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Guignon,RDH, MPH, CSP Inflammation and the human microbiome - Stunning revelations about how microbes actually create disease Anne N. Guignon,RDH, MPH, CSP [email protected] 832-971-4540 © 2019 ‣ in-depth health history ‣ tell the truth ‣ assess total needs ‣ provide all op+ons Tina Carvalho © 2019 © 2019 What is a biofilm? A 3-Dimensional “community” of microbes a:ached to a surface • fluid interac=on • channels / pores • complex structure Illustration by Keith Kasnot,: Scientific American, July 2001 © 2019 Emerging Trends in Oral Care - Philips Oral Healthcare Symposium 2003 © 2019 Dr. Bill Costerton - The "Father" of Biofims www.youtube.com/watch?v=M_DWNFFgHbE Dr. Bill Costerton - The "Father" of Biofilms www.youtube.com/watch?v=M_DWNFFgHbE © 2019 Annu Rev Microbiol. 1995;49:711-45. millions of interac=ng microbes Microbial biofilms. Costerton JW, Lewandowski Z, Caldwell DE, Korber DR, Lappin-Scott HM. bacteria / spirochetes / protozoa / fungi / viruses Source Center for Biofilm Engineering, Montana State University, Bozeman 59717, USA. Abstract Direct observations have clearly shown that biofilm bacteria predominate, numerically and metabolically, in virtually all nutrient-sufficient ecosystems. Therefore, these sessile organisms predominate in most of the environmental, industrial, and medical problems and processes of interest to microbiologists. If biofilm bacteria were simply planktonic cells that had adhered to a surface, this revelation would be unimportant, but they are demonstrably and ‣ extracellular polysaccharide - slime profoundly different. We first noted that biofilm cells are at least 500 times more resistant to ‣ proper=es not seen in isolated micro-orGanisms antibacterial agents. Now we have discovered that adhesion triggers the expression of a sigma EPS - polysaccharides, proteins, nucleic acids factor that derepresses a large number of genes so that biofilm cells are clearly phenotypically ‣ distinct from their planktonic counterparts. Each biofilm bacterium lives in a customized ‣ 80% - infec=ous diseases microniche in a complex microbial community that has primitive homeostasis, a primitive ‣ 80% - EPS circulatory system, and metabolic cooperativity, and each of these sessile cells reacts to its ‣ 99% - bacteria in nature - stable, persistent special environment so that it differs fundamentally from a planktonic cell of the same The biofilm primer. J. W. Costerton 2007 species. Maddi A, Scannapieco FA. Oral biofilms, oral and periodontal infections, and systemic disease. Am J Dent. 2013 Oct;26(5):249-54. ‣ 20% - microbes encased in EPS matrix © 2019 © 2019 Biofilms in wounds: management strategies. Rhodes DD, Wolco: RD, Percival SL. J Wound Care. November 2008.17(11). © 2019 Wessel SW, Chen Y, et al. forces and composition of planktonic and adhering oral microbiomes. J Dent Res. 2014 Jan;93(1):84-8. Strength Where do biofilms form? Biofilm facts - solid sub-stratums in ‣ mul=-species contact with moisture ‣ rapid regenera=on via signaling ‣ inter-species coopera=on ‣ tenacious - difficult to remove mechanically - so^ =ssue surfaces in living orGanisms intracellular matrix ‣ resistent - immune system / an=microbials ‣ - liquid-air interfaces - the surface of the ocean ‣ high adhesion to saliva-coated enamel ‣ FEP - func=onally equivalent pathogenicity The biofilm primer. J. W. Costerton 2007 Maddi A, Scannapieco FA. Oral biofilms, oral and periodontal infec=ons, and systemic disease. Am J Dent. 2013 Oct;26(5):249-54. Biofilms in wounds:management strategies. Rhodes DD, Wolcott RD, Percival SL. J Wound Care. November 2008.17(11). The biofilm primer. J. W. Costerton 2007 Wessel SW, Chen Y, et al. forces and composi=on of planktonic and adhering oral microbiomes. J Dent Res. 2014 Jan;93(1):84-8. Oliveira A, Cunha MLRS. Bacterial biofilms with emphasis on coagulase-negative staphylococci. J. Venom. Anim. Toxins incl. Trop. Dis. 2008.14(4): 572-596. http://www.scielo.br © 2019 © 2019 © 2019 Mixed biofilm community - proportions Forming a biofilm ‣ cri=cal density - release pheromones ‣ quorum sensing ‣ altered environment - phenotypic altera=ons in microbes Biofilms in wounds: management strategies. Rhodes DD, Wolco: RD, Percival SL. J Wound Care. November 2008.17(11). Bonnie Bassler: The secret, social lives of bacteria 4/8/2009 h:p://www.youtube.com/watch?v=TVfmUfr8VPA © 2019 © 2019 Costalonga M, Herzberg MC. The oral microbiome and the immunobiology of periodontal disease and caries. Immunology le6ers. 2014;162(2 0 0):22-38. = © 2019 Mixed biofilm community - Candida albicans (opportunis=c fungal pathogen) Liquid flowing through biofilm channels ‣ coadhesion ‣coaggrega=on ‣modified: ‣pH ‣nutrient supply ‣salivary factors ‣highly acidic pH The Great wave of Candida C. albicans, C. glabrata, C. parapsilosis © 2001 Stoodley, P. MSU Center for Biofilm Engineering Jenkinson HF and Douglas LJ. Interactions between Candida Species and Bacteria in Mixed Infections. www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=pmd&part=A2773#A Accessed 7/25/2009 Falsetta ML1, Klein MI, Symbiotic relationship between Streptococcus mutans and Candida albicans synergizes virulence of plaque biofilms in vivo. Infect Immun. 2014 May;82(5):1968-81.© 2019 Cris=na Marcos © 2019 Emerging Trends in Oral Care - Philips Oral Healthcare Symposium 2003 © 2019 Moving biofilm “ripples” in Viscoelastic Properties of S. aureus Biofilm Growth and spontaneous mixed species biofilm detachment of cell cluster Tap water biofilm 20 hour sequence P. aeruginosa P. fluorescens K. pneumoniae - common on skin S. maltophilia - natural flora - oral / nasal / vaginal - opportunis=c pathogen - nosocomial infec=ons © 2001 Stoodley, P. MSU Center for Biofilm Engineering © 2001 Stoodley, P. MSU Center for Biofilm Engineering Emerging Trends in Oral Care - Philips Oral Healthcare Symposium 2003 Emerging Trends in Oral Care - Philips Oral Healthcare Symposium 2003 © 2019 © 2019 © 2019 Shear induced creep and failure © 2001 Stoodley, P. MSU Center for Biofilm Engineering http://www.erc.montana.edu/biofilmbook/MODULE_01/Mod01_Blue/Mod01_S04_Blue.htm Accessed 7/25/09 © 2019 © 2019 http://www.erc.montana.edu/biofilmbook/MODULE_01/Mod01_Blue/Mod01_S04_Blue.htm Accessed 7/25/09 © 2019 Understanding the trouble makers - microbial defenses that make it hard to treat disease http://www.npuap.org/NPUAP%20Biofilms%202009%20Schultz%20mod%202%20compressed-1.pdf Bertesteanu S, Triaridis S, et al. Polymicrobial wound infec=ons: pathophysiology and current therapeu=c approaches. Int J Pharm. 2014 Mar 25;463(2):119-26. © 2019 h:p://www.erc.montana.edu/biofilmbook/MODULE_07/Mod07_S03_Blue.htm Accessed 7/25/09 © 2019 Layers pH and oxygen levels vary in biofilms surface microbes - most ac+ve ‣ most suscep=ble - an=microbials/host defenses deeper layers - sheltered ‣ less metabolically ac=ve ‣ more resistant - an=microbial therapies ‣ can recons=tute biofilm (persisters) http://www.cbe.montana.edu/biofilmbook/MODULE_07/Mod07_S01-2_Blue.htm Biofilms in wounds:management strategies. Rhodes DD, Wolcott RD, Percival SL. J Wound Care. November 2008.17(11). http://www.erc.montana.edu/biofilmbook/MODULE_01/Mod01_Blue/Mod01_S04_Blue.htm Accessed 7/25/09 © 2019 © 2019 © 2019 Resistance Antibiotic resistance - 1,000x greater adapts to stresses resistant to ‣as compared planktonic ‣ ultraviolet light ‣to antibiotics and biocides ‣ biocides biofilm-related infeCtions ‣ an=bio=cs can’t be treated with ‣ host defenses conventional antibiotic therapy management - mul+ple, concurrent strategies http://www.npr.org/sections/health-shots/2016/09/08/492965889/watch-bacteria-invade-antibiotics-and-transform-into-superbugs? Biofilms in wounds:management strategies. Rhodes DD, Wolcott RD, Percival SL. J Wound Care. November 2008.17(11). Sauer K, Thatcher E. et al. Biofouling 2009;25(1):45-54. © 2019 © 2019 utm_campaign=storyshare&utm_source=twitter.com&utm_medium=social Chronic wounds Chronic wound infections Host impairment ‣ immune system can’t clear ‣ barrier to healing ‣ repe==ve trauma ‣ an=microbial resistant ‣ anaerobes - chronic wounds ‣ hyperglycemia ‣ suscep=ble to contamina=on ‣ poor perfusion ‣ systemic / topical ‣ molecular techniques ‣ presence of a foreign body ‣ available substrate ‣ malnutri=on ‣ frequent debridement cri+Cal ‣ white blood cell disfunc=on ‣ diverse popula+ons ‣ surface for a:achment ‣ pressure www.erc.montana.edu/biofilmbook/MODULE_07/Mod07_S04-2_Blue.htm Accessed 11/11/09 © 2019 Biofilms in wounds: management strategies. Rhodes DD, Wolco: RD, Percival SL. J Wound Care. November 2008.17(11). © 2019 www.erc.montana.edu/biofilmbook/MODULE_07/Mod07_S04-2_Blue.htm Accessed 11/11/09 © 2019 Chronic wound infections Oral biofilm survival - Ecological plaque hypothesis - inflammatory periodontal disease making inflammation a lifestyle ‣ polymicrobial biofilms ‣ clinical aspects resemble other biofilm infec=ons Marsh PD, Mo:er A, Devine D. Dental plaque biofilms: Communi=es, conflict and control. Periodontology 2000, Vol. 55, 2011, 16–35. www.erc.montana.edu/biofilmbook/MODULE_07/Mod07_S04-2_Blue.htm Accessed 11/11/09 © 2019 © 2019 Inflammation Red complex microbes ‣ T. den=cola - long thin spirochete creates bridges ‣ P. gingivalis - grape-like ‣ originates - bacterial assault coccobacillus surface vesicles ‣ inflammatory response - most damage ‣ we used to think.........Only a handful of oral bacteria ‣ T. (Bactericides) forsythus larger fusiform rod were implicated in periodontal disease Könönen E, Müller HP. Microbiology of aggressive periodon==s. Periodontol 2000. 2014 Jun;65(1):46-7. © 2019 Zhu Y, Dashper SG, Chen YY, Crawford S, Slakeski N, et al. (2013)
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