Magister Chirurgiae Dentium (MChD) / The rate at which the population is ageing is much faster than in the past. An increase in age results in an increase in oral diseases. One of the most common types of oral diseases in the elderly are fungal infections caused by Candida albicans. It has been noted that drug resistance to fungal pathogens is developing into a serious threat to public health and healthcare systems worldwide. This has consequently led to the need to develop effective and innocuous treatment modalities. The purpose of this study was to explore the antimicrobial and cytotoxic potential of silver nanoparticles (AgNPs) synthesised from Berzelia lanuginose, Helichrysum cymosum, and Searsia crenata.

Objectives: Candida glabrata is the second most common cause of oral candidiasis, second only to C. albicans. Incidence of antifungal resistance has shown a steady increase for C. glabrata. Iron has shown to modulate C. albicans pathogenesis and affect drug-susceptibility. Here, we assess the effect of iron on the growth, antifungal-susceptibility, biofilms, and cell wall of C. glabrata.Methods: Growth, minimal inhibitory concentration (MIC), and biofilm experiments were conducted using 96-well polystyrene plates. Yeast Nitrogen Base medium was used for growth experiments. Cultures of C. glabrata and C. albicans were grown over two nights in respective media containing varying iron concentrations. Rosewell Park Memorial Institute medium was used for MIC and biofilm experiments. Serial dilution was performed to obtain desired concentrations of antifungal drugs. For all experiments, growth was assessed at OD600nm over 24 hours using BioTek Synergy Multi Mode Reader. Paraformaldehyde treated cells and specific stains were used for cell wall studies. Results: Growth of C. glabrata declined significantly below 5μM iron, while C. albicans continued to grow at decreasing iron concentrations, up to 0.5μM. MIC experiments revealed 1.562μM, 1.562μM, and 4μM, as the MIC for Deferasirox, Nystatin, and Fluconazole, respectively. Drug synergy experiments revealed a 128-fold reduction in the amount of Nystatin and Fluconazole needed, with the addition of 1/8th of Deferasirox concentration. The biofilm experiments were inconclusive and the cell wall studies showed decreased levels of mannan, chitin, and an increased β-glucan exposure in high iron conditions. Conclusion: C. glabrata is more sensitive to alterations in environmental iron when compared to C. albicans. Drug synergy experiments underscore the importance of Deferasirox in lowering the MICs of Nystatin or Fluconazole. This can allow use of classical antifungals at lower doses, thereby limiting their side effects. Cell wall studies discuss the effect of iron on the virulence of the C. glabrata. / Oral Biology

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Ziel der vorliegenden Arbeit war anhand eines Tiermodells zu untersuchen, 1. ob eine Dosis-Wirkungsbeziehung zwischen der Keimmenge und der Entstehung einer oralen C. albicans Infektion besteht, 2. welche zelluläre Immunantwort auf definierte inokulierte Keimmengen stattfindet, 3. ob sich die Adhärenz von C. albicans an murine Epithelzellen durch Spaltprodukte von Muzin (Glykopeptide) verhindern läßt. Material und Methode: Immunkompetente Inzuchtmäuse (Balb/c) (n=27) und Mäuse mit kombiniertem B- und T-Zelldefekt (SCID) (n=30) wurden mit Keimmengen von10^4 bis 10^8 C. albicans-Zellen/10 mikrol des Stammes DSM 3454 oral inokuliert. Darüber hinaus wurden Balb/c Mäuse (n=8) mit 10^8 C. albicans-Zellen in Kombination mit Glykopeptiden und SCID Mäuse (n=8) mit 10^5 C. albicans-Zellen mit Glykopeptiden inokuliert. Eine Zungenhälfte wurde histologisch mittels Periodic-Acid-Schiff (PAS) Reaktion auf Invasion von Hyphen untersucht. Die andere Hälfte wurde mittels Immunperoxidase-Technik auf die Verteilung immunkompetenter Zellen (CD4, CD13, ICAM-1, E-Selectin, CD74, CD80, CD86, CD103) im Epithel und subepithelialen Bindegewebe untersucht. Ergebnisse: Eine Woche post inoculationem fanden sich weder bei Balb/c noch bei SCID Mäusen klinische Zeichen einer oralen Candidiasis. Die histologischen Ergebnisse mittels PAS-Methode zeigten jedoch, daß eine Inokulationsmenge von 10^8 C. albicans-Zellen bei Balb/c Mäusen und 10^8 Keime bei SCID Mäusen zu einer Infektion der Zungenmukosa führte. Das Ausmaß der immunologischen Reaktion war abhängig von der Inokulationsdosis sowie vom Immunstatus der Tiere. Die Ergebnisse der Inokulation von 10^8 C. albicans-Zellen zusammen mit Glykopeptiden zeigten bei 2/8 Balb/c Mäusen eine Hypheninvasion in das Zungenepithel. Bei 0/8 SCID Mäusen wurde nach Inokulation von 10^4 C. albicans-Zellen zusammen mit Glykopeptiden eine Hypheninvasion in das Zungenepithel beobachtet. Die immunhistochemischen Ergebnisse zeigten, daß die Reaktionen des Wirtes auf die Gabe der Keim-Glykopeptidlösung denen ohne Inokulation entsprachen. Schlußfolgerung: Obwohl bei den eingesetzten C. albicans-Mengen keine klinisch manifeste orale Candidiasis vorhanden war, fanden sich in beiden Tierstämmen inapparente Infektionen des Zungenepithel (Hypheninvasion), die immunologische Reaktionen der Zungenmukosa auslösten. Da nach Inokulation von C. albicans-Zellen zusammen mit Glykopeptiden weniger häufig Infektionen nachgewiesen werden konnten als bei Inokulation derselben Keimmenge ohne Glykopeptide und Nebenwirkungen dieser antiadhäsiven Wirkstoffe bisher nicht nachgewiesen wurden, wäre der unterstützende Einsatz von Muzinen oder deren Spaltprodukten bei Patienten mit erhöhtem Candidiasisrisiko zu erwägen. / This study applied an animal model to address the following questions: 1. Does a dose/effect relationship exist between C. albicans load and the emergence of an oral C. albicans infection, 2. which cellular immune response takes place following inoculation with defined pathogen loads, 3. is it possible to inhibit C. albicans adhesion to murine epithelium cells through the local application of mucine metabolites (glycopeptides). Material and methods: Immunocompetent inbred mice (Balb/c) (n=27) and mice with combined B- and T-cell defects (SCID) (n=30) were orally inoculated with pathogen loads between 10^4 and 10^8 C. albicans cells/10 microl (strain DSM 3454). Moreover, Balb/c mice (n=8) were inoculated with 10^8 C. albicans cells in combination with glycopeptides; SCID mice (n=8) were inoculated with 10^5 cells, also in combination with glycopeptides. One half of the tongue tissue was histochemically examined with the Periodic Acid Schiff (PAS) Method for displaying the invasion of hyphae. The other half of the tissue was examined by immune peroxidase technique for analysing the distribution of immunocompetent cells (CD4, CD13, ICAM-1, E-Selectin, CD74, CD80, CD86, CD103) in the epithelial layers and subepithelial connective tissue. Results: One week following the inoculation, neither group's tissue showed clinical signs of oral candidiasis. Following histochemical preparation (PAS-Reaction) the tongue mucosa showed signs of infection (hyphae) with the inoculation dose of 10^8 C. albicans cells in the case of Balb/c mice and a load of 10^5 pathogens in the case of SCID mice. The extent of the immunologic reaction depended both on the inoculation dose given to the animals and on their immune status. The results of an inoculation of 10^8 C. albicans cells in combination with glycopeptides showed hyphae invasion of the tongue epithelium in 2/8 Balb/c mice. Following an inoculation of 10^5 pathogens in combination with glycopeptides hyphae invasion could be demonstrated in 0/8 SCID mice. The results of immunohistochemical studies showed that the host's reaction to combined glycopeptide-pathogen-inoculation correspond to the reaction without inoculation. Conclusion: Despite the lack of clinical signs of oral candidiasis in neither group's tissue, non-apparent infections of the tongue epithelium were evident leading to immunologic reactions of the tongue mucosa. Inoculation of C. albicans cells in combination with glycopeptides resulted in decreased infection rate compared to a corresponding inoculation dose without glycopeptides. As no side effects have been documented for the oral application of these antiadhesive agents, their use as complimentary therapy for patients at an increased risk for oral candidiasis should be considered.

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