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Science against microbial pathogens: communicating current research and technological advances _______________________________________________________________________________ A. Méndez-Vilas (Ed.) Antimicrobial properties of resveratrol: a review L. Paulo1,M. Oleastro2, Eugenia Gallardo1, J.A. Queiroz1 and F. Domingues1 1 CICS-UBI- Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior, Av. Infante D. Henrique, 6201-556 Covilhã, Portugal 2 Unidade Helicobacter/Campylobacter, Laboratório Nacional de Referência de Infecções Gastrentestinais, Departamento de Doenças Infecciosas, Instituto Nacional Saúde Dr. Ricardo Jorge, I. P., Lisboa, Portugal Antimicrobial therapy is a powerful tool for the treatment of several diseases, and a keystone of modern medical practice. However, the increased resistance of microorganisms to the currently used antimicrobials has created the need to evaluate other agents with potential antimicrobial activity.The phytoalexin resveratrol (3,4’,5-trihydroxistilbene) is commonly found in food and drinks, such as wines, grapes, vegetables, berries, peanuts and pistachios. This compound is thought to possess antimicrobial effects, along with antioxidant properties, which are benefic for the prevention of some diseases. This work reviewed the antimicrobial properties of resveratrol towards pathogenic microorganisms and investigated the antibacterial properties of resveratrol against different Helicobacter pylori strains. In addition we analysed different virulence profiles and different susceptibility patterns against the antibiotics that are usually used in anti-H. pylori therapy. Finally, we verified the ability of resveratrol to inhibit activity of the H. pylori urease, the key enzyme in colonization and persistence of this pathogen. Nowadays, the use of natural products as antibacterial agents is a promising area of investigation. Keywordsresveratrol; antimicrobial activity;Helicobacter pylori;urease 1. Health benefits of resveratrol Resveratrolis a phytoalexin found in grapes, grape products, wine, peanuts, cranberries,strawberry, and some other botanical sources. The discovery of resveratrol occurred in 1940, but just in the 90’s were conducted the first studies showing the beneficial effects of resveratrol on human health. Since then, several papers are published annually elucidating the benefits of this molecule. Resveratrol has wide ranging biologicalactivities and consequently many different targets and mechanisms of action.Resveratrol can prevent or slow the progression of several diseases, including cardiovascular disease [1], carcinogenic [2, 3] and neurodegenerative [4, 5], prevent many aging processes and increase longevity as well[6].Resveratrol also has anti-inflammatory [7], antioxidant [8] and antimicrobial properties [9] (see Fig. 1). Cancer Chemopreventive Antioxidant Anti-inflamatory Reduces obesity Cardio protective Neuroprotective Prevents aging Fig. 1- Health benefits of resveratrol. We will now give particular emphasis to the antimicrobial activity of resveratrol, which is one of the objectives of this review. ©FORMATEX 2011 1225 Science against microbial pathogens: communicating current research and technological advances ______________________________________________________________________________ A. Méndez-Vilas (Ed.) 1.1 Antimicrobial properties Antibacterial therapy is a powerful tool for the treatment ofseveral diseases, and is a keystone of modern medicinalpractice. However, the increased resistance of microorganismsto the currently used antimicrobials has lead to theevaluation of other agents with potential antimicrobialactivity[10-12]. During the last century, antimicrobial agents have substantially reduced the threats associated with infectious diseases. The use of these drugs, combined with improvements in sanitation, housing and nutrition and the existence of comprehensive immunization programs, has allowed a radical reduction of untreatable infectious diseases, often fatal, contributing to increased life expectancy. However, the adaptation of microorganisms own defences against the antibiotics used has made the development, proliferation and persistence of antimicrobial resistance, a currently major public health problem, making urgent the discovery of new drugs endowed with antimicrobial activity [13, 14]. It is important to note that, besides the importance of finding new antibiotics to be used as drugs, there is also a huge research in developing new preservatives in food industry. Thus, although most synthetic preservatives are effective, there is a greater concern of consumers about their health, which means that there is a growing interest in new antimicrobial compounds obtained from natural sources [15]. In recent years, an increasing interest has been developed in biologically active compounds including antioxidants from plants and other natural sources [16]. Thus, resveratrol, in addition to the biological activities described above, has been the subject of study for its ability to inhibit the growth of some pathogenic microorganisms such as Gram-positive and Gram-negative bacteria and fungi [17-20]. Table 1 presents a review of the published studies about the antimicrobial activity of this compound. Table 1Review of literature on the antimicrobial activity of resveratrol. Sample Resveratrol Resveratrol Resveratrol Resveratrol extracted from wine Resveratrol isolated from seeds of melinjo (Gnetumgne monL.) 1226 Strain Cronobacter sakazakii Fec39 Cronobacter sakazakii MSDH Xylella fastidiosa Temecula Xylella fastidiosa Conn Creek Xylella fastidiosa Dixon Almond Xylella fastidiosa Tulare Bacillus cereus ATCC 11771 Staphylococcus aureus ATCC 25923 Staphylococcus aureus MSSA Staphylococcus aureus MRSA Staphylococcus aureus MRSA Enterococcus faecalis ATCC 29212 Escherichia coli ATCC 25922 Escherichia coli clinical strain Klebsiella pneumoniae ATCC 13883 Klebsiella pneumoniae clinical strain Salmonella typhimurium ATCC 13311 Pseudomonas aeruginosa ATCC 27853 Pseudomonas aeruginosaclinical strain Salmonella enterica ATCC 13076 Escherichia coli ATCC 25922 Bacillus subtilis Marburg 168 Luconostoc mesenteroides 9a4 Lactobacillus plantarum NRIC1067 Escherichia coli IFO3301 Saccharomyces cerevisiae IFO2347 Penicillium expansum IFO6096 Clostridium perfringens NCT8238 Bifidobacterium bifidum NRBC100015 ©FORMATEX 2011 Methods Reference Broth Dilution [21] Agar Dilution [22] Disk Diffusion, Microdilution and Time-kill Curves [23] Time-kill Curves [24, 25] Agar Dilution [26] Science against microbial pathogens: communicating current research and technological advances _______________________________________________________________________________ A. Méndez-Vilas (Ed.) Sample Resveratrol isolated from grapes Strain Helicobacter pyloriclinical strain G21, cagA negative Methods Reference Helicobacter pyloriclinical strain 10K, cagA positive (cagA+) Microdilution [27] Disk Diffusion and Microdilution [28] Agar Dilution [29] Agar Dilution and Microdilution [15] Broth Dilution [9] Candida albicans ATCC 90028 Cryptococcus neoformans ATCC 90112 Staphylococcus aureus ATCC 29213 Streptococcus pneumoniae ATCC 6303 Enterococcus faecalis ATCC 29212 Resveratrol Micrococcus luteus Presque Isle 456 Stenotrophomonas maltophilia ATCC 13637 Escherichia coli ATCC 25922 Enterobacter cloacae ATCC 13047 Neisseria gonorrhoeae ATCC 49226 Resveratrol Resveratrol Resveratrol Candida albicans ATCC 90028 Candida albicans ATCC 76615 Candida albicans SC 5314 Candida dubliniensis CBS 8500 Candida tropicalis ATCC 750 Candida tropicalis ATCC 90874 Candida parapsilosis Y 05.01 Candida glabrata Y 33.90 Candida krusei ATCC 90878 Bacillus cereus Listeria monocytogenes Staphylococcus aureus Escherichia coli ATCC 25922 Salmonella anatum Propionibacterium acnes ATCC 25746 Propionibacterium acnes ATCC 29399 Propionibacterium acnes ATCC 33179 Resveratrol extracted from grapes Candida albicans TIMM 1768 Time-kill Curves [30] Resveratrol Proteus mirabilis P19, WT Proteus mirabilis P1100 Proteus mirabilis Pc Agar Dilution [31] Protykin® (containing 50% of resveratrol) Helicobacter pylori ATCC 49503 Broth Dilution [32] Resveratrol Aspergillus flavus KCTC 1375 Saccharomyces cerevisiae KCTC 7296 Trichosporon beigelii KCTC 7707 Candida albicans TIMM 1768 Microdilution and Time-kill Curves [33] ©FORMATEX 2011 1227 Science against microbial pathogens: communicating current research and technological advances ______________________________________________________________________________ A. Méndez-Vilas (Ed.) Sample Strain Methods Reference Resveratrol Helicobacter pylori OMU 89–362 Time-kill Curves [34] Protykin® (containing 50% of resveratrol) and resveratrol Helicobacter pylori ATCC 49503 Broth Dilution [35] Resveratrol Penicillium expansum DBM 4061 Aspergillus niger DMF 0801 Botrytis cinerea DBM 4111 Saccharomyces cerevisiae DBM 181 Broth Dilution [8] Agar Dilution [36] Microdilution [37] Microdilution [20] Microdilution [19] Two extracts of red wine and resveratrol Resveratrol Resveratrol Resveratrol 1228 Helicobacter pyloricagA+ M23-3 Helicobacter pyloricagA+ GTD7-13 Helicobacter pyloricagA+ G1-1 Helicobacter pyloricagA+ SS1 Helicobacter pylori ATCC43504 Stenotrophomonas maltophilia Micrococcus luteus Staphylococcus aureus Escherichia coli Enterobacter cloacae Enterococcus faecalis Streptococcus pneumoniae Neisseria gonorrhoeae Candida albicans Cryptococcus neoformans Staphylococcus aureus 8325-4 WT Staphylococcus aureus 1758 Escherichia coli K-12 WT Escherichia coli KLE701 Pseudomonas aeruginosa PA767 WT Pseudomonas aeruginosa K1119 Salmonella enterica ST329 WT Pseudomonas syringae pv. maculicolaES4326 WT Xanthomonas campestris XCC528 WT Agrobacterium tumefaciens GV3101 WT Erwinia rhapontici Er1 WT Erwinia carotovora ATCC 358 WT Sinorhizobium meliloti Rm1021 WT Bacillus megaterium 11561 WT Staphylococcus aureus ATCC 29213 Enterococcus faecalis ATCC 29212 Pseudomonas aeruginosa ATCC 27853 Trichophyton mentagrophytes ATCC 18748 Trichophyton tonsuransATCC 28942 Trichophytonrubrum ATCC 18762 Epidermophyton floccosum ATCC 52066 ©FORMATEX 2011 Science against microbial pathogens: communicating current research and technological advances _______________________________________________________________________________ A. Méndez-Vilas (Ed.) Sample Sixteen Chilean wines, two selected extracts and resveratrol Resveratrol Red wine extract and resveratrol Strain Microsporum gypseum ATCC 14683 Methods Reference Disk Diffusion [38] Agar Dilution [18] Agar Dilution [17] 5 clinical isolates of Helicobacter pylori Helicobacter pylori ATCC 43504 Neisseria gonorrhoeae Neisseria meningitidis ATCC 13090 Escherichia coli Staphylococcus aureus Streptococcus pyogenes Pseudomonas aeruginosa Candida albicans 15 clinical isolates of Helicobacter pylori Helicobacter pylori ATCC 43504 MSSA Methicillin-SensitiveStaphylococcus aureus; MRSA Methicillin-ResistantStaphylococcus aureus; ATCC American Type Culture Collection; WT Wild Type According to these results, resveratrol has potential due to its antimicrobial properties and may in the future be used in the treatment and prevention of infections caused by certain pathogens. Oneof the aimsof this work was to evaluate the antibacterial properties of resveratrol towards different Helicobacter pylori strains. In addition, we verified the ability of resveratrol to inhibit activity of the H. pylori urease, the key enzyme in colonization and persistence of this pathogen. 2. Helicobacter pylori 2.1 Brief History In 1982 two Australian researchers, Barry Marshall and Robin Warren, discovered that all the patientswith duodenal ulcers and 80% of the patients with gastric ulcers had a common characteristic: theyhad a spiral-shaped non-identified bacteria present in their gastrointestinal tract. Based on theseobservations they suggested that the bacteria was the principal cause of gastritis and peptic ulcer[39]. The discovery of the bacterium H. pylori and its role in gastritis and peptic ulcer disease resulted in a Nobel Prize in Medicine for Marshall and Warren in 2005. During the following 10 years, research from all over the world confirmed the presence of H.pylori in patients with peptic ulcer disease. Moreover, in 1994, the International Agency for Research on Cancer (IARC), a World Health Organization agency included H. pylori as a group 1 carcinogen in humans. Since those early days, many advances in the understanding of H. pyloriand particularcharacteristics were achieved. A great deal of the bacterium’s biochemical pathways hasbeen identified, the prevalence in the human population in several countries all around theworld described, and its role in certain human diseases such as gastritis and stomach ulcerclarified. Research has also allowed for the development of reliable diagnostic methodsfor H. pylori infection and suitable treatment procedures. The peculiarity of H. pylori has also turned the bacteria into one of the hot-topics for scientists. Between 1990 and 2010, an average of more than 2000 papers was published annuallyin international peer-reviewed journals(Fig. 2). It was also one of the first bacteria to havethe genome sequenced for two different strains, J99 [40] and 26695 [41]. ©FORMATEX 2011 1229 Science against microbial pathogens: communicating current research and technological advances ______________________________________________________________________________ A. Méndez-Vilas (Ed.) Number of Publications 35000 30000 25000 20000 15000 10000 5000 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 0 Yea ar Fig. 2- Plot of o the number of publicationns per year in international peer-reviewed p j journals, as obbtained using th he ISI Web off Knowledge seearch. The searcch was performeed with the worrds “Helicobactter AND pylorii”. 2.2 Predominancce worldwide H. pylori occcurs worldwiide and affects on averagee approximateely 50% of thhe world poppulation [42], although thee incidence haas been decreaasing in recennt years [43].. Distribution appears to have h a higher incidence in undevelopedd countries andd a low inciddence in deveeloped countrries (Fig. 3). In undeveloped countries reaches abou ut 80% of thee population annd the infectioon rate has rem mained constaant; in develop ped countries reaches abouut 40%, observ ving a declinee in prevalencee due to improovements in thhe hygiene andd sanitation [4 43]. Fig. 33 Worldwide prevalenceofHe p elicobacterpylorri[44]. 1230 ©FORMATEX 2011 Science against microbial pathogens: communicating current research and technological advances _______________________________________________________________________________ A. Méndez-Vilas (Ed.) 2.3Virulence facctors Helicobacterr pylori is a Gram-negativve spiral-shapped, fastidiouss, microaerophilic bacillus which rapidlly hydrolysess urea as part of its adaptedd survival metthods [45, 46]]. It has been implicated ass the etiologicc agent of chrronic gastritis,, peptic ulcer, gastric adenoocarcinoma annd related gasttroduodenal disorders d [47].. Several poteential virulence factors mayy be responsibble for the pathogenicitty of H. pyylori, such as a the cytottoxin-associatted gene A (cagA), thee vacuolatingccytotoxin A (vvacA) and urrease [45]. Thhe cagA and vacA genes are the two major H. pyllori virulencee markers. Thee cagA gene is a strain-speccific gene, belonging to thee cag pathogeenicity island, which has beeen associatedd with severe gastric g disease [48, 49]. Thhe vacA gene encodes for a vacuolatingg toxin and is characterized d by a mosaicc structure for which differeent alleles havve been identiified in the sig gnal (s), midddle and interm mediate region ns of the genee s type has beeen associatedd with in vitrrocytotoxin acctivity [52]. T The bacteria produces p highh [50, 51]. Onnly the vacA s1 levels of the enzyme ureasse which convverts urea intoo ammonia, prroducing a loccal alkaline ennvironment that enables thee o the gastricc organism to survive on thhe acidic envvironment of the stomach as well as aidds its initial ccolonization of 4 mucosa [53, 54] (see Fig. 4). Fig. 4-Helicobbacter pyloria Electron E microggraph and b schhematic represeentation showing shape, polar fflagella, urease, H+-gated ureaa channel and thhe production of ammonia [45]]. 2.44 Anti-Helicobbacter pylori activity of ressveratrol In recent yeaars, and due too a worrying rise in the preevalence of an ntibiotic resisttant strains, w we assisted to an increasingg interest in biiologically active compounnds including antioxidants from plants and a other natuural sources. Indeed, somee epidemiologiical studies have h shown a correlation between sero opositivity too H. pylori aand environm mental factors,, including dieet[55,56]. Thee phytoalexin resveratrol (3,4’,5-trihydroxistilbene) haas been attribuuted to numero ous beneficiall biological efffects[2, 57, 58], includinng potent antiimicrobial activity[9, 15, 17, 19, 23, 331, 36, 38] as a previouslyy mentioned. d strainns of H. pylorri was examin ned (Table 2)) In this woork, the antibaacterial activiity of resverattrol against different [59]. ©FORMATEX 2011 1231 Science against microbial pathogens: communicating current research and technological advances ______________________________________________________________________________ A. Méndez-Vilas (Ed.) Table 2.Helicobacter pylori strains characterization regarding virulence factors, antibiotic and resveratrol susceptibility. Virulence factor Strain Numbera cagA vacAc Antibiotic susceptibility Metronidazole MIC 1692/05 94/99 957/03 18/99 67/99 1152/04 1776/05 32/00 1025/03 553A/02 184/99 8/00 5/00 690/99 565/99 + + + + + + + + + - + + + + + + + + - 24 0.5 24 257 257 0.094 0.19 0.5 0.19 0.047 0.19 0.19 0.064 0.38 0.094 Clarithromycin MIC R S R R R S S S S S S S S S S >256 257 0.016 0.032 0.032 <0.016 0.016 0.5 < 0.016 0.023 0.016 0.016 0.015 0.032 257 R R S S S S S S S S S S S S R Ciprofloxacin MIC or inhibition diameterb 46b 0.094 40 b 0.125 0.016 55 b 42 b 0.125 50 b 51 b 0.064 0.023 0.032 0.032 0.094 S S S S S S S S S S S S S S S Resveratrol susceptibility Disk Agar Diffusion Dilution Inhibition diameter MIC 21.7 16.3 17.3 23.3 20.7 19.7 18.5 17.3 26.7 19.8 20.5 22.8 27.8 21.3 19.7 50 50 50 100 100 50 50 50 25 50 50 25 25 50 50 MIC - Minimum inhibitory concentration (µg/mL). - negative; + positive; S- sensitive; R- resistant; a H. pylori strains are indicated by their collection number.b The inhibition diameter is measured in mm; disk diffusion method. cThe vacA status was determined according to the presence of the s1 toxigenic allele (vacA positive) or s2 nontoxigenicallele (vacA negative). In addition we analyzed different virulence profiles and different susceptibility patterns against the antibiotics that are usually used in anti-H. pylori therapy. The diameter of inhibition zone and the minimum inhibitory concentration (MIC) were evaluated (Table 2). From the results of the disk diffusion assay we observed that resveratrol prevented the growth of all tested strains, with the inhibition diameters of growth ranging from 16.3 to 27.8 mm (Table 2), indicating a variable susceptibility of the strains to resveratrol. The observed differences may be explained by the fact that the strains are very heterogeneous, presenting different virulence profiles and diverse antibiotics susceptibility patterns[27, 36].Using theagar dilution method, the MIC was determined for all strains. The MIC ranged between 25 and 100 µg/mL, with the majority of the strains presenting a similar susceptibility pattern (MIC=50 µg/mL) (Table 2).The three H. pylori strains that were inhibited with the lowest resveratrol concentration were susceptible to all the antibiotics tested, two of them (strains 8/00 and 5/00) were negative for both cagA and vacAgenes and thethird strain (1025/03) was positive for cagAand negative for vacA[59]. In contrast, resveratrol showed less activity against strains 67/99 and 18/99 (MIC= 100 µg/mL), which were positive for both virulence factors and resistant to metronidazole (Table 2) [59].These results were consistent with previous studies demonstrating that resveratrol has different antibacterial activity against various H. pylori strains [17, 27, 32, 34-36, 38, 60-62]. According to the literature, resveratrol exhibits the most potent inhibitory activity on H. pylori infection under neutral conditions [34]. 2.4.1 Urease H. pylori is a unique bacteria that can survive in the acidic environment of animal stomach since it has the ability to neutralize gastric acids with ammonia produced by urease. In this study, the urease inhibitory activity of resveratrol, acetohydroxamic acid (AHA) (as positive control) and two red wine samples with different amounts of resveratrol were tested. The studied concentrations of resveratrol and AHA ranged from 6.25 to 400 µg/mL (Fig. 5). 1232 ©FORMATEX 2011 Science against microbial pathogens: communicating current research and technological advances _______________________________________________________________________________ A. Méndez-Vilas (Ed.) Fig. 5-Inhibitory effect of various concentrations (6.25-400 µg/mL) of resveratrol and acetohydroxamic acid on the urease activity.Resveratrol, filled symbols, and AHA, open symbols, in three Helicobacterpylori strains: 26695, squares, 1692/05 circles and 553A/02 triangles. Data corresponds to the average of three experiments. Our results demonstrated that the addition of resveratrol decreased urease activity in the three H. pylori strains tested, and this inhibitory effect was proportional to the concentration of resveratrol. For the three strains tested, a decrease of 90% in the ureaseactivity was observed for a concentration of 400 µg/mLof resveratrol. In identical concentrations, AHA exhibited lower urease inhibitory activity, 72, 49 and 73%, for strains 26695, 1692/05 and 553A/02, respectively. According to these results, resveratrol exhibited higher in vitro urease inhibitory activity than AHA. The analysis of the slopes and shapes of the semilog curves of resveratrolsuggests that different strains of H. pylori react differently to the presence of resveratrol. On a global scale the burden of disease due to H. pylori is enormous; elimination of these bacteria would have a major impact on present and future world health. Diagnosis and therapy constitute the only treatment at present, however current treatments are not an effective strategy.Thus, the availability of new anti-H.pylori compounds opens up new expectations to fight this infectious disease. Acknowledgements The support by FCT, the Portuguese Foundation for Science and Technology (SFRH/BD/28168/2006) is gratefully acknowledged. References [1] Bradamante S, Barenghi L, Villa A. Cardiovascular protective effects of resveratrol. Cardiovascular Drug Reviews.2004; 22: 169- 188. [2] Jang M, Cai L, Udeani GO, Slowing KV, Thomas CF, Beecher CW, Fong HH, Farnsworth NR, Kinghorn AD, Mehta RG, Moon RC, Pezzuto JM. 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