INTRODUCTION
Extracellular DNA (eDNA), one of the major components of biofilms, contributes to biofilm formation and the mechanical stability of biofilms (
1). eDNA is predicted to be generated primarily by lysis of a subpopulation of cells and the subsequent release of genomic DNA from the cytoplasm into the extracellular environment. In Gram-positive bacteria, eDNA production is mediated by quorum sensing (
2,
3), autolysis (
3,
4), H
2O
2 production (
5–7), and bacteriophages (
8,
9). However, how bacterial cells produce eDNA is poorly documented.
In
Streptococcus mutans, an etiological agent of dental caries and infective endocarditis, eDNA is one of the major biofilm components (
2,
10). eDNA is thought to be used for initial attachment to substratum surfaces in
S. mutans biofilm formation (
11). DNase I treatment shows an inhibitory effect on the biofilm formation of
S. mutans (
2). Thus, eDNA production contributes to biofilm formation and the pathogenesis of
S. mutans. The main production system of eDNA is considered to be an autolysis-dependent mechanism (
12,
13). eDNA is also produced via a membrane vesicle-mediated pathway that is independent of autolysis (
14).
lytF, which is a conserved gene in the genus
Streptococcus, encodes an autolysin in
S. mutans (
15). LytF has a group B streptococcal secreted protein (Bsp) domain and a cysteine, histidine-dependent amidohydrolase/peptidase (CHAP) domain (
15). The expression of
lytF is regulated by two types of secretory peptide signals called competence-stimulating peptide (CSP) and
sigX-inducing peptide (XIP) (
16–21). CSP signaling is necessary for eDNA production (
22), however it is still unclear how CSP-regulated
lytF contributes to eDNA production in biofilms.
The precursor of CSP is encoded by the
comC gene. It is secreted into the extracellular environment via ComAB (also known as NlmTE) and then processed by SepM, an extracellular protease (
23). The processed CSP is an active form and is received by a two-component regulatory system ComDE, which induces the expression of the ComE regulon. The
cipB gene in the ComE regulon encodes bacteriocin, and CipI is reported as its immune protein (
12).
cipB is essential for the induction of the downstream
comRS-sigX system, which directly upregulates
lytF expression when exogenous CSP is supplemented in the medium (
24).
comS encodes the precursor of XIP. Extracellular XIP is taken up by cells through oligopeptide permease (Opp) and binds to ComR. The ComR-XIP complex induces the expression of
sigX, an alternative sigma factor, resulting in the expression of the SigX regulon, including
lytF. Synthetic CSP (sCSP) induces the expression of the
sigX regulon but not XIP in complex media (
17,
25). In addition, in planktonic cells, sCSP induces the expression of the ComE regulon in a unimodal manner but induces the expression of the
sigX regulon in a bimodal manner (
26). The SigX regulon contains late competence genes and several genes of unknown function. The
lytF gene in the SigX regulon encodes autolysin, which is involved in cell death in planktonic cells (
15). Cell death is expected to result in eDNA production, which contributes to the structural stability of biofilms. Thus, the distribution of the bimodal expression of the
sigX regulon within the biofilm may be strongly related to the physiological function and the pathogenesis, though little is currently known regarding the localization of the expression of the
sigX regulon within biofilms.
S. mutans biofilms are composed of numerous microcolonies, the formation of which requires insoluble glucan synthesis (
22). The
gtfB and
gtfC genes encode the enzymes responsible for insoluble glucan synthesis, which is a major characteristic of
S. mutans. Glucans synthesized by GtfB (Gtf-I) are responsible for microcolony formation, while glucans synthesized by GtfC (Gtf-SI) strongly attach cells and microcolonies to the substratum surfaces (
27). There is an acidic microenvironment inside the microcolony due to the accumulation of lactic acid produced by
S. mutans. The central portion and the bottom layer of the microcolony (close to the substratum surface) are hardly neutralized even when treated with a neutral buffer (
28). The acidic environment is reported to result in increased eDNA production in planktonic cells (
11). However, the localization of eDNA within biofilms has not been clarified. In addition, the
comDE gene is highly expressed near the bottom of the biofilm (
29). Given the heterogeneity within the biofilm, the induction of cell death and eDNA production would be spatiotemporally regulated. However, the direct link between
lytF expression, cell death, and eDNA production in the biofilm remains unclear.
In this study, we focused on lytF-mediated cell death induced by CSP to elucidate eDNA production within the biofilm, which is the dominant state of S. mutans in the human oral cavity. Using time-lapse imaging, we analyzed lytF expression in the biofilm and the location where cells release eDNA. Here, we succeeded in visualizing eDNA production at the single-cell level. We revealed the heterogeneous localization of lytF-expressing cells, dead cells, and eDNA in the biofilm. These results provide insights into how S. mutans forms structurally stable biofilms.
DISCUSSION
We succeeded in observing the eDNA production process at the single-cell level and experimentally showed that eDNA is released to the extracellular milieu from dead cells. In
S. mutans, since random amplified polymorphic DNA indicates that eDNA is derived from genomic DNA, eDNA has been suggested to be mainly genomic DNA released from dead cells (
10). Our data show that cell death that occurs in a subpopulation is a source of eDNA in
S. mutans. Additionally, we found that not all cells stained with SYTOX Green release nucleic acids into the extracellular environment (Movie S1B). In addition, in the absence of sCSP we observed a few dead cells but did not see eDNA released from these cells. This indicates that not all dead cells are employed to release eDNA. In pyroptosis of mammalian cells, a model has been proposed in which cell death and cell lysis are not necessarily coupled (
36). Similarly, bacterial cell death may not always lead to eDNA production.
S. mutans possesses a thick cell wall, which provides the cell with a fairly rigid structure and could interfere with genomic DNA release from dead cells unless the cell walls are lysed. Therefore, we suggest that both cell death and autolysin expression, such as
lytF, are necessary for the release of eDNA.
lytF deletion resulted in a significant reduction in cell death induction and eDNA production in the presence of sCSP, but did not completely abolish them. Besides
lytF,
cipB is a gene that is induced by CSP and is predicted to be involved in its own cell death in
S. mutans (
12). The deficiency of
cipB completely abolished cell death induction and eDNA production in response to sCSP.
cipB is essential for the CSP-induced expression of the ComR regulon and SigX regulon in complex media, such as the BHI medium that was used in this study (
24). This could be why the
cipB mutant displays decreased cell death and eDNA production. In contrast, in chemically defined medium (CDM), synthetic XIP can induce
lytF without
cipB (
17). CDM could be useful to assess the impact of CipB and LytF on cell death and eDNA production. However, SigX activates the
cipB expression in the presence of XIP in CDM (
17). Thus, it is difficult to completely distinguish
lytF-dependent cell death from
cipB-dependent cell death in both complex medium and CDM. In the present study, we also observed that the deletion of
comS,
comR, or
sigX completely abolished cell death and eDNA production in response to sCSP. Given that the
comRS-sigX system is not necessary for
cipB expression in complex media (
19), the SigX regulon is mainly responsible for cell death and eDNA production under our experimental conditions. Therefore, we suggest that
lytF-dependent cell death, rather than
cipB, is dominant in response to CSP. In addition, our data imply the presence of cell death-related factors other than LytF in the SigX regulon.
We showed that cell death occurs in a subpopulation of
lytF-expressing cells. This result strongly supports the idea that the
lytF of
S. mutans encodes a self-acting autolysin (
15). The communication system via CSP is conserved in streptococci, and several competence-associated murein hydrolases have been reported (
37–41). In
Streptococcus pneumoniae, competent cells secrete the muralytic enzyme CbpD and kill noncompetent cells (
42,
43). This suggests there is a strategy to make it easier for competent cells to acquire new genes, which are released from noncompetent siblings and related species (
44). Most streptococcal species that do not have CbpD, such as
S. mutans, have the
lytF gene, which is predicted to be a functional analog of
cbpD (
45). However,
S. mutans LytF acts within the produced cells rather than intercellularly, as does CbpD.
Streptococcus sanguinis also has LytF, which is composed of the Bsp and CHAP domains, although the number of Bsp domains in LytF of
S. sanguinis is different from the number in LytF of
S. mutans. Since LytF of
S. sanguinis can digest not only its own peptidoglycans but also the peptidoglycans of
Streptococcus gordonii and
S. mutans, it has been hypothesized that this LytF may kill other bacteria to induce eDNA production (
40). For these reasons, there is a possibility that the physiological role of murein hydrolase associated with genetic competence may vary depending on the species. In addition, the finding that not all
lytF-expressing cells cause cell death to produce eDNA implies the presence of other factor(s) that determine the survival or death of
lytF-expressing cells. Therefore, this suggests that cell death mediated by LytF autolysin activity is controlled at posttranscriptional and/or posttranslational levels by unknown factor(s) that are necessary for the activity of LytF or to counteract the function of LytF.
lytF-expressing cells were observed near the bottom of the 2-h biofilm and gradually increased in the presence of sCSP. In addition, the deficiency of
lytF reduced the adhesion of cells to the surface. In
S. sanguinis, a strain overexpressing
lytF by plasmid complementation was shown to decrease the biofilm formation (
40). Thus, proper regulation of
lytF expression within the biofilm may contribute to biofilm stability. The promoter activity of
lytF is increased by heat shock, low pH, and oxidative stress, suggesting that CSP is an alarmone induced by stress (
15). Cells located in the deep part of biofilms are exposed to various stresses, such as low pH, metabolic substrate limitations, and metabolite accumulation. It has been reported that the degradation of exopolysaccharides by dextranase treatment results in the disappearance of the acidic environment in microcolonies (
28). Thus, the chemical gradient formation within the biofilms requires the exopolysaccharides produced by
S. mutans. We show that the population of
lytF-expressing cells in Δ
gtfB cells, which were unable to produce the insoluble polysaccharides necessary for microcolony formation, was comparable to that in WT cells. Furthermore, our data show that even if
lytF-expressing cells increase in the biofilm, these cells stay near the bottom of the biofilm. Recently, AI-2-mediated quorum sensing was found to control the expression of several genes in cells close to a substratum surface in
S. mutans (
29). However, the heterogeneous distribution of
lytF-expressing cells in the biofilm was maintained with Δ
luxS, which was unable to produce AI-2. Therefore, it is thought that other environmental factor(s) surrounding the cells near the bottom of the biofilm contribute to the induction of the localized
lytF expression.
In addition, similar distributions of
lytF-expressing cells were observed on surfaces with different properties, such as polystyrene, glass, and saliva-coated glass. These points suggest the heterogeneous expression of
lytF in the biofilm is not dependent on the nature of substratum surface. Bacterium-substratum physicochemical interactions and cell wall deformation have been shown to affect gene expression (
46). In
Pseudomonas aeruginosa, the expression of
algC, a gene involved in alginate biosynthesis, is induced by surface attachment (
47). In
Staphylococcus aureus, it is suggested that adhesion force regulates biofilm matrix production (
48). Although the surface recognition mechanism is unclear in
S. mutans, SpaP and GbpC on the cell surface attach cells to the tooth surface by binding to salivary agglutinin glycoprotein (
49,
50). Since our data indicate that the presence or absence of the saliva coat does not affect the localization of
lytF-expressing cells and eDNA production within the biofilm, SpaP- and GbpC-mediated adherence to the substratum surface is unlikely to cause these localizations. In addition, Wang et al. reported that adherence to the substratum surface and AI-2-mediated quorum sensing triggered the increased expression of
comDE and
brpA near the bottom of the biofilm (
29). However, our data show that the localization of
lytF-expressing cells was not altered even in the biofilm formed by Δ
luxS cells. BrpA is involved in the regulation of the response to cell surface stress (
51). Comparison of gene expression by DNA microarrays of
S. mutans UA159 and the
brpA mutant shows no change in the expression of most SigX regulon genes, including
lytF (
51). Therefore, surface recognition appears to play a role in the localization of
lytF-expressing cells in the biofilm, though the detailed mechanism needs to be elucidated in future studies.
In addition to surface recognition, the bottom of the biofilm has particularly high cell density and cell proximity and these may also be involved in
lytF expression. In
Streptococcus pyogenes, peptide signaling-mediated cell density-dependent gene expression alters the expression of many genes, including pathogenic factors (
52). In addition, CSP signaling in
S. pneumoniae occurs through cell contact (
53). Thus, differences in cell density and cell proximity within
S. mutans biofilms may also be involved in inducing
lytF expression.
Consistent with the localization of
lytF-expressing cells, eDNA was also localized near the bottom of the biofilm. It has been reported that eDNA is mainly involved in initial attachment to the substratum surface in
S. mutans biofilm formation (
11). Our data show that eDNA contributes to the early stages of biofilm formation, while the mature biofilm can retain the structure when eDNA is removed. After the initial attachment by eDNA, insoluble glucan is mainly responsible for the development of the biofilm and the maintenance of the structure of the mature biofilm. Thus, we hypothesize that
S. mutans effectively utilizes the eDNA produced at the expense of a subpopulation of cells by locally producing the eDNA required for initial attachment near the bottom of the biofilm.
Even without the addition of sCSP, lytF-expressing cells were observed in the 6-h biofilm. In previous studies, the expression of the SigX regulon, including lytF, was analyzed with the external addition of the sCSP signal. Our data are important and show that the CSP-mediated communication system works in actual biofilms without the external addition of CSP.
In conclusion, we have shown that CSP induces lytF-dependent cell death and eDNA production. lytF expression in biofilms is induced at the bottom, which contributes to cell adhesion to the substratum surface. Our data suggest that the heterogeneous lytF expression in the biofilm was due to physical contact with the surfaces rather than environmental heterogeneity, based on the three-dimensional structure of the biofilm. However, we could not exclude the possibility that other environmental factors at the bottom of the biofilm, such as high cell density and cell proximity, affect lytF expression, which should be addressed in future work. Moreover, we also show that a subpopulation of cells expressing lytF undergoes cell death and produces eDNA, while lytF-expressing live cells also exist. SigX, the sigma factor essential for lytF expression, also induces the expression of genes involved in genetic competence. Therefore, since the bottom of the biofilm is expected to have abundant eDNA and competent cells, it has the potential to be a site where horizontal gene transfer occurs. Analyzing the heterogeneity in biofilms from the functional aspect is a future challenge.
MATERIALS AND METHODS
Bacterial strains and culture conditions.
The bacterial strains used in this study are listed in
Table 1. The bacterial cells were grown in an aerobic atmosphere containing 5% CO
2 in brain heart infusion (BHI) broth (Difco Laboratories, Detroit, MI) at 37°C.
Construction of deletion mutants.
The primers used for the construction of deletion mutant strains are listed in Table S1. Sequence information was obtained from the KEGG (
http://www.genome.jp/kegg/) and NCBI (
https://www.ncbi.nlm.nih.gov/) databases. The deletion mutant strains were constructed by replacing the target gene with an erythromycin resistance gene (
ermBP) or spectinomycin resistance gene (
aad9) using a DNA fragment constructed by overlap extension PCR. The upstream and downstream sequences of the target genes were amplified from the genomic DNA of
S. mutans UA159. The
ermBP and
aad9 genes were amplified from pJIR418 and pDL278, respectively (
54,
55). Nested PCR was performed as necessary. The amplicons were connected by overlap extension PCR and introduced into
S. mutans UA159. To induce genetic competence, 1 μM sCSP was added to the
S. mutans UA159 culture grown in BHI at early log phase. The transformants were screened on Mitis Salivarius (MS) agar (Difco Laboratories, Detroit, MI) plates with erythromycin (10 μg/ml) or spectinomycin (200 μg/ml). Insertion into the target region of genomic DNA was confirmed by colony PCR and DNA sequencing.
Construction of promoter reporter strains.
The primers used for the construction of promoter reporter strains are listed in Table S2. The promoter reporter strains were constructed by inserting the promoter sequence, fluorescent protein gene (
mScarlet-I or
mNeonGreen), and drug resistance marker (
ermBP or
aph3) at the loci of
SMU_437c, a pseudogene, and/or
SMU_1405c, a gene that does not affect the typical phenotype (
56). The adjacent sequences of insertion loci,
ermBP, and promoter sequences were amplified from the genomic DNA of
S. mutans UA159 or YN102 (
56). We used the
ldh promoter as a constitutive reporter (
57). The
mScarlet-I and
mNeonGreen genes were artificially synthesized (Eurofins Genomics, Tokyo, Japan) and amplified by PCR. A kanamycin resistance gene (
aph3) was amplified from
Bacillus subtilis TAY3203 (
58). The DNA fragments were connected by overlap extension PCR and introduced into
S. mutans UA159, as previously described (
56). The transformants were screened on MS agar plates with erythromycin (10 μg/ml) and/or kanamycin (900 μg/ml). Insertion into the target region of genomic DNA was confirmed by colony PCR and DNA sequencing.
Construction of a complemented strain.
The primers used for the construction of the
lytF-complemented strain (
lytF comp) are listed in Table S3. We constructed the complemented strain by introducing
lytF transcribed from the native promoter into the
SMU_437c locus. The adjacent region of
SMU_437c, the
lytF promoter and the
lytF gene were amplified by PCR from the genome of
S. mutans UA159.
aph3 from
B. subtilis TAY3203 was connected downstream of
lytF as a selection marker (
58). DNA fragments were ligated by overlap extension PCR. The DNA fragment was introduced into Δ
lytF. The transformants were screened on MS agar (Difco Laboratories, Detroit, MI) plates with kanamycin (900 μg/ml). Insertion into the target region of genomic DNA was confirmed by colony PCR and DNA sequencing.
Microfluidic experiment.
The microfluidic device was made from polydimethylsiloxane (PDMS) from a single mold and sealed with a cover glass (
59). High-aspect ratio quasi-two-dimensional microfluidic chambers for two-dimensional bacterial growth were made using the mold previously reported by our group (
59). We used the Sylgard 184 silicone elastomer kit (Dow Chemical Company, Midland, MI). The silicone elastomer base component and curing agent were mixed at a ratio of 10:1. After degassing, the mixture was poured into the mold. To solidify the PDMS, the mixture was heated to 70°C for 12 h. We cut out the device from the mold and punched holes to connect fluoropolymer tubing (FEP tube, Junkosha, Ibaraki, Japan). The device was sealed by permanently bonding it to cover glass (Matsunami, Osaka, Japan) by treating it in O
2 plasma for 20 s at 50 W using a plasma cleaner (Cute, Femto Science, Gyeonggi, South Korea).
Bacterial cells in the mid-log phase were inoculated into the flow cell chamber filled with BHI or BHI with 1 μM CSP supplemented with 1.25 μM SYTOX Green and cultured at 37°C. The medium was infused at a constant rate (150 μl/h) using a syringe pump. We acquired images every 10 min using an Axio observer Z1 (Carl Zeiss, Oberkochen, Germany) with a Plan-Apochromat 100×/1.46 oil-immersion objective lens.
eDNA quantification.
We diluted the overnight culture to an optical density at 600 nm (OD600) of 0.05 with fresh medium with or without 1 μM sCSP and grew the cells in an aerobic atmosphere containing 5% CO2 at 37°C for 6 h. The cells and supernatant were separated by centrifugation, and the DNA was extracted from 500 μl of the supernatant by using cetyltrimethylammonium bromide (CTAB) and phenol. The supernatant was mixed with 500 μl of CTAB solution and incubated at 65°C for 15 min. An equal amount of phenol-chloroform-isoamyl alcohol (Nippon Gene, Tokyo, Japan) was added. After centrifugation, we collected the aqueous phase, and the DNA was precipitated using isopropanol. The DNA pellet was washed with 70% ethanol and dissolved in TE buffer (10 mM Tris-HCl, 1 mM EDTA). We quantified the DNA with a plate reader (Varioskan Flash, Thermo Fisher Scientific, Waltham, MA) using a Quant-iT PicoGreen dsDNA assay kit (Thermo Fisher Scientific, Waltham, MA). The results were standardized by OD600 of the 6-h culture solution.
Flow cytometry.
We diluted overnight culture to an OD600 of 0.05 with fresh BHI with or without 1 μM sCSP and grew the cells in an aerobic atmosphere containing 5% CO2 at 37°C for 6 h. For biofilm induction, we used BHI supplemented with 1% (wt/vol) sucrose (BHIs). After 6 h of incubation, the culture medium was removed and cells were washed twice with sterile phosphate-buffered saline (PBS). The biofilm cells were collected using a cell scraper and sonicated for 10 s at 25 W to disperse aggregates. We stained the dead cells with 500 nM SYTOX Green (Thermo Fisher Scientific, Waltham, MA) for 15 min. The cells were diluted with filtered PBS. The bacterial suspension was analyzed with a cell sorter (SH800Z, Sony, Japan). For SYTOX Green fluorescence, we used a laser excitation of 488 nm and detected the fluorescence with 525/±25 and 487.5 LP filters. For mScarlet-I fluorescence, we used a laser excitation of 561 nm and detected the fluorescence with 600/±30 and 561 LP sequential filters. The boundaries between the positive and negative fluorescence were set using nonfluorescent cells and single fluorescent cells (Fig. S1).
Fluorescence microscopy.
We diluted overnight culture to an OD600 of 0.05 with fresh medium with or without 1 μM sCSP and grew the cells in an aerobic atmosphere containing 5% CO2 at 37°C for 6 h. Dead cells were stained with 500 nM SYTOX Green for 15 min. The cells were placed on 0.8% (wt/vol) agarose and pressed with a cover glass to prevent the cells from moving during observation. We acquired images using an Axio observer Z1 with an AxioCam 506 mono camera or an AxioCam MRm camera and a Plan-Apochromat 63×/1.40 oil-immersion or an EC Plan-Neofluar 100×/1.30 oil-immersion objective lens.
Biofilm formation.
We diluted overnight culture to an OD
600 of 0.05 with BHIs with or without 1 μM sCSP and grew the cells in a 6-well plate (Iwaki, Shizuoka, Japan) or glass-bottom dish (Matsunami, Osaka, Japan) in an aerobic atmosphere containing 5% CO
2 at 37°C for 6 h. To remove the planktonic cells, the biofilms were washed twice with PBS. We stained the cells with 5 μM SYTO 59 (Thermo Fisher Scientific, Waltham, MA) for 30 min. The stained biofilms were washed 2 times with PBS. We acquired 3D images by using an upright confocal laser scanning microscope (LSM880, Carl Zeiss, Oberkochen, Germany) with an IR-Achroplan 40×/0.8 water-immersion objective lens or inverted confocal laser scanning microscope (LSM780, Carl Zeiss, Oberkochen, Germany) with an Apochromat 40×/1.1 water-immersion objective lens. Z-stacks were acquired at 0.5 μm intervals. mNeonGreen, mScarlet-I, and SYTO 59 were excited by 488 nm, 543 nm, and 633 nm lasers, respectively, and the emissions were detected (481 to 570 nm for mNeonGreen, 589 to 624 nm for mScarlet-I, and 642 to 695 nm for SYTO 59). For image analysis, we calculated the area where SYTO 59 and mScarlet-I fluorescence were detected using ImageJ and Fiji (
60,
61).
We used a 96-well plate (Sumitomo Bakelite, Tokyo, Japan) to perform a biofilm inhibition assay by DNase I (Roche Diagnostics GmbH, Germany). We diluted overnight culture to an OD600 of 0.05 with BHIs with 1 μM sCSP and added DNase I to the medium at 50 U/ml. The cells were incubated in an aerobic atmosphere containing 5% CO2 at 37°C for 6 h. After incubation, the medium was removed, and the wells were washed 2 times with PBS. We stained the biofilms with 0.1% (wt/vol) crystal violet (CV) for 15 min. The wells were washed 2 times with PBS to remove the excess CV. CV was extracted from the biofilms with 100 μl of 70% ethanol, and the absorbance at 595 nm was measured with a plate reader.
To test the effect of DNase I on the preformed biofilm, we used the 6-h biofilm formed in a 96-well plate. Before staining with CV, the biofilms were treated with incubation buffer (40 mM Tris-HCl, 10 mM NaCl, 6 mM MgCl2, 1 mM CaCl2, pH 7.9) with or without DNase I (50 U/ml) at 37°C for 6 h. The wells were washed 2 times with PBS. We quantified the remaining biofilm using CV by the same procedure as above.
Attachment assay.
We diluted overnight culture to an OD600 of 0.05 with fresh BHI with 1 μM sCSP and grew the cells in an aerobic atmosphere containing 5% CO2 at 37°C for 6 h. The culture solution was placed in a 96-well plate (100 μl/well) at 4°C for 6 h. The adherent cells were stained with CV for 15 min. The wells were washed twice with PBS. CV was extracted from the biofilms with 100 μl of 70% ethanol and the absorbance was measured at 595 nm with a plate reader. The results were standardized by OD600 of the 6-h culture solution.
Statistics.
The differences were analyzed for statistical significance with Student’s t test or one-way analysis of variance and Bonferroni’s posttest (IBM SPSS statistics 24, IBM Corporation, Armonk, NY). In this study, three independent experiments were performed in duplicate or triplicate. A P value of <0.05 was considered statistically significant.