Assessment of Ceragenins in Prevention of Damage to Voice Prostheses Caused by Candida Biofilm Formation

Abstract

This study aimed to investigate the potential application of ceragenins (CSAs) as new candidacidal agents to prevent biofilm formation on voice prostheses (VPs). The deterioration of the silicone material of VPs is caused by biofilm growth on the device which leads to frequent replacement procedures and sometimes serious complications. A significant proportion of these failures is caused by Candida species. We found that CSAs have significant candidacidal activities in vitro (MIC; MFC; MBIC), and they effectively eradicate species of yeast responsible for VP failure. Additionally, in our in vitro experimental setting, when different Candida species were subjected to CSA-13 and CSA-131 during 25 passages, no tested Candida strain showed the significant development of resistance. Using liquid chromatography–mass spectrometry (LC-MS), we found that VP immersion in an ethanol solution containing CSA-131 results in silicon impregnation with CSA-131 molecules, and in vitro testing revealed that fungal biofilm formation on such VP surfaces was inhibited by embedded ceragenins. Future in vivo studies will validate the use of ceragenin-coated VP for improvement in the life quality and safety of patients after a total laryngectomy.

Efficacy of Ceragenins in Controlling the Growth of Oral Microorganisms: Implications for Oral Hygiene Management

“…In a study by Leszczyńska et al, S. aureus cells were not able to develop adaptive survival strategies upon exposure to CSA-13 [ 36 ]. Among five Candida clinical isolates tested by Spałek et al, none was able to develop resistance to CSA-131 (MICs not higher than 2 µg/mL for 25 passages), although some increase in MICs of CSA-13 were noted [ 51 ]. In another study, CSA-13 retained its bactericidal activity against S. aureus for 30 passages but induced some insensitivity in Gram-negative isolates upon several passages [ 52 ].…”

Local Antibiotic Delivery Options in Prosthetic Joint Infection

“…CSA disrupt bacterial cell membranes through interaction with negatively charged phosphatidylglycerol and lipid A lipopolysaccharides [ 150 ]. Activity against a wide range of pathogens including antimicrobial resistant bacteria and yeasts has been demonstrated in vitro including in biofilms and in vivo animal models of urinary tract infection, prosthetic joint infection and peritonitis [ 151 , 152 , 153 , 154 , 155 ]. Furthermore, CSA may be adapted to coat surfaces of medical devices.…”

Our current clinical understanding of Candida biofilms: where are we two decades on?

“…The rapid colonization of silicone voice prostheses by resident yeasts leads to device failure and the need for removal, as these have a lifespan of 4–6 months (46). This is important as these microbes have the capacity to deteriorate silicone materials if unmanaged, though there are possibilities to coat with antimicrobials and prevent this biodegradation (47).…”