In vitro Candida albicans biofilm induced proteinase activity and SAP8 expression correlates with in vivo denture stomatitis severity.

Denture stomatitis is a common inflammatory disorder of the palatal mucosa amongst denture wearers. The pathological changes are induced by Candida albicans biofilm on the fitting surface of the upper denture, and different individuals experience different levels of disease. C. albicans is known to produce secreted aspartyl proteinases (SAPs) to aid adhesion, invasion and tissue destruction. We hypothesised that differential expression and activity of SAPs from denture stomatitis isolates results in different levels of disease amongst denture wearers. We selected C. albicans isolates from asymptomatic controls and three different severities of disease [Newton’s type (NT) 0, I, II and III]. We assessed biofilm formation and proteinase activity for each biofilm and investigated the transcriptional profile of SAPs 1, 2, 5, 6 and 8 from early (12 h) and mature (24 h) biofilms. There were no significant differences between isolates with respect to biofilm formation, whereas proteinase activity normalised to biofilm growth was significantly increased in the diseased groups (p < 0.0001). Proteinase activity correlated strongly with SAP expression (p < 0.0001). SAP8 expression was the greatest, followed by SAP5, 6, 2 and 1. The diseased groups showed the greatest levels of SAP expression, with significant differences also observed between the groups (p < 0.005). All SAPs except SAP5 were expressed in greater amounts in the mature biofilms compared to early biofilms. Overall, this study suggests that SAP activity in biofilms determined in vitro may help to explain differences in disease severity. SAP8 has been shown for the first time to play a prominent role in biofilms.