IN VITRO EFFECT OF STATINS ON STREPTOCOCCUS MUTANS, STREPTOCOCCUS SANGUIS, AND STREPTOCOCCUS SALVARIUS

Abstract

Objectives: Cardiovascular disease (CVD), including heart attack, angina, and stroke, is ranked as the number one cause of mortality world wide. High blood cholesterol is linked to CVD and is an important risk factor. Statins – cholesterol lowering drugs- are first choice drugs for reducing the chance of suffering a CVD event. In the USA alone, approximately 32 million individuals take statins. Although randomized control trials of statins have demonstrated their efficacy in preventing CVD, much less information has been reported on their unintended effects. Although not thought of traditionally as antimicrobials, statins have been shown to have antimicrobial effects in vitro. The statins belong to a family of drugs that lower cholesterol levels by inhibiting 3-hydroxy-3-methylglutaryl-CoA reductase, a rate limiting enzyme in the human mevalonate pathway of which cholesterol in the biosynthetic end product. The mevalonate pathway is an important cellular metabolic pathway present in many bacteria. Hence, the aim of this study was to assess the in vitro efficacy of statins against selected strains of oral streptococci, as determined by the minimum inhibitory concentration. A second related objective is to assess the in vitro effect of statins on single species biofilm formation , as determined by binding of the same streptococci to hydroxyapatite pegs. Methods: The effect of statins on S. mutans, S. sanguis, and S. salivarius was determined by finding the minimum inhibitory concentration (MIC) by broth dilution assays. Simvastatin, pravastatin atorvastatin, and rousuvastatin were used in this study. The minimum inhibitory concentration was considered to be the lowest concentration of statin that prevented bacterial growth, i.e. a clear test tube. Experiments were repeated twice for each bacterial species. The effect of simvastatin, atorvastatin, and pravastatin on the ability of S. mutans and S. sanguis to form single species biofilm was assayed using sterile microplates and the MBEC Biofilm Inoculator (Innovatech). Results: Two trials indicated that the MIC of simvastatin against the selected oral bacteria was determined to be 15.6 μg/ml for S. mutans and S. sanguis, and 7.8 μg/ml for S. salivarius. The MIC of rosuvastatin and atorvastatin was determined to be 100 μg/ml against all three streptococci, whereas the MIC of pravastatin was even higher (200 μg/ml) against all three streptococci. Likewise, two trials indicated that statins decreased single species biofilm formation by S. mutans and S. sanguis. For simvastatin, biofilm formation was decreased by concentrations eight fold below the MIC . The results were substantiated by spectrophotometric assay . For atorvastatin and pravastatin, biofilm formation was decreased by concentrations 3-4 fold below the MIC. Conclusions: These experiments demonstrate the in vitro antimicrobial effect of statins on S. mutans, S.sanguis, and S. salivarius. The data indicate that the statins inhibit growth of the test organisms with MIC’s ranging from 7.8-200 μg/ml. Simvastatin has in vitro efficacy against the specific strains of bacteria used in this study at concentrations slightly less than the observed MIC’s of 15.6-7.8 μg/ml . The MIC’s for atorvastatin, pravastatin, and rosuvastatin are much higher than simvastatin, in the range of 100-200 μg/ml . The effects of statins on biofilm parallels the effect on growth of the bacteria.