Efeito antimicrobiano e anti-inflamatório de ácidos fenólicos isolados, combinados e incorporados em hidrogéis de quitosana para aplicação endodôntica
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Data
2022-10-24
Autores
Santos, Vanessa Rodrigues dos [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O objetivo do tratamento endodôntico é manter a integridade da raiz, bem como, prevenir ou resolver doenças periapicais, pela erradicação dos microrganismos e de suas fontes de nutrientes provenientes do sistema de canais radiculares. A complexidade da anatomia dos canais radiculares e dos biofilmes multiespécies aumenta a dificuldade em eliminar os microrganismos e controlar a inflamação por procedimentos químico-mecânicos convencionais, o que justifica o uso de medicações intracanais. Novos compostos com amplo efeito antimicrobiano e potencial antiinflamatório, como os ácidos fenólicos, poderiam ser explorados como princípios ativos de medicamentos intracanais. Entretanto, para aumentar a solubilidade, controlar a liberação e estender os efeitos biológicos dos ácidos fenólicos, seria interessante incorporá-los em carreadores de medicamentos como os hidrogéis de quitosana. Este estudo foi dividido em dois capítulos que apresentaram como objetivos: 1) avaliar as atividades antimicrobiana, antibiofilme e antiinflamatória e a citotoxicidade do ácido cinâmico e seus derivados; 2) sintetizar e caracterizar as propriedades químicas e físico-mecânicas de hidrogéis termossensíveis de quitosana e poloxamer contendo ácidos fenólicos, e avaliar o efeito desses hidrogéis sobre biofilmes multiespécies e na viabilidade de macrófagos e fibroblastos. No capítulo 1, a atividade antimicrobiana do ácido cinâmico (CI) e seus derivados ácido cumárico (CO), ácido cafeico (CA), ácido ferúlico (FE) e ácido sinápico (SI) foi avaliada pela determinação da concentração inibitória e bactericida mínima (CIM/CBM) e Concentração Inibitória Fracionada (CIF) sobre Enterococcus faecalis, Streptococcus mutans, Lactobacillus casei, Actinomyces israelii e Fusobacterium nucleatum. Os ácidos fenólicos foram selecionados e seu efeito em biofilmes dual-espécies e multiespécies com as mesmas cepas padrão ou cepas clínicas foram avaliados por contagem bacteriana, microscopia eletrônica de varredura e microscopia confocal. A viabilidade de fibroblastos L929 e macrófagos RAW 264.7 na presença desses ácidos fenólicos foi avaliada por ensaios de resazurina. Além disso, os níveis de mRNA dos marcadores pró-inflamatórios TNF-α, IL-1β, iNOS e COX-2 foram determinados por PCR quantitativo TaqMan após exposição de macrófagos aos ácidos fenólicos e ao lipopolissacarídeo (LPS). No capítulo 2, foi realizada a síntese e caracterização físico-mecânica de hidrogéis de quitosana-poloxamer (CPH) contendo ácidos fenólicos e avaliado seus efeitos no biofilme multiespécies e na viabilidade de macrófagos e fibroblastos. Os dados foram analisados estatisticamente considerando p<0,05. O ácido cinâmico e o ácido cafeico apresentaram efeito inibitório e bactericida contra todas as espécies bacterianas testadas, com os menores valores de CIM e CBM. Entretanto, não houve efeito sinérgico entre eles (FICI>0,5). Ambos os compostos (5x a CIM mais alta) foram eficazes na eliminação de biofilmes dual-espécies e na redução significativa de biofilmes multiespécies, especialmente o ácido cinâmico. O ácido cinâmico causou toxicidade mínima para ambas as culturas celulares nas concentrações de CIM e o ácido cafeico não foi citotóxico em concentrações abaixo de 0,125 mg/mL. Ambos os compostos reduziram significativamente TNF-α, IL-1β, iNOS e COX-2, de maneira dose-dependente. Os CPH foram caracterizados como termorreversíveis e com propriedades mecânicas e bioadesivas desejáveis. O efeito dos hidrogéis CPH+CA (77,8%) e CPH+CI (73,2%) em reduzir os biofilmes multiespécies foi superior ao CPH+ hidroxido de cálcio (CH) (53,6%) e CPH+ clorexidina (CHX) (39,9%). Em geral, CPH + CI causou menor citotoxicidade quando comparado a CPH + CA, para ambas as linhagens celulares. Conclui-se que o ácido cinâmico e ácido cafeico apresentaram efeito bactericida e contra biofilmes formados por bactérias associadas com infecções endodônticas, causando baixa citotoxicidade. Ambos os compostos apresentaram efeito antiinflamatório, inibindo a expressão de marcadores pró-inflamatórios em macrófagos estimulados por LPS. Os hidrogéis de quitosana-poloxamer foram termorreversíveis e apresentaram adequadas propriedades mecânicas e adesivas para aplicação clínica, e quando combinados principalmente com ácido cinâmico, promoveram a redução de biofilmes multiespécies formados nos túbulos dentinários, causando baixa toxicidade em fibroblastos e macrófagos.
The objective of endodontic treatment is to maintain the integrity of the root, as well as to prevent or resolve periapical diseases, by eradicating microorganisms and their sources of nutrients from the root canal system. The complexity of root canal anatomy and multispecies biofilms increases the difficulty in eliminating microorganisms and controlling inflammation by conventional chemical-mechanical procedures, which justifies the use of intracanal medications. New compounds with broad antimicrobial effect and anti-inflammatory potential, such as phenolic acids, could be explored as active principles of intracanal medications. However, to increase the solubility, control the release and extend the biological effects of phenolic acids, it would be interesting to incorporate them into drug carriers such as chitosan hydrogels. This study was divided into two chapters with the following objectives: 1) to evaluate the antimicrobial, antibiofilm and anti-inflammatory activities and the cytotoxicity of cinnamic acid and its derivatives; 2) synthesize and characterize chemical and physico-mecanical properties of thermosensitive chitosan and poloxamer hydrogels containing phenolic acids and evaluate the effect of these hydrogels on multispecies biofilms and on the viability of macrophages and fibroblasts. In chapter 1, the antimicrobial activity of cinnamic acid (CI) and its derivatives coumaric acid (CO), caffeic acid (CA), ferulic acid (FE) and sinapic acid (SI) was evaluated by determining the minimum inhibitory and bactericidal concentration (MIC/MBC) and Fractional Inhibitory Concentration (FIC) on Enterococcus faecalis, Streptococcus mutans, Lactobacillus casei, Actinomyces israelii and Fusobacterium nucleatum. Phenolic acids were selected and their effect on bispecies and multispecies biofilms with the same standard or clinical strains were evaluated by bacterial counts, scanning electron microscopy and confocal microscopy. The viability of L929 fibroblasts and RAW 264.7 macrophages in the presence of these phenolic acids was evaluated by resazurin assays. In addition, mRNA levels of the pro-inflammatory markers TNF-α, IL-1β, iNOS and COX-2 were determined by quantitative TaqMan PCR after macrophage exposure to phenolic acids and lipopolysaccharide (LPS). In chapter 2, the synthesis and physical-mechanical characterization of chitosan-poloxamer (CPH) hydrogels containing phenolic acids were performed and their effects on multispecies biofilm and on the viability of macrophages and fibroblasts were evaluated. Data were statistically analyzed considering p<0.05. Cinnamic acid and caffeic acid showed an inhibitory and bactericidal effect against all bacterial species tested, with the lowest MIC and MBC values. However, no synergistic effect was observed between the compounds (FICI>0.5). Both compounds (at 5x the highest MIC) were effective in eliminating dual-species biofilms and significantly decreasing multispecies biofilms, especially cinnamic acid. Cinnamic acid caused minimal toxicity to both cell cultures at MIC concentrations and caffeic acid was not cytotoxic at concentrations below 0.125 mg/mL. Both compounds significantly reduced TNF-α, IL-1β, iNOS and COX-2, in a dose-dependent manner. CPH were characterized as thermoreversible and with adequate mechanical and bioadhesive properties. The effect of CPH+CA (77.8%) and CPH+CI (73.2%) hydrogels against multispecies biofilms was superior to CPH + calcium hydroxide (CH) (53.6%) and CPH + chlorhexidine (CHX) (39.9%). In general, CPH + CI caused less cytotoxicity when compared to CPH + CA, for both cell lines. In conclusion, cinnamic acid and caffeic acid showed bactericidal effect and against biofilms of bacteria associated with endodontic infections, causing minimal cytotoxicity. In addition, both compounds showed an anti-inflammatory effect, inhibiting the expression of pro-inflammatory markers in LPS-stimulated macrophages. The chitosan-poloxamer hydrogels were thermoreversible and presented adequate mechanical and bioadhesive properties for clinical application, and when combined specially with cinnamic acid, they promoted the reduction of multispecies biofilms formed in the dentinal tubules, causing low toxicity to fibroblasts and macrophages.
The objective of endodontic treatment is to maintain the integrity of the root, as well as to prevent or resolve periapical diseases, by eradicating microorganisms and their sources of nutrients from the root canal system. The complexity of root canal anatomy and multispecies biofilms increases the difficulty in eliminating microorganisms and controlling inflammation by conventional chemical-mechanical procedures, which justifies the use of intracanal medications. New compounds with broad antimicrobial effect and anti-inflammatory potential, such as phenolic acids, could be explored as active principles of intracanal medications. However, to increase the solubility, control the release and extend the biological effects of phenolic acids, it would be interesting to incorporate them into drug carriers such as chitosan hydrogels. This study was divided into two chapters with the following objectives: 1) to evaluate the antimicrobial, antibiofilm and anti-inflammatory activities and the cytotoxicity of cinnamic acid and its derivatives; 2) synthesize and characterize chemical and physico-mecanical properties of thermosensitive chitosan and poloxamer hydrogels containing phenolic acids and evaluate the effect of these hydrogels on multispecies biofilms and on the viability of macrophages and fibroblasts. In chapter 1, the antimicrobial activity of cinnamic acid (CI) and its derivatives coumaric acid (CO), caffeic acid (CA), ferulic acid (FE) and sinapic acid (SI) was evaluated by determining the minimum inhibitory and bactericidal concentration (MIC/MBC) and Fractional Inhibitory Concentration (FIC) on Enterococcus faecalis, Streptococcus mutans, Lactobacillus casei, Actinomyces israelii and Fusobacterium nucleatum. Phenolic acids were selected and their effect on bispecies and multispecies biofilms with the same standard or clinical strains were evaluated by bacterial counts, scanning electron microscopy and confocal microscopy. The viability of L929 fibroblasts and RAW 264.7 macrophages in the presence of these phenolic acids was evaluated by resazurin assays. In addition, mRNA levels of the pro-inflammatory markers TNF-α, IL-1β, iNOS and COX-2 were determined by quantitative TaqMan PCR after macrophage exposure to phenolic acids and lipopolysaccharide (LPS). In chapter 2, the synthesis and physical-mechanical characterization of chitosan-poloxamer (CPH) hydrogels containing phenolic acids were performed and their effects on multispecies biofilm and on the viability of macrophages and fibroblasts were evaluated. Data were statistically analyzed considering p<0.05. Cinnamic acid and caffeic acid showed an inhibitory and bactericidal effect against all bacterial species tested, with the lowest MIC and MBC values. However, no synergistic effect was observed between the compounds (FICI>0.5). Both compounds (at 5x the highest MIC) were effective in eliminating dual-species biofilms and significantly decreasing multispecies biofilms, especially cinnamic acid. Cinnamic acid caused minimal toxicity to both cell cultures at MIC concentrations and caffeic acid was not cytotoxic at concentrations below 0.125 mg/mL. Both compounds significantly reduced TNF-α, IL-1β, iNOS and COX-2, in a dose-dependent manner. CPH were characterized as thermoreversible and with adequate mechanical and bioadhesive properties. The effect of CPH+CA (77.8%) and CPH+CI (73.2%) hydrogels against multispecies biofilms was superior to CPH + calcium hydroxide (CH) (53.6%) and CPH + chlorhexidine (CHX) (39.9%). In general, CPH + CI caused less cytotoxicity when compared to CPH + CA, for both cell lines. In conclusion, cinnamic acid and caffeic acid showed bactericidal effect and against biofilms of bacteria associated with endodontic infections, causing minimal cytotoxicity. In addition, both compounds showed an anti-inflammatory effect, inhibiting the expression of pro-inflammatory markers in LPS-stimulated macrophages. The chitosan-poloxamer hydrogels were thermoreversible and presented adequate mechanical and bioadhesive properties for clinical application, and when combined specially with cinnamic acid, they promoted the reduction of multispecies biofilms formed in the dentinal tubules, causing low toxicity to fibroblasts and macrophages.
Descrição
Palavras-chave
Cinamatos, Ácidos cafeicos, Anti-infecciosos, Biofilmes, Agentes anti-inflamatórios, Quitosana, Chitosan