Breaking Up is Hard to Do – Biofilms and Their Connection to Chronic Illness
Eighty percent of chronic infections are associated with biofilm formation.1
In the last few decades, biofilms have received increased attention for their significant role in chronic disease. Why are biofilms such a problem? Simply put, they can be very challenging to address. Biofilm bacteria can resist up to 5000 times the antibiotic concentration usually needed to resolve an infection.2 They also create resistance to host defense systems and external stresses. In fact, that is precisely the point from a microbial perspective – protection.
Biofilms: Alive, United, Diverse, and Stealth
Approximately 10% of bacteria are planktonic (free-floating). The remaining 90% form colonies that excrete a sticky matrix called extracellular polymeric substance (EPS), which serves as the backbone of a biofilm.3 A biofilm is a living community of organisms that stick to each other and attach to surfaces. They do not discriminate and are typically polymicrobial, including bacterial, fungal, and viral species. Biofilms can form in less than an hour.4 They create a mechanical barrier protecting the internal organisms from the immune system and antimicrobials. Think of it as an invisibility cloak.
Biofilms: Here, There, and Everywhere
Biofilms are not exclusive to the human body – they exist in several environments. Have you ever slipped on a rock while crossing a creek or found washing the slime out of your dog’s water bowl difficult? How about the goo in your kitchen sink drain? That sticky film is a biofilm.
A common example of a biofilm inside the human body is dental plaque. Teeth provide a non-shedding surface for biofilms to accumulate. When bacteria and yeast build up in the mouth, they form a biofilm on the surface of the teeth. It will not go away unless it is mechanically removed. If left unaddressed, it can lead to the demineralization of the enamel and the formation of dental caries, not to mention gingivitis and periodontal disease.
Biofilms can also be found on the skin, mucosa throughout the body, and implanted medical devices. It is difficult for the host’s immune defenses or antibiotic therapies to remove them. This can result in an ongoing cycle of chronic symptoms.
Common Risk Factors for Biofilm Development
- Implants
- Prosthetics
- Catheterization
- Oral appliances
- Antibiotic-resistant infections
- Chronic candida infections
- Microbial dysbiosis
Lifecycle of a Biofilm
The lifecycle of a biofilm can be divided into five stages:
- Initial Attachment – The formation begins with a reversible attachment of the planktonic free-floating cells onto a surface.
- Irreversible Attachment – The bacteria then form a monolayer and irreversibly attach by excreting an extracellular matrix.
- Maturation I – Formation of microcolonies through cell-to-cell communication (quorum sensing). Colonies grow (multilayers appear), divide, and develop biofilm.
- Maturation II – During later stages, the biofilm forms a three-dimensional “mushroom” like structure due to the polysaccharides in the EPS.
- Dispersion – Finally, some cells start to detach, and the biofilm will disperse, potentially reseeding infection and beginning a new cycle of biofilm formation
In the last stage of development – dispersion – single bacterium or aggregates of bacteria detach and disperse into the surrounding environment as planktonic cells. During the dispersion stage, negative symptoms often resurface while the planktonic cells travel to other areas of the body to start a new biofilm formation and reseed infections.
Not all Biofilms are Problematic – What Makes a Biofilm Pathological?
Not all biofilms are pathogenic! However, with the overuse of antibiotics, chronic stress, and a Standard American Diet (SAD) – high in processed foods and refined carbohydrates while lacking prebiotic fiber and phytonutrients, biofilms are becoming more problematic. Interesting tidbit – herbs, aromatics, and spices, traditionally consumed in global foods, can help maintain healthy biofilms – and are sorely lacking in Western menus.
Biofilms develop in 3 phases:
- Physiologic (normal) biofilm: Everyone has these; they are akin to the “good flora” organisms in the GI tract.
- Phase 1: Low to normal pathogenicity – These may be normal and can often be addressed by using aromatic herbs in food or botanicals. Addressing biofilms in the early stages can prevent them from becoming a bigger problem.
- Phase 2: Later stages are universally an obstacle to healing. Multiple pathogens are present, and the biofilm requires disruption so that antimicrobials and the immune system can work.
For chronically ill patients to heal and experience lasting results, phase 1 and 2 biofilms must be addressed.
Illnesses associated with biofilms and organisms of concern
Here are some common biofilm-producing microorganisms and areas they create problems5:
How do Biofilms Contribute to Chronic Infection?
The proximity of microorganisms in a biofilm creates an environment where various microbial species can support each other and multiply by the distribution of metabolic products, DNA transfer, and removal of toxins.
By adopting a sessile (not-motile) mode of life, microorganisms embedded in a biofilm enjoy several advantages over their planktonic counterparts, such as:
- protection from environmental fluctuations in moisture, temperature, pH, and UV light
- capturing and concentrating environmental nutrients, such as carbon, nitrogen, and phosphate
- shielding from host defense mechanisms – the EPS matrix acts like a force field, and it is too large to be phagocytized by immune cells
- antibiotic resistance – bacteria can use multidrug efflux pumps to pump antibiotic agents out of the maturing biofilms and into the extracellular matrix.
Quorum Sensing Plays a Role
Recent studies indicate that many bacterial species use quorum sensing (cell-to-cell communication) to coordinate the production of:
- Virulence factors – cellular structures, molecules, and regulatory systems that enable microbial pathogens to overcome host defenses
- Biofilm formation/dispersal (more on this later)
- Swarming motility – a coordinated translocation of a bacterial population.6,7
How to Stop the Cycle?
Biofilms create resistance to antibiotics and antimicrobial agents, creating a barrier to optimal health. The treatment of biofilm-associated cells can be complicated. Fortunately, several herbal extracts and essential oils have antimicrobial and anti-biofilm mechanisms of action.
Botanicals have been shown to inhibit every phase of the life cycle of a biofilm. Historically, botanicals have been utilized to inhibit:
- Initial attachment and cell adhesion
- Formation of EPS matrix
- Quorum sensing
- Virulence factor production
In recent years, botanicals have been a focus of research, highlighting their health-promoting effects. Over the last two decades, evidence has demonstrated that plants and natural products have antimicrobial properties as well as modifying biofilm formation.8 Botanicals and nutritional supports have long been used to prevent, disrupt, and eradicate biofilm-associated infections – and when layered in a formula, the synergistic effects amplify beneficial activities.
For more information on how to resolve biofilms download this biofilms protocol.
References:
- Joo, H. S., & Otto, M. (2012). Molecular basis of in vivo biofilm formation by bacterial pathogens. Chemistry & biology, 19(12), 1503–1513. https://doi.org/10.1016/j.chembiol.2012.10.022
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312881
- Petrova, O. E., & Sauer, K. (2012). Sticky situations: key components that control bacterial surface attachment. Journal of bacteriology, 194(10), 2413–2425.
- Hall-Stoodley L, Stoodley P. Biofilm formation and dispersal and the transmission of human pathogens. Trends Microbiol. 2005 Jan;13(1):7-10. doi: 10.1016/j.tim.2004.11.004.
- https://aricjournal.biomedcentral.com/articles/10.1186/s13756-019-0533-3
- https://doi.org/10.1016/j.mib.2014.02.008
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517333/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6425673/