Theranostic nanoplatforms of emodin-chitosan with blue laser light on enhancing the anti-biofilm activity of photodynamic therapy against Streptococcus mutans biofilms on the enamel surface

Development of photodynamic therapy in treating oral diseases

The morbidity of oral disorders, including gingivitis, caries, endodontic-periodontal diseases, and oral cancer, is relatively high globally. Pathogenic cells are the root cause of many oral disorders, and oral therapies depend on eradicating them. Photodynamic therapy (PDT) has been established as a potential and non-invasive local adjuvant treatment for oral disorders. PDT consists of three essential components: photosensitizer (PS), a light source with a certain wavelength, and oxygen dissolved in the cells. These three components can interact to cause damage to proteins, lipids, nucleic acids, and other biological components within diseased tissues. Herein, we aimed to provide a detailed understanding of PDT and how it can treat oral diseases. Concerns about PDT and potential remedies are also a factor. PDT has been shown in numerous clinical studies to be an efficient supplementary therapy that can reduce pathogenic cells. The PDT has great potential for dental applications, including treating bacterial and fungal infections during root canal therapy and preventing oral cancer, potentially malignant disorders, periodontitis, dental caries, and peri-implant disorders. Although PDT has been promoted as having significant potential and utility in dentistry, more clinical research must be conducted before being used broadly.

Chitosan-Based Multifunctional Biomaterials as Active Agents or Delivery Systems for Antibacterial Therapy

Antibiotic therapy has been a common method for treating bacterial infections over the past century, but with the rise in bacterial resistance caused by antibiotic abuse, better control and more rational use of antibiotics have been increasingly demanded. At the same time, a journey to explore alternatives to antibiotic therapies has also been undertaken. Chitosan and its derivatives, materials with good biocompatibility, biodegradability, and excellent antibacterial properties, have garnered significant attention, and more and more studies on chitosan and its derivatives have been conducted in recent years. In this work, we aim to elucidate the biological properties of chitosan and its derivatives and to track their clinical applications, as well as to propose issues that need to be addressed and possible solutions to further their future development and application.

Recent progress in understanding the role of bacterial extracellular DNA: focus on dental biofilm

Dental biofilm is a highly complicated and dynamic structure comprising not only microbial communities but also the surrounding matrix of extracellular polymeric substances (EPS), including polysaccharides, proteins, extracellular DNA (eDNA) and other biopolymers. In recent years, the important role of bacterial eDNA in dental biofilms has gradually attracted attention. In this review, we present recent studies on the presence, dynamic conformation and release of oral bacterial eDNA. Moreover, updated information on functions associated with oral bacterial eDNA in biofilm formation, antibiotic resistance, activation of the immune system and immune evasion is highlighted. Finally, we summarize the role of oral bacterial eDNA as a promising target for the treatment of oral diseases. Increasing insight into the versatile roles of bacterial eDNA in dental biofilms will facilitate the prevention and treatment of biofilm-induced oral infections.

Marine polysaccharides for antibiofilm application: A focus on biomedical fields

Microbial pathogens such as bacteria and fungi form biofilms, which represent substantial hurdles in treating human illness owing to their adaptive resistance mechanism to conventional antibiotics. Biofilm may cause persistent infection in a variety of bodily areas, including wounds, oral cavity, and vaginal canal. Using invasive devices such as implants and catheters contributes significantly to developing healthcare-associated infections because they offer an ideal surface for biofilm formation. Marine organisms produce a variety of polysaccharides, which have recently attracted worldwide attention due to their biochemical features, various applications, and advantageous properties such as bioactivity, biodegradability, and biocompatibility. Because of their antimicrobial and antibiofilm features, several polysaccharides such as chitosan, fucoidan, carrageenan, alginate, and hyaluronic acid have been used to treat infected wounds as well as ophthalmic, oral, and vaginal infections. In addition, marine polysaccharides are currently employed as coatings on medical devices and implant materials, alone or in combination with other bioactive substances or nanomaterials, to protect the materials' undertones from microbial contamination. This review discussed the recent advancements in marine polysaccharides and their derivatives as a therapeutic potential against biofilm-associated diseases. The potential obstacles in the scalability of their production, clinical translation, and/or regulatory hurdles have also been discussed.

Study on the Hepatotoxicity of Emodin and Its Application in the Treatment of Liver Fibrosis

Emodin (EMO) is an anthraquinone compound derived from Rheum palmatum L., which has rich pharmacological activity. However, studies have shown that EMO may cause hepatotoxicity. In this study, EMO was combined with tetrandrine and prepared as lipid nanoparticles (E-T/LNPs). The anti-liver fibrosis activity of EMO before and after formulation was evaluated by zebrafish and mice. In addition, the toxicity of EMO and E-T/LNPs was compared and the toxicity-efficacy concentrations of E-T/LNPs in zebrafish were verified. E-T/LNPs are morphologically stable (particle size within 100 nm), have high encapsulation efficiency and good stability, and are capable of long-lasting slow release in vitro. The combination and preparation can reduce the toxicity and enhance the effect of EMO, and increase the toxicity and effect concentration of E-T/LNPs in vivo. In a short period, low doses of E-T/LNPs can be used for the treatment of liver fibrosis; high doses of E-T/LNPs cause toxicity in vivo. Immunohistochemistry showed that E-T/LNPs inhibited hepatic fibrosis by downregulating the levels of IL-1β and TGF-β. Based on the advantages of combination therapy and nanotechnology, it can play a role in reducing the toxicity and increasing the efficacy of EMO in the treatment of liver fibrosis.

Photodynamic therapy on mRNA levels in bacteria

Antimicrobial photodynamic therapy (aPDT) has shown efficacy in inactivating different bacterial species by photosensitizer-induced free radical production. Despite aPDT is considered unable to cause resistant strains, enzymatic pathways for detoxification of reactive oxygen species and transmembrane photosensitizer efflux systems could cause resistance to aPDT. Resistance mechanisms can be evaluated by measurement of mRNA from by quantitative reverse transcription polymerase chain reaction (RT-qPCR). Thus, the aim of this study was to access the mRNA level data obtained by RT-qPCR in bacterial cells submitted to photodynamic therapy. Studies performed on mRNA levels in bacteria after PDT were assessed on MEDLINE/Pubmed. The mRNA levels from genes related to various functions have been successfully evaluated in both Gram-positive and -negative bacteria after aPDT by RT-qPCR. Such an approach has improved the understanding of aPDT-induced effects, and reinforced the effectiveness of aPDT on bacteria, which can cause infections in different human tissues.

In vitro effects of antimicrobial properties and shear bond strength of different concentrations of Emodin nanoparticles incorporated orthodontic composites

OBJECTIVE

Fixed appliances used in orthodontic treatment are accompanied by some drawbacks, including the development of white spots or enamel demineralization in the vicinity of the brackets and bonding failures. This study aims to evaluate the effect of combining different wt.% of Emodin nanoparticles (ENPs) with orthodontic adhesives to attain adhesives with improved antimicrobial and mechanical properties.

METHODS

ENPs were synthesized and added to orthodontic composite at different concentrations (0.5%, 1%, and 2%). The distribution of ENPs within the composite was evaluated using a field emission scanning electron microscope (FESEM). A total of 216 disks were prepared, with 144 subjected to an eluted components test, 36 used for disk agar diffusion (DAD) test, and 36 for biofilm inhibition test. These tests aimed to assess the antimicrobial activity of the composites against Streptococcus mutans, Lactobacillus acidophilus, and Candida albicans. Additionally, the bond strength between stainless-steel brackets and teeth was evaluated using the shear bond strength (SBS) test, and the adhesive remnant index (ARI) score was determined. One-way analysis of variance and Kruskal-Wallis test were used to analyse the SBS and ARI, respectively. For pairwise group comparison concerning the biofilm inhibition, DAD, and eluted components tests, the Tamhane and Games-Howell tests for data with unequal variances and the post-hoc Tukey's HSD and Scheffe tests for data with equal variances were used.

RESULTS

The FESEM results confirmed the synthesis and even distribution of ENPs in the composite. Only the 2% group showed significant biofilm inhibition against all microorganisms studied (P<0.05). The DAD test revealed that a 1% concentration of ENPs is sufficient to inhibit growth for all microorganisms. The eluted components test demonstrated that the 2% concentration of ENPs performed significantly better against S. mutans compared to the control group (P<0.05). The highest mean SBS was observed with the 0.5% ENP concentration, while no significant differences in SBS and ARI were found among the groups (P>0.05).

CONCLUSIONS

This in vitro study showed that the 2% concentration of ENP produced significantly improved antimicrobial activity without adversely affecting SBS and ARI score. This would support the addition of 2% ENP to orthodontic adhesives.

Neuroprotective, Anti-Inflammatory and Antifibrillogenic Offerings by Emodin against Alzheimer's Dementia: A Systematic Review

Background: Alzheimer's disease (AD) is among the major causes of dementia in the elderly and exerts tremendous clinical, psychological and socio-economic constraints. Currently, there are no effective disease-modifying/retarding anti-AD agents. Emodin is a bioactive phytochemical with potent multimodal anti-inflammatory, antioxidant, and antifibrillogenic properties. In particular, emodin may result in significant repression of the pathogenic mechanisms underlying AD. The purpose of this review is to accumulate and summarize all the primary research data evaluating the therapeutic actions of emodin in AD pathogenesis. Methodology: The search, selection, and retrieval of pertinent primary research articles were systematically performed using a methodically designed approach. A variety of keyword combinations were employed on online scholarly web-databases. Strict preset inclusion and exclusion criteria were used to select the retrieved studies. Data from the individual studies were summarized and compiled into different sections, based upon their findings. Results: Cellular and animal research indicates that emodin exerts robust multimodal neuroprotection in AD. While emodin effectively prevents tau and amyloid-beta (Aβ) oligomerization, it also mitigates their neurotoxicity by attenuating neuroinflammatory, oxidative, and bioenergetic defects. Evidences for emodin-mediated enhancements in memory, learning, and cognition were also found in the literature. Conclusion: Emodin is a potential anti-AD dietary supplement; however, further studies are warrantied to thoroughly understand its target players and mechanisms. Moreover, human clinical data on emodin-mediated amelioration of AD phenotype is largely lacking, and must be addressed in the future. Lastly, the safety of exogenously supplemented emodin must be thoroughly evaluated.

The Use of Photoactive Polymeric Nanoparticles and Nanofibers to Generate a Photodynamic-Mediated Antimicrobial Effect, with a Special Emphasis on Chronic Wounds

This review is concerned with chronic wounds, with an emphasis on biofilm and its complicated management process. The basics of antimicrobial photodynamic therapy (PDT) and its underlying mechanisms for microbial eradication are presented. Intrinsically active nanocarriers (polydopamine NPs, chitosan NPs, and polymeric micelles) that can further potentiate the antimicrobial photodynamic effect are discussed. This review also delves into the role of photoactive electrospun nanofibers, either in their eluting or non-eluting mode of action, in microbial eradication and accelerating the healing of wounds. Synergic strategies to augment the PDT-mediated effect of photoactive nanofibers are reviewed.

Photodynamic therapy empowered by nanotechnology for oral and dental science: Progress and perspectives

Photodynamic therapy (PDT), as a noninvasive therapeutic modality, has significantly revolutionized the contemporary management of oral and dental health. Recently, PDT has witnessed significant technological advancements, especially with the introduction of biomaterials and nanotechnologies, thus highlighting its potential as a multi-functional tool in therapeutics. In this review, our objective was to provide a comprehensive overview of the advancements in nanotechnology-enhanced PDT for the treatment of oral diseases, encompassing dental caries, root canal infection, periodontal disease, peri-implant inflammation, tooth staining, and whitening, as well as precancerous lesions and tumors. Furthermore, we extensively deliberated upon the persisting challenges and prospective avenues of nanotechnology-enhanced PDT in the realm of oral diseases, which will open up new possibilities for the application of nanotechnology-enhanced PDT in clinical implementation.

Formulation and antibacterial properties of lollipops containing of chitosan- zinc oxide nano particles on planktonic and biofilm forms of Streptococcus mutans and Lactobacillus acidophilus

This study aimed to formulate and characterize the experimental lollipops containing chitosan- zinc oxide nanoparticles (CH-ZnO NPs) and investigate their antimicrobial effects against some cariogenic bacteria. The CH-ZnO NPs were synthesized and characterized by X-ray diffraction (XRD), Fourier Transform Infrared Spectroscopy (FTIR) analysis, and Transmission electron microscope (TEM). Then, four groups were made, including lollipops coated with 2 and 4 ml of CH-ZnO NPs, 0.7 ml CH-ZnO NPs incorporated lollipops, and those with no CH-ZnO NPs. Their antibacterial effectiveness against Streptococcus mutans and Lactobacillus acidophilus was evaluated by direct contact test and tissue culture plate method in planktonic and biofilm phases, respectively. Chlorhexidine mouthrinse (CHX) was used as a positive control group. In the planktonic phase, the antibacterial properties of both groups coated with CH-ZnO NPs were comparable and significantly higher than incorporated ones. There was no significant difference between CHX and the lollipops coated with 4 ml of NPs against S. mutans and CHX and two coated groups against L. acidophilus. None of the experimental lollipops in the biofilm phase could reduce both bacteria counts. The experimental lollipops coated with 2 and 4 ml of CH-ZnO NPs could reveal favorable antimicrobial properties against two cariogenic bacteria in the planktonic phase.

Chitosan as a biomaterial for the prevention and treatment of dental caries: antibacterial effect, biomimetic mineralization, and drug delivery

Dental caries is a chronic, progressive disease caused by plaque, influenced by multiple factors and can damage the hard tissues of the teeth. In severe cases, it can also lead to the onset and development of other oral diseases, seriously affecting patients' quality of life. The creation of effective biomaterials for the prevention and treatment of dental caries has become one of the relentless goals of many researchers, with a focus on inhibiting the production of cariogenic plaque and retaining beneficial bacteria, guiding and promoting the reconstruction of dental hard tissues, and delaying the progression of existing caries. Chitosan is a natural cationic polymer extracted from the shells of crustaceans and shellfish. Since its discovery, chitosan has shown to have various biological functions such as antibacterial, biomimetic mineralization, drug delivery, etc., making it one of the most promising biopolymers for new caries prevention and materials of prostheses. Therefore, this article provides an overview of the anti-caries applications of chitosan, which mainly covers the basic research on the application of chitosan in caries prevention and treatment since 2010, with a focus on categorizing and summarizing the following characteristics of chitosan as a caries prevention material, including its antibacterial effect, biomimetic mineralization effect and delivery ability of caries prevention drugs and vaccines. It also explores the limitations of current research on chitosan as a caries prevention biomaterial and the difficulties that need to be focused on and overcome in the future to provide theoretical reference for the clinical implementation of chitosan as a caries prevention biomaterial.

Drug delivery strategies for antibiofilm therapy

Although new antibiofilm agents have been developed to prevent and eliminate pathogenic biofilms, their widespread clinical use is hindered by poor biocompatibility and bioavailability, unspecific interactions and insufficient local concentrations. The development of innovative drug delivery strategies can facilitate penetration of antimicrobials through biofilms, promote drug dispersal and synergistic bactericidal effects, and provide novel paradigms for clinical application. In this Review, we discuss the potential benefits of such emerging techniques for improving the clinical efficacy of antibiofilm agents, as well as highlighting the existing limitations and future prospects for these therapies in the clinic.

Antimicrobial photodynamic therapy against oral biofilm: influencing factors, mechanisms, and combined actions with other strategies

Oral biofilms are a prominent cause of a wide variety of oral infectious diseases which are still considered as growing public health problems worldwide. Oral biofilms harbor specific virulence factors that would aggravate the infectious process and present resistance to some traditional therapies. Antimicrobial photodynamic therapy (aPDT) has been proposed as a potential approach to eliminate oral biofilms via in situ-generated reactive oxygen species. Although numerous types of research have investigated the effectiveness of aPDT, few review articles have listed the antimicrobial mechanisms of aPDT on oral biofilms and new methods to improve the efficiency of aPDT. The review aims to summarize the virulence factors of oral biofilms, the progress of aPDT in various oral biofilm elimination, the mechanism mediated by aPDT, and combinatorial approaches of aPDT with other traditional agents.

Smart dental materials for antimicrobial applications

Smart biomaterials can sense and react to physiological or external environmental stimuli (e.g., mechanical, chemical, electrical, or magnetic signals). The last decades have seen exponential growth in the use and development of smart dental biomaterials for antimicrobial applications in dentistry. These biomaterial systems offer improved efficacy and controllable bio-functionalities to prevent infections and extend the longevity of dental devices. This review article presents the current state-of-the-art of design, evaluation, advantages, and limitations of bioactive and stimuli-responsive and autonomous dental materials for antimicrobial applications. First, the importance and classification of smart biomaterials are discussed. Second, the categories of bioresponsive antibacterial dental materials are systematically itemized based on different stimuli, including pH, enzymes, light, magnetic field, and vibrations. For each category, their antimicrobial mechanism, applications, and examples are discussed. Finally, we examined the limitations and obstacles required to develop clinically relevant applications of these appealing technologies.

Chitosan-Based Smart Biomaterials for Biomedical Applications: Progress and Perspectives

Over the past decade, smart and functional biomaterials have escalated as one of the most rapidly emerging fields in the life sciences because the performance of biomaterials could be improved by careful consideration of their interaction and response with the living systems. Thus, chitosan could play a crucial role in this frontier field because it possesses many beneficial properties, especially in the biomedical field such as excellent biodegradability, hemostatic properties, antibacterial activity, antioxidant properties, biocompatibility, and low toxicity. Furthermore, chitosan is a smart and versatile biopolymer due to its polycationic nature with reactive functional groups that allow the polymer to form many interesting structures or to be modified in various ways to suit the targeted applications. In this review, we provide an up-to-date development of the versatile structures of chitosan-based smart biomaterials such as nanoparticles, hydrogels, nanofibers, and films, as well as their application in the biomedical field. This review also highlights several strategies to enhance biomaterial performance for fast growing fields in biomedical applications such as drug delivery systems, bone scaffolds, wound healing, and dentistry.

Biofilm ecology associated with dental caries: Understanding of microbial interactions in oral communities leads to development of therapeutic strategies targeting cariogenic biofilms

A biofilm is a sessile community characterized by cells attached to the surface and organized into a complex structural arrangement. Dental caries is a biofilm-dependent oral disease caused by infection with cariogenic pathogens, such as Streptococcus mutans, and associated with frequent exposure to a sugar-rich diet and poor oral hygiene. The virulence of cariogenic biofilms is often associated with the spatial organization of S. mutans enmeshed with exopolysaccharides on tooth surfaces. However, in the oral cavity, S. mutans does not act alone, and several other microbes contribute to cariogenic biofilm formation. Microbial communities in cariogenic biofilms are spatially organized into complex structural arrangements of various microbes and extracellular matrices. The balance of microbiota diversity with reduced diversity and a high proportion of acidogenic-aciduric microbiota within the biofilm is closely related to the disease state. Understanding the characteristics of polymicrobial biofilms and the association of microbial interactions within the biofilm (e.g., symbiosis, cooperation, and competition) in terms of their potential role in the pathogenesis of oral disease would help develop new strategies for interventions in virulent biofilm formation.

Caries Management with Non-Metallic Nanomaterials: A Systematic Review

BACKGROUND

Non-metallic nanomaterials do not stain enamel or dentin. Most have better biocompatibility than metallic nanomaterials do for management of dental caries.

OBJECTIVE

The objective of this study is to review the types, properties and potential uses of non-metallic nanomaterials systematically for managing dental caries.

METHODS

Two researchers independently performed a literature search of publications in English using PubMed, Scopus and Web of Science. The keywords used were (nanoparticles OR nanocomposites OR nanomaterials) AND (caries OR tooth decay). They screened the titles and abstracts to identify potentially eligible publications of original research reporting non-metallic nanomaterials for caries management. Then, they retrieved and studied the full text of the identified publications for inclusion in this study.

RESULTS

Out of 2497 resulting publications, this study included 75 of those. The non-metallic nanomaterials used in these publications were categorized as biological organic nanomaterials (n=45), synthetic organic nanomaterials (n=15), carbon-based nanomaterials (n=13) and selenium nanomaterials (n=2). They inhibited bacteria growth and/or promoted remineralization. They could be incorporated in topical agents (29/75, 39%), dental adhesives (11/75, 15%), restorative fillers (4/75, 5%), dental sealant (3/75, 4%), oral drugs (3/75, 4%), toothpastes (2/75, 3%) and functional candies (1/75, 1%). Other publications (22/75, 29%) do not mention specific applications. However, most publications (67/75, 89%) were in vitro studies. Six publications (6/75, 8%) were animal studies, and only two publications (2/75, 3%) were clinical studies.

CONCLUSION

The literature showed non-metallic nanomaterials have antibacterial and/or remineralising properties. The most common type of non-metallic nanomaterials for caries management is organic nanomaterials. Non-metallic nanomaterials can be incorporated into dental sealants, toothpaste, dental adhesives, topical agents and even candies and drugs. However, the majority of the publications are in vitro studies, and only two publications are clinical studies.

Natural products from traditional medicine as promising agents targeting at different stages of oral biofilm development

Oral cavity is an ideal habitat for more than 1,000 species of microorganisms. The diverse oral microbes form biofilms over the hard and soft tissues in the oral cavity, affecting the oral ecological balance and the development of oral diseases, such as caries, apical periodontitis, and periodontitis. Currently, antibiotics are the primary agents against infectious diseases; however, the emergence of drug resistance and the disruption of oral microecology have challenged their applications. The discovery of new antibiotic-independent agents is a promising strategy against biofilm-induced infections. Natural products from traditional medicine have shown potential antibiofilm activities in the oral cavity with high safety, cost-effectiveness, and minimal adverse drug reactions. Aiming to highlight the importance and functions of natural products from traditional medicine against oral biofilms, here we summarized and discussed the antibiofilm effects of natural products targeting at different stages of the biofilm formation process, including adhesion, proliferation, maturation, and dispersion, and their effects on multi-species biofilms. The perspective of antibiofilm agents for oral infectious diseases to restore the balance of oral microecology is also discussed.

Aptamer decorated emodin nanoparticles-assisted delivery of dermcidin-derived peptide DCD-1L: Photoactive bio-theragnostic agent for Enterococcus faecalis biofilm destruction

BACKGROUND

Despite the high success rate of root canal treatment, failures are observed in a broad range of cases. Therefore, the need for novel approaches with the development of new generations of antimicrobial agents and intracellular drug delivery systems as adjunctive therapy is undeniable. In this study, we investigated the antimicrobial effects of antimicrobial photodynamic therapy (aPDT) using dermcidin‑derived peptide DCD‑1L loaded onto aptamer-functionalized emodin nanoparticles (Apt@EmoNp-DCD-1L) against Enterococcus faecalis as one of the most common bacteria involved in recurrent root canal treatment failures.

MATERIALS AND METHODS

Following preparation of EmoNp-DCD-1L, the binding of selected labeled Apt to EmoNp-DCD-1L was performed, followed by the specificity of Apt@EmoNp-DCD-1L to E. faecalis was determined. The antimicrobial potential of aPDT was then assessed after the determination of the minimum inhibitory concentration (MIC) of Apt@EmoNp-DCD-1L. The molecular docking analysis was conducted to evaluate the potential binding modes of EmoNp to the proteins involved in E. faecalis pathogenesis. Eventually, the anti-virulence capacity of Apt@EmoNp-DCD-1L-mediated aPDT was investigated via quantitative real-time PCR (qRT-PCR) assay following measurement of intracellular reactive oxygen species (ROS) generation.

RESULTS

The binding specificity of Apt@EmoNp-DCD-1L to E. faecalis was confirmed by flow cytometry. The results showed that the cell viability of E. faecalis exposed to aPDT groups employing the sub-MIC doses of Apt@EmoNp-DCD-1L (7.8 and 15.6 µM) was significantly reduced compared to the control group (P < 0.05). Also, Apt@EmoNp-DCD-1L in combination with a blue laser light was capable of enhancing the anti-biofilm activity of aPDT against E. faecalis biofilm. Data obtained from the qRT-PCR analysis showed significant downregulation in the expression level of genes involved in bacterial biofilm formation after exposure to aPDT (P < 0.05).

CONCLUSIONS

This in vitro study highlights that aPDT with the minimum concentration of Apt@EmoNp-DCD-1L can be considered as a targeted bio-theragnostic agent for the detection and elimination of E. faecalis in the dispersed and biofilm states.