Phage therapy againstEnterococcus faecalisin dental root canals

Abstract

Antibiotic resistance is an ever-growing problem faced by all major sectors of health care, including dentistry. Recurrent infections related to multidrug-resistant bacteria such as methicillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, and vancomycin-resistant enterococci (VRE) in hospitals are untreatable and question the effectiveness of notable drugs. Two major reasons for these recurrent infections are acquired antibiotic resistance genes and biofilm formation. None of the traditionally known effective techniques have been able to efficiently resolve these issues. Hence, development of a highly effective antibacterial practice has become inevitable. One example of a hard-to-eradicate pathogen in dentistry is Enterococcus faecalis, which is one of the most common threats observed in recurrent root canal treatment failures, of which the most problematic to treat are its biofilm-forming VRE strains. An effective response against such infections could be the use of bacteriophages (phages). Phage therapy was found to be highly effective against biofilm and multidrug-resistant bacteria and has other advantages like ease of isolation and possibilities for genetic manipulations. The potential of phage therapy in dentistry, in particular against E. faecalis biofilms in root canals, is almost unexplored. Here we review the efforts to develop phage therapy against biofilms. We also focus on the phages isolated against E. faecalis and discuss the possibility of using phages against E. faecalis biofilm in root canals.

Efficacy of Propolis Fluoride and Nano Silver Fluoride for Inhibition of Streptococcus Mutans and Enterococcus Faecalis Biofilm Formation

“…E. faecalis is a facultative anaerobe and a Gram-positive bacteria. Therefore, the cell wall and cell membrane of E. faecalis have specific proteins that allow E. faecalis to penetrate the dentine tubule and form a single species biofilm in any environmental condition and destroy antibacterial defences [22].…”

Phage therapy: present and future

“…For example, a study using the drug « Sextaphag » has proven its efficiency in treating gingivitis and parodontium [10]. Bacteriophages have shown a bactericidal effect on E. faecalis even when a root canal biofilm is formed [11].…”

Physiology and Pathology of Multidrug-Resistant Bacteria: Phage-Related Therapy

“…More than 27 phages have been isolated and tested for their protective efficacy VRE infection [52]. Most of these phages belong to the Myoviridae or the Siphoviridae families [52].…”

“…Most of these phages belong to the Myoviridae or the Siphoviridae families [52]. Phage ENB6, isolated from raw sewage, has lytic activity against a wide range of clinical VRE isolates and single dose of intraperitoneal injection was sufficient to rescue 100% of the fatally infected mice [53].…”

“…Biofilm-associated VRE infections are challenging for treatment. EFDG1, isolated from sewage water, was efficient not only in nearly eliminating 2-week old E. faecalis biofilms of around 100 μm thickness but also in prevention of E. faecalis root canal infection [52,56].…”