Urinary tract infections (UTIs) are the most common infections in clinical practice, especially in women of childbearing age (Foxman, 2014; Guglietta, 2017; Kenneally et al., 2022). From a public health perspective, UTIs represent an emerging concern due to their close relationship with the spread of antimicrobial-resistant strains. This relationship begins with the mistaken delimitation of asymptomatic bacteriuria and urinary tract infection. When there is an error in differentiation, asymptomatic bacteriuria is considered a UTI and the individual is unnecessarily subjected to the use of antimicrobials, favoring the development of resistant strains and recurrent urinary infections (Rossi et al., 2020; Lawati, Blair and Larnard, 2021). The recurrent use of antimicrobials in recurrent UTIs promotes a long-term change in the microbiome of the patient and contributes to the development of multidrug-resistant strains of bacteria (Kostakioti et al, 2012).
The core of this study was the bioactivity of LPA2 and LP2.1 supernatants against E.coli ATCC25922, mainly because this bacterium represents around 70% of the causative agents of UTIs, both in the community and hospital-acquired types (Grey et al., 2023). The usual mechanism by which E.coli causes urinary tract infections is the colonization of the urethra and bladder from the gastrointestinal tract, triggering an inflammatory response in the host (Riley, 2020; Lawati, Blair and Larnard, 2021). The development of the ability to adapt to a new nutritional niche, to grow and multiply in the urinary tract involves the expression of virulence factors related to biofilm formation by commensal strains of E.coli (Foxman et al., 2000; Shah et al., 2019). The most studied virulence factors so far are the adhesive organelles fimbria type 1 and fimbria “curli”, which act in the initial stage of biofilm formation and are responsible for bacteria-surface interaction and cell-cell communication, strengthening the maturation of the structured biofilm (Shah et al., 2019; Ruhal e Kataria, 2021). The biofilm organization also promotes the development of multidrug-resistant strains and their subsequent dispersion, as it delays the penetration of antimicrobial agents through the extracellular matrix (Soto et al., 2006; Dumaru et al., 2019).
Given the problems related to the increase in the dispersion of multi-resistant strains, as well as the financial burden on health systems, the National Health Surveillance Agency (ANVISA) banned the sale of antimicrobials without a medical prescription in Brazil in October 2010. However, this measure was not enough to reduce the occurrence of multidrug-resistant strains (Rodrigues et al., 2021). Therefore, this study analyzes the viability of LPA2 and LP2.1 supernatants as a tool for controlling the proliferation of E.coli in cases of asymptomatic bacteriuria in healthy, non-pregnant women, reducing the need for traditional antimicrobials, stopping the development of multi-resistant strains and preserving the balance of the microbiota. Therefore, we began the study with the evaluation of antimicrobial activity using the semi-solid agar diffusion assay and the 96-well microplate assay. In the semi-solid agar diffusion assay, LPA2 exhibited a 17 mm inhibition halo and LP2.1 showed a 12 mm one, whereas the MRS control did not form an inhibition halo (Fig. 1, in the Supplementary Material). The inhibition effect of the supernatants was repeated in the 96-well microplate assay, with LPA2 reaching 89.96% inhibition and LP2.1 reaching 91.22% (Fig. 1). Unlike in the semi-solid agar diffusion assay, MRS showed a slight inhibitory effect in the microplate assay, but it was not statistically significant when compared to those of the supernatants (Fig. 1).
Lactobacilli are already recognized for their ability to antagonize other microorganisms through the production and release of antimicrobial substances, which can act by inhibiting adhesion to surfaces, blocking their ability to invade tissues, and limiting their growth (Kim et al., 2019). The inhibition effect of L.plantarum supernatants, more specifically, has been demonstrated through various in vitro techniques over time. In semi-solid agar diffusion assays, the size of the inhibition zones against E.coli formed by L.plantarum supernatants generally varies between 10 mm and 20 mm, in studies evaluating antimicrobial activity (Shim et al., 2016; Chen et al., 2021; Fijan et al., 2022). In the techniques conducted in a 96-well microplate, it is possible to understand that the inhibitory effect of L.plantarum supernatants is only perceived in supernatants produced within 48 hours of strain growth. After 72 hours, their inhibitory effect is lost (Danilova et al., 2019). The choice to evaluate antimicrobial activity by two different methods considered the assumption that the method used can also affect the degree of the inhibitory effect, in addition to factors related to the probiotic strain and the bacteria strain targeted by the inhibition (Pazhoohan et al, 2020). Microplate tests are more sensitive to inhibition effects because they facilitate the diffusion of the supernatant (Scillato et al., 2021), which can be seen in the high percentages of inhibition obtained in the microplate assay (Fig. 1). In tests in petri dishes, the solid or semi-solid culture medium acts as a limiting factor for the diffusion of the supernatant. Thus, the fact that LPA2 and LP2.1 demonstrate inhibition capacity in both methods tested proves their potential for antimicrobial activity against E.coli.
In order to complement the information obtained on the inhibitory effect exerted by LPA2 and LP2.1, it was decided to also evaluate their capacity to inhibit the formation of E.coli biofilm. Firstly, it was necessary to classify E.coli according to its biofilm formation ability. This classification was based on the cutoff value (ODC=0.21559) calculated for the microplate, which determines a threshold for biofilm formation of the studied strain (Stepanovic et al, 2007; Cepas et al, 2019; Naziri et al, 2021). From the cutoff value, the final OD value was calculated (ODF = 0.58931), allowing the classification of E.coli as a moderate biofilm producer. After this, the ability of LPA and LP2.1 supernatants to inhibit biofilm formation was evaluated. Following 24 hours of treatment, LPA2 showed 80.96% inhibition, LP2.1 81%, and the MRS control 26.55% (Fig. 2). In general, studies evaluating antibiofilm activity demonstrate that lactobacilli supernatants of extraintestinal origin are efficient in inhibiting E.coli biofilm formation, with percentages ranging from 48.68–52.61% (Lee et al., 2020; Sornsenee et al., 2021). The percentages of inhibition obtained by the present study, combined with the electron microscopy findings (Fig. 3), indicate that the antibiofilm activity of LPA2 and LP2.1 occurs through membrane disruption and cell death during the initial phase of biofilm formation, since the untreated E.coli sample presented a completely intact biofilm structure (Fig. 3a), while those treated with LP2.1 (Fig. 3b) and LPA2 (Fig. 3c) did not present a formed biofilm structure. It is worth mentioning that images referring to the MRS control treatment were not obtained since its percentage of inhibition was not statistically significant when compared to those of LPA2 and LP2.1 (Fig. 2). In this study, MRS was used as a basis for the growth of lactobacilli and for the subsequent production of their supernatants. Therefore, it was used as a control for the bioactivity of LPA2 and LP2.1 throughout the work. The inhibitory effect of MRS is attributed to the presence of polysorbate 80 in its composition (Sloup et al., 2016; Wilson et al., 2021). As in the present study, the inhibition effect of MRS was not statistically significant when compared to that of LPA2 and LP2.1, it is possible to infer that the inhibitory effect demonstrated by LPA2 and LP2.1 is due to the production and release of biomolecules from the metabolism of the respective strains and not the presence of polysorbate 80.
The second part of our study aimed to understand - albeit indirectly - which metabolites produced by L.plantarum A2 and L.plantarum 2.1 are involved in the inhibitory effect against E.coli. For this purpose, three tests were performed: the antimicrobial activity test in microplates with previously treated and untreated supernatants, the biosurfactant production test, and, by FTIR, the analysis of functional groups. The results obtained from the microplate assay indicated the presence of thermostable and acid pH-dependent substances in the lactobacilli supernatants (Table 1, Fig. 3 of Supplementary Material). Chait et al. (2021) and Selis et al. (2021) found similar results when analyzing the metabolites involved in the antimicrobial activity of lactobacilli strains. Both proposed that the inhibitory activity of the supernatants was due to their acidic pH. According to our results, this effect could not be caused by the action of proteinaceous substances, since the enzymatic treatment did not suspend the inhibitory effect of any of the supernatants. However, when analyzing the ideal conditions for the action of bacteriocins produced by L.plantarum ST31, Todorov et al. (2000) found that they exerted their inhibitory action at an acidic pH. In 2022, Pei et al. found that plantaricin YKX can only form pores in the membrane of Staphylococcus aureus and promote a bactericidal effect at an acidic pH. This allows us to infer that the suspension of the antimicrobial action when neutralizing the acidic pH of the lactobacilli supernatants may have been a consequence of the alteration of the optimal pH range for the activity of molecules such as bacteriocins.
Regarding biosurfactant production, the emulsifying activity indices obtained demonstrate that L.plantarum A2 and L.plantarum 2.1 are biosurfactant-producing strains (Fig. 4). The analysis of published studies on the subject allows us to state that the emulsifying activity index of lactobacilli supernatants varies considerably depending on the lactobacillus strain and the substrate used, ranging from 7.38–84.50% (Madhu & Prapulla, 2014; Mouafo et al., 2020; Sakr et al., 2021). Furthermore, the analysis of these studies revealed that the most significant emulsifying activity indices were obtained after 24 hours of incubation (Patel et al., 2021; Sittisart et al., 2022). The emulsifying activity index demonstrated by the MRS sample (Fig. 4) was not statistically significant, and it was attributed to the presence of polysorbate 80, a biosurfactant that is part of its composition. This denotes a difference in composition and properties between MRS and the LPA2 and LP2.1 supernatants produced on the MRS medium.
Based on the results obtained so far, we have conducted a Fourier transform infrared spectroscopy (FTIR) to evaluate the functional groups present in both supernatants. The similarity between the spectra of LPA2 and LP2.1 was already expected (Fig. 5) since their performances in the assays on microplates were also similar. The verified hydroxyl groups (Table 2) can be found in biomolecules such as carbohydrates, carboxylic acids, and proteins or peptide structures (Yusof et al., 2020; Sakr et al., 2021). C-H bonds of aliphatic compounds (Table 2), in turn, are attributed to the lipid portions of the substances (Sakr et al., 2021). Furthermore, vibrations related to CH2 bonds (Table 2) are associated with lipids or regions containing proteins and lipids (Moen et al., 2005; Zoumpopoulou et al., 2010). The relationship between C = O double bonds, and waves at 1721.43 cm− 1 (Table 2), is associated with the presence of lipid esters. While C-O single bonds, in the region of 1100 − 1000 cm− 1 (Table 2), are associated with carbohydrates (Morais et al., 2017). The regions to which N-H bonds were provided (Table 2) are mainly related to proteinaceous compounds (Zoumpopoulou et al., 2010; Sakr et al., 2021; Sittisart et al., 2022). In view of this, the functional groups indicated by the peaks in wavelengths (Table 2) suggest that LPA2 and LP2.1 are composed of chemically diverse molecules and signal the presence of sugars, proteinaceous acids, carboxylic acids, and lipids. Furthermore, FT-IR analysis confirmed the assumption that the inhibitory effects exerted by lactobacilli supernatants are triggered by all the metabolites that compose them, in synergy (Letizia et al., 2022).
Therefore, it is possible to conclude that the LPA2 and LP2.1 supernatants consist of a complex of bioactive molecules, of different chemical natures, which may have their function impacted by changes in temperature and pH. As the identification of the biomolecules that make up the supernatants was not conducted in the present study, further research is needed, regarding molecular separation and characterization, to determine exactly which metabolites are involved in the antimicrobial and antibiofilm properties. Despite not having identified biomolecules, this study fulfilled its purpose by demonstrating that both supernatants studied are capable of antagonizing E.coli ATCC 25922 in vitro and that they have the potential to control its proliferation, maintain the balance of the microbiota during antimicrobial therapy, and reestablish the balance of the microbiota post-antimicrobial therapy.
FINAL CONSIDERATIONS
In summary, the set of data obtained by the present study attested that the supernatants LPA2 and LP2.1 can antagonize E.coli ATCC 25922 in vitro and control the proliferation of E.coli in cases of asymptomatic bacteriuria in healthy, non-pregnant women; maintain microbiota balance during antimicrobial therapy; and reestablish microbiota balance post-antimicrobial therapy. Therefore, we consider that LPA2 and LP2.1 are ready for molecular separation and characterization studies, to determine exactly which metabolites are involved in their antimicrobial and antibiofilm properties and, subsequently, for in vivo studies.