Biofilm in Chronic Health Conditions, Why is it Overlooked?

Biofilms are powerful structures, often multi-species, created by bacteria to ensure long-term survival. They are up to 1000 times more resistant to traditional antibiotics than the planktonic form of bacteria.[1] They are encased in a structure of extracellular DNA, with channels designed to allow sugar and nutrients to flow inside. It grows and occasionally releases planktonic bacteria via dispersal. It effectively is a protective structure that grows unlimited bacteria. The immune system has ways of fighting this of course, but in many chronic conditions, biofilm can overpower or evade the immune system.

Many, to reduce your anxiety on the subject, may be quick to inform you that there are good biofilms in the large intestine, which help restore the beneficial microbiome when something disturbs it, but that's not what I'm talking about here. There is evidence that in many chronic conditions, biofilm establishes long-term residence in areas of the body such as atherosclerotic plaque,[2][3][4] wounds, cysts and bodily medical devices,[5] in the mucosal lining of the stomach,[6] and, in rare cases, the brain.[7]

So, if this problem can contribute to so many chronic conditions, why do so few people know about it, and why does it not get more attention? I think the sad reality is that at present, it's difficult for pharmaceutical corporations to make money off of it. Traditional antibiotics don't work effectively on biofilms, and, though there are many studies to show that natural herbal plants and supplements can fight biofilms, there hasn't been much progress on patenting new drugs that effectively combat biofilm. In addition to this, there is a very significant incentive to ignore the problem and continue with existing treatments which reduce the severity of symptoms. Not only that, but the current methods that are hypothesized are not yet proven beyond a shadow of a doubt to be effective, and medical professionals may not feel comfortable suggesting them to patients out of fear of legal punishment.

It has been said even recently that atherosclerotic plaque may be impossible to reverse if it progresses beyond a certain point,[9] but is this actually true? A clinical study of 1062 participants found an arterial plaque reduction of an enormous 36% by consuming nattokinase for six months.[10] Nattokinase was discovered in natto, a Japanese meal of fermented soybeans. Natto consumption is believed to be a significant contributor to the longevity of the Japanese population and a high intake of natto is associated with a decreased risk of total cardiovascular disease mortality.[10] It's no coincidence that this was discovered in a fermented food, bacteria often create chemicals which seem to have evolved for the purpose of eliminating competition, such as bacteriocins which exist to poison other bacteria (this is what penicillin is, although it's not referred to as a bacteriocin since it's produced by a fungus, but its purpose is the same). Nattokinase is produced by bacillus subtilis, the bacteria used to create natto, the fermented soybean meal. Nattokinase has been shown to dissolve biofilms, in addition to human fibrin.

BUT, the story is not as one-sided as it could be. There is a known case of an elderly woman (admittedly 92 years old) who died after consuming too much nattokinase.[11] In the study, she is unsure how many she takes, “sometimes a handful”.[11] A CT scan showed a ruptured hepatic cystic lesion in the kidneys. If biofilm has been shown to exist in both cystic lesions and atherosclerotic plaque, I don't think nattokinase's connection here should be overlooked. It's possible that nattokinase could be extremely beneficial, but it may free bacteria from their non-motile state, and it may even open up structures such as cysts.

There is evidence to suggest that OCD may relate to bacterial infection, especially streptococcal infection.[12] Many children are also burdened by subtypes of OCD: PANDAS and PANS.[13] It is believed that even after streptococcus bacteria are eliminated from the body, autoimmune responses will continue in the body. But, is this the full story? What if biofilm is yet again going overlooked in these cases? Atherosclerosis can start as early as childhood,[14] and many of the cases for the removal of tonsils are due to biofilm infection of the tonsils.[15] Is it possible that these children, despite having most of the streptococcus removed via antibiotics, may still have chronic biofilm infection which is responsible for (at the very least, a portion of) their autoimmune reactions?

To be honest, the thing which bothers me the most is that we may very well have ways of fighting biofilms without the need for any drugs at all. A number of natural substances have shown potential in fighting biofilms (although it should be kept in mind that each biofilm may consist of different microbial communities, which furthers the difficulty in fighting and understanding them). Vitamin C,[16] flavonoids,[17] and plant-derived chemicals such as berberine and allicin (from garlic) have been shown to have anti-biofilm activity.[18][19] But as these compounds cannot be patented as a drug can, will they receive the clinical trials that will get them serious medical consideration?

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2920928/

[2] https://journals.asm.org/doi/10.1128/mbio.01206-14

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9241811/

[4] https://pubmed.ncbi.nlm.nih.gov/26878370

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926955/

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4452508/

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8778325/

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008232/

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7375463/

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9441630/

[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8723721/

[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710247

[13] https://www.ncbi.nlm.nih.gov/books/NBK333433/

[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5345217/

[15] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9774359/

[16] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9163820

[17] https://www.nature.com/articles/s41598-020-75929-2

[18] https://pubs.rsc.org/en/content/articlehtml/2018/ra/c8ra06413j

[19] https://www.ijidonline.com/article/S1201-9712(20)30886-9/fulltext