A Membrane-Targeted Photosensitizer Prevents Drug Resistance and Induces Immune Response in Treating Candidiasis

A "three-in-one" thermosensitive gel system that enhances mucus and biofilm penetration for the treatment of vulvovaginal candidiasis

The special physiological barriers of women, such as vaginal mucus and self-cleaning behavior, pose great challenges for the treatment of vulvovaginal candidiasis (VVC), and the drug resistance caused by fungal biofilms limits the application of existing antifungal drugs. Based on this, we designed a "three-in-one" thermosensitive gel system (AF/BP Gel) loaded with antibiofilm nanoparticles (AF NPs) and mucus penetration-assisting nanoparticles (BP NPs) to achieve vaginal adhesion while enhancing mucus and biofilm penetration. AF NPs were loaded with farnesol (FAR) and amphotericin B (AMB), and FAR is one of quorum sensing molecules which can interfere with biofilm-related genes such as ALS3, HWP1, RAS1, CPH1, EFG1, NRG1, TUP1, UME6, and disperse mature biofilm, thus playing a synergic antibiofilm role with AMB. BP NPs was loaded with bromelain (BRO), which cleared the mucus barrier for AF NPs and help it penetrate deep into the infection. These two kinds of nanoparticles use the thermosensitive gel matrix to reach the surface of the vaginal mucosa uniformly and persistently to overcome the obstacle of vaginal self-cleaning. AF/BP Gel showed great anti-candida albicans activity in vitro and in vivo, and greatly improved the inflammatory conditions in VVC mice. Overall, this "three-in-one" thermosensitive gel system can overcome multiple physiological barriers and resist different periods of biofilm, providing a new platform for treating vagina-associated infections.

Designing Lignin-Based Nanophotocomposites as Reactive Oxygen Species Generators for Inactivating Candida Strains

A combination of sustainable resources and precision biotherapeutics is a game changer for affordable healthcare. A natural biopolymer, lignin, present in agri-biomass, can serve as a nanodrug carrier for targeted delivery. Photodynamic therapy (PDT) is a noninvasive tool to accomplish targeted delivery. Photosensitizers, which are frequently used macrocycles in PDT, lack sufficient hydrophilicity for biological applications. In this regard, lignin-derived nanocarriers provide a sustainable solution, imparting bioavailability to the photosensitizers. In this study, a series of metalloporphyrins were designed and converted into lignin-based nanophotocomposites to augment their photostability and biological efficacy. Such nanophotocomposites played a significant role in eradicating candida infection via PDT by generating reactive oxygen species upon light irradiation. Computational studies (time-dependent density functional theory) established good photosensitizing properties of the metalloporphyrins. These nanophotocomposites demonstrated a pH-triggered release of photosensitizer drugs. The lignin-based nanophotocomposites could be used as low-cost, light-assisted treatment probes for curing candida infections.

H2S Donor Functionalized Molecular Machine for Combating Multidrug-Resistant Bacteria Infected Chronic Wounds

Chronic wounds are a worldwide medical challenge due to the complex and multifaceted etiologies, including bacterial infection, persistent inflammation, and impaired angiogenesis. Developing a comprehensive strategy integrating antibiosis and anti-inflammation to promote revascularization and accelerate wound healing is highly desirable. Nevertheless, current therapeutic methods still face two major challenges: 1) how to combat bacterial drug resistance, 2) how to achieve spatiotemporal control over bacterial elimination and inflammation reduction. To address these issues, a novel H2S donor functionalized molecular machine (MM), ACR-DM-HS, was developed. It selectively binds to and disturbs the bacterial membrane through a light-active vibronic-driven mechanochemical action (VDA), which synergizes with photodynamic therapy (PDT) to efficiently eradicate multidrug-resistant bacteria and biofilms, and conquers the evolution of bacterial resistance. Furthermore, it releases H2S in infected tissues to scavenge excess reactive oxygen species (ROS), inhibit the secretion of inflammatory factors, promote angiogenesis, and accelerate the healing of diabetic wounds in vivo. This work provides an integrated strategy combining antibiotics and anti-inflammation to treat with multidrug resistance bacterial-infected chronic wounds.

AIE-Active Antibacterial Photosensitizer Disrupting Bacterial Structure: Multicenter Validation against Drug-Resistant Pathogens

Antimicrobial resistance (AMR) has emerged as a global challenge in treating bacterial infections, creating an urgent need for broad-spectrum antimicrobial agents that can effectively combat multidrug-resistant (MDR) bacteria. Despite advancements in novel antimicrobial agents, many fail to comprehensively cover common resistant bacterial strains or undergo rigorous multi-center validation. Herein, a cationic AIE-active photosensitizers are developed, ITPM, derived from a triphenylamine-pyridine backbone to address the MDR challenge. Rigorous validation demonstrates that ITPM possesses superior fluorescence imaging capabilities and exceptional antibacterial efficacy. And its broad-spectrum activity is verified through a multi-center study involving six clinically relevant MDR strains. Additionally, resistance development studies and comparisons with advanced clinical antibiotics reveal that ITPM exhibits potent, broad-spectrum antimicrobial activity with minimal resistance development. This efficacy is attributed to its unique antibacterial mechanism involving disrupting bacterial internal structures. These findings establish ITPM as a promising candidate for broad-spectrum antimicrobial therapy, offering a potential solution to the growing crisis of AMR in clinical settings.

Phototheranostics: An advanced approach for precise diagnosis and treatment of gynecological inflammation and tumors

Gynecological inflammations have a significant impact on the daily lives of women. Meanwhile, cancers such as ovarian, cervical, and endometrial cancers pose severe threats to their physical and mental well-being. While current options such as conventional pharmacotherapy, surgical interventions, and recent advancements in immunotherapy and targeted therapy provide viable solutions, they possess limitations in effectively addressing the intricacies associated with gynecological diseases. These complexities include post-surgical complications, early cancer detection, and drug resistance. The management of these challenges, however, requires the implementation of innovative treatment modalities. Phototheranostics has emerged as a promising approach to effectively address these challenges. It not only treats inflammation and tumors efficiently but also aids in disease imaging and diagnosis. The distinguishing features of phototheranostics lie in their non-invasive nature, minimal risk of drug resistance, and precise targeting capabilities through the use of photosensitizers or photothermal agents. These distinctive features underscore its potential to revolutionize early diagnosis and treatment of gynecological conditions. This review aims to summarize the application of phototheranostics in managing gynecological inflammation and tumors while highlighting its significant potential for early disease detection and treatment.

Vaginal mycobiome characteristics and therapeutic strategies in vulvovaginal candidiasis (VVC): differentiating pathogenic species and microecological features for stratified treatment

SUMMARYVulvovaginal candidiasis (VVC) is a prevalent global health burden, particularly among reproductive-aged women. Recurrent VVC affects a significant proportion of this population, presenting therapeutic challenges. The predominant pathogen, Candida albicans, opportunistically transitions from a commensal organism to a pathogen when microenvironmental conditions become dysregulated. Recently, non-albicans Candida species have gained attention for their reduced antifungal susceptibility and recurrence tendencies. Diagnosis is constrained by the limitations of conventional microbiological techniques, while emerging molecular assays offer enhanced pathogen detection yet lack established thresholds to differentiate between commensal and pathogenic states. Increasing resistance issues are encountered by traditional azole-based antifungals, necessitating innovative approaches that integrate microbiota modulation and precision medicine. Therefore, this review aims to systematically explore the pathogenic diversity, drug resistance mechanisms, and biofilm effects of Candida species. Vaginal microbiota (VMB) alterations associated with VVC were also examined, focusing on the interaction between Lactobacillus spp. and pathogenic fungi, emphasizing the role of microbial dysbiosis in disease progression. Finally, the potential therapeutic approaches for VVC were summarized, with a particular focus on the use of probiotics to modulate the VMB composition and restore a healthy microbial ecosystem as a promising treatment strategy. This review addresses antifungal resistance and adopts a microbiota-centric approach, proposing a comprehensive framework for personalized VVC management to reduce recurrence and improve patient outcomes.

Advancements in photodynamic inactivation: A comprehensive review of photosensitizers, mechanisms, and applications in food area

Food microbial contamination results in serious food safety issues and numerous food loss and waste, presenting one of the most significant challenges facing the global food system. Photodynamic inactivation (PDI) technology, which combines light and photosensitizers (PS) to provide antimicrobial effects, is an ideal nonthermal antimicrobial technique for the food industry. This review provides a comprehensive overview of PDI technology, beginning with the fundamental photoactivation principles of PS and the pathways of photoinduced reactive oxygen species (ROS) generation. PS is the most critical factor affecting PDI efficiency, which is categorized into three types: organic, metal oxide-, and carbon-based. This review systemically summarizes the photophysical properties, in vitro PDI performances, potential enhancement strategies, and the advantages and limitations of each type of PS. Furthermore, the antimicrobial mechanisms of the PDI technologies are analyzed at both microscopic and molecular levels. Finally, the current applications of PDI in various food systems are discussed, along with the associated challenges and opportunities. Overall, this review offers crucial insights into optimizing and advancing PDI technology, highlighting key challenges and suggesting future research directions to enhance the effectiveness and scalability of PDI for diverse food applications.

Photoimmunologic Therapy of Stubborn Biofilm via Inhibiting Bacteria Revival and Preventing Reinfection

Stubborn biofilm infections pose serious threats to public health. Clinical practices highly rely on mechanical debridement and antibiotics, which often fail and lead to persistent and recurrent infections. The main culprits are 1) persistent bacteria reviving, colonizing, and rejuvenating biofilms, and 2) secondary pathogen exposure, particularly in individuals with chronic diseases. Addressing how to inhibit persistent bacteria revival and prevent reinfection simultaneously is still a major challenge. Herein, an oligo-ethylene glycol-modified lipophilic cationic photosensitizer (PS), TBTCP-PEG7, is developed. It effectively eradicates Methicillin-Resistant Staphylococcus aureus (MRSA) under light irradiation. Furthermore, TBTCP-PEG7-mediated photodynamic therapy (PDT) not only conquers stubborn biofilm infections by downregulating the two-component system (TCS), quorum sensing (QS), and virulence factors, thereby reducing intercellular communication, inhibiting persistent bacterial regrowth and biofilm remodeling but also prevents reinfection by upregulating heat shock protein-related genes to induce immunogenetic cell death (ICD) and establish immune memory. In vivo, TBTCP-PEG7 efficiently eradicates MRSA biofilm adhered to medical catheters, stimulates angiogenesis, reduces inflammatory factor expression, and accelerates wound healing. Furthermore, ICD promotes short-term immune and long-term immunological memory for coping with secondary infections. This two-pronged strategy not only effectively overcomes stubborn, persistent and recurrent biofilm infection, but also provides theoretical guidance for designing the next generation of antibacterial materials.

[Mechanisms of Wandai Decoction in Improving Vaginal Flora of Vulvovaginal Candidiasis of the Spleen Deficiency and Excessive Dampness Type: A Study Based on Metagenomics and Metabolomics]

Objective

To explore the mechanism by which Wandai Decoction prevents and treats vulvovaginal candidiasis (VVC) of the spleen deficiency and excessive dampness type and restores the vaginal flora structure, and to identify the potential metabolic pathways involved using metagenomics and metabolomics.

Methods

Twenty VVC patients who met the inclusion criteria were randomly assigned to a Wandai Decoction group and a fluconazole group (n = 10 in each group). Subjects in the fluconazole group were given a single oral dose of 150 mg fluconazole, while those in the Wandai Decoction group took the Wandai Decoction orally for 14 days. The vulvovaginal signs and symptoms (VSS) scores of both patient groups were evaluated before and after treatment. Vaginal secretions were collected before and after treatment. The Illumina sequencing and the liquid chromatography with tandem mass spectrometry (LC-MS/MS) platform were used to conduct metagenomic and metabolomics analyses of the vaginal secretions, respectively.

Results

The VSS score results showed that the VSS scores of both groups decreased after treatment compared with those before treatment (P < 0.01), and there was no statistically significant difference in the VSS scores between the two groups after treatment. Metagenomics results showed that, after treatment, the vaginal microbial communities in the Wandai Decoction group were of CST Ⅱ and Ⅴ types (predominated by Lactobacillus gasseri and Lactobacillus jensenii), while those in the fluconazole group were Lactobacillus_intestinalis and Streptococcus_sp._oral_ taxon_431. KEGG functional enrichment analysis results showed that, in terms of the cell cycle and meiosis functions of Candida albicans, statistically significant differences between the Wandai Decoction and fluconazole groups were observed (P < 0.05). Metabolomic analysis identified 120 differential metabolites between the two groups after treatment. The results of KEGG metabolic pathway enrichment analysis of differential metabolites showed that the Wandai Decoction might be significantly superior to fluconazole in improving local vaginal metabolic pathways of α-linolenic acid, glycerophospholipid metabolism, pentose and glucuronic acid interconversion, and arachidonic acid.

Conclusion

The Wandai Decoction can improve the vaginal flora of VVC patients. It may be superior to fluconazole in the signaling pathways of the cell cycle and meiosis. The improvement of the vaginal flora by the Wandai Decoction may be associated with its effect on metabolic pathways of glycerophospholipid metabolism, pentose and glucuronic acid interconversion, and others in the vagina.

An AIE fungal vacuole membrane probe toward species differentiation, vacuole formation visualization, and targeted photodynamic therapy

Vacuoles are unique organelles of fungi. The development of probes targeting the vacuoles membrane will enable visualization of physiological processes and precise diagnosis and therapy. Herein, a zwitterionic molecule, MXF-R, comprising of an aggregation-induced emission (AIE) photosensitizing unit and an antibiotic moxifloxacin, was found capable of specifically imaging vacuole membrane and using for targeted antifungal therapy. MXF-R demonstrated a higher signal-to-noise ratio, stronger targeting capability, and better biocompatibility than the commercial probe FM4-64. By using MXF-R, real-time visualization of vacuole formation during Candida albicans (C. albicans) proliferation was achieved. More importantly, owing to its varying staining ability towards different fungus, MXF-R could be used to quickly identify C. albicans in mixed strains by fluorescence imaging. Moreover, MXF-R exhibits a remarkable ability to generate reactive oxygen species under white light, effectively eradicating C. albicans by disrupting membrane structure. This antifungal therapy of membrane damage is more effective than clinical drug fluconazole. Therefore, this work not only presents the initial discovery of a probe targeting vacuolar membrane, but also provides a way to develop novel materials to realize integrated diagnosis and therapy.

Regulation of Charge Transfer Pathway in Ag-ZnIn2S4 Nanowires for Visible Photodynamic Therapy on Candida Albicans Infections

Photodynamic therapy (PDT) is receiving extensive attention as an antimicrobial strategy that does not cause drug resistance by reactive oxygen species (ROS). Herein, hierarchical Ag-ZnIn2S4 (Ag-ZIS) core-shell nanowires are synthesized by in situ Metal-Organic Framework derived method for efficient PDT of Candida albicans (C. albicans). The core-shell structure enables spatial synergy strategy to regulate the charge transfer pathway under visible light excitation, in which the Ag nanowires are like the highway for the photogenerated electrons. The enhanced charge carrier separation efficiency greatly increased the chances for the generation of ROS. As expected, the optimized Ag-ZIS nanowires exhibit excellent performance for inactivation of C. albicans under visible light irradiation (λ ≥ 420 nm, 15 min), and the effective sterilization concentration is as high as 107CFU mL-1. Moreover, in vivo infection experiments suggested that the PDT effect of Ag-ZIS nanowires on the mouse wound healing is better than that of the clinical Ketoconazole drug. The PDT antifungal mechanism of Ag-ZIS nanowires is also investigated, and superoxide anion is found to be the predominant active species to causes C. albicans damage. This work provides a new perspective for designing novel interface structures to regulate charge transfer to achieve efficient PDT antifungal therapy.

Type I Photosensitizer Targeting Glycans: Overcoming Biofilm Resistance by Inhibiting the Two-Component System, Quorum Sensing, and Multidrug Efflux

Stubborn biofilm infections pose serious threats to human health due to the persistence, recurrence, and dramatically magnified antibiotic resistance. Photodynamic therapy has emerged as a promising approach to combat biofilm. Nevertheless, how to inhibit the bacterial signal transduction system and the efflux pump to conquer biofilm recurrence and resistance remains a challenging and unaddressed issue. Herein, a boric acid-functionalized lipophilic cationic type I photosensitizer, ACR-DMP, is developed, which efficiently generates •OH to overcome the hypoxic microenvironment and photodynamically eradicates methicillin-resistant Staphylococcus aureus (MRSA) and biofilms. Furthermore, it not only alters membrane potential homeostasis and osmotic pressure balance due to its strong binding ability with plasma membrane but also inhibits quorum sensing and the two-component system, reduces virulence factors, and regulates the activity of the drug efflux pump attributed to the glycan-targeting ability, helping to prevent biofilm recurrence and conquer biofilm resistance. In vivo, ACR-DMP successfully obliterates MRSA biofilms attached to implanted medical catheters, alleviates inflammation, and promotes vascularization, thereby combating infections and accelerating wound healing. This work not only provides an efficient strategy to combat stubborn biofilm infections and bacterial multidrug resistance but also offers systematic guidance for the rational design of next-generation advanced antimicrobial materials.