1. Introduction
Selective environmental pressures force bacteria to adapt by altering their growth state. One preferred state is biofilm, which exists in almost 90% of bacteria. Biofilm is a three-dimensional, multicellular surface-tethered bacterial aggregation embedded in an extracellular matrix (ECM). During biofilm formation, planktonic cells attach to surface and transition to the sessile state to secrete an extracellular polymeric substance (EPS) forming a protective barrier against abiotic and biotic stressors. Upon maturation of biofilm, the cells are shed for dispersal which then transition into planktonic cells [
1]. Biofilm is an inherent physiological and regulatory strategy for being refractory to antimicrobial treatments and the host immune system [
1,
2]. Clinically relevant biofilm-associated infections are either tissue or device-related infections. Chronic tissue infections include wounds, dental plaque, urinary tract infection, cystic fibrosis, and so on, while medical devices like catheters, prosthetic heart valves, orthopedic implants, and so on are colonized by bacteria [
3].
Up to 65% and 80% of microbial and chronic infections respectively are linked to bacterial biofilms [
4]. Additionally, recurrent bacterial infections are due to the persistent nature of the biofilms [
1]. Currently, ESKAPE group organisms (
Enterococcus faecium,
Staphylococcus aureus,
Klebsiella pneumoniae,
Acinetobacter baumannii,
Pseudomonas aeruginosa, and
Enterobacter spp.) are the most prevalent cause of multidrug resistant biofilm-associated chronic infections [
5]. Certain biofilm producers, such as
Staphylococcus epidermidis and the ESKAPE group, have been implicated in nosocomial infections from contaminated medical devices [
6,
7]. Biofilm plays a critical role in the pathogenesis of chronic diseases like tuberculosis and cystic fibrosis [
8]. Treatment of biofilm-associated infections is becoming increasingly difficult due to multidrug resistance, and thereby they still pose a significant risk to human health. This study focuses on optimizing and evaluating different formulations to find effective therapeutics for biofilm-related bacterial infections.
Green tea, derived from
Camellia sinensis, has held a significant place for a long time in traditional medicine. It is the second most popular beverage consumed in the world [
9]. Epigallocatechin gallate (EGCG), the most abundant polyphenol/catechin in green tea, has been attributed numerous health benefits including antioxidant, anti-inflammatory, anti-cancerous, and antimicrobial properties [
10,
11,
12,
13]. United States Food and Drug Administration (FDA) classified EGCG as a safe compound due to its non-toxic nature and lack of side effects after application or consumption [
14,
15]. Many studies indicated antimicrobial [
16,
17] and anti-biofilm activity of EGCG on various Gram-positive and Gram-negative bacteria [
18]. Parallel studies suggested synergism of antibiotics and EGCG on bacterial growth wherein EGCG is shown to enhance bacterial susceptibility, including methicillin-resistant
Staphylococcus aureus (MRSA),
Porphyromonas gingivalis (
P. gingivalis) and
Klebsiella pneumoniae (
K. pneumoniae) to antibiotics [
19,
20,
21,
22,
23].
Besides the beneficial properties, the natural water-soluble form of EGCG is relatively unstable, which affects its bioavailability and makes formulations difficult [
24,
25,
26]. The rapid metabolism of EGCG results in a loss of therapeutic properties [
19]. Several modifications of green tea polyphenols (GTPs) were synthesized to resolve the stability issue. Lipid-soluble analogs were found to be effective GTPs as they were highly stable with improved bioavailability [
27]. Modified lipophilic polyphenols (LTPs) were shown to act synergistically with antibiotics to inhibit the growth of various Gram-positive and Gram-negative bacteria [
19]. Another lipophilic EGCG derivative, EGCG-palmitate-based formulations exhibited sporicidal activity [
28,
29]. Recently, a derivative of EGCG known as epigallocatechin-3-gallate-stearate (EGCG-S) was synthesized by esterification of fatty acid making EGCG lipophilic and thereby, enhancing its absorption in the lipid bilayer. EGCG-S has been successfully shown to inhibit spores produced by
Bacillus spp. and the growth of
Streptococcus mutans (
S. mutans) [
30,
31]. Additionally, EGCG-S was shown to improve the efficacy of antibiotics against various bacteria, thereby making it a potential synergistic anti-bacterial agent [
32]. Various antibiotics have been previously shown to have synergism with EGCG/EGCG-S to inhibit bacterial growth [
32]. The bacteria were more susceptible to specific antibiotics such as tetracycline and erythromycin respectively when used in combination with EGCG/EGCG-S [
32].
In this study biofilm formation in five potentially pathogenic bacteria, including
Escherichia coli (
E. coli),
Mycobacterium smegmatis (
M. smegmatis),
Pseudomonas aeruginosa (
P. aeruginosa),
Staphylococcus aureus (
S. aureus), and
Staphylococcus epidermidis (
S. epidermidis) were studied.
E. coli has been implicated in urinary tract infections (UTIs) [
33]. The biofilm associated UTIs are frequently found in patients that use catheters [
34,
35]. The non-infectious
M. smegmatis was used as a surrogate for
M. tuberculosis as they share growth characteristics [
36]. Both strains have been used as model organisms for biofilm studies [
37]. Development of
M. tuberculosis biofilm leads to cavity formation and necrosis in lung tissue [
38].
P. aeruginosa is a major cause of nosocomial infections that fail to resolve with antibiotic treatment. Biofilms of these bacteria are found on implanted and indwelling devices [
39].
S. aureus biofilm is one of the major hallmarks of cystic fibrosis respiratory infections. These infections have become refractory to antibiotics and have led to emergence of methicillin-resistant
S. aureus (MRSA) [
40].
S. epidermidis, a human commensal microorganism, is a causative agent of chronic infections in compromised hosts [
41]. These infections are associated with the introduction of foreign biomaterials like catheters and prostheses [
42]. All biofilm infections are becoming highly recalcitrant to host immune system and multiple drugs.
The classic biofilm measurements are based on direct cell enumeration by colony forming unit (CFU) counting and indirect biofilm accumulation by crystal violet (CV) staining. However, these techniques require biofilm resuspension and the potential carryover of the antimicrobials may skew the results [
43]. Resazurin assay rapidly quantifies metabolic cell activity, is sensitive, simple, and requires no biofilm isolation [
44]. This assay is a preferred choice for biofilm quantification [
45] and is widely used in biofilm-associated studies [
46,
47,
48].Therefore, this study utilized three independent quantitative assays, CFU analysis, CV staining, and resazurin, to ensure consistent data with high confidence. Furthermore, a fluorescent dye-based microscopic analysis was performed to study the viability of the cells. According to Clinical Laboratory Standards Institute (CLSI) Kirby-Bauer disk diffusion [
49] profiling results,
E. coli and
M. smegmatis were intermediate to erythromycin while
P. aeruginosa was resistant to erythromycin. Both
S. aureus and
S. epidermidis were intermediate to tetracycline. We previously reported that EGCG-S can enhance the erythromycin on Gram-negative bacteria such as
E. coli,
P. aeruginosa and converted the bacteria from antibiotic resistant or intermediate category to sensitive. EGCG-S can enhance tetracycline on
S. aureus and
S. epidermidis and converted the bacteria from antibiotic resistant or intermediate category to sensitive [
32]. In this study, erythromycin was used on the Gram-negative and acid-fast bacteria; tetracycline was used on Gram-positive bacteria to study the synergistic action of EGCG-S and erythromycin/tetracycline in inhibiting biofilm production.
3. Discussion
EGCG exerts its antimicrobial effect on bacteria using various mechanisms, such as cell membrane damage, enzyme inhibition, impairment of fatty acid biosynthesis, and so forth [
50]. EGCG has been shown to inhibit biofilm formation in diverse bacteria including
E. coli [
51],
P. aeruginosa [
23],
Staphylococcal spp. [
52],
S. mutans [
53],
P. gingivalis [
54], and
Fusobacterium nucleatum [
55] under in vitro and in vivo conditions. Recently, a detailed mechanism of action for EGCG was described using
E. coli as a model system; EGCG synergistically targets amyloid curli fibers (anti-amyloidogenic) and cellulose synthesis, the two crucial processes of biofilm formation [
56]. Furthermore, this study identified cell envelope stress as a second target for biofilm interference. Under stress, the cell downregulates the translation of trans-membrane proteins like protein complexes used in the biosynthesis of amyloid fibers and cellulose. This stress is potentially induced by the interaction of EGCG and the cell lipid bilayer [
57], which can create temporal disturbances like perforations and grooves at the cell surface, thereby inducing cell damage [
58,
59,
60]. EGCG impacts the integrity of the cell envelope, not only in
E. coli but also in other bacteria, including
M. smegmatis [
61]. Although the trigger for this cell-envelope stress is unknown, it is proposed that reactive oxygen species (ROS) are involved in the bactericidal action of catechins [
62]. ROS-mediated permanent damage has also been observed in a combination study of EGCG with antibiotic cefotaxime on
E. coli cells [
58]. In
Staphylococcus spp. EGCG impairs the assembly of phenol-soluble modulins (PSMs) fibril formation and targets the preformed fibrils for disentanglement [
63]. Another study found flavonoids can specifically prevent biofilm-associated proteins (Bap)–mediated biofilms [
64]. Additionally, EGCG is shown to interfere with the polysaccharides that form the glycocalyx and bind peptidoglycan impairing the integrity of the cell wall, thereby suggesting that it can affect the initial attachment of biofilm to the surface [
52]. EGCG has been found to be very effective in interfering with the action of amyloid fibers, FapC in
P. aeruginosa [
65] and amyloid proteins in
S. mutans [
66]. Besides, EGCG is involved in suppressing multiple virulence factors deployed by pathogenic bacteria to infections [
67,
68]. These studies suggest amyloid fibrils as a common target of EGCG, however EGCG can have multiple targets for a specific bacterial species and is efficient in interfering with multiple cellular processes without even entering a bacterial cell.
Some studies have suggested the synergism between EGCG and different antibiotics on inhibiting bacteria like methicillin-resistant
S. aureus (MRSA),
P. gingivalis, and
K. pneumoniae [
22,
69,
70], and on bacterial biofilms. Biofilm formation by pathogenic organisms has developed tolerance to elevated levels of antimicrobials [
71]. Most studies demonstrate that EGCG can work synergistically with antibiotics by breaking down the extracellular matrix components, thereby favoring antibiotics penetration and action on bacterial cells in biofilms [
21,
22,
23], while other studies report opposite results [
67,
72]. These counterproductive effects raise questions about the efficacy of EGCG as its stability and bioavailability fluctuate with research conditions. EGCG, a hydrophilic molecule with low membrane permeability and chemical stability [
73], is not a suitable candidate to be formulated in therapeutic preparations without rapid oxidation and loss of antimicrobial activity. Thus, in this study, we have used a patented (US8076484B2) esterified derivative of EGCG, EGCG-Stearate (EGCG-S) which improves the bioavailability significantly [
74,
75]. Previously, we reported that EGCG-S can be used as an anti-spore agent, as it inhibits germination of spores produced by
Bacillus species [
30]. In 2018, our study highlighted the anti-cariogenic property of EGCG-S as it was able to inhibit the growth and biofilm formation of
S. mutans, an etiological agent of dental caries [
31]. Taken together, evidence shows EGCG-S inhibits spore germination and biofilm formation. However, whether the synergism of EGCG-S with antibiotics extends to interfere with biofilm formation is still unknown. To the best of our knowledge, this research is the first to illustrate that the combination of EGCG-S and antibiotics not only inhibits bacterial growth, but also biofilm formation.
4. Materials and Methods
4.1. Bacterial Cultures
Five potential pathogenic biofilm producers, Escherichia coli (ATCC® CRM-8739), Pseudomonas aeruginosa (ATCC® CRM-9027), Staphylococcus aureus (ATCC® CRM-6538), Staphylococcus epidermidis (ATCC® 14990), and Mycobacterium smegmatis (ATCC® 19420) were grown aseptically on nutrient agar or broth. The stock cultures were stored at 4 °C. Fresh overnight cultures were maintained at 37 °C with constant shaking at 250 rpm. Gram staining was performed before each experiment to confirm the culture purity.
4.2. EGCG-S and Antibiotic Formulations
EGCG-S (US Patent 8076484) purchased from Camellix LLC (Evans, GA, USA), was dissolved in absolute ethanol to make a stock concentration of 10 mg/mL prior to formulations. The stock was diluted to the required concentrations for each experiment. Phosphate buffer saline (PBS) was used as a negative control, while 10% bleach was used as a positive control. Antibiotics erythromycin (E0774) and tetracycline (T3258), were purchased from Sigma Aldrich (St. Louis, MO, USA). The stock concentration (1000 μg/mL) was prepared by dissolving antibiotics in absolute ethanol. Final concentrations of ethanol in the working solutions were all less than 5%, which did not inhibit the growth of the bacteria. The solutions were filter sterilized and stored at −20 °C. The required concentrations were diluted from the stock aseptically prior to the experiment. The formulations consisted of varying concentrations of EGCG-S and antibiotics depending on the selected bacterium.
4.3. Quantitative Absorbance-Based Biofilm Measurement (Crystal Violet Assay)
The cultures were treated with EGCG-S and antibiotics alone and different formulations followed up by incubation at 37 °C for 4 days. The liquid was aspirated, the biofilm (if any) was washed and then stained with 0.1% crystal violet (CV) for 24 h. After strain aspiration and a final 1 × PBS wash, the biofilms were dried for 24 h. Biofilm was resuspended in 30% acetic acid and the optical density (OD) were recorded at 595 nm [
76]. All experiments were performed in triplicate, with mean and standard deviation calculated. These readings were then used to determine the percentage of biofilm inhibition. 10% bleach and PBS were used as the positive and negative control, respectively.
4.4. Quantitative Fluorescence-Based Biofilm Measurement (Resazurin Assay)
Fresh log-phase bacterial cultures were incubated at 37 °C for 4 days in 96-well plates. After the media was aspirated, the biofilm was rinsed with 1 × PBS and stained with a 200 μM Resazurin solution. After overnight incubation in the dark at 4 °C, fluorescence was measured at excitation and an emission wavelength of 560 nm and 590 nm respectively using a microplate reader (Infinite 200 PRO, Tecan, Männedorf, Switzerland) adjusted to the fluorescent mode [
47]. The Relative Light Units (RLU) were measured, and the percentage (%) of inhibition was calculated for each treatment according to the following formula.
4.5. Quantitative Growth-Based Cell Viability Measurement (Colony Forming Unit Assay)
Bacterial cultures were incubated at 37 °C for 4 days in 24-well plates. The biofilm attached to the well plate was scrapped and suspended in 100 μL of deionized water. The samples were serially diluted (from 10
0 to 10
−4) and 100 μL of each dilution was spread plated on nutrient agar aseptically. The media plates were incubated overnight at 37 °C. Colony-forming units (CFUs) were recorded and percentage of inhibition was calculated using the following formula. LD
50 represents the lethal concentration to 50% of the population.
Additionally, the CFU measurement was used to calculate log10 (fold) reduction using the following equation:
4.6. Qualitative Microscopy-Based Cell Viability Assay
The LIVE/DEAD® BacLight™ Bacterial Viability Kit (Thermo Fisher, Waltham, MA, USA) was used according to the manufacture manual. The scrapped biofilms were grown in a 6-well plate with/without different treatments. After incubation at 37 °C for 4 days, the liquid was aspirated exposing the biofilms adhering to the well surface. The biofilms were then washed and stained with dye mixture. After proper staining coverslips were placed in the well to view under the microscope. The molecular probes used were SYTO 9, a green-fluorescent membrane-permeant dye that stains live cell, and propidium iodide (PI), red fluorescence dye that stains dead cells due to damaged cell membrane. All samples were viewed under a fluorescent microscope (Axio Scope A1, Carl Zeiss, München, Germany).
4.7. Statistical Analysis
All assays were performed in triplicate. Statistically significant differences between control and test were analyzed by one-way analysis of variance (one-way ANOVA) with Dunnett’s multiple comparison post-test at p < 0.05. The analyses were carried out in GraphPad Prism Software (GraphPad Software Inc., San Diego, CA, USA).