The human body is home for millions of bacteria. The largest microbial community is located in the gastro-intestinal (GI) tract, including the oral cavity with >700 identified taxa. Lactobacillus, which is normal inhabitant of the GI tract, contributes to health by possible biofilm and immune modulation. Breast milk is a claimed source for transmittance of Lactobacillus to infants’ GI tract, but there is limited information if breastfeeding affects lactobacilli in the oral cavity. The objectives of Papers I and II of this dissertation were to compare infant oral microbiota by feeding mode, and to characterize oral lactobacilli including potential probiotic properties of the dominant Lactobacillus species. Two cohorts with a total of 340 healthy 3- to 4-month-old infants were investigated. Saliva and oral mucosal swab samples were collected. Bacteria were characterized by culture-dependent and -independent methods, including 16S rRNA genes sequencing, quantitative PCR, and the Human Microbe Identification Microarray (HOMIM). Inhibition of growth and adhesion were also tested. Multivariate modeling of HOMIM-detected oral bacteria clustered breastfed infants separately from formula-fed infants, and linked breastfed infants to a more health-associated flora. Lactobacilli were essentially detected in breastfed infants only. Lactobacillus gasseri was most prevalent out of six identified Lactobacillus species. Infant isolates of L. gasseri bound to saliva gp340 and MUC7 and adhered to gingival epithelial cells. Infant isolates also inhibited adhesion of Streptococcus mutans to saliva-coated hydroxyapatite, and inhibited growth of S. mutans, Streptococcus sobrinus, Actinomyces naeslundii, Actinomyces oris, Candida albicans and Fusobacterium nucleatum in a concentration-dependent fashion. Papers III and IV aimed to assess persistence of probiotic Lactobacillus reuteri, if persistence is necessary for a regrowth of mutans streptococci (MS), and if L. reuteri intake affects oral microbiota composition. Two well-documented L. reuteri strains (DSM 17938 and PTA 5289) were used in two double-blind, randomized controlled trials. In the first, 62 subjects (test=32, placebo=30) with high counts of MS were exposed to L. reuteri for 6 weeks. Exposure followed full-mouth disinfection with chlorhexidine. In the second study, 44 healthy subjects (test=22, placebo=22) consumed the L. reuteri for 12 weeks. Saliva and biofilm samples were collected before, during and up to 6 months after exposure. Analyses included culture, strain-specific PCR and 454-pyrosequencing targeting the hypervariable region V3-V4 of the 16S rRNA gene. L. reuteri test strains were detected in the mouth of approximately two thirds of test participants during intake. However, their presence decreased gradually when consumption stopped. Subjects with detectable L. reuteri had slower regrowth of MS compared to non-carriers. Pyrosequencing yielded a total of 812,547 high-quality sequencing reads. Firmicutes, Proteobacteria, Bacteroidetes, Fusobacteria and Actinobacteria were the major bacterial phyla recovered. Exposure to L. reuteri strains did not affect overall phylotype abundance, but multivariate modeling clustered 12-week-treated test subjects separately from those who received placebo. Exposure to the test strains was strongly associated with presence and increased levels of F. nucleatum and Streptococcus spp. In conclusion, the oral microbiota differed by feeding mode in infants. One third of breastfed infants had lactobacilli in the mouth, while only single formula-fed infant had it. L. gasseri, predominant in infants, displayed probiotic characteristics in vitro. Retention of probiotic L. reuteri was a prerequisite for delay of MS regrowth after disinfection. However, probiotic bacteria may not be beneficial for all, since L. reuteri DSM 17938 and PTA 5289 were retained in only 2 of 3 consumers. Finally, the altered microbiota after 12 weeks consumption of L. reuteri indicates that intake of probiotic bacteria, or at least L reuteri, has an impact on oral ecology. However, this finding needs further investigation. / Vår kropp består av fler mikroorganismer än egna celler.  De miljontals bakterier som finns på ut - och insidan av kroppen är som regel harmlösa och vissa är till och med till nytta för oss. Magtarmkanalen, som startar med munnen, är den kroppsdel som härbärgerar flest bakterier. Till exempel har man bara i munnen identifierat totalt mer än 700 olika arter. En av dessa är Lactobacillus, en bakterieart som finns i normalfloran och som har probiotiska egenskaper. Hos spädbarn anses bröstmjölk vara en källa för Lactobacillus i tarmen, men hur amning påverkar laktobacillförekomst i munnen är oklart. Den första delen i denna avhandling syftar till att jämföra mikrofloran i munnen hos spädbarn som ammas kontra de som får ersättning, att karakterisera vilka laktobaciller som finns i munnen hos respektive grupp och undersöka om dessa har probiotiska egenskaper. Totalt studerades saliv och prov från munslemhinnan från 340 friska 3-4 månader gamla spädbarn. Proven karakteriserades med odling, sekvensering, kvantitativ PCR och en microarraymetod (Human Microbe Identification Microarray, HOMIM), och isolerade laktobacillers effekt på växt och vidhäftning av andra munbakterier studerades. Ammade barn hade en mer hälsoassocierad mikroflora i munnen. Laktobaciller fanns bara hos ammade barn, men bara hos vart 3:e ammat barn. Av totalt sex identifierade laktobacillarter var Lactobacillus gasseri den i särklass mest förekommande arten. L. gasseri isolerade från spädbarnen band till salivproteinerna gp-340 och MUC7 samt till orala epitelceller. L. gasseri kunde även förhindra adhesion av Streptococcus mutans till konstgjord tandemalj och hämma växt av S. mutans, Streptococcus sobrinus, Actinomyces naeslundii, Actinomyces oris, Candida albicans och Fusobacterium nucleatum. Laktobaciller förekommer i många hälsoprodukter med påstådd probiotisk effekt. Andra delen av denna avhandling syftade till att bedöma om intag av tabletter med den probiotiska arten Lactobacillus reuteri påverkar ekologin i mikrofloran i munnen, om arten etablerar sig hos alla vid exponering, och om etablering är nödvändig för probiotisk effekt (mätt som hämmad återväxt av kariesassocierade mutansstreptokocker efter antimikrobiell behandling). Två stammar L. reuteri (DSM 17938 and PTA 5289) användes i två dubbelblinda, randomiserade studier. I båda studierna intog deltagarna i testgruppen tabletter med L. reuteri-stammarna och de i kontrollgruppen identiska tabletter utan bakterier. I den första studien deltog 62 deltagare (32 test, 30 kontroll) i 6 veckor och i den andra 44 personer (22 test, 22 placebo) under 12 veckor. Saliv och biofilmsprover samlades in vid studiestart, under och upp till 6 månader efter avslutad testperiod. Proverna analyserades med odling, PCR och 454-pyrosekvensering. L. reuteri etablerade sig hos 2/3 av testpersonerna under testperioden men mängden minskade gradvis efter avslutat intag. Bland de som fick L. reuteri hade deltagarna med påvisbara teststammar fördröjd återväxt av mutansstreptokocker jämfört med de som inte hade det. Pyrosekvensering visade att totalantalet phylotyper inte skiljde sig mellan de som fick aktiva kontra placebotabletter, men att ekologin i bakteriefilmerna hos de som ätit de aktiva tabletterna ändrades. Att exponeras för L. reuteri var starkt associerat med förhöjda nivåer av F. nucleatum and Streptococcus spp. Sammanfattningsvis visar dessa studier att amning är associerad med att ha probiotiska laktobaciller i munnen men bara vissa etablerar arten i munnen. Hos vuxna försenade L. reuteri återkolonisation av mutansstreptokocker efter antibakteriell behandling, och påverkade ekologin i bakteriefilmerna i munnen. Även hos vuxna ledde exponering till etablering bara hos vissa individer.

Background Observational studies have shown that early nutrition influences short- and long-term health of infants. Formula-fed infants have higher protein and energy intakes and lower intakes of several biologically active components present in human milk. Some of these are present in the milk fat globule membrane (MFGM). The aim of the present study was to examine the effects of feeding term infants an experimental low energy low protein formula supplemented with bovine milk fat globule membranes. Our hypothesis was that infants fed experimental formula (EF), compared to infants fed standard formula (SF), would have outcomes more similar to a breast-fed reference (BFR) group. Methods In a double-blinded randomized controlled trial, 160 exclusively formula-fed, healthy, term infants were randomized to receive EF or SF from <2 to 6 months of age. A BFR group consisted of 80 breast-fed infants. Measurements were made at baseline, 4, 6 and 12 months of age. The EF had lower energy (60 vs. 66 kcal/100 mL) and protein (1.20 vs. 1.27 g/100 mL) concentrations, and was supplemented with a bovine MFGM concentrate. Results At 12 months of age, the EF group performed better than the SF group in the cognitive domain of Bayley Scales of Infant Development, 3rd Ed. During the intervention, the EF group had a lower incidence of acute otitis media than the SF group, less use of antipyretics and the EF and SF groups differed in concentrations of s-IgG against pneumococci. The formula-fed infants regulated their intakes by increasing meal volumes. Thus, there were no differences between the EF and SF groups in energy or protein intakes, blood urea nitrogen, insulin or growth including body fat percent until 12 months of age. Pressure-to-eat score at 12 months of age was reported lower by parents of formula-fed infants than by parents of breast-fed infants, indicating a low level of parental control of feeding in the formula-fed groups. Neither high pressure-to-eat score nor high restrictive score was associated with formula feeding. During the intervention, the EF group gradually reached higher serum cholesterol concentrations than the SF group, and closer to the BFR group. At 4 months of age, there was no significant difference in the prevalence of lactobacilli in saliva between the EF and SF groups. Conclusions Supplementation of infant formula with a bovine MFGM fraction enhanced both cognitive and immunological development in formula-fed infants. Further, the intervention narrowed the gap in serum cholesterol concentrations between formula-fed and breast-fed infants. The lower energy and protein concentrations of the EF were totally compensated for by a high level of self-regulation of intake which might, at least partly, be explained by a low level of parental control of feeding in the study population. The findings are of importance for further development of infant formulas and may contribute to improved short- and long-term health outcomes for formula-fed infants.

While consumer awareness of benefits of adequate nutrition has noticeably surged in recent years, developing countermeasures against improper eating habits still represents a public health priority in view of the growing prevalence of diet-related diseases. Eating behaviours are complex phenomena driven by a spectrum of biological and environmental factors, wherein (chemo)sensory perception is reckoned amongst the most influential. Analogously, chemosensation is affected by a myriad of determinants, and this warrants the commonly observed large variation in how tastes and smells are perceived among individuals. Given how such variability intimately relates to dietary habits, deciphering its underlying mechanisms is paramount to promoting healthier food choices. In this vein, emerging evidence suggests that human eating behaviours can also be affected by interactions between the gastrointestinal microbiota and the chemosensory systems. Despite growing interest, the sensory-oriented microbiome field suffers from obvious limitations due to its recent emergence. As a result, little efforts has been devoted to elucidating: a) the associations between the oral microbiota and olfaction or known psychological mediators of sensory perception; b) the links between the distal gut microbiota and taste functioning; c) the consequences of interactions between chemosensation and the gastrointestinal microbiota on dietary intakes. Against this backdrop, this thesis aimed at expanding the current knowledge on the interplays between domains of sensory perception and the gastrointestinal microbiota and how these might mirror variations in habitual food habits. In detail, four studies probing the associations a) between a psychosocial correlate of sensory perception (food neophobia), olfaction (Chapter 2) and the oral microbiota (Chapter 3); and b) between distal gut (Chapter 4) or oral (Chapter 5) microbiota, taste functioning and dietary intakes are here presented. In Chapter 2 and 3, a healthy cohort of 83 individuals (57.8 % women; aged 22-68 yo) remotely filled out the common Food Neophobia Scale and the trait anxiety subscale of the State-Trait Anxiety Inventory prior to providing a salivary sample for subsequent metataxonomic analysis (16S rRNA gene sequencing). Next, volunteers were tested for orthonasal olfactory functioning via the Sniffin’ Sticks battery, and monitored for retronasal aroma release while consuming a strawberry jelly candy by nose-space analysis (Selected-Ion Flow-Tube Mass Spectrometry). In Chapter 4 and 5, instead, 100 young adult volunteers (52 % women; aged 18-30 yo) attended a 7-day lasting remote protocol where responsiveness to genetically-mediated bitterness of 6-n-propylithiuracil (PROP), hedonics and intensity of oral sensations elicited by ten commercially-available food products, a battery of food-related psychological traits, a 4-day food record, and one salivary and one stool sample (sequenced by targeting the 16s rRNA gene) were collected. Overall, results substantially strengthen past evidence suggesting: a) that pronounced neophobic tendencies translate into higher levels of (negative) emotional activation or arousal towards foods; b) the existence of homogenous groups of individuals with generalized hypergeusia towards oral stimulations; c) that hyperresponsiveness to a peculiar taste quality is a barrier to the intake of foods evoking such sensation; d) that habitual consumption of dietary fibers and simple carbohydrates can shape both the gut and oral microbial ecology, respectively. Intriguingly, food neophobia and poor olfaction were positively associated with oral microbial markers of dysbiosis (e.g., Porphyromonas gingivalis), whilst a Clostridia-enriched salivary microbiota co-occurred with low responsiveness to alarming oral sensations (astringency, bitter, sour) elicited by real foods. Similarly, an ample panel of commensal gut bacterial genera mainly allocated to the families Lachnospiraceae and Ruminococcaceae was found to be enriched in individuals exhibiting lower acuity to both tastes (bitter, salty, sour, sweet) and trigeminal sensations (astringent, pungent). Besides taxonomically annotating a range of microbial taxa tied to sensory perception, putative metabolic pathways used by salivary and gut microbial communities to modulate taste perception were inferred and discussed. To conclude, this thesis supports the notion that the gastrointestinal microbiota is an additional candidate to explain interindividual variations in taste and smell perception, and provides novel important insights into the aetiology of eating behaviours. More importantly, this work also offers methodological cues to robustly assess the associations between chemosensation and host-related non genetic factors, and paves the way for future interventional studies targeting the efficacy of sensory-related microbial taxa as potential modulators of dietary habits.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-03-24T19:12:52Z No. of bitstreams: 1 jessicadoamaralbastos.pdf: 1006529 bytes, checksum: b3c22bd9504dc4480527e616b99836a2 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-03-27T17:56:07Z (GMT) No. of bitstreams: 1 jessicadoamaralbastos.pdf: 1006529 bytes, checksum: b3c22bd9504dc4480527e616b99836a2 (MD5) / Made available in DSpace on 2017-03-27T17:56:07Z (GMT). No. of bitstreams: 1 jessicadoamaralbastos.pdf: 1006529 bytes, checksum: b3c22bd9504dc4480527e616b99836a2 (MD5) Previous issue date: 2009-08-03 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Periodontite crônica (PC) é uma doença inflamatória causada por bactérias Gram negativas que causam destruição dos tecidos de suporte do dente e tem sido considerada fator de risco não tradicional para a doença renal crônica (DRC). No presente estudo, realizado em portadores de PC, a frequência dos principais patógenos periodontais identificados em pacientes com DRC foi comparada com os detectados em indivíduos sem doença sistêmica. Foram avaliados 19 indivíduos com PC e sem evidências de doença sistêmica (grupo controle), 25 pacientes com PC e com DRC em estágio pré-dialítico (grupo pré-diálise) e 22 pacientes com PC e DRC em terapia renal substitutiva (grupo TRS). A gravidade da PC baseou-se na profundidade de sondagem (PS) e no nível de inserção clínica (NIC). O estadiamento da DRC baseou-se nos critérios do Kidney Disease Outcome Quality Initiative. A filtração glomerular (FG) foi estimada pela equação do Modified Diet in Renal Disease e a identificação dos microrganismos na placa subgengival foi realizada pela técnica de reação em cadeia da polimerase. Entre os microrganismos identificados, a C. albicans e P. gingivalis foram mais frequentes, respectivamente, nos pacientes em TRS (72,7% e 100%) e pré-diálise (52% e 94,7%) do que nos pacientes sem doença sistêmica (26,3% e 72,2% ), p< 0,05. Nos pacientes com PC e DRC, tanto nos estágios pré-dialíticos quanto em TRS, a presença de P.gingivalis, T.denticola e C. albicans se associou com níveis mais elevados de NIC comparativamente aos indivíduos sem doenças sistêmicas. Também observou-se maior gravidade da PC nos pacientes com DRC tanto nos estágios pré-dialíticos quando sujeito a tratamento dialítico. Nos pacientes com DRC, a PC é mais grave e se associa com maior frequência de C. albicans e P.gingivalis. / Chronic periodontitis (CP) is a destructive inflammatory disease of the supporting tissues of the teeth caused by Gram-negative bacterias and has been considered as a non traditional risk factor for chronic kidney disease (CKD). In this study, done in patients with CP, the frequency of the main periodontal pathogens were compared in patients with CKD and health individuals. Material and Methods: Ninetheen with no evidence of systemic disease (control group) with CP, 25 patients with CP and CKD not yet on dialysis (pre-dialysis group), and 22 patients with CP and CKD on dialysis (RRT group) were studied. The severity of the CP was based on probing pocket depth (PPD) and clinical attachment level (CAL). CKD was defined and staged as recommended by Kidney Disease Outcome and Quality Initiative. The glomerular filtration rate was estimated with the equation of Modified Diet in Renal Disease. The polymerase chain reaction was used in the identification of oral microrganisms. Candida albicans and Porphyromonas gingivalis were more frequently identified in patients with CP and CKD in RRT (72,7% and 100%) and in the pre-dialysis stages (52% and 94,7%) than in health individuals (26,3% and 72,2%) (p <0,05). In patients with elevated CP and CKD, in the pre-dialysis and RRT groups, the presence of P.gingivalis, T.denticola e C. albicans was associated with elevated index of CAL measurements comparing to the individuals without no evidence of systemic disease. It was also observed that the CP was more severe in the CKD patients than in the health controls. In patients with CKD, the CP is more severe and is due more frequently to Candida albicans and Porphyromonas gingivalis.

A presente investigação teve como objetivo avaliar a prática de cirurgiões dentistas em uma unidade de terapia intensiva (UTI) de um hospital militar, o estabelecimento de um protocolo de higiene oral e os seus efeitos sobre a redução de pneumonias associadas à ventilação mecânica (PAVM). As percepções da equipe da UTI sobre as atividades dos cirurgiões dentistas também foram avaliadas por meio de um questionário. O perfil de colonização microbiana da mucosa oral antes e depois do estabelecimento das medidas de higiene oral também foi avaliado tanto por diluição e plaqueamento em meios de cultura microbiológicos seletivos e enriquecidos e através da amplificação pelo método de PCR e eletroforese em gel desnaturante em gradiente (DGGE), subsequente ao sequenciamento dos amplicons. A carga microbiana foi avaliada após a contagem de placas de agar e através da amplificação por PCR em tempo real (qPCR) do gene rrs nas amostras. O protocolo de higiene oral, realizado pelos cirurgiões dentistas, foi capaz de reduzir a incidência de PAVM (p <0,05). O questionário revelou que a modificação da halitose foi percebida por 93,33% dos participantes. A redução da ocorrência das úlceras orais e dos lábios durante a internação dos pacientes foi observada por 80% da equipe da UTI. Foi observada a redução da produção das secreções nasais e bucais por 70% da equipe dos profissionais da UTI. Para 86,66% dos participantes a assistência aos pacientes tornou-se mais agradável após a instituição dos cuidados bucais. O protocolo, realizado com a utilização de solução 0,12% de clorexidina, não foi capaz de evitar a colonização da mucosa oral por patógenos microbianos usualmente encontrados no ambiente hospitalar tais como os bastonetes Gram-negativos entéricos e não fermentadores, nem foi capaz de eliminá-los quando tais micro-organismos já se encontravam presentes antes dos procedimentos de higiene bucal. Alguns Bastonetes Gram-positivos (Lactobacillus sp e corinebactérias) e Staphylococcus epidermidis permaneceram após a realização dos procedimentos. O protocolo de higiene oral permitiu a redução da carga microbiana na mucosa oral de 50% dos pacientes considerando-se o método de contagem microbiana e para 35% dos pacientes pela avaliação dos números de cópias de genes rrs através de qPCR. Em conclusão, o protocolo de higiene oral desenvolvido pelos cirurgiões dentistas foi capaz de reduzir a incidência de PAV na UTI, embora não tenha sido capaz de prevenir a colonização da mucosa oral por supostos patógenos microbianos. O protocolo de higiene oral com a participação ativa dos cirurgiões dentistas foi bem aceito pelos profissionais da UTI e foi capaz de melhorar a qualidade da assistência aos pacientes críticos. / This investigation aimed to evaluate the practice of dentists in an intensive care unit (ICU) of a military hospital, the establishment of a protocol for oral hygiene, and the effect of the protocol on the reduction of ventilator associated pneumonia (VAP) after the introduction of the oral hygiene protocol. The opinion of the ICU staff about the activity of the dentists was also evaluated by means of a questionnaire. In addition, the microbial colonization profile of the oral mucosa before and after the establishment of the oral hygiene measures was evaluated by means of both dilution and plating the samples in microbiological culture mediums (both selective and rich agar media) and DGGE technique, with sequencing of amplicons. The microbial load was evaluated after counting agar plates and by real time rrs gene PCR amplification (qPCR) in the samples. The oral hygiene protocol performed by dentists was capable to reduce the incidence of VAP (p< 0.05). The questionnaire revealed that the change of the oral odor was noticed by 93.33% of the participants. The reduction of oral and lip ulcers during the hospitalization of the patients was observed by 80% of the staff. The patients were observed to reduce the production of oral and nasal secretions after the establishment of the oral hygiene procedures by 70% of the ICU professionals. The approach to the patients developed by the staff became more pleasant after the establishment of the oral protocol for 86.66%. The protocol, with the use of 0,12% chlorhexidine solution, was not capable to avoid the colonization of the oral mucosa by the microbial pathogens usually found in nosocomial environment, in especial Gram-negative enteric and non-fermentative rods, nor eliminated these organisms previously found before the oral care procedures. Gram-positive rods (Lactobacillus sp, and corynebacteria) and Staphylococcus epidermidis remained after the procedures. The protocol reduced the microbial load in the oral mucosa of 50% of the patients considering the microbial counting and in 35% of the patients evaluated by the numbers of copies of rrs genes by qPCR. In conclusion, the oral hygiene protocol developed by dentists was capable to reduce the incidence of VAP in the studied ICU, though was not capable to prevent the colonization of oral mucosa by putative microbial pathogens. The oral hygiene protocol with active participation of dentists was well accepted by the ICU professionals and was capable to improve the quality of assistance to critically ill patients.

A presente investigação teve como objetivo avaliar a prática de cirurgiões dentistas em uma unidade de terapia intensiva (UTI) de um hospital militar, o estabelecimento de um protocolo de higiene oral e os seus efeitos sobre a redução de pneumonias associadas à ventilação mecânica (PAVM). As percepções da equipe da UTI sobre as atividades dos cirurgiões dentistas também foram avaliadas por meio de um questionário. O perfil de colonização microbiana da mucosa oral antes e depois do estabelecimento das medidas de higiene oral também foi avaliado tanto por diluição e plaqueamento em meios de cultura microbiológicos seletivos e enriquecidos e através da amplificação pelo método de PCR e eletroforese em gel desnaturante em gradiente (DGGE), subsequente ao sequenciamento dos amplicons. A carga microbiana foi avaliada após a contagem de placas de agar e através da amplificação por PCR em tempo real (qPCR) do gene rrs nas amostras. O protocolo de higiene oral, realizado pelos cirurgiões dentistas, foi capaz de reduzir a incidência de PAVM (p <0,05). O questionário revelou que a modificação da halitose foi percebida por 93,33% dos participantes. A redução da ocorrência das úlceras orais e dos lábios durante a internação dos pacientes foi observada por 80% da equipe da UTI. Foi observada a redução da produção das secreções nasais e bucais por 70% da equipe dos profissionais da UTI. Para 86,66% dos participantes a assistência aos pacientes tornou-se mais agradável após a instituição dos cuidados bucais. O protocolo, realizado com a utilização de solução 0,12% de clorexidina, não foi capaz de evitar a colonização da mucosa oral por patógenos microbianos usualmente encontrados no ambiente hospitalar tais como os bastonetes Gram-negativos entéricos e não fermentadores, nem foi capaz de eliminá-los quando tais micro-organismos já se encontravam presentes antes dos procedimentos de higiene bucal. Alguns Bastonetes Gram-positivos (Lactobacillus sp e corinebactérias) e Staphylococcus epidermidis permaneceram após a realização dos procedimentos. O protocolo de higiene oral permitiu a redução da carga microbiana na mucosa oral de 50% dos pacientes considerando-se o método de contagem microbiana e para 35% dos pacientes pela avaliação dos números de cópias de genes rrs através de qPCR. Em conclusão, o protocolo de higiene oral desenvolvido pelos cirurgiões dentistas foi capaz de reduzir a incidência de PAV na UTI, embora não tenha sido capaz de prevenir a colonização da mucosa oral por supostos patógenos microbianos. O protocolo de higiene oral com a participação ativa dos cirurgiões dentistas foi bem aceito pelos profissionais da UTI e foi capaz de melhorar a qualidade da assistência aos pacientes críticos. / This investigation aimed to evaluate the practice of dentists in an intensive care unit (ICU) of a military hospital, the establishment of a protocol for oral hygiene, and the effect of the protocol on the reduction of ventilator associated pneumonia (VAP) after the introduction of the oral hygiene protocol. The opinion of the ICU staff about the activity of the dentists was also evaluated by means of a questionnaire. In addition, the microbial colonization profile of the oral mucosa before and after the establishment of the oral hygiene measures was evaluated by means of both dilution and plating the samples in microbiological culture mediums (both selective and rich agar media) and DGGE technique, with sequencing of amplicons. The microbial load was evaluated after counting agar plates and by real time rrs gene PCR amplification (qPCR) in the samples. The oral hygiene protocol performed by dentists was capable to reduce the incidence of VAP (p< 0.05). The questionnaire revealed that the change of the oral odor was noticed by 93.33% of the participants. The reduction of oral and lip ulcers during the hospitalization of the patients was observed by 80% of the staff. The patients were observed to reduce the production of oral and nasal secretions after the establishment of the oral hygiene procedures by 70% of the ICU professionals. The approach to the patients developed by the staff became more pleasant after the establishment of the oral protocol for 86.66%. The protocol, with the use of 0,12% chlorhexidine solution, was not capable to avoid the colonization of the oral mucosa by the microbial pathogens usually found in nosocomial environment, in especial Gram-negative enteric and non-fermentative rods, nor eliminated these organisms previously found before the oral care procedures. Gram-positive rods (Lactobacillus sp, and corynebacteria) and Staphylococcus epidermidis remained after the procedures. The protocol reduced the microbial load in the oral mucosa of 50% of the patients considering the microbial counting and in 35% of the patients evaluated by the numbers of copies of rrs genes by qPCR. In conclusion, the oral hygiene protocol developed by dentists was capable to reduce the incidence of VAP in the studied ICU, though was not capable to prevent the colonization of oral mucosa by putative microbial pathogens. The oral hygiene protocol with active participation of dentists was well accepted by the ICU professionals and was capable to improve the quality of assistance to critically ill patients.

Tesis por compendio / [ES] Se ha estimado que obtenemos más de las tres cuartas partes del nitrato que ingerimos de la fruta y la verdura. Los vegetales ricos en nitratos incluyen verduras de hoja verde y ciertos tubérculos (p. ej., remolachas y rábanos). Las glándulas salivales concentran activamente el nitrato plasmático, lo que da lugar a concentraciones elevadas de nitrato en la saliva (5 a 8 mM) después de una comida rica en nitratos. El nitrato es un factor ecológico que puede inducir cambios rápidos en la estructura y función de las comunidades polimicrobianas. Sin embargo, los efectos sobre la microbiota oral no se han estudiado en detalle, mientras que un número limitado de estudios previos a esta tesis indican que es probable que el nitrato sea beneficioso para la salud bucal. El objetivo de esta tesis es, por tanto, estudiar los cambios microbiológicos inducidos por nitratos e identificar posibles mecanismos de homeostasis generados por este compuesto, con el fin de determinar si el nitrato puede considerarse un prebiótico para la salud bucal. Un segundo objetivo fue aislar cepas reductoras de nitrato y probar su potencial probiótico in vitro. En el capítulo 1, se realizó un estudio in vitro para testar el efecto del nitrato 6,5 mM en comunidades orales cultivadas a partir de la saliva de 12 individuos sanos. En el capítulo 2, se obtuvieron 53 aislados de bacterias reductoras de nitrato y se probó el efecto de seis candidatos a probióticos en comunidades orales sanas cultivadas a partir de saliva de diferentes donantes con o sin nitrato 6,5 mM. En el capítulo 3, se estudió el efecto de un extracto de remolacha rico en nitrato sobre la acidificación oral después de un enjuague con azúcar en 24 individuos sin caries activas. Se tomaron sobrenadantes (capítulos 1 y 2) o muestras de saliva (capítulo 3) para mediciones de nitrato, nitrito, amonio, lactato y pH. Además, la composición bacteriana de la biopelícula in vitro y del pellet salivar se determinó usando secuenciación Illumina del rRNA 16S y/o qPCR del género nitratorreductor Rothia. Los datos demuestran que el nitrato estimula el crecimiento de los géneros beneficiosos Rothia y Neisseria en nuestro modelo in vitro, mientras que potencialmente disminuye las bacterias asociadas a la caries, la halitosis y la enfermedad periodontal. Además, los datos in vitro e in vivo presentados en esta tesis indican que el nitrato puede limitar o prevenir caídas de pH cuando los azúcares son fermentados por la microbiota oral, un mecanismo de resiliencia que podría ser estimulado por el consumo de extractos vegetales ricos en nitratos. Los principales mecanismos de amortiguación del pH por parte del nitrato son el uso de acido láctico durante la desnitrificación (observado tanto in vivo como in vitro) y durante la reducción de nitrito a amonio, así como la producción potencial de amoníaco (observado in vitro). En esta tesis, los efectos del nitrato se observaron después de períodos cortos, es decir, después de 5-9 h de incubación in vitro y 1-4 horas después de la ingesta del suplemento de nitrato in vivo. Los estudios futuros deberían centrarse en los efectos longitudinales de la ingesta diaria de nitratos. En el capítulo 2, se aislaron bacterias reductoras de nitrato pertenecientes a los géneros Rothia y Actinomyces. Una selección de aislados de Rothia aumentó el uso de lactato y la capacidad de reducción de nitratos de las comunidades bucales, lo que potencialmente beneficiaría la salud dental y la salud sistémica, respectivamente. Los datos in vitro e in vivo presentados en esta tesis sugieren que el nitrato puede modular la microbiota oral en aspectos que son beneficiosas para el huésped y, por lo tanto, podría considerarse una sustancia prebiótica para la microbiota oral. Además, los aislados reductores de nitratos pueden estimular los efectos beneficiosos del metabolismo del nitrato, sobre todo en personas con bajos niveles de estas bacterias. / [CA] S'ha estimat que obtenim més de les tres quartes parts del nitrat que ingerim de la fruita i la verdura. Els vegetals rics en nitrats inclouen verdures de fulla verda i uns certs tubercles (p. ex., remolatxes i raves). Les glàndules salivals concentren activament el nitrat plasmàtic, la qual cosa dona lloc a concentracions elevades de nitrat a la saliva (5 a 8 mm) després d'un menjar ric en nitrats. El nitrat és un factor ecològic que pot induir canvis ràpids en l'estructura i funció de les comunitats polimicrobianes. No obstant això, els efectes sobre la microbiota oral no s'han estudiat detalladament, mentre que un nombre limitat d'estudis previs a aquesta tesi indiquen que és probable que el nitrat siga beneficiós per a la salut bucal. L'objectiu d'aquesta tesi és, per tant, estudiar els canvis microbiològics induïts per nitrats i identificar possibles mecanismes d'homeòstasi generats per aquest compost, amb la finalitat de determinar si el nitrat pot considerar-se un prebiòtic per a la salut bucal. Un segon objectiu va ser aïllar soques reductores de nitrat i provar el seu potencial probiòtic in vitro. En el capítol 1, es va realitzar un estudi in vitro per a testar l'efecte del nitrat 6,5 mm en comunitats orals cultivades a partir de la saliva de 12 individus sans. En el capítol 2, es van obtindre 53 aïllats de bacteris reductors de nitrat i es va provar l'efecte de sis candidats a probiòtics en comunitats orals sanes cultivades a partir de saliva de diferents donants amb o sense nitrat 6,5 mm. En el capítol 3, es va estudiar l'efecte d'un extracte de remolatxa ric en nitrat sobre l'acidificació oral després d'un glopeig amb sucre en 24 individus sense càries actives. Es van prendre sobrenadants (capítols 1 i 2) o mostres de saliva (capítol 3) per a mesuraments de nitrat, nitrit, amoni, lactat i pH. A més, la composició bacteriana de la biopel·lícula in vitro i del pèl·let salivar es va determinar usant seqüenciació Illumina del RNAr 16S i/o qPCR del gènere nitratorreductor Rothia. Les dades demostren que el nitrat estimula el creixement dels gèneres beneficiosos Rothia i Neisseria en el nostre model in vitro, mentre que potencialment disminueix els bacteris associats a la càries, l'halitosi i la malaltia periodontal. A més a més, les dades in vitro i in vivo presentades en aquesta tesi indiquen que el nitrat pot limitar o previndre caigudes de pH quan els sucres són fermentats per la microbiota oral, un mecanisme de resiliència que podria ser estimulat pel consum d'extractes vegetals rics en nitrats. Els principals mecanismes d'amortiment del pH per part del nitrat són l'ús de àcid làctic durant la desnitrificació (observat tant in vivo com in vitro) i durant la reducció de nitrit a amoni, així com la producció potencial d'amoníac (observat in vitro). En aquesta tesi, els efectes del nitrat es van observar després de períodes curts, és a dir, després de 5-9 h d'incubació in vitro i 1-4 hores després de la ingesta del suplement de nitrat in vivo. Els estudis futurs haurien de centrar-se en els efectes longitudinals de la ingesta diària de nitrats. En aquesta tesi es van aïllar bacteris reductors de nitrat pertanyents als gèneres Rothia i Actinomyces. Una selecció d'aïllats de Rothia va augmentar l'ús de lactat i la capacitat de reducció de nitrats de les comunitats bucals, la qual cosa potencialment beneficiaria la salut dental i la salut sistèmica, respectivament. Les dades in vitro i in vivo presentats en aquesta tesi suggereixen que el nitrat pot modular la microbiota oral en aspectes que són beneficiosos per a l'hoste i, per tant, podria considerar-se una substància prebiòtica per a la microbiota oral. A més, els aïllats reductors de nitrats poden estimular els efectes beneficiosos del metabolisme del nitrat, sobretot en persones amb baixos nivells d'aquests bacteris. El nitrat i els bacteris reductors de nitrat són, per tant, components prometedors per a futurs productes de salut oral. / [EN] It has been estimated that we obtain over three quarters of dietary nitrate from vegetables and fruits. Nitrate-rich vegetable types include leafy greens and certain root vegetables (e.g., beetroots and radishes). The salivary glands actively concentrate plasma nitrate, leading to high salivary nitrate concentrations (5-8 mM) after a nitrate-rich meal. Nitrate is an ecological factor that can induce rapid changes in structure and function of polymicrobial communities. However, the effects on the oral microbiota have not been clarified, whilst a limited number of previous studies did indicate that nitrate is likely to be beneficial for oral health. The aim of this thesis was therefore to study nitrate-induced microbiome changes and identify potential mechanisms for nitrate-induced homeostasis, in order to determine if nitrate can be considered a prebiotic compound for oral health. A second aim was to isolate nitrate-reducing isolates and test their probiotic potential in vitro. In chapter 1, an in vitro study was set up testing the effect of 6.5 mM nitrate on oral communities grown from saliva of 12 healthy individuals. In chapter 2, fifty-three nitrate-reducing isolates were obtained and the effect of six probiotic candidates was tested on healthy oral communities grown from saliva of different donors with or without 6.5 mM nitrate. In chapter 3, the effects of nitrate-rich beetroot extracts on oral acidification after sugar rinsing was tested in 24 individuals without active caries. Supernatants (chapters 1 and 2) or saliva samples (chapter 3) were taken for nitrate, nitrite, ammonium, lactate and pH measurements. Additionally, the bacterial composition of in vitro biofilms and salivary pellets were determined using 16S rRNA gene Illumina sequencing and/or qPCR of the nitrate-reducing genus Rothia. We showed that nitrate stimulates the growth of the beneficial genera Rothia and Neisseria in our in vitro model, while potentially decreasing caries-, halitosis- and periodontal disease-associated bacteria. Additionally, the in vitro and in vivo data presented in this thesis indicate that nitrate can limit or prevent pH drops when sugars are fermented by the oral microbiota - a mechanism of resilience that could be stimulated by the consumption of nitrate-rich vegetable extracts. The main pH buffering mechanisms of nitrate were lactic acid usage during denitrification (observed both in vivo and in vitro) and during the reduction of nitrite to ammonium, as well as the potential production of ammonia (observed in vitro). In this thesis, the effects of nitrate were observed after short periods, i.e., after 5-9 h incubation in vitro and/or after 1-4 hours after nitrate supplement intake in vivo. Future studies should focus on the longitudinal effects of daily nitrate intake. In chapter 2, nitrate-reducing species belonging to the genera Rothia and Actinomyces were isolated. A selection of Rothia isolates increased lactate usage and nitrate reduction capacities of oral communities, potentially benefitting dental health and systemic health, respectively. The in vitro and in vivo data presented in the current thesis suggest that nitrate can modulate the oral microbiota in ways that are beneficial for the host and could thus be considered a prebiotic substance for the oral microbiota. Additionally, nitrate-reducing isolates can stimulate certain beneficial effects of nitrate metabolism. Nitrate and nitrate-reducing bacteria are thus promising components for future oral care products to prevent or treat oral diseases and this should be further investigated. / Rosier, BT. (2022). Nitrate as a Prebiotic and Nitrate-Reducing Bacteria as Probiotics for Oral Health [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/181578 / TESIS / Compendio

[ES] Antecedentes: Los patrones de colonización microbiana alterados durante la infancia pueden ser en parte responsables del aumento de enfermedades alérgicas en los países desarrollados. La microbiota intestinal difiere en composición y diversidad durante los primeros meses de vida en niños que luego desarrollan o no una enfermedad alérgica. Sin embargo, poco se sabe sobre la importancia de las respuestas inmunitarias tempranas de la mucosa a la microbiota intestinal en el desarrollo de alergias infantiles. Además, los estudios con respecto al efecto protector de la microbiota de la leche materna en el riesgo de desarrollar alergias no han sido concluyentes. Aunque la cavidad bucal es el primer lugar de encuentro entre la mayoría de los antígenos exógenos y el sistema inmunológico, no existen datos sobre la influencia de las bacterias orales en el desarrollo de alergias durante la infancia. Objetivos: El objetivo general de esta tesis fue evaluar la composición y diversidad microbiana en muestras orales, intestinales y de leche materna, junto con su interacción con IgA, para estudiar el papel de la colonización microbiana durante edades tempranas de la vida en condiciones de salud y de enfermedad alérgica. Sujetos: Los bebés y las madres incluidas en este estudio forman parte del ensayo aleatorio doble ciego más grande de Suecia, entre 2001 y 2003, donde se evaluaron los posibles efectos preventivos sobre la alergia de Lactobacillus reuteri ATCC 55730 hasta los 2 y 7 años. En esta tesis, utilizamos muestras de heces recogidas a los 1 y 12 meses, y muestras orales de bebés, obtenidas longitudinalmente a los 3, 6, 12, 24 meses y 7 años. Además, analizamos muestras de leche materna, recogidas a un mes después del parto de las madres correspondientes. Métodos: Se utilizaron tecnologías de secuenciación de segunda generación dirigidas al gen 16S rARN, en combinación con citometría de células marcadas por fluorescencia, para abordar las respuestas de IgA de la mucosa hacia las bacterias intestinales y de la leche materna. Además, se utilizó la secuenciación del gen 16S para describir la colonización oral de la microbiota, en muestras de saliva, de niños que desarrollaron alergias o de aquellos que se mantuvieron sanos. Los niveles de carga bacteriana en diferentes hábitats microbianos se obtuvieron mediante la metodología de qPCR y los niveles totales de IgA de las muestras de heces se determinaron mediante inmuno-ensayo ELISA. Resultados y conclusión: La colonización de la cavidad bucal durante la infancia temprana es progresiva, aumenta en complejidad con el tiempo, y varios factores externos parecen influir en gran medida en la maduración de la microbiota oral, ya sea con un impacto a corto o largo plazo. Los cambios tempranos en la composición microbiana oral parecen influir en la maduración inmune y el desarrollo de alergias en la infancia, y la presencia de especies bacterianas específicas puede ser importante para este proceso. Además, las respuestas de IgA alteradas hacia la microbiota intestinal durante la infancia precedieron a las manifestaciones de asma y alergia durante los primeros 7 años de vida, y el consumo de leche materna con una riqueza microbiana reducida en el primer mes de vida puede aumentar el riesgo de desarrollar alergia durante la infancia. Los hallazgos observados en la presente tesis deben confirmarse en cohortes más grandes y la importancia de los factores ambientales postnatales para el desarrollo temprano de la microbiota debe abordarse más a fondo. Las investigaciones futuras deben ir más allá de la caracterización de la composición de la comunidad bacteriana e investigar los mecanismos funcionales entre los microorganismos colonizadores tempranos, la maduración inmunitaria y la alergia, así como el desarrollo del asma durante la infancia. / [CAT] Antecedents: S'ha proposat que els patrons de colonització microbiana alterats durant la infància podrien ser en part els responsables de l'augment de malalties al·lèrgiques als països desenvolupats. La microbiota intestinal difereix en composició i diversitat durant els primers mesos de vida en els nens que després van desenvolupar una malaltia al·lèrgica. No obstant això, poc es sap sobre la importància de les respostes immunes de la mucosa a la microbiota intestinal en el desenvolupament d'al·lèrgies infantils. A més, les investigacions amb relació a l'efecte protector de la microbiota de la llet materna en el risc de desenvolupar al·lèrgies no han sigut concloents. Encara que la cavitat bucal és el primer lloc de trobada entre la majoria dels gèneres externs i el sistema immunològic, encara no s'ha descobert la influència dels bacteris en el desenvolupament d'una al·lèrgia durant la infància. Objectius: L'objectiu general d'aquesta tesi va ser avaluar la composició microbiana i la diversitat de mostres orals, fecals i llet materns, juntament amb la seva interacció amb IgA, per estudiar el paper del desenvolupament microbià durant el període de la infància primerenca a la salut i la malaltia al·lèrgica. Subjectes: Les mares i xiquets inclosos en aquest estudi formen part d'un estudi aleatori doble-cec a Suècia, entre el 2001 i el 2003, on es van avaluar els possibles efectes preventius de la suplementació amb Lactobacillus ATCC 55730 fins als 2 i 7 anys. En aquesta tesi, s'utilitzaren mostres de bebès arreplegades longitudinalment, obtinguts a 1 i 12 mesos, 3, 6, 12, 24 mesos i 7 anys, respectivament. A més, s'analitzaren les mostres de llet materna, arreplegades a un mes postpart de les corresponents mares. Mètodes: S'han utilitzat tecnologies de seqüenciació de nova generació dirigides al ARNr 16S, en combinació amb la classificació de les cèl·lules activades, per abordar les respostes de la mucosa cap als bacteris intestinals i de la llet materna. A més, s'utilitzà la seqüenciació d'Illumina MiSeq del gen 16S per descriure la colonització microbiana oral, i es van obtenir mostres longitudinals de saliva de menuts que varen desenvolupar al·lèrgies i d'alguns que es van mantenir saludables. Els nivells de càrrega bacteriana en diferents nínxols microbians s'han obtingut mitjançant la metodologia de qPCR i els nivells totals d'IgA de les mostres fecals es determinaren mitjançant l'immunoassaig ELISA. Resultats i conclusions: La colonització de la cavitat bucal durant la primera infància és transitòria, augmenta la seva complexitat amb el temps, i diversos factors externs influeixen en gran mesura el procés de maduració de la microbiota oral, amb un impacte a curt i llarg termini. Els canvis primerencs en la composició microbiana oral pareixen influir en la maduració del sistema immunològic i el desenvolupament d'al·lèrgies a la infància, així com la presència d'espècies bacterianes específiques pot ser important per a aquest progrés. A més, les respostes d'IgA alterades cap a la microbiota intestinal durant la infància precedeixen a les manifestacions relatives a la malaltia asmàtica i al·lèrgiques durant els primers 7 anys de vida. Per altra banda, el consum de llet materna amb una microbiota de riquesa reduïda al primer mes de vida podria augmentar el risc de desenvolupar al·lèrgia durant la infància. Els resultats observats en aquest estudi haurien de confirmar-se en cohorts humanes més grans i la importància dels factors ambientals post natals que influeixen en el desenvolupament de la microbiota primerenca han de ser més estudiats. Les investigacions futures deuen anar més enllà de la caracterització de la composició de la comunitat bacteriana i investigar els mecanismes funcionals entre els microorganismes colonitzadors primerencs, la maduració del sistema immunològic i el desenvolupament de l'al·lèrgia i l'asma durant la in / [EN] Background: It has been proposed that altered microbial colonization patterns during infancy may be partly responsible for the increase of allergic diseases in developed countries. The gut microbiota differs in composition and diversity during the first months of life in children who later do or do not develop allergic disease. However, little is known about the significance of early mucosal immune responses to the gut microbiota in childhood allergy development, and the findings regarding the protective effect of breastmilk microbiota in the risk of allergy development have been inconclusive. Furthermore, even though the oral cavity is the first site of encounter between a majority of foreign antigens and the immune system, the influence of oral bacteria on allergy development during childhood has not yet been reported. Objectives: The general aim of this thesis was to assess the microbial composition and diversity of oral, fecal and breastmilk samples, together with its interaction with IgA, in order to study the role of microbial development during early childhood in health and allergic disease. Subjects: The infants and mothers included in this study were part of a larger randomized double-blind trial in Sweden, between 2001 and 2003, where potential allergy preventive effects of Lactobacillus reuteri ATCC 55730 were evaluated until 2 and 7 years of age. In this thesis, we used longitudinally collected stool and oral samples from infants, obtained at 1 and 12 months and 3, 6, 12, 24 months and 7 years of age, respectively. Furthermore, we analyzed breastmilk samples, collected at one month post partum, from the corresponding mothers. Methods: Next-generation sequencing technologies targeting the 16S rRNA gene, in combination with cell activated cell sorting, were used in order to address mucosal IgA responses towards gut and breastmilk bacteria. Furthermore, sequencing of the 16S rRNA gene was used in order to describe oral microbiota colonization, in longitudinally obtained saliva samples, from children developing allergy or staying healthy. Bacterial load levels in different microbial habitats were obtained by qPCR methodology and total IgA levels of stool samples were determined by ELISA immunoassays. Results and conclusion: Colonization of the oral cavity during early childhood is transitional, increasing in complexity with time, and several external factors appear to greatly influence oral microbiota maturation, having either a short or a long-term impact. Early changes in oral microbial composition seem to influence immune maturation and allergy development in childhood, and the presence of specific bacterial species may be important for this progress. Furthermore, altered IgA responses towards the gut microbiota during infancy preceded asthma and allergy manifestations during the first 7 years of life, and consumption of breastmilk with a reduced microbial richness in the first month of life may increase the risk for allergy development during childhood. Findings observed here need to be confirmed in larger cohorts and the importance of postnatal environmental factors for early microbiota development should be addressed further. Future research should go beyond characterization of bacterial community composition and investigate the functional mechanisms between early colonizing microorganisms, immune maturation and allergy and asthma development during childhood. / Dzidic, M. (2019). Microbiota development and mucosal IgA responses during childhood in health and allergic disease [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/125479 / TESIS