Abstract
Denture stomatitis (DS) is characterized by inflammation of the oral mucosa in direct contact with dentures and affects a significant number of otherwise healthy denture wearers. The disease is caused by Candida albicans, which readily colonizes and form biofilms on denture materials. While evidence for biofilms on abiotic and biotic surfaces initiating Candida infections is accumulating, a role for biofilms in DS remains unclear. Using an established model of DS in immunocompetent animals, the purpose of this study was to determine the role of biofilm formation in mucosal damage during pathogenesis using C. albicans or mutants defective in morphogenesis (efg1-/-) or biofilm formation (bcr1-/-). For in vivo analyses, rats fitted with custom dentures, consisting of fixed and removable parts, were inoculated with wild-type C. albicans, mutants or reconstituted strains and monitored weekly for fungal burden (denture and palate), body weight and tissue damage (LDH) for up to 8 weeks. C. albicans wild-type and reconstituted mutants formed biofilms on dentures and palatal tissues under in vitro, ex vivo and in vivo conditions as indicated by microscopy demonstrating robust biofilm architecture and extracellular matrix (ECM). In contrast, both efg1-/- and bcr1-/- mutants exhibited poor biofilm growth with little to no ECM. In addition, quantification of fungal burden showed reduced colonization throughout the infection period on dentures and palates of rats inoculated with efg1-/-, but not bcr1-/-, compared to controls. Finally, rats inoculated with efg1-/- and bcr1-/- mutants had minimal palatal tissue damage/weight loss while those inoculated with wild-type or reconstituted mutants showed evidence of tissue damage and exhibited stunted weight gain. These data suggest that biofilm formation is associated with tissue damage during DS and that Efg1 and Bcr1, both central regulators of virulence in C. albicans, have pivotal roles in pathogenesis of DS.
Highlights
Denture stomatitis (DS) is an inflammatory fungal infection, presenting as erythematous inflammation beneath primarily maxillary dentures [1,2,3,4,5,6,7]
We developed a model of Candida-associated denture stomatitis in immunocompetent rats, which results in palatal inflammation and clinical signs of disease following both denture and palate biofilm formation [25]
For the in vitro model, Polymethyl methacrylate (PMMA) denture samples were inoculated with C. albicans strains in filter-sterilized human saliva and allowed to grow for 24h at 37°C to mimic in vivo conditions
Summary
Denture stomatitis (DS) is an inflammatory fungal infection, presenting as erythematous inflammation beneath primarily maxillary (upper) dentures [1,2,3,4,5,6,7]. DS is the most common form for oral candidiasis, affecting approximately 30–75% of otherwise healthy denture wearers. Candida albicans being the most common etiologic agent; non-albicans Candida species are associated with infection [8]. Symptoms of Candida-associated denture stomatitis range from mild to severe, including palatal edema, painful inflammation, and papillary hyperplasia (small pebble-like sores) [9]. Denture stomatitis can have a negative impact on the quality of life for those affected, with very high recurrence rates despite treatment with antifungal therapy [10,11,12,13,14,15]. The pathogenesis of DS and role of fungal virulence factors contributing to infection are not well understood
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