Comparative assessment of antibacterial, antifungal, and cytotoxic activities of ceragenins CSA-44 and CSA-131 against endodontic pathogens.

Cationic steroid antimicrobials (CSA-ceragenin), which includes CSA44 and CSA 131, constitute a novel family of antimicrobial drugs. This study aims to examine the antibacterial and antifungal properties of CSA-44 and CSA-131 against Staphylococcus aureus, methicillin-resistant S. aureus (MRSA), Enterococcus faecalis, and Candida albicans. Additionally, the cytotoxic effects of both compounds were addressed using dental pulp stem cell lines. The CSA-44 compound with a concentration of 0.05% yielded the lowest minimum inhibitory concentration (MIC) of 0.04 µg/mL against E. faecalis. The minimum inhibitory concentration (MIC) values for all concentrations of CSA-44 and CSA-131 against S. aureus ranged between 2.50 and 5.00 µg/mL. Inhibitory action against C. albicans was found to be most pronounced in CSA-131 and CSA-44. The 0.2% of CSA-44 yielded the highest minimum bactericidal concentration (MBC) value of 5.00 µg/mL against S. aureus. The 1xMIC of CSA-44 (0.2%) decreased the bacterial load against E. faecalis at 3 h, even though the same effect was recorded at 6 h against S. aureus. CSA-44 and CSA-131 prevented the growth at 1.5xMIC at 3 h, whereas 1xMIC concentration inhibited the growth at 6 h for all tested microorganisms. The lowest viability was observed with CSA-131 (0.2% 100%), whereas CSA-44 shows lower toxicity than CSA-131 at the same dose. This study provides the first comparative evaluation of the antibacterial, antifungal, and cytotoxic properties of CSA-44 and CSA-131 against clinically relevant endodontic pathogens, offering novel insight into the therapeutic potential of ceragenins in dental applications.