Thanks to the folks who requested info on treating biofilms. In my previous blog post on biofilms, Viva La Commensal Biofilms, I discuss the basics of healthy biofilm, laboratory evaluations of biofilm status, and interventions to improve healthy biofilm formation.

In this blog post, we’re looking at dysbiotic or pathogenic biofilms and interventions, per your request!

Simply put, quorum sensing is communication between microbes via signal molecules (called auto-inducers) to ensure survival of the microbial population against exogenous antimicrobials and host immune mechanisms. As I mentioned in the previous post, biofilms can increase resistance to antimicrobials up to 1000%.¹ Biofilm development is a central quorum sensing process.

“Quorum quenching” (QQ) is the vogue term used to describe the interruption of quorum sensing. Inherent in quorum sensing interruption is biofilm disruption. If the biofilm is disrupted, then antimicrobial interventions (and host immune response) may be much more effective at eradicating the microbes.

As antimicrobial resistance marches ahead, quorum quenching is an area of intense research.^2-4 We’ll discuss QQ treatment considerations below.

Biofilms are implicated in many intestinal and extraintestinal conditions, from inflammatory bowel disease, chronic prostatitis, chronic candidiasis to dental caries and periodontitis.⁵

Indeed, any refractory conditions with a microbial component may be due to a biofilm presence. Think about individuals who respond fabulously well to initial treatment, only to relapse into previous symptoms a short time later.

The treatment approach for
GI biofilm disruption is multifactorial

I think the technical write-up Life on the Edge: The Clinical Implications of Gastrointestinal Biofilm by Olmstead el al from Klaire is quite fabu.⁵ Klaire/Prothera have a number of great technical write-ups you can access at the above link.  (login required)

Structurally, biofilms contain polysaccharides and peptides. Targeted enzyme therapy has shown efficacy against biofilms.^{2, 3, 5} Metals are also a key aspect to biofilm structure. Thus, chelating agents may be another important piece of quorum quenching.⁵ Indeed, the iron-chelating protein lactoferrin is produced by neutrophils to protect the host against pathogenic organisms. Could this be our endogenous attempt at quorum quenching?

Concomitant with biofilm disruption must be the introduction of antimicrobials, pharmaceutical or botanical.⁵

Reseeding the gut with aggressive pre- and probiotics should also occur, (inulin alone has been shown effective against some biofilms⁴) but these should be taken away from the antimicrobial to minimize the bacteriocidal effects. Klaire Labs recommends 1 hour before or 2 hours after the antimicrobial.⁵

Obviously, a general “4R” protocol (see PDF - p 2) is indicated in conjunction with the above therapies.

References

1. Stewart PS, Costerton JW. Antibiotic resistance of bacteria in biofilms. Lancet. Jul 14 2001;358(9276):135-138.
2. Longhi C, Scoarughi GL, Poggiali F, et al. Protease treatment affects both invasion ability and biofilm formation in Listeria monocytogenes. Microb Pathog. Jul 2008;45(1):45-52.
3. Momb J, Wang C, Liu D, et al. Mechanism of the quorum-quenching lactonase (AiiA) from Bacillus thuringiensis. 2. Substrate modeling and active site mutations. Biochemistry. Jul 22 2008;47(29):7715-7725.
4. Kleessen B, Blaut M. Modulation of gut mucosal biofilms. Br J Nutr. Apr 2005;93 Suppl 1:S35-40.
5. Olmstead S, Meiss D, Ralston J. Life on the Edge: The Clinical Implications of Gastrointestinal Biofilm. 2009.