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Bekeschus S, von Woedtke T, Emmert S, Schmidt A. Medical gas plasma-stimulated wound healing: Evidence and mechanisms. Redox Biol 2021; 46:102116. [PMID: 34474394 PMCID: PMC8408623 DOI: 10.1016/j.redox.2021.102116] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022] Open
Abstract
Defective wound healing poses a significant burden on patients and healthcare systems. In recent years, a novel reactive oxygen and nitrogen species (ROS/RNS) based therapy has received considerable attention among dermatologists for targeting chronic wounds. The multifaceted ROS/RNS are generated using gas plasma technology, a partially ionized gas operated at body temperature. This review integrates preclinical and clinical evidence into a set of working hypotheses mainly based on redox processes aiding in elucidating the mechanisms of action and optimizing gas plasmas for therapeutic purposes. These hypotheses include increased wound tissue oxygenation and vascularization, amplified apoptosis of senescent cells, redox signaling, and augmented microbial inactivation. Instead of a dominant role of a single effector, it is proposed that all mechanisms act in concert in gas plasma-stimulated healing, rationalizing the use of this technology in therapy-resistant wounds. Finally, addressable current challenges and future concepts are outlined, which may further promote the clinical utilization, efficacy, and safety of gas plasma technology in wound care in the future.
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Affiliation(s)
- Sander Bekeschus
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), A Member of the Leibniz Research Alliance Leibniz Health Technology, Felix-Hausdorff-Str. 2, 17489, Greifswald, Germany.
| | - Thomas von Woedtke
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), A Member of the Leibniz Research Alliance Leibniz Health Technology, Felix-Hausdorff-Str. 2, 17489, Greifswald, Germany; Institute for Hygiene and Environmental Medicine, Greifswald University Medical Center, Sauerbruchstr., 17475, Greifswald, Germany
| | - Steffen Emmert
- Clinic for Dermatology and Venereology, Rostock University Medical Center, Strempelstr. 13, 18057, Rostock, Germany
| | - Anke Schmidt
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), A Member of the Leibniz Research Alliance Leibniz Health Technology, Felix-Hausdorff-Str. 2, 17489, Greifswald, Germany
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Time Dependency of Non-Thermal Oxygen Plasma and Ultraviolet Irradiation on Cellular Attachment and mRNA Expression of Growth Factors in Osteoblasts on Titanium and Zirconia Surfaces. Int J Mol Sci 2020; 21:ijms21228598. [PMID: 33202662 PMCID: PMC7697706 DOI: 10.3390/ijms21228598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 12/21/2022] Open
Abstract
Ultraviolet (UV) light and non-thermal plasma (NTP) are promising chair-side surface treatment methods to overcome the time-dependent aging of dental implant surfaces. After showing the efficiency of UV light and NTP treatment in restoring the biological activity of titanium and zirconia surfaces in vitro, the objective of this study was to define appropriate processing times for clinical use. Titanium and zirconia disks were treated by UV light and non-thermal oxygen plasma with increasing duration. Non-treated disks were set as controls. Murine osteoblast-like cells (MC3T3-E1) were seeded onto the treated or non-treated disks. After 2 and 24 h of incubation, the viability of cells on surfaces was assessed using an MTS assay. mRNA expression of vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) were assessed using real-time reverse transcription polymerase chain reaction analysis. Cellular morphology and attachment were observed using confocal microscopy. The viability of MC3T3-E1 was significantly increased in 12 min UV-light treated and 1 min oxygen NTP treated groups. VEGF relative expression reached the highest levels on 12 min UV-light and 1 min NTP treated surfaces of both disks. The highest levels of HGF relative expression were reached on 12 min UV light treated zirconia surfaces. However, cells on 12 and 16 min UV-light and NTP treated surfaces of both materials had a more widely spread cytoskeleton compared to control groups. Twelve min UV-light and one min non-thermal oxygen plasma treatment on titanium and zirconia may be the favored times in terms of increasing the viability, mRNA expression of growth factors and cellular attachment in MC3T3-E1 cells.
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Schmidt A, Bekeschus S, Jablonowski H, Barton A, Weltmann KD, Wende K. Role of Ambient Gas Composition on Cold Physical Plasma-Elicited Cell Signaling in Keratinocytes. Biophys J 2017; 112:2397-2407. [PMID: 28591612 DOI: 10.1016/j.bpj.2017.04.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/10/2017] [Accepted: 04/24/2017] [Indexed: 01/22/2023] Open
Abstract
A particularly promising medical application of cold physical plasma is the support of wound healing. This is presumably achieved by modulating inflammation as well as skin cell signaling and migration. Plasma-derived reactive oxygen and nitrogen species (ROS/RNS) are assumed the central biologically active plasma components. We hypothesized that modulating the environmental plasma conditions from pure nitrogen (N2) to pure oxygen (O2) in an atmospheric pressure argon plasma jet (kINPen) will change type and concentration of ROS/RNS and effectively tune the behavior of human skin cells. To investigate this, HaCaT keratinocytes were studied in vitro with regard to cell metabolism, viability, growth, gene expression signature, and cytokine secretion. Flow cytometry demonstrated only slight effects on cytotoxicity. O2 shielding provided stronger apoptotic effects trough caspase-3 activation compared to N2 shielding. Gene array technology revealed induction of signaling and communication proteins such as immunomodulatory interleukin 6 as well as antioxidative and proproliferative molecules (HMOX1, VEGFA, HBEGF, CSF2, and MAPK) in response to different plasma shielding gas compositions. Cell response was correlated to reactive species: oxygen-shielding plasma induces a cell response more efficiently despite an apparent decrease of hydrogen peroxide (H2O2), which was previously shown to be a major player in plasma-cell regulation, emphasizing the role of non-H2O2 ROS like singlet oxygen. Our results suggest differential effects of ROS- and RNS-rich plasma, and may have a role in optimizing clinical plasma applications in chronic wounds.
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Affiliation(s)
- Anke Schmidt
- Plasma Life Science, Leibniz Institute for Plasma Science and Technology (INP Greifswald), Greifswald, Germany.
| | - Sander Bekeschus
- Center for Innovation Competence (ZIK) Plasmatis, Greifswald, Germany
| | | | - Annemarie Barton
- Center for Innovation Competence (ZIK) Plasmatis, Greifswald, Germany
| | - Klaus-Dieter Weltmann
- Plasma Life Science, Leibniz Institute for Plasma Science and Technology (INP Greifswald), Greifswald, Germany; Center for Innovation Competence (ZIK) Plasmatis, Greifswald, Germany
| | - Kristian Wende
- Center for Innovation Competence (ZIK) Plasmatis, Greifswald, Germany
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Lührmann A, Matthes R, Kramer A. Impact of cold atmospheric pressure argon plasma on antibiotic sensitivity of methicillin-resistant Staphylococcus aureus strains in vitro. GMS HYGIENE AND INFECTION CONTROL 2016; 11:Doc17. [PMID: 27610332 PMCID: PMC5005816 DOI: 10.3205/dgkh000277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM The antimicrobial activity of cold atmospheric pressure plasma (CAP), also called tissue tolerable plasma (TTP), could be a promising option to eradicate methicillin-sensitive as well as methicillin-resistant Staphylococcus aureus strains, which often colonize chronic wounds. Currently, the influence of CAP on the susceptibility of S. aureus to antibiotics is scarcely known, but could be important for treatment of wounds. Therefore, the aim of this study was to investigate whether CAP has an impact on the susceptibility of different S. aureus strains to different antibiotics. METHOD For assessment, the agar diffusion test with different antibiotic test disks (cefuroxime, gentamicin, oxacillin, vancomycin, ciprofloxacin, co-trimoxazole, clindamycin, erythromycin) was used. Test strains were spread on agar plates and CAP treated before the antibiotic disks were placed. After 24 hours cultivation, the inhibited growth zones were measured and differences statistically evaluated. RESULTS In most cases, CAP had a negligible influence on the susceptibility to antibiotics. For two strains, the susceptibility significantly decreased to β-lactam antibiotics. CONCLUSION Because CAP can influence the antibiotic susceptibility of S. aureus, before conducting combined treatment with local plasma application on wounds and systemic antibiotics, their interaction must be analysed in vitro to exclude unwanted combination effects.
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Affiliation(s)
- Anne Lührmann
- Institute for Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Rutger Matthes
- Unit of Periodontology, Dental School, University of Greifswald, Greifswald, Germany
| | - Axel Kramer
- Institute for Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
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Cold plasma: a novel approach to treat infected dentin—a combined ex vivo and in vitro study. Clin Oral Investig 2016; 20:2429-2435. [DOI: 10.1007/s00784-016-1723-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 01/12/2016] [Indexed: 10/22/2022]
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Herbst SR, Hertel M, Ballout H, Pierdzioch P, Weltmann KD, Wirtz HC, Abu-Sirhan S, Kostka E, Paris S, Preissner S. Bactericidal Efficacy of Cold Plasma at Different Depths of Infected Root Canals In Vitro. Open Dent J 2015; 9:486-91. [PMID: 26962378 PMCID: PMC4768658 DOI: 10.2174/1874210601509010486] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 11/03/2015] [Accepted: 11/06/2015] [Indexed: 11/27/2022] Open
Abstract
Objectives: Cold plasma (CP) has been shown to be effective even against multiresistant microorganisms. As previous investigations on the effect of CP in root canals showed promising results, the aim of the present study was to analyze the bactericidal efficacy of CP in different depths of infected dentin. Methods: 32 standardized root canals of human mandibular premolars were infected with Enterococcus faecalis and incubated for one week. Specimens were randomly selected for one of four disinfection methods: control (5mL NaCl), 5mL chlorhexidine (CHX), CP alone (CP), and a combination of 5mL CHX and cold plasma (CHX+CP). CHX was ultrasonically activated for 30s, while cold plasma was used for 60s in the root canals. Dentin samples at depths of 300, 500 and 800 µm were obtained and diluted serially. Colony forming units (CFUs) were counted on agar plates after 24h of incubation. Results: The highest overall logarithmic reduction factors (RF) were obtained from CHX+CP (log RF 3.56 p<0.01; Mann-Whitney U test), followed by CP (log RF 3.27 p<0.01) and CHX alone (log RF 2.65 p<0.01) related to the control. All disinfection methods showed significantly lower CFU counts compared to the control group in 300 µm and 800 µm (both p<0.01, Kruskal-Wallis test). Discussion: The adjuvant use of CP might be beneficial in highly infected root canals to improved disinfection. However, the disinfection effect against Enterococcus faecalis of CP is comparable to ultrasonically activated CHX.
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Affiliation(s)
- Sascha R Herbst
- Charité - Universitätsmedizin Berlin, Department of Operative and Preventive Dentistry, Germany
| | - Moritz Hertel
- Charité - Universitätsmedizin Berlin, Department of Oral Medicine, Dental Radiology and Oral Surgery, Germany
| | - Husam Ballout
- Charité - Universitätsmedizin Berlin, Department of Operative and Preventive Dentistry, Germany
| | - Philipp Pierdzioch
- Charité - Universitätsmedizin Berlin, Department of Operative and Preventive Dentistry, Germany
| | - Klaus-Dieter Weltmann
- INP Greifswald, Leibniz Institute for Plasma Science and Technology, Greifswald, Germany
| | - Henrik C Wirtz
- Charité - Universitätsmedizin Berlin, Department of Operative and Preventive Dentistry, Germany
| | - Shady Abu-Sirhan
- Charité - Universitätsmedizin Berlin, Department of Operative and Preventive Dentistry, Germany
| | - Eckehard Kostka
- Charité - Universitätsmedizin Berlin, Department of Operative and Preventive Dentistry, Germany
| | - Sebastian Paris
- Charité - Universitätsmedizin Berlin, Department of Operative and Preventive Dentistry, Germany
| | - Saskia Preissner
- Charité - Universitätsmedizin Berlin, Department of Operative and Preventive Dentistry, Germany
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Haertel B, von Woedtke T, Weltmann KD, Lindequist U. Non-thermal atmospheric-pressure plasma possible application in wound healing. Biomol Ther (Seoul) 2014; 22:477-90. [PMID: 25489414 PMCID: PMC4256026 DOI: 10.4062/biomolther.2014.105] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/10/2014] [Accepted: 11/10/2014] [Indexed: 11/17/2022] Open
Abstract
Non-thermal atmospheric-pressure plasma, also named cold plasma, is defined as a partly ionized gas. Therefore, it cannot be equated with plasma from blood; it is not biological in nature. Non-thermal atmospheric-pressure plasma is a new innovative approach in medicine not only for the treatment of wounds, but with a wide-range of other applications, as e.g. topical treatment of other skin diseases with microbial involvement or treatment of cancer diseases. This review emphasizes plasma effects on wound healing. Non-thermal atmospheric-pressure plasma can support wound healing by its antiseptic effects, by stimulation of proliferation and migration of wound relating skin cells, by activation or inhibition of integrin receptors on the cell surface or by its pro-angiogenic effect. We summarize the effects of plasma on eukaryotic cells, especially on keratinocytes in terms of viability, proliferation, DNA, adhesion molecules and angiogenesis together with the role of reactive oxygen species and other components of plasma. The outcome of first clinical trials regarding wound healing is pointed out.
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Affiliation(s)
- Beate Haertel
- Department of Pharmaceutical Biology, Institute of Pharmacy, Ernst-Moritz-Arndt University of Greifswald, D17489 Greifswald, Germany
| | - Thomas von Woedtke
- Leibniz Institute of Plasma Science and Technology Greifswald e.V (INP), Felix-Hausdorff Str. 2, 17489 Greifswald, Germany
| | - Klaus-Dieter Weltmann
- Leibniz Institute of Plasma Science and Technology Greifswald e.V (INP), Felix-Hausdorff Str. 2, 17489 Greifswald, Germany
| | - Ulrike Lindequist
- Department of Pharmaceutical Biology, Institute of Pharmacy, Ernst-Moritz-Arndt University of Greifswald, D17489 Greifswald, Germany
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Hoffmann C, Berganza C, Zhang J. Cold Atmospheric Plasma: methods of production and application in dentistry and oncology. Med Gas Res 2013; 3:21. [PMID: 24083477 PMCID: PMC4016545 DOI: 10.1186/2045-9912-3-21] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 09/05/2013] [Indexed: 11/10/2022] Open
Abstract
Cold Atmospheric Plasma is an ionized gas that has recently been extensively studied by researchers as a possible therapy in dentistry and oncology. Several different gases can be used to produce Cold Atmospheric Plasma such as Helium, Argon, Nitrogen, Heliox, and air. There are many methods of production by which cold atmospheric plasma is created. Each unique method can be used in different biomedical areas. In dentistry, researchers have mostly investigated the antimicrobial effects produced by plasma as a means to remove dental biofilms and eradicate oral pathogens. It has been shown that reactive oxidative species, charged particles, and UV photons play the main role. Cold Atmospheric Plasma has also found a minor, but important role in tooth whitening and composite restoration. Furthermore, it has been demonstrated that Cold Atmospheric Plasma induces apoptosis, necrosis, cell detachment, and senescence by disrupting the S phase of cell replication in tumor cells. This unique finding opens up its potential therapy in oncology.
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Affiliation(s)
- Clotilde Hoffmann
- Department of Physiology, Loma Linda University School of Medicine, Risley Hall, Room 223, Loma Linda, CA 92354, USA
| | - Carlos Berganza
- Department of Physiology, Loma Linda University School of Medicine, Risley Hall, Room 223, Loma Linda, CA 92354, USA
| | - John Zhang
- Department of Physiology, Loma Linda University School of Medicine, Risley Hall, Room 223, Loma Linda, CA 92354, USA
- Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda, CA, USA
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Antimicrobial efficacy of two surface barrier discharges with air plasma against in vitro biofilms. PLoS One 2013; 8:e70462. [PMID: 23894661 PMCID: PMC3722131 DOI: 10.1371/journal.pone.0070462] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 06/24/2013] [Indexed: 11/19/2022] Open
Abstract
The treatment of infected wounds is one possible therapeutic aspect of plasma medicine. Chronic wounds are often associated with microbial biofilms which limit the efficacy of antiseptics. The present study investigates two different surface barrier discharges with air plasma to compare their efficacy against microbial biofilms with chlorhexidine digluconate solution (CHX) as representative of an important antibiofilm antiseptic. Pseudomonas aeruginosa SG81 and Staphylococcus epidermidis RP62A were cultivated on polycarbonate discs. The biofilms were treated for 30, 60, 150, 300 or 600 s with plasma or for 600 s with 0.1% CHX, respectively. After treatment, biofilms were dispensed by ultrasound and the antimicrobial effects were determined as difference in the number of the colony forming units by microbial culture. A high antimicrobial efficacy on biofilms of both plasma sources in comparison to CHX treatment was shown. The efficacy differs between the used strains and plasma sources. For illustration, the biofilms were examined under a scanning electron microscope before and after treatment. Additionally, cytotoxicity was determined by the MTT (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay with L929 mouse fibroblast cell line. The cell toxicity of the used plasma limits its applicability on human tissue to maximally 150 s. The emitted UV irradiance was measured to estimate whether UV could limit the application on human tissue at the given parameters. It was found that the UV emission is negligibly low. In conclusion, the results support the assumption that air plasma could be an option for therapy of chronic wounds.
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