. Chromatographic properties of the proteins were similar to those of LP from bovine milk (BM-LP) and MPO from human leukocytes. The identity and amounts of the enzymes were confirmed by the absorption spectra and by immunoblotting with antibodies to BM-LP and human MPO. Eosinophil peroxidase (EPO), a distinct enzyme found in eosinophilic leukocytes, was not detected by chromatography or with antibodies to human EPO. On average, 75% of the activity in samples from normal donors was due to MPO and 25% to HS-LP. When corrected for the lower specific activity of HS-LP in this assay, the average amount of MPO (3.6 micrograms/mL) was twice the amount of HS-LP (1.9 micrograms/mL). The amount of MPO corresponded to 1 x 10(6) PMN leukocytes/mL of saliva. The enzymes were distributed differently: Eighty-nine percent of the HS-LP was in the soluble portion of saliva, and 78% of the MPO was in the sediment, which contained 51% of the total activity. In contrast to results obtained with PMN leukocytes from blood, detergent was not required for MPO activity to be measured in saliva, indicating that the enzyme was accessible to peroxidase substrates. The results indicate that MPO is responsible for a large portion of peroxidase-catalyzed reactions in mixed saliva. The unique function of HS-LP may be carried out within the salivary glands, prior to secretion into the oral cavity.

Antibacterial activity of hydrogen peroxide and the lactoperoxidase-hydrogen peroxide-thiocyanate system against oral streptococci

In secreted fluids, the enzyme lactoperoxidase (LP) catalyzes the oxidation of thiocyanate ion (SCN-) by hydrogen peroxide (H2O2), producing the weak oxidizing agent hypothiocyanite (OSCN-), which has bacteriostatic activity. However, H2O2 has antibacterial activity in the absence of LP and thiocyanate (SCN-). Therefore, LP may increase antibacterial activity by using H2O2 to produce a more effective inhibitor of bacterial metabolism and growth, or LP may protect bacteria against the toxicity of H2O2 by converting H2O2 to a less-potent oxidizing agent. To clarify the role of LP, the antibacterial activities of H2O2 and the LP-H2O2-SCN- system were compared by measuring loss of viability and inhibition of bacterial metabolism and growth. The relative toxicity of H2O2 and the LP system to oral streptococci was found to depend on the length of time that the bacteria were exposed to the agents. During incubations of up to 4 h, the LP system was from 10 to 500 times more effective than H2O2 as an inhibitor of glucose metabolism, lactic acid production, and growth. However, if no more H2O2 was added, the concentration of the inhibitor OSCN- fell because of slow decomposition of OSCN-, and when OSCN- fell below 0.01 mM, the bacteria resumed metabolism and growth. In contrast, the activity of H2O2 increased with time. H2O2 persisted in the medium for long periods of time because H2O2 reacted slowly with the bacteria and streptococci lack the enzyme catalase, which converts H2O2 to oxygen and water. After 24 h of exposure, H2O2 was as effective as the LP system as an inhibitor of metabolism. H2O2 also caused a time-dependent loss of viability, whereas the LP system had little bactericidal activity. The concentration of H2O2 required to kill half the bacteria within 15 s was 1.8 M (6%) but fell to 0.3 M (1%) at 2 min, to 10 mM (0.03%) at 1 h, and to 0.2 mM (0.0007%) with a 24-h exposure. The results indicate that if high levels of H2O2 can be sustained for long periods of time, H2O2 is an effective bactericidal agent, and the presence of LP and SCN- protects streptococci against killing by H2O2. Nevertheless, the combination of LP, H2O2, and SCN- is much more effective than H2O2 alone as an inhibitor of bacterial metabolism and growth.

Longitudinal study of relations between human salivary antimicrobial proteins and measures of dental plaque accumulation and composition

Many studies have attempted to relate levels of antimicrobial proteins in saliva to oral health; results have been inconsistent, and one reason might be inconsistency of measures of plaque and saliva within subjects. This study investigated associations between plaque and salivary variables in longitudinal data. Whole saliva, and 8-h plaque pooled from buccal first permanent molars, was obtained from 32 dental students on Tuesdays from 3:00-6:00 p.m. over 4 weeks. Salivary flow rate was determined, and samples were assayed for lysozyme, lactoferrin, total peroxidase, myeloperoxidase, OSCN-, sIgA and total protein. Colonies on mitis-salivarius agar were assigned to Streptococcus sanguis, Strep. mutans or Strep. salivarius on the basis of morphology, supplemented by the API Rapid Strep identification system. Consistency of values within subjects across weeks was evaluated by repeat-measures analysis of variance and intraclass correlation; data were transformed to reduce skewness. Pearson's r was used to determine associations between plaque and salivary variables. Significant intraclass correlations (alpha = 0.05) were found for all salivary variables except myeloperoxidase, and for total flora, total streptococci, Strep. sanguis and Strep. sanguis as a proportion of total streptococci. Significant Pearson correlations with Strep. sanguis as a proportion of total streptococci were found for total protein (r = -0.24), sIgA (r = -0.22), lactoferrin (r = -0.19) and OSCN- (r = 0.20) when data from all weeks were pooled (n = 128). Strep. sanguis proportions tended to be low in subjects with high values for salivary proteins; the range of proportions was wider in subjects with low salivary values. These findings suggest some consistency of weekly values for many plaque and salivary variables. They also support previous cross-sectional data which suggested that salivary antimicrobial proteins may have some effect on plaque composition. This study was made before recent revisions in streptococcal taxonomy, and further research is needed to clarify interactions of salivary proteins with currently defined species.

Concentrations of thiocyanate, hypothiocyanite, 'free' and 'total' lysozyme, lactoferrin and secretory IgA in resting and stimulated whole saliva of children aged 12-14 years and the relationship with plaque accumulation and gingivitis

Resting and stimulated whole saliva was collected from 94 children aged 12-14 years and analyzed for thiocyanate, hypothiocyanite, 'free' and 'total' lysozyme, lactoferrin and secretory IgA. Clinical assessments of the amounts of plaque and gingival inflammation were made, and plaque was collected for determination of dry weight. An inverse relationship was observed between salivary thiocyanate concentrations in both resting and stimulated saliva and the amounts of plaque and gingival inflammation in these subjects (p < 0.05). Lactoferrin concentration in stimulated saliva was directly related to the amounts of plaque and gingivitis (p < 0.05). 'Total' lysozyme concentration in stimulated saliva was directly related to the amount of plaque (p < 0.05), and the 'free' lysozyme concentration in the same saliva was directly related to the amount of gingivitis (p < 0.05). The direct relationship observed between clinical measurements and both lysozyme and lactoferrin concentrations in saliva may have been due to contributions from gingival crevicular fluid. Cluster analysis identified three groups of subjects with different profiles in resting whole saliva, and in particular with different levels of secretory IgA. A statistically significant difference was observed in the quantity of plaque collected from subjects in two of these groups (p < 0.05). These results from cluster analysis using resting whole saliva from children confirmed the findings of a previous study with young adults.

Lactoperoxidase-catalyzed oxidation of thiocyanate ion: a carbon-13 nuclear magnetic resonance study of the oxidation products

Products formed from the lactoperoxidase (LPO) catalyzed oxidation of thiocyanate ion (SCN-) with hydrogen peroxide (H2O2) have been studied by 13C-NMR at pH 6 and pH 7. Ultimate formation of hypothiocyanite ion (OSCN-) as the major product correlates well with the known optical studies. The oxidation rate of SCN- appears to be greater at pH < or = 6.0. At [H2O2]/[SCN-] ratios of < or = 0.5, OSCN- is not formed immediately, but an unidentified intermediate is produced. At [H2O2]/[SCN-] > 0.5, SCN- appears to be directly oxidized to OSCN-. Once formed, OSCN- slowly degrades over a period of days to carbon dioxide (CO2), bicarbonate ion (HCO3-), and hydrogen cyanide (HCN). An additional, previously unrecognized product also appears after formation of OSCN-. On the basis of carbon-13 chemical shift information this new species is suggested to result from rearrangement of OSCN- to yield the thiooxime isomer, SCNO- or SCNOH.

Inhibition of Candida albicans by the Peroxidase/SCN-/H2O2 system

Effects of the salivary peroxidase (SPO) system on the growth, glucose uptake and metabolic activities of oral bacteria are well documented but the effects on oral fungi are virtually unknown. Therefore, the viability of Candida albicans (ATCC 28366) exposed to the peroxidase/SCN-/H2O2 system was studied in sterilized saliva, in phosphate-buffered saline (PBS) and in potassium chloride. The growth of C. albicans in glucose-supplemented saliva was faster at pH 5.5 than at pH 7. The addition of the complete SPO (or lactoperoxidase) system to either sterilized saliva, KCl (50 microM) or PBS at pH 5.5 inhibited dose-dependently the viability of C. albicans in KCl, but no inhibition was found in PBS or saliva. Maximal inhibition was achieved in 2 h and with > 320 microM of peroxidase-generated HOSCN/OSCN-. However, physiological salivary concentrations of phosphate (> or = 1.0 mM) and PBS blocked the antifungal effect of HOSCN/OSCN-. The relative proportions of SCN- and H2O2 were critical to the antifungal effects. With 0.2 mM KSCN, a complete loss of viability was achieved, though the HOSCN/OSCN- concentrations did not exceed 100 microM. It is concluded that C. albicans is sensitive to HOSCN/OSCN- but salivary concentrations of phosphate block the antifungal effect of the peroxidase systems.

Lysozyme enhances the inhibitory effects of the peroxidase system on glucose metabolism of Streptococcus mutans

The combined effect of the salivary peroxidase system and lysozyme on the glucose uptake of Streptococcus mutans NCTC 10449 was investigated. The bacteria were grown to late-exponential phase, washed, re-suspended in buffer at pH6, and incubated with (1) 50 micrograms/mL lysozyme from human milk for 60 min; (2) 7-15 mumol/L hypothiocyanous acid/hypothiocyanite for 10 min; and (3) lysozyme for 60 min prior to addition of and incubation with hypothiocyanous acid/hypothiocyanite for 10 min. Glucose uptake was initiated by adding the bacterial suspensions to 10 mL of pre-warmed 50 mumol/L glucose containing 0.98 mumol/L D-(U-14C-)-glucose, and the mixture was incubated in a shaking water-bath at 37 degrees C. Samples were withdrawn at various time intervals, rapidly filtered through 0.45-microns membranes, washed with ice-chilled buffer, and the incorporated radioactivity determined. Lysozyme stimulated S. mutans glucose uptake slightly, but significantly inhibited S. rattus glucose metabolism. A 20-30% inhibition of radiolabeled glucose incorporation was observed with hypothiocyanous acid/hypothiocyanite alone. Incubation of the bacteria with lysozyme prior to addition of hypothiocyanous acid/hypothiocyanite containing peroxidase resulted in a total inhibition of the glucose uptake. In contrast, lysozyme in combination with hypothiocyanous acid/hypothiocyanite without peroxidase gave only a 30-50% inhibition. The addition of 5 mmol/L dithiothreitol after incubation with lysozyme and hypothiocyanous acid/hypothiocyanite eliminated the inhibition of the bacterial glucose uptake. The viability of S. mutans was not affected by treatment with any of the components used. Our results indicate that physiological concentrations of lysozyme and the salivary peroxidase system components have a synergistic effect which results in a significant inhibition of glucose metabolism by S. mutans.

The relationship between 48-h dental plaque accumulation in young human adults and the concentrations of hypothiocyanite, 'free' and 'total' lysozyme, lactoferrin and secretory immunoglobulin A in saliva

Samples of resting and stimulated whole saliva and stimulated parotid saliva were collected from 40 young adults. One week later, after 48 h on a standardized diet without oral hygiene, all available plaque was collected for dry weighing. An inverse relationship was found between the 'free' lysozyme concentration in stimulated parotid saliva and plaque dry weight (r = -0.46, p less than 0.01). There were no other statistically significant correlation coefficients between concentrations of individual salivary constituents and plaque dry weight. However, cluster analysis of constituents in resting whole saliva revealed three groups of subjects with different salivary profiles, and in particular with different concentrations of both IgA and hypothiocyanite. Subsequent analysis revealed differences in plaque dry weight between the groups, demonstrating the potential biological significance of cluster membership based on salivary factors.

Antimicrobial proteins in human unstimulated whole saliva in relation to each other, and to measures of health status, dental plaque accumulation and composition

Saliva antimicrobial proteins may interact in a common system to influence the oral ecology. Clinical studies of antimicrobial protein action thus may require a multiple-protein approach. Multivariate statistical methods have been used to describe possible patterns of interaction for lysozyme, lactoferrin, salivary peroxidase and secretory IgA in stimulated parotid saliva. However, oral microbes are most likely to encounter antimicrobial proteins in mixed resting saliva. Relationships among levels of lysozyme, lactoferrin, salivary peroxidase, and secretory IgA therefore were investigated in whole saliva from 216 subjects, and an attempt made to relate interperson variation in those proteins to differences in health and status, and dental plaque accumulation and composition. All proteins were significantly (alpha = 0.05) correlated with each other (r = 0.38-0.52, p less than 0.001). There was only one axis of common variation among proteins, and that axis was significantly correlated (p less than 0.001) with total protein (r = 0.84) and flow rate (r = -0.56). That pattern deviated from the previous finding that proteins of acinar origin tended to vary independently from proteins of ductal origin in stimulated parotid saliva. The difference between parotid and whole saliva may reflect constitutive secretion of all proteins at low levels of stimulation. Common variation of unstimulated saliva proteins suggests that antimicrobial actions can be compared in subjects at population extremes. There were no significant associations between antimicrobial proteins in whole saliva and measures of health status or plaque accumulation. However, the proportions of Streptococcus sanguis were significantly correlated with lysozyme (r = -0.26), lactoferrin (r = -0.34), peroxidase (r = -0.30), total protein (r = -0.37), flow rate (r = 0.24) and principal-components scores (r = -0.33) in a subset of subjects (n = 85) where commercial biochemical tests were used to supplement species identification by colony morphology. Those findings may indicate that saliva antimicrobial proteins can affect the composition of dental plaque.

Cytotoxic properties of salivary oxidants

Salivary peroxidase and to a lesser extent myeloperoxidase are present in significant concentrations in saliva and catalyze the oxidation of thiocyanate anion (SCN-) by H2O2 to yield the potent oxidants hypothiocyanous acid (HOSCN) and its conjugate base hypothiocyanite anion (OSCN-). The objective of this study was to characterize the cytotoxic potential of peroxidase-generated HOSCN/OSCN- toward human erythrocytes. We found that HOSCN/OSCN- (0.25 mM) generated by the peroxidase-H2O2-SCN- system caused significant hemolysis at pH 6.0 but not at pH 6.5, 7.0, or 7.4. Erythrocyte hemoglobin (OxyHb) was oxidized to methemoglobin (MetHb) at all pH values tested; however, the rate of MetHb formation was dramatically increased at low pH and was not affected by inosine hexaphosphate, suggesting that hemoglobin was oxidized primarily by HOSCN. Concurrent with oxidation of hemoglobin (Hb), there was a pH-dependent consumption of HOSCN/OSCN- with more of the oxidant consumed at pH 6.0 compared with pH 6.5, 7.0, or 7.4. The enhanced oxidation of Hb at acidic pH was not due simply to increased membrane permeability by the uncharged species (HOSCN), since both erythrocyte lysate Hb and purified Hb were oxidized to the same extent at low pH as were intact erythrocytes. It is concluded that both OSCN- and HOSCN enter human erythrocytes where the protonated oxidant (HOSCN) mediates hemolysis and oxidizes OxyHb to MetHb, whereas both HOSCN and OSCN- oxidize glutathione (GSH). These data suggest that the extracellular pH may play an important role in modulating the cytotoxic properties of salivary oxidants.

Antimicrobial systems of human whole saliva in relation to dental caries, cariogenic bacteria, and gingival inflammation in young adults

The association of salivary antibody (total IgA, IgG, and IgM and antibodies reactive with Streptococcus mutans) and non-antibody (lysozyme, lactoferrin, salivary peroxidase, myeloperoxidase, hypothiocyanite, thiocyanate) defense factors with oral health (past and present dental caries, gingival bleeding, the number of salivary S. mutans and lactobacilli) were studied in 50 naval recruits. Dental caries was significantly associated with large amounts of S. mutans, lactobacilli, and total salivary immunoglobulins and with low salivary flow rate and buffer capacity. Salivary anti-S. mutans antibodies did not correlate with dental caries or S. mutans levels. Moreover, none of the salivary non-antibody factors alone had any strong relationship to dental caries or S. mutans levels. Gingival inflammation was associated with elevated levels of lysozyme in whole saliva. It is concluded that in adults the associations between single-point measurements of most salivary antimicrobial constituents and the factors describing oral health are weak.

Is thiocyanate peroxidation at equilibrium in vivo?

The peroxidase-catalyzed oxidation of SCN- by H2O2 is an important in vivo reaction because it limits the accumulation of toxic H2O2 and provides significant concentrations of the antimicrobial agents, HOSCN and OSCN-. Data presented in this report suggest that the reaction: (Formula: see text) is in a state of dynamic equilibrium in vivo. Since OSCN- can form the weak acid HOSCN (pKa = 5.3), the equilibrium constant expression (Kox) for thiocyanate peroxidation is dependent on the concentration of hydrogen ions as well as the concentrations of H2O2, SCN-, HOSCN, OSCN- and water, and on the HOSCN ionization constant, Ka: (Formula: see text). The concentration of water is assumed to be constant and unaffected by the other components and is omitted from the Kox equation. The value of Kox was estimated from in vitro data to be 3.7 X 10(3) M-1 (S.D. = 0.8 X 10(3) M-1, n = 8). Using this value for Kox and observations of salivary concentrations of SCN- and HOSCN + OSCN- from several previous reports, the equilibrium concentrations of H2O2 in whole saliva were calculated to range from 8 to 13 microM. This range is consistent with reported estimates of 10 microM as the hydrogen peroxide tolerance limit for human cells.

Human parotid proline-rich proteins: correlation of genetic polymorphisms to dental caries

Parotid saliva contains a variety of proline-rich proteins. This study found that, among 306 children between the ages of 5 to 15 years, there is a significant increase in the decayed-missing-filled tooth surface (DMFS) score of the permanent teeth with age in children with the specific proline-rich protein phenotypes Pa and Pr. However, the increase in DMFS score of the permanent teeth of children was significantly greater in children with Pa+ and Pr22 than in those with the other phenotypes (Pa- or Pr11 and Pr12). The previously established close correlation between the Pa and Pr phenotypes and the genetic variants of salivary peroxidase (a powerful antibacterial system in the oral cavity) may provide an explanation for the relationship of certain proline-rich protein phenotypes to dental caries.

The role of H2O2 and the lactoperoxidase-SCN(-)-H2O2 system on the interaction between two bacteria originating from human dental plaque, Streptococcus rattus (mutans) BHT and Streptococcus mitior LPA-1, grown on human teeth in an artificial mouth

Teeth were inoculated with either the organisms separately or with a freshly-prepared mixture of both. The apparatus was swept with 5 per cent (v/v) CO2 in either air or N2, and incubated for 90 h. A nutrient supplement containing 1 per cent (w/v) glucose was supplied for 1 h in every 6 h. Both organisms achieved similar numbers when grown aerobically in pure culture, yet in mixed culture there was pronounced inhibition of BHT (p less than 0.001). When the synthetic saliva was supplemented with catalase the strain BHT count in mixed culture was much higher (p less than 0.001). It was concluded, therefore, that the strain LPA-1 produced inhibitory levels of hydrogen peroxide (H2O2) on the tooth surface under aerobic conditions. This was supported by finding that a lower viable count of LPA-1 in pure culture was attained when lactoperoxidase (LPO) was included in the saliva (p less than 0.005), as all components of the LPO-SCN-H2O2 system were presumably present. With the N2-CO2 mixture, conditions were not strictly anaerobic and both catalase and LPO increased all viable counts. Under these conditions, therefore, when H2O2 was limiting, LPO protected bacteria against its bactericidal effect.

Relationship of the human salivary peroxidase system to oral health

The human salivary peroxidase system (SPS) contributes in several ways to the maintenance of good oral health. The SPS is one of the non-immunoglobulin defense factors which regulate the quantity and species distribution of oral micro-organisms. The SPS also prevents toxic accumulations of hydrogen peroxide (H2O2) and it inactivates many carcinogenic and mutagenic compounds. The salivary glands secrete a peroxidase enzyme (salivary peroxidase) as well as the thiocyanate ion (SCN-, derived from diet). The enzyme catalyzes the oxidation of SCN- by hydrogen peroxide (H2O2). The H2O2 is excreted by oral bacteria and by host cells in amounts which vary with the state of cellular metabolism, the diet and other factors. Oxidized forms of SCN- temporarily inhibit the growth, respiration and metabolism of most species of oral bacteria. The major oxidized form generated in the mouth is the hypothiocyanite ion (OSCN-) which must reach a minimum threshold concentration before bacterial inhibition occurs. This threshold concentration varies from species to species. The concentration of OSCN- in the mouth rises and falls with the availability of H2O2. This natural rise and fall, together with bacterial variation in sensitivity to OSCN- inhibition, suggests a role for the SPS in the regulation of the oral microflora. As a result of the rapid consumption of H2O2 by the SPS, host cells are protected from a toxic build up of this potent oxidizing agent. The major product of the reaction, OSCN-, does not harm human cells. Many carcinogenic and mutagenic compounds may serve as substrates for the SPS and be oxidized to less harmful compounds.

The protective effect of peroxidase and thiocyanate against hydrogen peroxide toxicity assessed by the uptake of [3H]-thymidine by human gingival fibroblasts cultured in vitro

The hypothiocyanite ion (OSCN-) is the principal oxidation product of the salivary peroxidase-thiocyanate (SCN-)-hydrogen peroxide antimicrobial system. Supplementation of human saliva in vitro and in vivo with low amounts (less than 1.0 mM) of hydrogen peroxide increase the concentration of salivary OSCN- (in vivo up to 0.3 mM). Elevated concentrations of OSCN- are strongly antimicrobial and may therefore be protective against dental caries. However, as OSCN- is a highly-reactive oxidizing agent, its possible toxic effect on human cells was studied using gingival fibroblasts as target cells. Concentrations of OSCN- (up to 300 microM) had no effect on [3H]-thymidine incorporation into the cells. However, fibroblasts were sensitive to peroxide so that 100 microM of H2O2 caused over 80 per cent reduction in [3H]-thymidine incorporation. The toxicity of H2O2 could be entirely prevented by adding lactoperoxidase and SCN- to the cell culture before the addition of peroxide. Thus, conversion of toxic H2O2 to non-toxic OSCN- in fibroblast culture by lactoperoxidase and SCN- suggests a dual role for the salivary peroxidase system: protection of human cells from H2O2 toxicity and antimicrobial action against oral pathogens. Furthermore, the elevated concentrations of OSCN- which produce inhibition of bacterial metabolism did not damage human cells.

A mouthrinse which optimizes in vivo generation of hypothiocyanite

We report here the properties of a mouthrinse which enhances one of the natural defense factors in human saliva, the salivary peroxidase system. Concentrations of the antimicrobial agent, the hypothiocyanite (OSCN-) ion, can be increased in vivo to bacteriostatic levels by use of a mouthrinse which is 4 mM (0.014%) in hydrogen peroxide and 1 mM (0.0097%) in potassium thiocyanate at pH 5.5. The volume of the rinse, the H2O2 concentrations, and the pH were shown to be determinants of the concentration of OSCN- generated by the rinse.

Effect of growth phase and cell envelope structure on susceptibility of Salmonella typhimurium to the lactoperoxidase-thiocyanate-hydrogen peroxide system

The lactoperoxidase-thiocyanate-hydrogen peroxide system was found to have both bacteriostatic and bactericidal activities against strains of Salmonella typhimurium. The bactericidal activity was clearly dependent on the permeability of the bacterial cell envelope. The deep rough mutant TA1535, with the most permeable cell envelope, was killed both at neutral and acid pH, whereas very little or no killing was observed with the intact cells of the parent strain hisG46. The delta gal mutant, TA1530, representing an intermediate in cell envelope permeability, was inhibited to a much lesser extent than TA1535. Bacteria in log phase of growth were more sensitive to the bactericidal effects than were those in stationary phase. Growth phase had little influence on the bacteriostatic effects. The hisG46 strain produced significant quantities of acid in the presence of glucose. This acid production was inhibited by the lactoperoxidase-thiocyanate-hydrogen peroxide system, and, in contrast to results obtained with several strains of streptococci, this inhibition was not reversed by addition of a reducing agent (2-mercaptoethanol).

Peroxidase-thiocyanate-peroxide antibacterial system does not damage DNA

The hypothiocyanite ion (OSCN(-)) is a normal component of human saliva. It is a highly reactive oxidizing agent, and at concentrations above the values normally found in human saliva, it inhibits the growth and metabolism of oral bacteria. This finding has led to the suggestion that antibacterial properties of human saliva might be enhanced in vivo by appropriate supplements which elevate OSCN(-) concentrations. Since DNA is sensitive to oxidizing agents (hydrogen peroxide attacks nucleosides), high concentrations of OSCN(-) in human saliva might damage DNA and produce deleterious effects on the oral mucosa. In the present study, the effect of high OSCN(-) concentrations on several mutagen-sensitive Salmonella typhimurium strains was determined. These strains are used to detect base-pair substitutions and frameshift mutations. We also studied the effects of OSCN(-) on a Saccharomyces cerevisiae (yeast) strain commonly employed as a test cell for evaluating the potential of a compound to produce gene conversion, mitotic crossing-over, or reverse mutation. By recording the UV spectra of mixtures of calf thymus DNA and OSCN(-), we explored the possible in vitro reactions of this oxidizing agent with eucaryotic genetic material. Our results show that, at concentrations above 10 muM, OSCN(-) is toxic for the tested Salmonella typhimurium strains. The mutant strains with defects in cell wall lipopolysaccharides are killed more readily by OSCN(-) than is the strain lacking these defects. However, OSCN(-) was not mutagenic for any of the tested strains. Saccharomyces cerevisiae was not affected by OSCN(-) even at concentrations above 800 muM. Calf thymus DNA was not oxidized by OSCN(-). We conclude that the elevated concentrations of OSCN(-) required to produce antibacterial effects in the human mouth pose no threat to the genetic material of host tissues.

Detection of the hypothiocyanite (OSCN-) ion in human parotid saliva and the effect of pH on OSCN- generation in the salivary peroxidase antimicrobial system

Human whole saliva contains the hypothiocyanite ion (OSCN-) which is the principal antimicrobial product of the salivary peroxidase system. The peroxidase system requires a source of peroxide in order to produce OSCN- and in the human mouth this source has been assumed to be primarily the peroxidogenic oral bacteria. However, we report here studies which show that samples of stimulated human parotid saliva collected directly from Stenson's duct have concentrations of OSCN- which are similar to those found in human whole saliva. Thus, the peroxidogenic bacteria are not an absolute requirement for the generation of significant levels of OSCN- in the human mouth. Supplementation of human whole saliva with components [thiocyanite (SCN-), hydrogen peroxide (H2O2)] of the peroxidase system produces a 10-fold or greater increase in OSCN- concentration. However, the magnitude of this increase is critically dependent upon pH and upon the relative and absolute concentrations of SCN- and H2O2. The pH dependence of OSCN- generation is similar for human whole saliva and for the lactoperoxidase/SCN-/H2O2 system. The optimum is in the range 6.5-7.0. Samples of parotid saliva adjusted to pH 6.5 and supplemented with appropriate amounts of SCN- and H2O2 show increases in OSCN- concentrations which are similar to those observed with whole saliva. The results show that there is a significant source of H2O2 within the parotid gland, that the OSCN- generating potential of parotid saliva is similar to that of whole saliva and that the enhancement of OSCN- levels in saliva by addition of SCN- and H2O2 is critically dependent upon pH and upon the relative and absolute concentrations of H2O2 and SCN-.