(Ars Tech did a deep dive on the oral bacteria posted above )
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The human mouth contains hundreds of species of bacteria that function together in a community—an oral microbiome. A healthy bacterial balance keeps teeth and gums in good shape.
Cavities are caused by acid-producing bacteria. Several kinds of oral bacteria can make acid, explained Jonathon Baker, an assistant professor of dentistry at Oregon Health & Science University. But one bacterium, Streptococcus mutans, especially wreaks havoc because it can make both acid and biofilms, including dental plaque. That sticky coating traps acid on teeth, eroding tooth enamel and creating cavities.
In the 1980s, Hillman discovered a naturally occurring version of S. mutans that secretes the antibiotic mutacin 1140. Because mutacin broadly kills other species of bacteria, he realized it could potentially outcompete other harmful strains. (It’s not known how many people naturally have mutacin-producing S. mutans in their mouths; Hillman found this version in one sample out of 115.)
To make sure the bacteria wouldn’t cause cavities itself, Hillman genetically altered it to metabolize sugar in such a way that it produces alcohol instead of tooth-damaging lactic acid, like other cavity-causing Streptococcus strains do. Bacteria often swap genetic material, so he also tweaked the strain to prevent it from taking genes from other bacteria; other bacteria can still take genes from the genetically modified Streptococcus.
Hillman announced the new strain, called BCS3-L1, in 2000. Around that same time, Oragenics sought to begin a clinical trial. But due to concerns that the bacteria could be transmitted between people, have unintended consequences, or revert back to a cavity-causing strain, the company told The New York Times in 2004, the Food and Drug Administration put constraints on the trial, which was then never completed.
Hillman continued his research: A 2009 study showed that his bacteria appeared to colonize rats’ mouths and outcompete other Streptococcus strains that can contribute to tooth decay. But studies have been limited since, and Hillman and Oragenics eventually abandoned the project. About 12 years ago, he retired.
“Without human trials, you really can't determine whether it's safe or efficacious.”
Silverbook picked up where Hillman left off: The genetically modified version of Streptococcus mutans is the basis of Lumina. After considering whether to market it as a cosmetic product, as teeth whiteners are, or as a probiotic, which falls under FDA regulation as a dietary supplement, Silverbook decided to go the cosmetic route. In the US, only drugs and medical devices must go through the strict process for the FDA to deem them safe and effective.
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The FDA did not provide direct comment in response to a list of questions sent by Undark. Courtney Rhodes, an FDA spokesperson, did, however, point to the agency’s website, which notes that drugs are defined by their intended use for “diagnosis, cure, mitigation, treatment, or prevention of disease,” and that mismarketing a product is against the law.
Lumina isn’t the first genetically engineered bacteria to hit the market: A company called ZBiotics launched a hangover preventive probiotic in 2019. The small drink contains Bacillus subtilis bacteria, common in other probiotic blends, but with an added gene that helps break down acetaldehyde, a byproduct of alcohol linked to headaches. (There is no published evidence that it helps with hangovers, nor colonizes the gut—there’s only a small toxicity study in rats.)
Lumina is different, though, in that it’s a modified version of what is technically a pathogen that causes dental decay, said Paul Jensen, a biomedical engineering professor who studies oral microbiology at the University of Michigan. Other probiotic supplements are “generally regarded as safe," Jensen said. "They're usually in our food to begin with. We know that they're not pathogens."
When asked about concerns that distributing a modified bacteria could potentially cause harm, Silverbook responded, “I think that this is not the kind of air-quotes pathogen that will make anything worse.”
Hillman’s goal was to make “an affordable product that helps prevent a very painful disease,” he said, “but, you want it to be safe and effective.” When asked if more research is needed to determine its safety and effectiveness, he responded, “I was certainly always planning to do more studies,” but declined to comment further.
Silverbook sees his product as a way to save people time and money: Dental care costs $136 billion a year in the US, according to the Centers for Disease Control and Prevention. Untreated dental infections can also be dangerous, “and there's plenty of people who, for whatever reason, have a lot of trouble going to the dentist at all,” he said. “It would be really nice to have something that helps with that.”
Silverbook stressed that he is not making a medical claim—a key strategy, he said, in terms of regulation. “A lot of our regulatory system is based on claims, and if you're really careful about not making a disease treatment claim, then you can get around the drug safety and efficacy trials,” said Kuzma, the North Carolina State University professor.
Clinical trials in the US are especially difficult to carry out, said Jeff Banas, a professor and microbiology researcher at the University of Iowa College of Dentistry, because they are expensive, take time, and face stricter guidelines.
If you're really careful about not making a disease treatment claim, then you can get around the drug safety and efficacy trials.”
“If we do a clinical trial, then we are a drug and we cannot sell it unless I have half a billion dollars and 10 years,” Silverbook said.
Scott Aaronson, a theoretical computer scientist and professor at the University of Texas at Austin, volunteered to take Lumina after reading about it on a blog, and got it during a trip to Berkeley, California. He had lost trust in the FDA during the pandemic, such as when the agency delayed the rollout of COVID tests. When he heard that Lumina might help with cavities, Aaronson “was completely ready to believe that if something like this existed, then it would not have been approved by the FDA.”
“I gave this a try simply because it was fast and easy,” he wrote in an email to Undark. “And the downside risk seemed negligible.”
Jensen, the biomedical engineering professor, cautions that more research is needed to show that genetically engineered microbes can improve oral health and don’t have unintended side effects.
The antibiotic in Lumina, he noted, could potentially wipe out other Streptococcus species that are associated with good oral health. And there are other microbes at play that determine gum health. “They're not the same bacteria that cause tooth decay,” he said. “But you have to be worried about messing up those communities at the same time.”
Additionally, people swallow about a liter of saliva every day, meaning the S. mutans’ antibiotic could end up in the intestine, potentially disrupting the gut microbiome, Jensen said. And because Lumina produces alcohol as a byproduct, it’s possible that might have an impact, too, though the amounts are tiny, and it’s hard to know without more research, he added.
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In an email to Undark, Silverbook wrote that the company has been following the “fifty or so” people who have volunteered to take Lumina, and that no adverse events have been noted so far. Their follow-ups, according to Silverbook, consist of a self-reported survey and taking swabs to track whether S. mutans has successfully colonized the mouth. “We haven't yet decided how long the follow up will be,” Silverbook wrote in another email, “but we anticipate colonization of the mouth to take about two years.” Regarding concerns about the gut microbiome, he wrote that Lumina “isn't especially intended to be swallowed.”
Given the lack of evidence, Jensen said, “I don't think I would take it.”
Quite a few oral probiotics have been tested in clinical trials as a solution for better oral health, though none of those are genetically modified. These products aim to add beneficial bacteria to the mouth. For instance, ProBiora, a chewable oral probiotic already available in the US, showed a modest reduction in cavities in children in one clinical trial. (ProBiora3, the bacterial blend in the tablets, was developed by Hillman at Oragenics.)
The Lumina microbe, though, was intended to be a kind of oral replacement therapy, so that the genetically modified bacteria would fight and overtake bad bacteria. Replacement therapy, Hillman said, “is doing what nature would eventually do given enough time. Pathogens, especially organisms that live with us on a day-to-day basis, do not want to harm their host. It’s contrary to their own self-interest.”
(more)
https://arstechnica.com/health/2024/04/the-gmo-tooth-microbe-that-is-supposed-to-prevent-cavities/#p3