The biomedical effects of laser application

Low-energy helium-neon laser irradiation stimulates interleukin-1 alpha and interleukin-8 release from cultured human keratinocytes

Clinical observations have suggested that low-energy lasers might promote wound healing. Evidence suggests that He-Ne laser irradiation induces an increase in the rate of keratinocyte migration and proliferation as compared with nonirradiated controls in vitro. This study sought to determine whether He-Ne laser could induce cytokine production in cultured keratinocytes. The results revealed (i) a significant increase in interleukin-1 alpha and interleukin-8 production and their respective mRNA expression in He-Ne laser-treated groups as compared with nonirradiated controls, and (ii) under 1.5 joules/cm2 irradiation, this stimulating effect of He-Ne laser treatment is concentration-dependent. Because interleukin-1 alpha induces keratinocyte migration, this finding may partially explain the stimulatory effects on the motility of keratinocytes. As both interleukin-1 alpha and interleukin-8 provoke proliferation of keratinocytes, it is not unreasonable to propose that these two cytokines play a profound role in the enhancement of keratinocyte proliferation as a result of He-Ne laser irradiation. Our findings provide further evidence of enhanced wound healing at the cellular and molecular level as a result of the He-Ne laser.

Reactive oxygen species inducible by low-intensity laser irradiation alter DNA synthesis in the haemopoietic cell line U937

BACKGROUND AND OBJECTIVE

The purpose of this study was to evaluate the possible role of reactive oxygen species (ROS) in mediating previously recorded alterations in DNA synthesis, inducible by low-intensity laser irradiation (LILI), in the haemopoietic cell line U937.

STUDY DESIGN/MATERIALS AND METHODS

The ability of LILI (660 nm, 12 mW, 5 kHz) to induce ROS from U937 cells was assessed spectrophotometrically at energy densities (E.D.) from 1.0 to 11.5 J/cm2. In order to assess whether laser-induced ROS could alter cellular proliferation DNA synthesis was measured post-irradiation, by the incorporation of tritiated thymidine (3H-TdR) into the cells in both the presence and absence of the antioxidant catalase (CAT).

RESULTS

Detectable ROS were produced post-irradiation only from the differentiated form of the cell line. Analysis by Student's t-test for unrelated groups showed a significant difference, at E.D.s 2.9 and 8.6 J/cm2, in the extent of DNA synthesis occurring in cells irradiated in the presence of CAT or in its absence.

CONCLUSION

These findings demonstrate that laser-inducible ROS can mediate laser's effects on this cell line.

[Determination of the energy density of rapid periodic laser light patterns of homogeneous superficial coverage for medical applications]

The use of laser light in in vitro experiments on fibroblasts and osteoblasts and animal experiments has revealed similar thresholds the crossing of which is apparently necessary for achieving photobiological effects. Clinical observations suggested that such a threshold might apply to energy density, while further investigations seemed to indicate that a threshold for intensity (power density) might also be of importance. This was investigated in the clinical setting involving laser light applications to large areas. Initial measurements obtained with available measuring equipment pointed up the problems associated with the measurement of power and energy in different-speed radiation systems. Using a laser in conjunction with a "light chopper", a way of determining the range of a measuring system, in which useful measurements can be obtained is described.

He-Ne laser therapy by fibroendoscopy in the mucosa of the equine upper airway

BACKGROUND AND OBJECTIVE

A study was made of the effects of low-level laser irradiation on the cicatrization of superficial wounds in the pharyngeal mucosa of the horse.

STUDY DESIGN/MATERIALS AND METHODS

Duplicate pharyngeal mucosal ulcers were induced in 12 Spanish horses with submucosal injection of sulfuric acid. A fibroendoscope and an He-Ne laser were used to treat one of the ulcers and the second ulcer in each animal was left untreated, serving as a control. Biopsy samples for the histological study were taken after the seventh laser therapy session from the two animals.

RESULTS

Irradiated lesions cicatrized at 10.5 days and nonirradiated lesions cicatrized at 18.0 days. Statistical analysis revealed highly significant differences (P < 0.0001) between the irradiated and control groups. Histological study of the control samples showed epithelial coagulation necrosis, edema, and microthrombi. However, in samples from the irradiated lesions no inflammatory edema, numerous active fibroblasts, connective tissue, and intensive epithelial regeneration were observed.

CONCLUSION

Macroscopic and microscopic results indicated that laser treatment accelerated the cicatrization. Irradiated lesions cicatrized faster than control. These results suggest beneficial effects of low-level laser irradiation therapy on equine pharyngeal ulcerative lesions.

Low intensity laser therapy: still not an established clinical tool

The surgical, ophthalmological, and dermatological applications of high power lasers are well known and easily understood. What is neither as well known nor as easily understood is that lasers at powers that are orders of magnitude smaller have also been used in the laboratory and clinic for nearly 30 years to modulate cell function, lessen pain, and accelerate healing of soft tissue injuries. This article analyzes the rationale of this approach, examines the utility of laser therapy in its most common clinical applications, reviews and synthesizes the findings, and concludes that although laboratory findings seem authentic, clinical utility remains unestablished.

Ophthalmic effects of low-energy laser irradiation

Laser irradiation at subthreshold energies exerts various effects on the eye and other parts of the body, mainly the skin and nervous system, through a mechanism that has yet to be adequately explained. The ocular bioeffects are manifested mostly in the retina, but also in other ocular tissues. This review outlines the reported effects of low-energy laser irradiation on nonophthalmological tissues and organs, including those of the nervous system, with special emphasis on the optic nerve. It also details the ophthalmic phenomena induced by low-energy laser irradiation and examines claims of its therapeutic efficacy in several eye diseases, such as keratitis, glaucoma and macular degeneration.

The effect of laser irradiation on the release of bFGF from 3T3 fibroblasts

Studies have shown that low-level laser irradiation increases the proliferation of fibroblasts in cell culture. The mechanism of action is unknown. Basic fibroblast growth factor (bFGF) is a multifunctional polypeptide that has been detected in most tissues and which supports cell proliferation and differentiation. The purpose of this study was to determine whether laser irradiation (660 nm) can stimulate production of bFGF from fibroblast cells in cell culture. Our study showed that fibroblasts irradiated with laser energy at 2.16 J/cm2 demonstrated increased cell proliferation and enhanced production of bFGF, whereas fibroblasts irradiated with laser energy at 3.24 J/cm2 neither demonstrated increased cell proliferation or an enhanced release of bFGF as compared to the control group. These results provide direct evidence that the proliferation of fibroblasts as a result of stimulation by low level laser irradiation may be associated with the autocrine production of bFGF from fibroblasts.

Effect of low-intensity argon laser irradiation on mitochondrial respiration

We studied influences of low-intensity argon laser irradiation at various wavelengths on mitochondrial respiration in vitro. Isolated guinea pig liver mitochondria were suspended in an isotonic buffer solution (pH 7.4, 37 degrees C). The mitochondrial suspension was introduced into a constant temperature reaction chamber in which an irradiation fiber, a thermocouple, an oxygen electrode, and a stirrer were installed. Under respiratory conditions of state 4, state 3, and uncoupled respiration, mitochondrial oxygen consumption was measured during low-intensity argon laser irradiations at 351nm, 458 nm, and 514.5 nm. The 351 nm and the 458 nm irradiations at 200 mW inhibited uncoupled respiration by 19% and 11%, respectively, and the irradiation at 351 nm inhibited state 3 respiration as well by 10%. In contrast, the 514.5 nm irradiation enhanced both state 3 and uncoupled respiration by 6-7%. Temperature reference experiments indicated that the thermal effect alone could not account for the effects of laser irradiation on mitochondrial oxygen consumption. These results suggest that the 351 nm and the 458 nm laser irradiation may injure the mitochondrial inner membrane, while the 514.5 nm laser irradiation may slightly promote the rate of ATP synthesis.

Evidence for the existence of low-energy laser bioeffects on the nervous system

The reported effects of low-energy laser irradiation on the nervous system are manifested in alterations in cellular and extracellular biochemical constituents and reactions, as well as in changes in cell division rates. These bioeffects were observed in both in vivo and in vitro experiments. Other observed phenomena relate to the function of the nervous system and consist mainly of induced alteration in electrical conduction, stimulation thresholds, and behavioral effects. Clinical aspects of low-energy laser bioeffects relate mainly to pain mitigation and postponement of the posttraumatic neural degeneration processes. Many of the reported observations were obtained by experiments apparently conducted according to less than rigorous scientific criteria, and some could not be duplicated. On the whole, however, there is little doubt that low-energy laser irradiation exerts some effects on the nervous system under specific conditions of irradiation and tissue exposure via a mechanism which is probably photochemical in nature.

Effect of low level diode laser irradiation of human oral mucosa fibroblasts in vitro

The effects of low level laser (LLL) irradiation on the proliferation of human buccal fibroblasts were studied. A standardized LLL set-up was developed (812 nm, 4.5 +/- 0.5 mW/cm2). Cultures in petridishes were divided into eight groups (1 group served as control). On day 6 after seeding, routine growth medium was replaced with PBS for 1/2 hour. At the beginning of this period, LLL irradiation was performed for 0, 1, 3, 10, 32, 100, 316, or 1,000 seconds, respectively--corresponding to the radiant exposures 0, 4.5, 13.5, 45, 144, 450, 1,422, 4,500 mJ/cm2. Subsequently the cells received 3H-dT in fresh medium for 16 hours DNA-incorporation. Scintillations from tritium and total protein concentration per culture dish were determined. The individual 3H-cpm/protein-concentration ratios were calculated in % of control. Three experiments were performed (N = 151). Following LLL exposure the 3H-cpm/protein ratio was increased with maximum cpm/protein ratio (132.5% +/- 10.6% SEM) in the group receiving 450 mJ/cm2 (P < 0.03 nonparametric Kruskal Wallis one-way ANOVA-test). This study demonstrated an increased incorporation on tritiated thymidine in cultured human oral fibroblasts following LLL exposure and suggests that LLL irradiation can induce increased DNA synthesis.

Low intensity laser irradiation inhibits tritiated thymidine incorporation in the hemopoietic cell lines HL-60 and U937

The purpose of this study was to determine the effect of low intensity laser irradiation (660 nm, 12 mW, 5 kHz) on tritiated thymidine incorporation in two hemopoietic cell lines, HL-60 and U937. Cells were suspended at a concentration of 1 x 10(6)/ml in their respective serum-free media and irradiated at energy densities from 1.0 to 11.5 J/cm2. Twenty-four hours after irradiation the cells were assayed for their ability to incorporate tritiated thymidine (3H-TdR) in comparison with nonirradiated cells. Analysis by two-way analysis of variance (ANOVA) for unrelated groups showed that laser irradiation at all energy densities > or = 5.8 J/cm2 produced a significant decrease in 3H-TdR incorporation (P < 0.05) into HL-60 cells. In U937 cells, irradiation at energy densities of 5.8, 7.2, and 11.5 J/cm2 caused a similar reduction in 3H-TdR incorporation (P < 0.01), although not at 8.6 and 9.6 J/cm2. The temperature of each cell suspension was recorded both during and immediately postirradiation, and no significant thermal changes were observed. These findings demonstrate a direct photobiological effect of laser irradiation on these two cell lines. The precise mechanism for this effect is unknown but may have significance in understanding the biological action of laser's known therapeutic effectiveness in promoting wound repair.

Laser therapy: scientific basis and clinical role

The ability of laser irradiation to destroy tissue is well known. Less well known is the fact that the same radiation, at much lower intensities, can non-destructively alter cellular function. This latter phenomenon, which occurs in the absence of significant heating, is now a basis for the conservative treatment of a variety of musculoskeletal, neurological, and soft tissue conditions in many parts of the world. This review first examines the 25-year history and scientific basis of "laser therapy." Clinical applications are discussed and the reasons for its relative lack of acceptance in the US are examined. The article concludes with an overview of current research and the impact it will have on laser therapy's role in US clinical practice.

Modification of late dermal necrosis in the pig by treatment with multi-wavelength light

Low-level light from a multi-wavelength light source has been used to prevent late X-ray-induced dermal necrosis in the pig. Skin fields, measuring 4 cm x 4 cm on the flank, were irradiated with graded doses of X rays and the incidence of late dermal necrosis at 10-16 weeks after irradiation was scored. The control skin sites were irradiated only with 250 kV X rays but the test skin sites were subsequently exposed to low-level light. Local light exposure was from an array of gallium aluminium arsenide diodes, which produced wavelengths of 660, 820, 880 and 950 nm, pulsating at 5 kHz. Light treatment was given three times a week, from 6-16 weeks after X irradiation. Each treatment session was 1 min, which was equivalent to energy density of 1.08 Jcm-2. Light treatment increased the ED50, the dose which causes dermal necrosis in 50% of the irradiated skin fields, from 20.10 +/- 0.12 Gy to 21.94 +/- 0.30 Gy. This difference, although small, was highly significant (p < 0.001) and was equivalent to a dose modification factor (DMF) of 1.09. The effect of light treatment was minimal at incidence levels of less than the 50% but greater at higher levels of effect. These findings suggest that low-level light, when applied appropriately, may be useful in the prevention of late X-ray-induced damage to the dermis.

Effects of 830 nm continuous wave laser diode irradiation on median nerve function in normal subjects

The presence, magnitude, and nature of the effect that low intensity laser irradiation has on nerve function, growth, and repair constitute a contentious area of research. We have addressed one aspect of this controversy by systematically examining the influence of 830 nm laser radiation on median nerve function. In particular, we investigated median nerve motor and sensory distal latencies, action potential amplitudes, action potential areas, and conduction velocities as well as dorsal hand skin temperatures in 33 normal subjects in a double-blinded, randomized controlled study. All subjects received identical treatment: 30 seconds of "irradiation" at 10 points over the course of the right median nerve (five sites on the forearm and five sites distal to the wrist crease) with either an active (1.2 J/point) or inactive (0 J/point) 40 mW 830 nm continuous wave IR laser diode. Latencies, conduction velocities, amplitudes, areas, and skin temperatures were collected bilaterally at a baseline immediately prior to irradiation and at intervals of 1, 5, 10, 15, 20, and 30 minutes following treatment. Analysis of the results reveals that motor and sensory distal latencies were decreased in the treated limbs of the laser-treated group relative to the control group by 3-4% (P < .016 and .046, respectively, rank sum test). No significant differences in these quantities were found between the limbs within either group. Similarly, no alterations of action potential amplitudes, action potential areas, forearm conduction velocities, or skin temperatures were detected within or between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Dose and temporal parameters in delaying injured optic nerve degeneration by low-energy laser irradiation

Low-energy laser irradiation has been reported to postpone the degenerative processes in crushed optic nerves of rats, which are part of the nonregenerable mammalian central nervous system. In the present study, we evaluated the optimal irradiation parameters for this purpose. Optic nerves of 141 rats were subjected to crush injury and then irradiated through the eye, starting at different points of time before or after the injury, for different durations and periods, using various intensities of either helium-neon laser or noncoherent infrared light (904 nm). The effect was evaluated by measurements of the compound action potentials of the nerve segments between the site of injury and the optic chiasm. The compound action potential amplitude of the crushed nonirradiated nerves, as measured 2 weeks after the injury, was found to be 0.51 +/- 0.30 mV, in contrast to 3.10 +/- 1.03 mV measured in 232 normal nerves. Irradiation with a 10.5 mW helium-neon laser for 2 and 3 min once a day for 14 consecutive days resulted in maximal preservation of action potentials (1.78 +/- 0.72 and 1.95 +/- 0.71 mV, respectively). Irradiations beginning immediately prior to the injury were as effective as irradiations beginning soon after it. Irradiations for longer than 3 min or twice a day aggravated the damage. Noncoherent infrared light was ineffective or adversely affected the injured nerves. Our experiments suggest that optimal delay of posttraumatic optic nerve degeneration in rats is attainable with 10.5 mW helium-neon laser irradiations for 2 or 3 min once a day for 14 consecutive days.

Low power laser irradiation alters the rate of regeneration of the rat facial nerve

Low power laser irradiation has been reported to cause biological effects due to the photochemical and/or photophysical action of the radiation. This study determined quantitatively if transcutaneous low power laser irradiation can affect the regeneration of the rat facial nerve. The facial nerve was crushed unilaterally in anesthetized rats and transcutaneously irradiated daily with a laser beam directed at the area of the crush injury. Laser treatment began on the day of the crush injury and was continued daily for 7, 8, or 9 days. Preliminary experiments determined the most effective wavelength, laser power, length of irradiation, and treatment schedule. The wavelengths examined were 361, 457, 514, 633, 720, and 1064. The laser powers and lengths of irradiation examined ranged from 8.5 to 40 mW and 13 to 120 min. Irradiation treatment was done daily, on alternating days and on the first 4 days postcrush. The most effective laser parameters for the low power treatment included daily irradiation with a helium-neon (HeNe) or argon pumped tunable dye laser a wavelength of 633 nm, with a power of 8.5 mW for 90 minutes (45.9 J, 162.4 J/cm2). The number of horseradish peroxidase (HRP) labeled neurons in the facial motor nucleus was used as an assay of the degree of regeneration. In rats in which the facial nerve was crushed but not irradiated, the average number of HRP labeled neurons in the facial nucleus was 22 on day 7 postcrush, 54 on day 8, 116 on day 9, and 1,149 on day 10. After HeNe or argon pumped tunable dye laser irradiation, the average number of HRP-labeled neurons increased to 34 on day 7 postcrush, 148 on day 8, and 1,725 on day 9. There was a statistically significant difference between the control and irradiated rats on day 9 postcrush (P < 0.01). These data indicate that transcutaneous low power irradiation with the lasers and parameters involved in this study increased the rate of regeneration of rat facial nerve following crush injury.

Effect of helium-neon laser irradiation on serum lipid peroxide concentrations in burnt mice

The effect of helium-neon irradiation on serum lipid peroxide concentrations in mice following 6-7% body surface area burns was investigated in a controlled study. Immediately following injury by an 8-sec 100 degrees C scalding, 25 mice were irradiated by a helium-neon laser at 0.05 J/cm2. A control group of the same size underwent identical treatment but received only sham irradiation. Serum lipid peroxide concentrations increased markedly in the control group at 0.5-4 h (P less than 0.0001, two sample t-test). In the laser treated group, the lipid peroxide concentrations remained relatively constant and were significantly depressed relative to the control group 4 h following burning (P less than 0.0001, two-sample t-test).

Ultrastructural morphometry of membrane-bound intracytoplasmic collagen fibrils in tendon fibroblasts exposed to He:Ne laser beam

Collagen fibrils are not found in fibroblast cytoplasm except in certain pathological conditions or in the presence of drugs and other agents that accelerate collagen turnover. Because low energy laser photostimulation is both a non-pathogenic and non-chemical accelerator of collagen synthesis, its effects were studied on four groups of calcaneal tendons from 18 rabbits (1) to test the hypothesis that vacuolar fibrils are not produced exclusively by diseases and chemical agents, and (2) to compare the morphometry of matrical and vacuolar fibrils. The right calcaneal tendons of nine rabbits were surgically tenotomized and repaired; six of these were transcutaneously irradiated with He:Ne laser everyday. The right calcaneal tendon of six of the remaining nine rabbits were similarly irradiated with laser, but without prior tenotomy and repair. 21 days later, all tendons were fixed in situ and processed for electron microscopy. Fibril-bearing vacuoles were found only in fibroblasts of tenotomized laser-irradiated tendons. Similar vacuoles were not seen in non-tenotomized laser-irradiated tendons nor in non-irradiated tendons whether tenotomized or not. Mann-Whitney U tests revealed no statistically significant differences in the cross-sectional areas or diameters of matrical and vacuolar fibrils. These findings suggest (a) that matrical and vacuolar fibrils have a common origin, and (b) that vacuolar fibrils can be induced by a non-pathologic, non-chemical accelerator of collagen synthesis.

The direct effect of light therapy on endothelial cell proliferation in vitro

During repair, new blood vessels are formed by the process of angiogenesis. The prerequisite to blood vessel formation is the proliferation of endothelial cells. The purpose of this study was to find out if light therapy is capable of affecting endothelial cell proliferation in vitro. The direct effect of light at wavelengths of either 660 or 820 nm was studied on primary cultures of bovine aortic endothelial cells using varying energy densities, of either 1, 2, 4, or 8 J/cm2. The proliferation of the endothelial cells was assessed over a period of five days after a single irradiation.

Prevention of X-ray-induced late dermal necrosis in the pig by treatment with multi-wavelength light

Low-level light from a multi-wavelength array of light sources has been used to prevent late X-ray-induced dermal necrosis in the pig. Skin fields, measuring 4 x 4 cm on the flank, were irradiated with a single dose of 23.4 Gy of X-rays. This X-ray dose was associated with the development of a 100% incidence of dermal necrosis, 10-16 weeks after irradiation. These irradiated skin sites were subsequently exposed to light of 660, 820, 880, and 950 nm wavelengths from a gallium aluminium arsenide multiple wavelength multidiode cluster probe (Biotherapy Medical Laser, 3ML), three times a week, from 4 to 16 weeks or 6 to 16 weeks after X-irradiation. The skin fields were exposed to the light pulsating at either 2.5 Hz or 5 kHz. With light pulsating at 5 kHz, energy densities of 0.22, 0.54, 1.08 2.16, 4.32, and 10.8 J/cm2 were used. Treatment with light pulsating at 2.5 Hz, 6-16 weeks after X-irradiation, or treatment with light pulsating at 5 kHz, 4-16 weeks after X-irradiation, did not have a significant effect on the incidence or the latency for the development of ischemic dermal necrosis irrespective of the exposure time to light at each treatment. With light pulsating at 5 kHz, no effect of light dose was observed. However, the overall incidence of dermal necrosis was significantly reduced (P = 0.001) to 52% in the X-irradiated fields receiving treatment with 5 kHz light, 6-16 weeks after X-irradiation.(ABSTRACT TRUNCATED AT 250 WORDS)

Photochemical effects of laser irradiation on neuritic outgrowth of olfactory neuroepithelial explants

The photochemical effect of low-intensity laser irradiation (LILI) on the maturation and regeneration of olfactory-immature estrus day 15 (E15) and olfactory-mature estrus day 22 (E22) rat fetuses was studied. Neuritic outgrowths of olfactory bipolar receptor cells were quantified in olfactory neuroepithelial explants. Explants in the experimental groups were irradiated with a helium-neon laser using different incident energy densities (IEDs). Explants in another group were exposed to fluorescent light. Control explants did not receive laser or fluorescent light irradiation. Neuritic outgrowths were analyzed on a regular basis for 12 days. Analysis of variance was used to evaluate the data. The parameters of neuritic outgrowth in E15 fetuses showed a significant increase of 30% to 50% vs. the control with a single laser irradiation of 0.5 J/cm2 IED. The rate of neuritic outgrowth observed in the E22 fetuses was less than in the E15 fetuses. The parameters of neuritic outgrowth in E22 fetuses showed a significant and substantially greater percentage increase than in the E15 fetuses with daily laser irradiations of 0.05 and 0.5 J/cm2 IED when compared to the control. The magnitude of these increases appears to be of biological significance as well as statistical significance.