Phage therapy against Enterococcus faecalis in dental root canals

Figures & data

Fig. 1.  Comparative analysis of the actions antibiotics and phages have on a mature biofilm. Antibiotics fail to penetrate the biofilm and only kill the bacteria superficially, and are thus unable to eradicate the biofilm. Phages, on the other hand, can infect bacterial cells on the outer layer of the biofilm, multiply, and in a chain reaction penetrate into the deeper layers, resulting in complete eradication of the biofilm in a single shot.

Table 1. Phage therapy trials on bacterial biofilms using different model systems

Bacteria	Model system	Phage treatment	Efficacy	References
P. aeruginosa	Catheters	Phage cocktail	99.9%	(97)
P. aeruginosa	Cystic fibrosis in lung airway cells	Single phage	75%	(98)
P. aeruginosa	Mouse wound model	Phage cocktail	Significant 2 log decrease	(99)
Proteus mirabillis	Catheters	3-phage cocktail	Complete prevention of blockage	(100)
S. epidermidis	Catheters	Single phage	–	(101)
S. aureus	Rabbit ear wound model	Single phage combined with debridement	Significant improvement in wound infection	(102)
E. coli	Urothelium	Single phage	45%	(103)
P. aeruginosa	In vitro biofilm from hospital isolates	Single phage	Highly efficient in prevention and dispersion of pre-formed biofilm	(104)
S. aureus and S. epidermidis	In vitro biofilm	Single phages and combined mixture of two phages	High efficiency in disrupting mono-species as well as dual-species biofilm.	(95)
P. fluorescens	In vitro biofilm grown on glass slides	Single phage	93% cell removal at early stage of biofilm formation and prevention of biofilm formation	(105)
MRSA and P. aeruginosa	Implant-related infection	Single phage combined with antibiotics	MRSA: biofilm absent P. aeruginosa: no significant difference	(106)
S. aureus	In vitro biofilm	Single phage with antibiotic	Highly efficient as combined effect	(107)
P. aeruginosa	In vitro biofilm and extracted tooth model for root canal treatment	Single phages and combined mixture of two phages	Highly effective against in vitro biofilm. No significant effect in extracted tooth model	(108)
E. faecalis	Human dental roots	Single phage	Substantial reduction in bacterial cell viability	(109)

The phage therapy here involves either use of single phages or phage cocktails or combination treatments where phages are used along with antibiotics or previous clinical treatments.

Table 2. Phages isolated against E. faecalis, their accession numbers, and the family they belong to. This indicates the huge possibility of using these phages for phage therapy in the future.

Phages of E. faecalis	Lytic/lysogenic phage	Accession number	Family	References
phiEF24C	Lytic	AP009390.1	Myoviridae	(126)
ECP3	Lytic	KJ801817.1	Myoviridae	Unpublished
IME-EF1	Lytic	KF1920531	Siphoviridae	(123)
SAP6		JF731128.1	Siphoviridae	(76)
BC611		AB712291.1	Siphoviridae	(127)
EfaCPT1		JX193904.1	Siphoviridae	Unpublished
EFDG1	Lytic	KP339049.1	Myoviridae	(128)
EFLK1	Lytic	KR049063.1	Myoviridae	(129)
Q69				(125)
Phi4D			Myoviridae	(130)
IME_EF3	Lytic	KF728385	Siphoviridae	(131)
EFRM31	Lytic	GU815339	Siphoviridae	(132)
EFRM42	Lytic		Siphoviridae	(132)
EFRM54	Lytic		Siphoviridae	(132)
PhiFL1A	Lysogenic	GQ478081	Siphoviridae	(133)
PhiFL1B	Lysogenic	GQ478082	Siphoviridae	(133)
PhiFL1C	Lysogenic	GQ478083	Siphoviridae	(133)
PhiFL2A	Lysogenic	GQ478084	Siphoviridae	(133)
PhiFL2B	Lysogenic	GQ478085	Siphoviridae	(133)
PhiFL3A	Lysogenic	GQ478086	Siphoviridae	(133)
PhiFL3B	Lysogenic	GQ478087	Siphoviridae	(133)
PhiFL4A	Lysogenic	GQ478088	Siphoviridae	(133)
EFC-1	Lysogenic	KJ608188	Siphoviridae	(134)
Phi EF11	Lysogenic	GQ452243	Siphoviridae	(135)
vB_EfaS_GEC_EfS_3			Siphoviridae	(136)
Phi FC1	Lysogenic			(137)
F4		EF653454		(138)

Fig. 2.  Scanning electron microscopy images of untreated and treated biofilms with the phage EFDG1. The image on the left shows a well-developed biofilm, while the right image is one with EFDG1 phage treatment. Both the biofilms are 2 weeks old.

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