BACTERIOLOGYOral cavity infection by Enterococcus faecalis: virulence factors and pathogenesisNajafi, Khadijeha,b; Ganbarov, Khudaverdic; Gholizadeh, Pouryab; Tanomand, Asghard; Rezaee, Mohammad Ahangarzadehe; Mahmood, Suhad Saadf; Asgharzadeh, Mohammadg; Kafil, Hossein SamadibAuthor Information aStudent Research Committee bDrug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran cDepartment of Microbiology, Baku State University, Baku, Republic of Azerbaijan dDepartment of Basic Sciences, Maragheh University of Medical Sciences, Maragheh eImmunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran fDeparment of Biotechnology, College of Science, University of Baghdad, Baghdad, Iraq gBiotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Correspondence to Hossein Samadi Kafil, PhD, Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Az-Sharghi, Iran. e-mail: Kafilhs@tbzmed.ac.ir Received 23 October, 2018 Revised 31 December, 2018 Accepted 2 January, 2019 Reviews in Medical Microbiology: April 2020 - Volume 31 - Issue 2 - p 51-60 doi: 10.1097/MRM.0000000000000168 Buy Metrics Abstract Enterococcus faecalis plays an important role in human oral cavity infections and may be one of the important species in endodontic treatment failure. In this review article, we provide an overview on the occurrence of the virulence factors associated with E. faecalis in oral infections. Seven virulence factors of E. faecalis have been associated with oral infections including extracellular surface protein (esp), gelatinase (GelE), aggregation substance (Asa), adhesion of collagen from E. faecalis (Ace), Serine protease (Spr), lipoteichoic acid (LTA) and E. faecalis antigen A (efaA). The absence of these factors leads to depletion of strains in attachment and biofilm formation procedure in oral infections. The virulence factors facilitate adherence, colonization and resistance of organisms against the host immune response. Each of the virulence factors may be associated with various stages of infection. Some products of the bacteria may be directly linked to damaging of the host tissues; most of the tissue damage is probably mediated by the host response to the bacteria and its products. Our knowledge regarding exact pathogenic factors is incomplete but it seems to be a sophisticated and tangled mechanism. Developing immunization against virulence factors of E. faecalis might be one of the effective prophylactic tool to prevent chronic infections in oral, dental and other sites of the body, such as endocardia. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.