Abstract

Enterococcus faecalis is a Gram-positive, facultative anaerobic bacterium frequently found in the gastrointestinal tract, oral cavity, and periodontal tissue. Although it is considered a commensal, it can cause bacteremia, endocarditis, endodontic infections, and urinary tract infections. Because antibiotics are cytotoxic not only to pathogens, but also to health-beneficial commensals, phage therapy has emerged as an alternative strategy to specifically control pathogenic bacteria with minimal damage to the normal flora. In this study, we isolated a novel phage, Enterococcus phage vB_EfaS_HEf13 (phage HEf13), with broad lytic activity against 12 strains of E. faecalis among the three laboratory strains and 14 clinical isolates of E. faecalis evaluated. Transmission electron microscopy showed that phage HEf13 has morphological characteristics of the family Siphoviridae. Phage HEf13 was stable at a wide range of temperature (4–60°C) and showed tolerance to acid or alkaline (pH 3–12) growth conditions. Phage HEf13 had a short latent period (25 min) with a large burst size (approximately 352 virions per infected cell). The lytic activity of phage HEf13 at various multiplicities of infection consistently inhibited the growth of diverse clinical isolates of E. faecalis without any lysogenic process. Moreover, phage HEf13 showed an effective lytic activity against E. faecalis on human dentin ex vivo infection model. Whole genome analysis demonstrated that the phage HEf13 genome contains 57,811 bp of double-stranded DNA with a GC content of 40.1% and 95 predicted open reading frames (ORFs). Annotated functional ORFs were mainly classified into four groups: DNA replication/packaging/regulation, phage structure, host cell lysis, and additional functions such as RNA transcription. Comparative genomic analysis demonstrated that phage HEf13 is a novel phage that belongs to the Sap6virus lineage. Furthermore, the results of multiple sequence alignment showed that polymorphism of phage infection protein of E. faecalis (PIPEF) contributes to determine the host specificity of phage HEf13 against various E. faecalis strains. Collectively, these results suggest that phage HEf13 has characteristics of a lytic phage, and is a potential therapeutic agent for treatment or prevention of E. faecalis-associated infectious diseases.

Highlights

  • Enterococcus is a genus of Gram-positive, non-sporeforming bacteria that are frequently found in the oral cavity, gastrointestinal tract, and vagina (Jett et al, 1994)

  • In order to determine whether the phage is lytic or lysogenic, we examined the growth of E. faecalis infected with phage HEf13 in the presence of mitomycin C (MMC), which is a lysogenic phage inducer (Stevens et al, 2009)

  • We evaluated the effect of phage HEf13 against E. faecalis using an ex vivo human dentin infection model

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Summary

Introduction

Enterococcus is a genus of Gram-positive, non-sporeforming bacteria that are frequently found in the oral cavity, gastrointestinal tract, and vagina (Jett et al, 1994). Most Enterococcus species are considered to be commensal in humans and animals (Gu et al, 2018), Enterococcus faecalis can act as an opportunistic pathogen causing bacteremia, meningitis, endocarditis, or urinary tract- and wound-related infections (Arias et al, 2010; Weiner et al, 2016). E. faecalis has been predominantly detected in the root canals of patients with post-treatment apical periodontitis or refractory apical periodontitis, suggesting an etiological role in progression of these diseases (Souto and Colombo, 2008; Vidana et al, 2011). Because most strains of E. faecalis isolated from root canal and periodontal infections show a high level of resistance to antibiotics including tetracycline and erythromycin used in dental procedures, antibiotic options for endodontic treatment are limited (Pinheiro and Mayer, 2014). Indiscriminate use of antibiotics can result in disruption of normal gut microflora, and can negatively affect human health by promoting the evolution of antibiotic resistance in the microbiome and compromising immune homeostasis (Cho and Blaser, 2012; Francino, 2015)

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