A critical review on innovative targets for signal disruption in Enterococcus faecalis infection management

Abstract

Enterococcus faecalis is a Gram-positive gut-associated microbe that commonly inhabits the human intestine and poses an immense threat to individuals with a compromised immune system, particularly in healthcare settings. It is also delineated for its various virulent factors, such as strong biofilm formation and resistance to multiple medications, which in turn challenge the current treatment strategies. Quorum sensing systems, particularly the Fsr and LuxS systems, play an important role in its virulence by regulating the synthesis of enzymes like gelatinase and serine protease, which help maintain biofilm stability and host tissue encroachment. E. faecalis biofilms are resistant to antimicrobial medications, making the bacteria challenging to eliminate. This review explores E. faecalis quorum sensing systems and their role in biofilm formation, emphasizing these pathways as prospective targets for therapeutic intervention. Emerging techniques, which include the application of phages, probiotics, nanoparticles, and phytochemicals, can inhibit quorum sensing, disrupt biofilm growth and reduce E. faecalis pathogenicity. Targeting these processes may provide beneficial substitutes or complements to standard antibiotics, especially for antibiotic-resistant bacteria. These strategies aid in improving infection control and therapeutic effectiveness toward E. faecalis in healthcare settings. © 2025 Elsevier Ltd