Antimicrobial Photodynamic Therapy: Latest Developments with a Focus on Combinatory Strategies

Salivary Proteins-Enhanced Antimicrobial Photodynamic Therapy: Overcoming Three Distinct Cultures of Resistant Mixed Biofilms

BACKGROUND

Denture stomatitis is frequently associated with biofilm formation by Candida albicans, which can coexist with Streptococcus mutans. Current treatments face several limitations, including the emergence of resistant strains and the persistent impact of biofilm formation on antimicrobial efficacy. The salivary proteins Histatin 3 (His3) and Histatin 5 (His5) have demonstrated effectiveness against C. albicans single-species biofilms. However, their efficacy against mixed-species biofilms, particularly those involving S. mutans and antifungal-resistant C. albicans strains, remains poorly understood.

OBJECTIVES

To investigate the efficacy of combining His3 and His5 with antimicrobial photodynamic therapy (aPDT) against mixed biofilms containing polyene-resistant (CaP+Sm), wild-type (CaW+Sm), and fluconazole-resistant (CaF+Sm) and S. mutans (Sm) on acrylic resins.

METHODS

48-hour mixed biofilms (37°C/5% CO₂) were formed on acrylic resin disks treated with His3 and His5 (2h/37°C/120 rpm). Biofilms were subjected to aPDT using Photodithazine (200 mg/L) followed by 30 min of red LED irradiation (660 nm, 50 J/cm²). Viability was assessed by colony-forming units (CFU), while ECM components (proteins, alkali-soluble polysaccharides (ASP), water-soluble polysaccharides (WSP), and extracellular DNA (eDNA)) were analyzed (n=6).

RESULTS

Complete eradication of mixed biofilms was observed in CaW+Sm and CaF+Sm treated with His3 + aPDT and His5 + aPDT, while CaP+Sm showed a 98% reduction in total microbiota. For CaP+Sm, combined His3+aPDT and His5+aPDT significantly reduced biofilm viability, achieving up to 99% reduction in C. albicans and 80% in S. mutans. ECM components, including proteins, ASP, WSP, and eDNA, were notably reduced, particularly in CaW+Sm and CaF+Sm cultures.

CONCLUSION

Combining Histatins with aPDT demonstrated superior efficacy compared to individual treatments, disrupting mixed biofilms of C. albicans and S. mutans and significantly reducing viability.

CLINICAL SIGNIFICANCE

Histatins with antimicrobial photodynamic therapy (aPDT) reduce biofilm viability and disrupt key components of extracellular matrix in resistant biofilm that contribute to the persistence of infections in denture stomatitis.

Light-driven self-sterilizing cotton fabric and drug delivery: improvement of the antimicrobial activity of 4-sulfo-1,8-naphthalimide via its dendrimer and metallic dendrimer formation

The search for new bioactive substances with microbiological activity is dictated by the increasing resistance of the drugs used in clinical practice against various pathogenic microorganisms. In this respect, particular attention is paid to the modified dendrimers with biologically active substances and their metal complexes. This work describes synthesizing and characterizing a new copper complex of first-generation polypropylene imine (PPI) dendrimer, modified with 4-sulfo-1,8-naphthalimide. The new metallodendrimer [Cu2(E)(NO3)4] has been characterized by IR and electron paramagnetic resonance (EPR) spectroscopy. Two copper ions were found to form a complex with the dendrimer ligand. Cotton fabrics were treated with the dendrimer ligand (E), its monomer structural analog (M), and metallodendrimer. The microbiological activity of the three compounds and the treated cotton fabrics with them has been tested in the dark and after light irradiation against bacterial strains: Gram-positive B. cereus and Gram-negative P. aeruginosa. The results showed that the metallodendrimer was slightly more effective than the dendrimer ligand E and monomer M, and their activity was enhanced after light irradiation. The increase in antimicrobial activity after light irradiation was due to the generation of highly reactive singlet oxygen, which damages bacteria's cell membrane, leading to their inactivation. The similar activity against both types of bacteria indicates that all three compounds can be classified as broad-spectrum antimicrobial agents. The virucidal effects of the studied compounds were also tested against human adenovirus type 5 (HAdV5) and human respiratory syncytial virus (HRSV-S2) after 30 min/60 min. The newly synthesized compounds showed no activity against HAdV-5, but the activity against HSV-2 viruses increases with the prolongation of their interaction.

Activatable Photosensitizers: From Fundamental Principles to Advanced Designs

Photodynamic therapy (PDT) is a promising treatment that uses light to excite photosensitizers in target tissue, producing reactive oxygen species and localized cell death. It is recognized as a minimally invasive, clinically approved cancer therapy with additional preclinical applications in arthritis, atherosclerosis, and infection control. A hallmark of ideal PDT is delivering disease-specific cytotoxicity while sparing healthy tissue. However, conventional photosensitizers often suffer from non-specific photoactivation, causing off-target toxicity. Activatable photosensitizers (aPS) have emerged as more precise alternatives, offering controlled activation. Unlike traditional photosensitizers, they remain inert and photoinactive during circulation and off-target accumulation, minimizing collateral damage. These photosensitizers are designed to "turn on" in response to disease-specific biostimuli, enhancing therapeutic selectivity and reducing off-target effects. This review explores the principles of aPS, including quenching mechanisms stemming from activatable fluorescent probes and applied to activatable photosensitizers (RET, PeT, ICT, ACQ, AIE), as well as pathological biostimuli (pH, enzymes, redox conditions, cellular internalization), and bioresponsive constructs enabling quenching and activation. We also provide a critical assessment of unresolved challenges in aPS development, including limitations in targeting precision, selectivity under real-world conditions, and potential solutions to persistent issues (dual-lock, targeting moieties, biorthogonal chemistry and artificial receptors). Additionally, it provides an in-depth discussion of essential research design considerations needed to develop translationally relevant aPS with improved therapeutic outcomes and specificity.

Pr3+ Visible to Ultraviolet Upconversion for Antimicrobial Applications

This paper addresses the upconversion of blue light to ultraviolet-C (UVC) with Pr3+-activated materials for antibacterial applications of UVC. It discusses the processes through which UV radiation provides biocidal effects on microorganisms, along with the most popular UVC sources employed in these processes. We describe the electronic and optical properties of the Pr3+ ion, emphasizing the conditions the host material must meet to obtain broad and intense emission in the UVC from parity-allowed transitions from the 4f5d levels and provide a list of materials that fulfill these conditions. This paper also delineates lanthanide-based upconversion, focusing on Pr3+ blue to UVC upconversion via the 3P0 and 1D2 intermediate states, and suggests routes for improving the quantum efficiency of the process. We review literature related to the use of upconversion materials in antimicrobial photodynamic treatments and for the blue to UVC upconversion germicidal effects. Further, we propose the spectral overlap between the UVC emission of Pr3+ materials and the germicidal effectiveness curve as a criterion for assessing the potential of these materials in antimicrobial applications. Finally, this paper briefly assesses the toxicity of materials commonly used in the preparation of upconversion materials.

The effect of photobiomodulation on oral microbiota dysbiosis: A literature review

The balance, or dysbiosis, of the microbial community is crucial for human health and disease. While most microbes are harmless, some can lead to oral infections such as periodontal disease, dental caries, and infections related to Candida biofilms. Conventional treatments, such as mechanical debridement, antibiotics, probiotics, and prebiotics, aim to restore the balance of oral microbiota, but they encounter challenges like microbial resistance and patient compliance issues. To address these problems, laser therapy has emerged as a promising local treatment option. Among the various types of lasers, low-power lasers-specifically low-level laser therapy or photobiomodulation (PBM) therapy-are particularly favored for oral applications due to their antimicrobial effects and non-invasive properties. PBM influences oral microbiota dysbiosis through both direct and indirect pathways. The direct effect occurs when endogenous targets are remained within the cell or released into the colony. In contrast, an indirect effect can result from targets located in the tissues and cells surrounding the bacteria. However, studies using different irradiation protocols have produced varied results. Therefore, this study aims to investigate and review the effects of PBM on oral microbiota dysbiosis and its potential in promoting the maintenance of human health.

The (re)emergence of aerosol delivery: Treatment of pulmonary diseases and its clinical challenges

Aerosol delivery represents a rapid and non-invasive way to directly reach the lungs while escaping the hepatic first-pass effect. The development of pulmonary drugs for respiratory diseases such as cystic fibrosis, lung infections, pulmonary fibrosis or lung cancer requires an enhanced understanding of the relationships between the natural physiology of the respiratory system and the pathophysiology of these conditions. This knowledge is crucial to better predict and thereby control drug deposition. Moreover, aerosol administration faces several challenges, including the pulmonary tract, immune system, mucociliary clearance, the presence of fluid on the airway surfaces, and, in some cases, bacterial colonisation. Each of them directly influences on the bioavailability of the active molecule. In addition to these challenges, particle size and the device used to administer the treatment are critical factors that can significantly impact the biodistribution of the drugs. Nanoparticles are very promising in the development of new formulations for aerosol drug delivery, as they can be fine-tuned to reach the entire pulmonary tract and overcome the difficulties encountered along the way. However, to properly assess drug delivery, preclinical studies need to be more thorough to efficiently enhance drug delivery.

Self-Assembled DNA/SG-I Nanoflower: Versatile Photocatalytic Biosensors for Disease-Related Markers

DNA nanostructures have recently attracted more attention with functionalities, programmability, and biocompatibility. Herein, a novel self-assembled photocatalytic DNA/SYBR Green I (SG-I) nanoflower (DSNF) was successfully synthesized by rolling circle amplification. DSNF was self-assembled through liquid crystallization of a high concentration of DNA in the RCA products, without relying on the Watson-Crick base-pairing principle. Interestingly, DSNF not only possessed a larger specific surface area and good stability but also exhibited excellent photocatalytic activity that generates singlet oxygen and superoxide anion to oxidate 3,3',5,5'-tetramethylbenzidine. Meanwhile, the photocatalytic DSNF combined with an enzyme-linked immunosorbent assay to develop a new colorimetric sensor for highly specific, sensitive, and visual detection of carcinoembryonic antigens (CEAs). The colorimetric sensor achieved sensitive and low-cost quantitative detection of CEA in the linear range of 0.5-80.0 ng/mL, and the LOD was 0.5 ng/mL. In addition, three negative and seven positive clinical serum samples of CEA were obtained with 100% accuracy using the proposed colorimetric sensor, showing great potential in the clinical application of cancer diagnosis. We envision that this photocatalytic DSNF is expected to provide important perspectives in fluorescence imaging, photosensitizing cancer therapy, and clinical diagnosis fields.

Light-based therapy of infected wounds: a review of dose considerations for photodynamic microbial inactivation and photobiomodulation

Significance

Chronic or surgical wound infections in healthcare remain a worldwide problem without satisfying options. Systemic or topical antibiotic use is an inadequate solution, given the increase in antimicrobial-resistant microbes. Hence, antibiotic-free alternatives are needed. Antimicrobial photodynamic inactivation (aPDI) has been shown to be effective in wound disinfection. Among the impediments to the wide utility of aPDI for wounds is the high variability in reported photosensitizer and light dose to be effective and unintentional detrimental impact on the wound closure rates. Additionally, the time required by the healthcare professional to deliver this therapy is excessive in the present form of delivery.

Aim

We reviewed the dose ranges for various photosensitizers required to achieve wound disinfection or sterilization while not unintentionally inhibiting wound closure through concomitant photobiomodulation (PBM) processes.

Approach

To allow comparison of aPDI or PBM administered doses, we employ a unified dose concept based on the number of absorbed photons per unit volume by the photosensitizer or cytochrome C oxidase for aPDI and PBM, respectively.

Results

One notes that for current aPDI protocols, the absorbed photons per unit volume for wound disinfection or sterilization can lead to inhibiting normal wound closure through PBM processes.

Conclusion

Options to reduce the dose discrepancy between effective aPDI and PBM are discussed.

Assessment of photodynamic therapy efficacy against Escherichia coli-Enterococcus faecalis biofilms using optical coherence tomography

Significance

In orthopedic trauma surgery, spatially structured biofilm ecosystems of bacteria that colonize orthopedic devices account for up to 65% of all healthcare infections, including tens of millions of people affected in the United States. These biofilm infections typically show increased resistance to antibiotics due to their structure and composition, which contributes significantly to treatment failure. Anti-biofilm approaches are needed together with clinically usable microscopic-resolution imaging techniques for treatment efficacy assessment.

Aim

Antimicrobial photodynamic therapy (aPDT) has been recently proposed to combat clinically relevant biofilms (chronic wound infections, dental biofilms, etc.) using photosensitizers excited with visible light to generate reactive oxygen species that can kill bacteria residing within pathogenic biofilms. We aim to assess the efficacy of this treatment for eradication of biofilms typically present on surfaces of orthopedic devices (e.g., intramedullary nails and osseointegrated prosthetic implants).

Approach

In the first phase reported here, we test aPDT in vitro by growing biofilms of Escherichia coli and Enterococcus faecalis bacteria (two of the seven most common pathogens found in orthopedic trauma patients) inside soft lithography-fabricated microfluidic devices. We treat these biofilms with 5-aminolevulinic acid (5-ALA)-based aPDT, evaluate treatment efficacy with optical coherence tomography, and compare with regular clinical antibiotic treatment outcomes.

Results

The antibacterial efficiency of 5-ALA-based aPDT showed nonlinear dependence on the photosensitizer concentration and the light power density, with low parameters ( 30    J / cm 2 light dose, 100    mg / mL 5-ALA concentration) being significantly more effective than antibiotic-treated groups ( p < 0.01 ), reaching 99.98% of bacteria killed at 150    J / cm 2 light dose and 200    mg / mL 5-ALA concentration setting.

Conclusions

Performed experiments enable the translation of this portable treatment/imaging platform to the second phase of the study: aPDT treatment response assessment of biofilms grown on orthopedic hardware.

Red and NIR light-triggered enhancement of anticancer and antibacterial activities of dinuclear Co(II)-catecholate complexes

Photoactive complexes of bioessential 3d metals, activable within the phototherapeutic window (650-900 nm), have gained widespread interest due to their therapeutic potential. Herein, we report the synthesis, characterization, and light-enhanced anticancer and antibacterial properties of four new dinuclear Co(II) complexes: [Co(phen)(cat)]2 (Co-1), [Co(dppz)(cat)]2 (Co-2), [Co(phen)(esc)]2 (Co-3), and [Co(dppz)(esc)]2 (Co-4). In these complexes, phen (1,10-phenanthroline) and dppz (dipyrido[3,2-a:2',3'-c]phenazine) act as neutral N,N-donor ligands, while cat2- and esc2- serve as O,O-donor catecholate ligands derived from catechol (1,2-dihydroxybenzene) and esculetin (6,7-dihydroxy coumarin). Their high-spin paramagnetic nature and dimeric identity in solution were confirmed by magnetic susceptibility, UV-visible, emission, and mass spectral data. Co-1-Co-4 exhibited an absorption band within the 600-850 nm range, originating from a charge transfer transition. The electrically neutral complexes demonstrated sufficient solution stability both in the dark and under irradiated conditions. The dppz complexes Co-2 and Co-4 exhibited notable toxicity towards A549 lung carcinoma cells, with potency increasing significantly under brief (5 min) exposure to 660 nm (red) and 808 nm (NIR) laser light (IC50 ∼ 8.9 to 14.9 μM). Notably, their toxicity towards normal NIH-3T3 fibroblast cells was minimal. Cellular assays highlighted that the induced cell death followed an apoptotic pathway, primarily due to mitochondrial damage. Co-2 and Co-4 also demonstrated significant antibacterial potency against Gram-(+) S. aureus and Gram-(-) P. aeruginosa, with effectiveness significantly enhanced upon 808 nm laser irradiation (MIC ∼ 15-142 μM). The increase in the anticancer and antibacterial efficacies was attributed to the generation of cytotoxic singlet oxygen (1O2) species upon red/NIR light exposure. Notably, 808 nm NIR irradiation produced more pronounced effects compared to 660 nm. This study is the first to report on cobalt complexes exhibiting red and NIR light-triggered enhancement of antibacterial and anticancer activities, illuminating the path for the development of long-wavelength absorbing cobalt complexes with enhanced therapeutic efficacy.

In vitro photodynamic therapy of Candida albicans, the cause of vulvovaginal candidiasis, is enhanced by Bacillus and Enterococcus probiotics

BACKGROUND

Candida albicans is the primary cause of vulvovaginal candidiasis, a worldwide health concern for women. The use of supplemental methods, such as antimicrobial photodynamic therapy (aPDT) and probiotics, was promoted by the ineffectiveness of the existing antifungal drugs.

METHODS

This study examines the combined effects of probiotics (Bacillus and Enterococcus isolated from the fermented pickles) and PDT (using red laser (655 nm, 18 J/cm2) as a light source and methylene blue dye (30 mg/mL) as a photosensitizer) on the in vitro virulence activity of C. albicans including growth, biofilm formation, antifungal resistance, biofilm elimination, and biofilm dispersion.

RESULTS

The probiotic strains demonstrated a higher resistance to PDT compared to the fungal cell. Bacillus and Enterococcus enhanced the antifungal effects of PDT on planktonic Candida cells in both pre-PDT and post-PDT interactions. The inhibition of biofilm formation by PDT was improved upon interaction with Bacillus (70 %) and Enterococcus (58 %). The eradication of Candida biofilm using PDT was increased after a combination with Bacillus (67 %) and Enterococcus (46 %). The nystatin resistance of the fungal biofilm following PDT treatment was decreased from (µg/ml) 25 to 6.25 due to the interaction with both probiotic strains. Fungal cell dispersion from the biofilm after PDT treatment diminished by 18 % and 25 % in the presence of Bacillus and Enterococcus strains. Galleria mellonella mortality was significantly changed following the PDT of the fungi/probiotic-injected larvae.

CONCLUSIONS

This synergistic activity suggests the use of probiotics/PDT as a supplemental treatment for vulvovaginal candidiasis.

Development of a hybrid CuS-ICG polymeric photosensitive vector and its application in antibacterial photodynamic therapy

At the present time, owing to the extremely high growth of microbial resistance to antibiotics and, consequently, the increased healthcare associated costs and the loss of efficacy of current treatments, the development of new therapies against bacteria is of paramount importance. For this reason, in this work, a hybrid synergetic nanovector has been developed, based on the encapsulation of a NIR (near infrared) photosensitive molecule (indocyanine green, ICG) in biodegradable polymeric nanoparticles (NPs). In addition, copper sulfide nanoparticles (CuS NPs), optically sensitive to NIR, were anchored on the polymeric nanoparticle shell in order to boost the generation of reactive oxygen species (ROS) upon NIR irradiation. As a result, the nanohybrid synthesized material is capable to generate ROS on demand when exposed to a NIR laser (808 nm) allowing for the repeated triggering of ROS production upon NIR light exposure. After each irradiation, the ROS generated were able to eliminate pathogenic bacteria, as it was demonstrated in-vitro with three bacterial strains, Staphylococcus aureus ATCC 25923 used as a reference strain (S. aureus), S. aureus USA300 (methicillin-resistantstrain, MRSA) and GFP-expressing antibiotic-sensitive S. aureus (methicillin-sensitive strain, MSSA). Finally, the effect of the hybrid NPs in the skin bed was tested on a plasma-derived in vitro skin model. Fluorescence and histological images showed the presence of CuS NPs all over the dermal layer lacking epidermis of the skin construct. Thus, the in vitro model facilitated the prediction of the nanovector's behavior in a human skin equivalent, showcasing its potential application against topical infections after wounding.

Building Block for Designing Bright Type I AIE-Active Photosensitizers with Deep/Near-infrared Red Fluorescence

Bright deep red/near-infrared red (DR/NIR) active type I photosensitizers (PSs) with generating superoxide anion and hydroxyl radical have been regarded as powerful functional materials to fight the "Achilles's heel" of hypoxia from solid tumor. But some problems have still existed, for example, lacking effective molecular designed strategy or typical building block to design precisely type I PSs. In addition, the relationship between fluorescent quantum efficiency and NIR fluorescent color is inconsistent according to energy gap rule. To overcome above mentioned problems, in this work, we propose a typical building block to design precisely type I PSs with DR/NIR fluorescence and high photoluminescent quantum yield at aggregation by combining molecular design of aggregation-induced emission and hybrid locally and charge transfer (HLCT) theory. The synthetic small molecular PSs just produce superoxide anion without any singlet oxygen production, which is ascribed to their lower T1 energy levels to suppress energy transfer from triplet state to oxygen. Two strategies of small molecular structural designing and polymeric nanoparticles modification are utilized to improve efficiency of type I ROS. More interestingly, original small molecular PSs is in capable to produce hydroxyl radical, once forming BSA encapsulated nanoparticles, obvious hydroxyl radical is appeared.

Colistin Resistance Mechanism and Management Strategies of Colistin-Resistant Acinetobacter baumannii Infections

The emergence of antibiotic-resistant Acinetobacter baumannii (A. baumannii) is a pressing threat in clinical settings. Colistin is currently a widely used treatment for multidrug-resistant A. baumannii, serving as the last line of defense. However, reports of colistin-resistant strains of A. baumannii have emerged, underscoring the urgent need to develop alternative medications to combat these serious pathogens. To resist colistin, A. baumannii has developed several mechanisms. These include the loss of outer membrane lipopolysaccharides (LPSs) due to mutation of LPS biosynthetic genes, modification of lipid A (a constituent of LPSs) structure through the addition of phosphoethanolamine (PEtN) moieties to the lipid A component by overexpression of chromosomal pmrCAB operon genes and eptA gene, or acquisition of plasmid-encoded mcr genes through horizontal gene transfer. Other resistance mechanisms involve alterations of outer membrane permeability through porins, the expulsion of colistin by efflux pumps, and heteroresistance. In response to the rising threat of colistin-resistant A. baumannii, researchers have developed various treatment strategies, including antibiotic combination therapy, adjuvants to potentiate antibiotic activity, repurposing existing drugs, antimicrobial peptides, nanotechnology, photodynamic therapy, CRISPR/Cas, and phage therapy. While many of these strategies have shown promise in vitro and in vivo, further clinical trials are necessary to ensure their efficacy and widen their clinical applications. Ongoing research is essential for identifying the most effective therapeutic strategies to manage colistin-resistant A. baumannii. This review explores the genetic mechanisms underlying colistin resistance and assesses potential treatment options for this challenging pathogen.

Lignin-Derived Gold-Titanium Dioxide Nanophotocomposites as Potent Photoactivatable Probes for Microbial Inactivation

The overuse of antibiotics has accelerated antibiotic resistance, and it is a significant global threat to public health. To combat the rising threat of drug-resistant microbes, antimicrobial photodynamic therapy (APDT) has emerged as a promising alternative therapeutic strategy. This study focuses on the synthesis of eco-friendly lignin-derived gold-titanium dioxide nanophotocomposites (L@Au-TiO2 NCs). Lignin was utilized as a sustainable precursor for the synthesis of L@Au-TiO2 NCs. The gold and TiO2 nanoparticles possess inherent photodynamic properties, and thus the developed L@Au-TiO2 NCs exhibit enhanced antimicrobial efficacy due to the synergistic combination of their attributes. The antimicrobial potential of the L@Au-TiO2 NCs was evaluated against various microbial strains (Escherichia coli, Bacillus megaterium, and Candida tropicalis) under dark and green light conditions. The outcome of this study highlights the promising potential of L@Au-TiO2 NCs for photodynamic antimicrobial applications. The L@Au-TiO2 nanophotocomposites could be explored in the fields of medicine and nanotechnology to introduce innovative ideas into the biomedical field.

A Combined Phyto- and Photodynamic Delivery Nanoplatform Enhances Antimicrobial Therapy: Design, Preparation, In Vitro Evaluation, and Molecular Docking

Microbial combating is one of the hot research topics, and finding an alternative strategy is considerably required nowadays. Here, we report on a developed combined chemo- and photodynamic delivery system with a core of zinc oxide nanoparticles (ZnO NPs), porphyrin photosensitizer (POR) connected to alginate polymer (ALG), and berberine (alkaloid natural agent, BER) with favorable antimicrobial effects. According to the achieved main designs, the results demonstrated that the loading capacity and entrapment efficiency reached 22.2 wt % and 95.2%, respectively, for ZnO@ALG-POR/BER nanoformulation (second design) compared to 5.88 wt % and 45.1% for ZnOBER@ALG-POR design (first design). Importantly, when the intended nanoformulations were combined with laser irradiation for 10 min, they showed effective antifungal and antibacterial action against Candida albicans, Escherichia coli, and Staphylococcus aureus. Comparing these treatments to ZnO NPs and free BER, a complete (100%) suppression of bacterial and fungal growth was observed by ZnO@ALG-POR/BER nanoformulation treated E. coli, and by ZnOBER treated C. albicans. Also, after laser treatments, most data showed that E. coli was more sensitive to treatments using nanoformulations than S. aureus. The nanoformulations like ZnOBER@ALG-POR were highly comparable to traditional antibiotics against C. albicans and E. coli before laser application. The results of the cytotoxicity assessment demonstrated that the nanoformulations exhibited moderate biocompatibility on normal human immortalized retinal epithelial (RPE1) cells. Notably, the most biocompatible nanoformulation was ZnOBER@ALG-POR, which possessed ∼9% inhibition of RPE1 cells compared to others. High binding affinities were found between all three microbial strains' receptor proteins and ligands in the molecular docking interaction between the receptor proteins and the ligand molecules (mostly BER and POR). In conclusion, our findings point to the possible use of hybrid nanoplatform delivery systems that combine natural agents and photodynamic therapy into a single therapeutic agent, effectively combating microbial infections. Therapeutic efficiency correlates with nanoformulation design and microorganisms, demonstrating possible optimization for further development.

The impact of antimicrobial photodynamic therapy on pain and oral health-related quality of life: A literature review

Antimicrobial photodynamic therapy (aPDT) is a non-invasive approach used for microbial decontamination, and it can also be beneficial as an adjunctive strategy for oral infections. The success of treatment in the long term is increasingly recognized to be influenced by patient's perception of the disease and its improvement. Recently, aPDT has been suggested as a dual approach to tissue repair, pain relief, and enhancement of oral health-related quality of life (OHRQoL). The first pathway involves the antimicrobial and anti-inflammatory effects of aPDT. It not only eliminates microorganisms but also helps regulate the immune response and reduce inflammation, leading to a faster and more effective healing process. This, in turn, provides relief from pain and associated symptoms, aiding in the management of treatment complications. The second pathway involves aPDT's ability to modulate nociception and alleviate pain. aPDT induces analgesia by releasing neurotransmitters such as β-endorphin, serotonin, and acetylcholinesterase. It also interacts with mitochondria through photoreceptors, initiating intracellular processes that alleviate pain. Furthermore, the therapy inhibits nerve fibers, reducing nerve impulse conduction and altering the pain threshold. Considering that the impact on patients' pain and OHRQoL is an important aspect of the decision-making process, this study aimed to review patient-based outcome measures during aPDT and assess its effects on pain and OHRQoL in patients. Understanding these factors will contribute to a better assessment of the overall benefits and effectiveness of aPDT as a treatment option for oral infections.

Hydrogels Associated with Photodynamic Therapy Have Antimicrobial Effect against Staphylococcus aureus: A Systematic Review

Staphylococcus aureus (S. aureus) is a Gram-positive bacterium that causes infections ranging from mild superficial cases to more severe, potentially fatal conditions. Many photosensitisers used in photodynamic therapy are more effective against superficial infections due to limitations in treating deeper tissue infections. Recently, attention to this bacterium has increased due to the emergence of multidrug-resistant strains, which complicate antibiotic treatment. As a result, alternative therapies, such as antimicrobial photodynamic therapy (PDT), have emerged as promising options for treating non-systemic infections. PDT combines a photosensitiser (PS) with light and oxygen to generate free radicals that destroy bacterial structures. This systematic review evaluates the effectiveness of PDT delivered via different types of hydrogels in treating wounds, burns, and contamination by S. aureus. Following PRISMA 2020 guidelines, a bibliographic search was conducted in PubMed, Web of Science, and Scopus databases, including articles published in English between 2013 and 2024. Seven relevant studies were included, demonstrating evidence of PDT use against S. aureus in in vitro and in vivo studies. We concluded that PDT can effectively complement antimicrobial therapy in the healing of wounds and burns. The effectiveness of this technique depends on the PS used, the type of hydrogel, and the lesion location. However, further in vivo studies are needed to confirm the safety and efficacy of PDT delivered via hydrogels.

Capped Plasmonic Gold and Silver Nanoparticles with Porphyrins for Potential Use as Anticancer Agents-A Review

Photothermal therapy (PTT) and photodynamic therapy (PDT) are potential cancer treatment methods that are minimally invasive with high specificity for malignant cells. Emerging research has concentrated on the application of metal nanoparticles encapsulated in porphyrin and their derivatives to improve the efficacy of these treatments. Gold and silver nanoparticles have distinct optical properties and biocompatibility, which makes them efficient materials for PDT and PTT. Conjugation of these nanoparticles with porphyrin derivatives increases their light absorption and singlet oxygen generation that create a synergistic effect that increases phototoxicity against cancer cells. Porphyrin encapsulation with gold or silver nanoparticles improves their solubility, stability, and targeted tumor delivery. This paper provides comprehensive review on the design, functionalization, and uses of plasmonic silver and gold nanoparticles in biomedicine and how they can be conjugated with porphyrins for synergistic therapeutic effects. Furthermore, it investigates this dual-modal therapy's potential advantages and disadvantages and offers perspectives for future prospects. The possibility of developing gold, silver, and porphyrin nanotechnology-enabled biomedicine for combination therapy is also examined.

Prevention and Management of Infectious Complications in Retrograde Intrarenal Surgery: A Comprehensive Review

Retrograde intrarenal surgery (RIRS) is a minimally invasive procedure increasingly used to treat renal stones and other intrarenal pathologies due to its reduced risk of complications, shorter recovery time, and lower postoperative pain compared to more invasive surgical techniques. However, despite its advantages, RIRS is associated with a significant risk of infectious complications, ranging from simple urinary tract infections (UTIs) to severe systemic infections such as urosepsis, which can lead to increased morbidity, prolonged hospitalization, and, in severe cases, mortality. This review aims to summarize the current knowledge on preventing and managing infectious complications associated with RIRS. By exploring the pathophysiology of these infections, identifying patient and procedural risk factors, and evaluating evidence-based strategies for prevention and management, this review provides comprehensive insights into minimizing infection risks in RIRS. A thorough literature review was conducted, examining studies and clinical trials that address the incidence, risk factors, prevention strategies, and management protocols for infections in RIRS. This review also assesses current guidelines from professional organizations and recent infection control technologies and practices advancements. The review identifies multiple risk factors contributing to infections in RIRS, including patient-specific factors such as comorbidities and procedural factors like the duration of surgery and use of instrumentation. Effective prevention strategies include preoperative antibiotic prophylaxis, stringent aseptic techniques during surgery, and careful postoperative monitoring. The review also highlights the importance of a multidisciplinary approach involving urologists, infectious disease specialists, and microbiologists in managing complex cases of infection. Infectious complications remain a significant concern in RIRS, necessitating a comprehensive approach to prevention and management. By adhering to evidence-based guidelines and utilizing a multidisciplinary strategy, healthcare professionals can significantly reduce the incidence of infections, thereby improving patient outcomes and the overall safety of RIRS. Future research should focus on advancing infection control technologies and developing novel prophylactic and therapeutic approaches to further enhance the safety and effectiveness of RIRS.

Highly Efficient Quenching of Singlet Oxygen by DNA Origami Nanostructures

DNA origami nanostructures (DONs) are able to scavenge reactive oxygen species (ROS) and their scavenging efficiency toward ROS radicals was shown to be comparable to that of genomic DNA. Herein, we demonstrate that DONs are highly efficient singlet oxygen quenchers outperforming double-stranded (ds) DNA by several orders of magnitude. To this end, a ROS mixture rich in singlet oxygen is generated by light irradiation of the photosensitizer methylene blue and its cytotoxic effect on Escherichia coli cells is quantified in the presence and absence of DONs. DONs are found to be vastly superior to dsDNA in protecting the bacteria from ROS-induced damage and even surpass established ROS scavengers. At a concentration of 15 nM, DONs are about 50 000 times more efficient ROS scavengers than dsDNA at an equivalent concentration. This is attributed to the dominant role of singlet oxygen, which has a long diffusion length and reacts specifically with guanine. The dense packing of the available guanines into the small volume of the DON increases the overall quenching probability compared to a linear dsDNA with the same number of base pairs. DONs thus have great potential to alleviate oxidative stress caused by singlet oxygen in diverse therapeutic settings.

Recent Advances in 3D Printing of Smart Scaffolds for Bone Tissue Engineering and Regeneration

The repair and functional reconstruction of bone defects resulting from severe trauma, surgical resection, degenerative disease, and congenital malformation pose significant clinical challenges. Bone tissue engineering (BTE) holds immense potential in treating these severe bone defects, without incurring prevalent complications associated with conventional autologous or allogeneic bone grafts. 3D printing technology enables control over architectural structures at multiple length scales and has been extensively employed to process biomimetic scaffolds for BTE. In contrast to inert and functional bone grafts, next-generation smart scaffolds possess a remarkable ability to mimic the dynamic nature of native extracellular matrix (ECM), thereby facilitating bone repair and regeneration. Additionally, they can generate tailored and controllable therapeutic effects, such as antibacterial or antitumor properties, in response to exogenous and/or endogenous stimuli. This review provides a comprehensive assessment of the progress of 3D-printed smart scaffolds for BTE applications. It begins with an introduction to bone physiology, followed by an overview of 3D printing technologies utilized for smart scaffolds. Notable advances in various stimuli-responsive strategies, therapeutic efficacy, and applications of 3D-printed smart scaffolds are discussed. Finally, the review highlights the existing challenges in the development and clinical implementation of smart scaffolds, as well as emerging technologies in this field.

Antimicrobial Photodynamic Therapy: Self-Disinfecting Surfaces for Controlling Microbial Infections

Microbial infections caused by bacteria, viruses, and fungi pose significant global health threats in diverse environments. While conventional disinfection methods are effective, their reliance on frequent chemical applications raises concerns about resistance and environmental impact. Photodynamic self-disinfecting surfaces have emerged as a promising alternative. These surfaces incorporate photosensitizers that, when exposed to light, produce reactive oxygen species to target and eliminate microbial pathogens. This review explores the concept and mechanism of photodynamic self-disinfecting surfaces, highlighting the variety and characteristics of photosensitizers integrated into surfaces and the range of light sources used across different applications. It also highlights the effectiveness of these surfaces against a broad spectrum of pathogens, including bacteria, viruses, and fungi, while also discussing their potential for providing continuous antimicrobial protection without frequent reapplication. Additionally, the review addresses both the advantages and limitations associated with photodynamic self-disinfecting surfaces and concludes with future perspectives on advancing this technology to meet ongoing challenges in infection control.

Recent breakthroughs in graphene quantum dot-enhanced sonodynamic and photodynamic therapy

Water-soluble graphene quantum dots (GQDs) have recently exhibited considerable potential for diverse biomedical applications owing to their exceptional optical and chemical properties. However, the pronounced heterogeneity in the composition, size, and morphology of GQDs poses challenges for a comprehensive understanding of the intricate correlation between their structural attributes and functional properties. This variability also introduces complexities in scaling the production processes and addressing safety considerations. Light and sound have firmly established their role in clinical applications as pivotal energy sources for minimally invasive therapeutic interventions. Given the limited penetration depth of light, photodynamic therapy (PDT) predominantly targets superficial conditions such as dermatological disorders, head and neck malignancies, ocular ailments, and early-stage esophageal cancer. Conversely, ultrasound-based sonodynamic therapy (SDT) capitalizes on its superior ability to propagate and focus ultrasound within biological tissues, enabling a diverse range of therapeutic applications, including the management of gliomas, breast cancer, hematological tumors, and modulation of the blood-brain barrier (BBB). Considering the advancements in theranostic and precision therapies, reevaluating these conventional energy sources and their associated sensitizers is imperative. This review introduces three prevalent treatment modalities that harness light and sound stimuli: PDT, SDT, and a synergistic approach that integrates PDT and SDT. This study delineated the therapeutic dynamics and contemporary designs of sensitizers tailored to these modalities. By exploring the historical context of the field and elucidating the latest design strategies, this review underscores the pivotal role of GQDs in propelling the evolution of PDT and SDT. This aspires to stimulate researchers to develop "multimodal" therapies integrating both light and sound stimuli.

Enhancing Rose Bengal penetration in ex vivo human corneas using iontophoresis

Aim: Rose Bengal photodynamic antimicrobial therapy (RB-PDAT) has poor corneal penetration, limiting its efficacy against acanthamoeba keratitis (AK). Iontophoresis enhances corneal permeation of charged molecules, piquing interest in its effects on RB in ex vivo human corneas.Methods: Five donor whole globes each underwent iontophoresis with RB, soaking in RB, or were soaked in normal saline (controls). RB penetration and corneal thickness was assessed using confocal microscopy.Results: Iontophoresis increased RB penetration compared with soaking (177 ± 9.5 μm vs. 100 ± 5.7 μm, p < 0.001), with no significant differences in corneal thickness between groups (460 ± 87 μm vs. 407 ± 69 μm, p = 0.432).Conclusion: Iontophoresis significantly improves RB penetration and its use in PDAT could offer a novel therapy for acanthamoeba keratitis. Further studies are needed to validate clinical efficacy.

Exploring the efficacy of photodynamic antimicrobial chemotherapy on diabetic foot ulcers in rats

We investigate the efficacy of photodynamic antimicrobial chemotherapy (PACT) and its combination with an antibiotic in the treatment of diabetic foot ulcers (DFUs) in rats using a novel cationic amino acid porphyrin-based photosensitizer. The research findings demonstrate that the combination of novel cationic photosensitizer-mediated PACT and an antibiotic exhibits significant therapeutic efficacy in treating deep ulcers in a rat model of DFUs. Moreover, the PACT + Antibiotic group displays enhanced angiogenesis, improved tissue maturation, and superior wound healing effect. Micro-computed tomography examination showed that the periosteal reaction was most obvious in the PACT + Antibiotic group. The cortical bone volume ratio (BV/TV), the bone mineral density, and trabecular thickness were significantly higher in the PACT + Antibiotic group than in the model group (p < 0.05). The combination of PACT and antibiotic plays a sensitizing therapeutic role, which provides a new idea for the clinical treatment of DFUs.

Reactive Oxygen Species (ROS)-Mediated Antibacterial Oxidative Therapies: Available Methods to Generate ROS and a Novel Option Proposal

The increasing emergence of multidrug-resistant (MDR) pathogens causes difficult-to-treat infections with long-term hospitalizations and a high incidence of death, thus representing a global public health problem. To manage MDR bacteria bugs, new antimicrobial strategies are necessary, and their introduction in practice is a daily challenge for scientists in the field. An extensively studied approach to treating MDR infections consists of inducing high levels of reactive oxygen species (ROS) by several methods. Although further clinical investigations are mandatory on the possible toxic effects of ROS on mammalian cells, clinical evaluations are extremely promising, and their topical use to treat infected wounds and ulcers, also in presence of biofilm, is already clinically approved. Biochar (BC) is a carbonaceous material obtained by pyrolysis of different vegetable and animal biomass feedstocks at 200-1000 °C in the limited presence of O2. Recently, it has been demonstrated that BC's capability of removing organic and inorganic xenobiotics is mainly due to the presence of persistent free radicals (PFRs), which can activate oxygen, H2O2, or persulfate in the presence or absence of transition metals by electron transfer, thus generating ROS, which in turn degrade pollutants by advanced oxidation processes (AOPs). In this context, the antibacterial effects of BC-containing PFRs have been demonstrated by some authors against Escherichia coli and Staphylococcus aureus, thus giving birth to our idea of the possible use of BC-derived PFRs as a novel method capable of inducing ROS generation for antimicrobial oxidative therapy. Here, the general aspects concerning ROS physiological and pathological production and regulation and the mechanism by which they could exert antimicrobial effects have been reviewed. The methods currently adopted to induce ROS production for antimicrobial oxidative therapy have been discussed. Finally, for the first time, BC-related PFRs have been proposed as a new source of ROS for antimicrobial therapy via AOPs.

Photodynamic therapy alone or in combination to counteract bacterial infections

INTRODUCTION

Antibacterial photodynamic therapy presents a promising alternative to antibiotics, with potential against multidrug-resistant bacteria, offering broad-spectrum action, reduced resistance risk, and improved tissue selectivity.

AREAS COVERED

This manuscript reviews patent literature in the field of antibacterial photodynamic therapy through the period of 2019-2023. All data are from the US and European patent databases and SciFinder.

EXPERT OPINION

Antibacterial photodynamic therapy (PDT) is an appealing approach for treating bacterial infections, especially biofilm-related ones, by releasing reactive oxygen species (ROS) upon light activation. Its success is driven by a growing variety of photosensitizers (PSs) with tailored properties, like water solubility, controllable surface charge, and ROS generation efficiency. Among them, Aggregation Induced Emission (AIE)-type PSs are promising, demonstrating enhanced efficacy when aggregated in biological environments. However, the penetration of pristine PSs into bacterial biofilms within deep tissues or complex anatomical regions is limited, reducing their antibacterial effectiveness. To address this, nanotechnology has been integrated into antibacterial PDT to synthesize various nano-PSs. This adaptability allows seamless integration with other antimicrobial treatments, offering a comprehensive approach to combat localized infections, especially in dentistry and dermatology. By combining PSs with complementary therapies, antibacterial PDT offers a multifaceted strategy for effective microbial control and management.

TMPyP-mediated photoinactivation of Pseudomonas aeruginosa improved in the presence of a cationic polymer

Pseudomonas aeruginosa is one of the most refractory organisms to antibiotic treatment and appears to be one of the least susceptible to photodynamic treatment. TMPyP is effective in the photoinactivation of P. aeruginosa, and the co-administration with the cationic polymer Eudragit®-E100 (Eu) potentiates this effect against isolates both sensitive and resistant to antibiotics. The fluorescent population (>98%) observed by flow cytometry after exposure to Eu + TMPyP remained unchanged after successive washings, indicating a stronger interaction/internalization of TMPyP in the bacteria, which could be attributed to the rapid neutralization of surface charges. TMPyP and Eu produced depolarization of the cytoplasmic membrane, which increased when both cationic compounds were combined. Using confocal laser scanning microscopy, heterogeneously distributed fluorescent areas were observed after TMPyP exposure, while homogeneous fluorescence and enhanced intensity were observed with Eu + TMPyP. The polymer caused alterations in the bacterial envelopes that contributed to a deeper and more homogeneous interaction/internalization of TMPyP, leading to a higher probability of damage by cytotoxic ROS and explaining the enhanced result of photodynamic inactivation. Therefore, Eu acts as an adjuvant without being by itself capable of eradicating this pathogen. Moreover, compared with other therapies, this combinatorial strategy with a polymer approved for pharmaceutical applications presents advantages in terms of toxicity risks.

Application of photosensitive dental materials as a novel antimicrobial option in dentistry: A literature review

The formation of dental plaque is well-known for its role in causing various oral infections, such as tooth decay, inflammation of the dental pulp, gum disease, and infections of the oral mucosa like peri-implantitis and denture stomatitis. These infections primarily affect the local area of the mouth, but if not treated, they can potentially lead to life-threatening conditions. Traditional methods of mechanical and chemical antimicrobial treatment have limitations in fully eliminating microorganisms and preventing the formation of biofilms. Additionally, these methods can contribute to the development of drug-resistant microorganisms and disrupt the natural balance of oral bacteria. Antimicrobial photodynamic therapy (aPDT) is a technique that utilizes low-power lasers with specific wavelengths in combination with a photosensitizing agent called photosensitizer to kill microorganisms. By inducing damage through reactive oxygen species (ROS), aPDT offers a new approach to addressing dental plaque and associated microbial biofilms, aiming to improve oral health outcomes. Recently, photosensitizers have been incorporated into dental materials to create photosensitive dental materials. This article aimed to review the use of photosensitive dental materials for aPDT as an innovative antimicrobial option in dentistry, with the goal of enhancing oral health.

Research progress in photodynamic therapy for Helicobacter pylori infection

Helicobacter pylori (H. pylori) is a pathogenic microorganism that colonizes the human gastric mucosa and can lead to various gastric disorders, including gastritis, gastric ulcers, and gastric cancer. However, the increasing prevalence of antibiotic resistance in H. pylori has prompted the search for alternative treatment options. Photodynamic therapy has emerged as a potential alternative therapy, thus offering the advantage of avoiding some of the side effects associated with antibiotics and effectively targeting drug-resistant strains. In the postantibiotic era, photodynamic therapy (PDT) has shown promise as a novel treatment for H. pylori infection. This review focused on elucidating the mechanism of photodynamic therapy in the treatment of H. pylori. Additionally, we present an overview of the current research on photodynamic therapy by examining both standalone photodynamic therapy and combination therapies for H. pylori infection treatment. Furthermore, the safety profile of photodynamic therapy was also evaluated. Finally, we discuss the challenges and prospects associated with this innovative technology, with an aim to provide new insights and methodologies for the treatment of H. pylori infection.

Photodynamic Antibacterial Therapy of Gallic Acid-Derived Carbon-Based Nanoparticles (GACNPs): Synthesis, Characterization, and Hydrogel Formulation

Carbon-based nanoparticles (CNPs) have gained recognition because of their good biocompatibility, easy preparation, and excellent phototherapy properties. In biomedicine applications, CNPs are widely applied as photodynamic agents for antibacterial purposes. Photodynamic therapy has been considered a candidate for antibacterial agents because of its noninvasiveness and minimal side effects, especially in the improvement in antibacterial activity against multidrug-resistant bacteria, compared with conventional antibiotic medicines. Here, we developed CNPs from an active polyhydroxy phenolic compound, namely, gallic acid, which has abundant hydroxyl groups that can yield photodynamic effects. Gallic acid CNPs (GACNPs) were rapidly fabricated via a microwave-assisted technique at 200 °C for 20 min. GACNPs revealed notable antibacterial properties against Gram-positive and Gram-negative bacteria, including Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). The minimum inhibitory concentrations of GACNPs in S. aureus and E. coli were equal at approximately 0.29 mg/mL and considerably lower than those in gallic acid solution. Furthermore, the GACNP-loaded hydrogel patches demonstrated an attractive photodynamic effect against S. aureus, and it was superior to that of Ag hydrofiber®, a commercial material. Therefore, the photodynamic properties of GACNPs can be potentially used in the development of antibacterial hydrogels for wound healing applications.

Synergistic effects of nano curcumin mediated photodynamic inactivation and nano-silver@colistin against Pseudomonas aeruginosa biofilms

BACKGROUND

Patients with burn injuries colonized by multidrug-resistant Pseudomonas aeruginosa face increased mortality risk. The efficacy of colistin, a last-resort treatment, is declining as resistance levels rise. P. aeruginosa's robust biofilm exacerbates antibiotic resistance. Photodynamic Inactivation (PDI) shows promise in fighting biofilm.

MATERIALS AND METHODS

Nano curcumin (nCur) particles were synthesized, and their chemical characteristics were determined using zeta potential (ZP), dynamic light scattering analysis (DLS), energy-dispersive X-ray (EDX) analysis, and fourier transform infrared (FTIR). We conducted an MTT assay to assess the cytotoxicity of nCur-mediated PDI in combination with nanosilver colistin. The fractional biofilm inhibitory concentration (FBIC) of two P. aeruginosa clinical isolates and P. aeruginosa ATCC 27853 during nCur-mediated PDI@AgNPs@CL was determined using a 3-dimensional (3-D) checkerboard assay. To study the effect of nCur-mediated PDI@AgNPs@CL on lasI, lasR, rhlI, rhlR, pelA, and pslA gene expression, Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was conducted at each isolate's FBIC. The impact of treatments was also investigated using scanning electron microscopy (SEM).

RESULTS

The ZP and mean DLS values of the nCur were 10.3 mV and 402.6 ± 24.6 nm, respectively. The distinct functional groups of nCur corresponded with the peaks of FTIR absorption. Moreover, the EDX analysis showed the ratios of different metals in nCur. Cell viability percentages of nCur-mediated PDI@AgNPs@CL at FBIC concentrations of clinical isolates Nos. 30, 354, and P. aeruginosa ATCC 27853 were 91.36 %, 83.20 %, and 92.48 %, respectively. nCur-mediated PDI@AgNPs@CL treatment showed synergistic effects in clinical isolates and P. aeruginosa ATCC 27853 in a 3-D checkerboard assay. All six of the investigated genes showed down-regulation after nCur-mediated PDI@AgNPs@CL treatment. The most suppressed gene during nCur-mediated PDI@AgNPs@CL treatment was the rhlR gene (-11.9-fold) of P. aeruginosa ATCC 27853. The SEM micrographs further proved the connecting cement reduction and biofilm mass mitigation following nCur-mediated PDI@AgNPs@CL treatments.

CONCLUSIONS

The combined effect of nCur-mediated PDI and AgNPs@CL synergistically reduce the formation of biofilm in P. aeruginosa. This may be attributable to the suppression of the genes responsible for regulating the production of biofilms.

Ruthenium(II) polypyridyl complexes as emerging photosensitisers for antibacterial photodynamic therapy

Photodynamic therapy (PDT) has recently emerged as a potential valuable alternative to treat microbial infections. In PDT, singlet oxygen is generated in the presence of photosensitisers and oxygen under light irradiation of a specific wavelength, causing cytotoxic damage to bacteria. This review highlights different generations of photosensitisers and the common characteristics of ideal photosensitisers. It also focuses on the emergence of ruthenium and more specifically on Ru(II) polypyridyl complexes as metal-based photosensitisers used in antimicrobial photodynamic therapy (aPDT). Their photochemical and photophysical properties as well as structures are discussed while relating them to their phototoxicity. The use of Ru(II) complexes with recent advancements such as nanoformulations, combinatory therapy and photothermal therapy to improve on previous shortcomings of the complexes are outlined. Future perspectives of these complexes used in two-photon PDT, photoacoustic imaging and sonotherapy are also discussed. This review covers the literature published from 2017 to 2023.

Combining ZnPc-liposomes and chitosan on a hybrid matrix for enhanced photodynamic therapy

Photodynamic therapy is an alternative treatment for several pathologies, including cancer. This therapy uses a photosensitizer capable of producing reactive oxygen species through irradiation, promoting cellular death. A limitation of photosensitizers is their low solubility in aqueous media. Hence, developing a suitable carrier for photosensitizers for specific applications is a challenge. Cervical cancer is one of the most common cancers in women, and photodynamic therapy could be an attractive alternative therapeutic approach. In this work, we synthesized films composed of chitosan, polyvinylpyrrolidone, and liposomes containing Zn-phthalocyanine. Photophysical characterization of ZnPc incorporated into films was determined by UV-vis and fluorescence. Film properties such as swelling, mechanical properties, and water vapor permeability were performed. Finally, in vitro, photodynamic evaluation of these films was performed on HeLa cells. The results indicate that incorporating Zn-Pc-liposomes into films decreases cell viability by >95 %.

A biomass-derived dual crosslinked DNA-nanoparticle hydrogel for visible light-induced photodynamic bacterial inactivation

Sustainability in developing novel nanomaterials (NPs) from biomass sources is a challenging proposition mainly due to the difficulty of infusing or retaining desired chemical functionalities in the biomass substrate. In this study, we demonstrate the synthesis of DNA-nanoparticles (DNA-NP) from onion genomic DNA as a plant biomass source through controlled hydrothermal pyrolysis to retain functional groups in the NPs for predictable downstream chemical transformations. A dual crosslinking scheme was introduced that involves the DNA-NP to form a hydrogel. Chemical crosslinking was achieved through the formation of a Schiff base between the -CHO groups of glutaraldehyde and the amine functionality present on the DNA-NP surface as well as in the nucleobases of the dangling DNA strands of DNA-NP. Simultaneous physical entanglement was attained through hybridization-mediated self-assembly of the dangling DNA strands of the DNA-NP with untransformed onion genomic DNA. As a corollary of the dual crosslinking, the resulting hydrogel not only displayed remarkable mechanical strength but also showed self-healing properties. The ability of the DNA-NP to generate reactive oxygen species (ROS) with visible light irradiation is translated to the hydrogel, making the system potent for biofilm destruction. The high loading efficiency of the model drug ampicillin sodium (Amp) in the hydrogel was achieved which was released in four days. This hints towards the application of the hydrogel through combination antibiotic-antibacterial photodynamic treatment (APDT) as demonstrated here with both Gram-positive and Gram-negative bacteria.

Impact of mucus and biofilm on antimicrobial photodynamic therapy: Evaluation using Ruthenium(II) complexes

The biofilm lifestyle of bacterial pathogens is a hallmark of chronic lung infections such as in cystic fibrosis (CF) patients. Bacterial adaptation to the complex conditions in CF-affected lungs and repeated antibiotherapies lead to increasingly tolerant and hard-to-treat biofilms. In the context of growing antimicrobial resistance and restricted therapeutic options, antimicrobial photodynamic therapy (aPDT) shows great promise as an alternative to conventional antimicrobial modalities. Typically, aPDT consists in irradiating a non-toxic photosensitizer (PS) to generate reactive oxygen species (ROS), which kill pathogens in the surrounding environment. In a previous study, we reported that some ruthenium (II) complexes ([Ru(II)]) can mediate potent photodynamic inactivation (PDI) against planktonic cultures of Pseudomonas aeruginosa and Staphylococcus aureus clinical isolates. In the present work, [Ru(II)] were further assayed to evaluate their ability to photo-inactivate such bacteria under more complex experimental conditions better recapitulating the microenvironment in lung infected airways. Bacterial PDI was tentatively correlated with the properties of [Ru(II)] in biofilms, in mucus, and following diffusion across the latter. Altogether, the results obtained demonstrate the negative impacting role of mucus and biofilm components on [Ru(II)]-mediated PDT, following different possible mechanisms of action. Technical limitations were also identified that may be overcome, making this report a pilot for other similar studies. In conclusion, [Ru(II)] may be subjected to specific chemical engineering and/or drug formulation to adapt their properties to the harsh micro-environmental conditions of the infected respiratory tract.

Photodynamic Eradication of Pseudomonas aeruginosa with Ru-Photosensitizers Encapsulated in Enzyme Degradable Nanocarriers

The development of new approaches for the treatment of the increasingly antibiotic-resistant pathogen Pseudomonas aeruginosa was targeted by enhancing the effect of local antimicrobial photodynamic therapy (aPDT) using poly(ethylene glycol)-block-poly(lactic acid) (PEG114-block-PLAx) nanocarriers that were loaded with a ruthenium-based photosensitizer (PS). The action of tris(1,10-phenanthroline) ruthenium (II) bis(hexafluorophosphate) (RuPhen3) encapsulated in PEG114-block-PLAx micelles and vesicles was shown to result in an appreciable aPDT inactivation efficiency against planktonic Pseudomonas aeruginosa. In particular, the encapsulation of the PS, its release, and the efficiency of singlet oxygen (1O2) generation upon irradiation with blue light were studied spectroscopically. The antimicrobial effect was analyzed with two strains of Pseudomonas aeruginosa. Compared with PS-loaded micelles, formulations of the PS-loaded vesicles showed 10 times enhanced activity with a strong photodynamic inactivation effect of at least a 4.7 log reduction against both a Pseudomonas aeruginosa lab strain and a clinical isolate collected from the lung of a cystic fibrosis (CF) patient. This work lays the foundation for the targeted eradication of Pseudomonas aeruginosa using aPDT in various medical application areas.

Photodynamic Suppression of Enterococcus Faecalis in Infected Root Canals with Indocyanine Green, TroloxTM and Near-Infrared Light

Recently, our group showed that additional supplementation of Trolox™ (vitamin E analogue) can significantly enhance the antimicrobial photodynamic effect of the photosensitizer Indocyanine green (ICG). Up to now, the combined effect has not yet been investigated on Enterococcus faecalis in dental root canals. In the present in vitro study, eighty human root canals were inoculated with E. faecalis and subsequently subjected to antimicrobial Photodynamic Therapy (aPDT) using ICG (250, 500, 1000 µg/mL) and near-infrared laser light (NIR, 808 nm, 100 Jcm-2). Trolox™ at concentrations of 6 mM was additionally applied. As a positive control, irrigation with 3% NaOCl was used. After aPDT, root canals were manually enlarged and the collected dentin debris was subjected to microbial culture analysis. Bacterial invasion into the dentinal tubules was verified for a distance of 300 µm. aPDT caused significant suppression of E. faecalis up to a maximum of 2.9 log counts (ICG 250 µg/mL). Additional application of TroloxTM resulted in increased antibacterial activity for aPDT with ICG 500 µg/mL. The efficiency of aPDT was comparable to NaOCl-irrigation inside the dentinal tubules. In conclusion, ICG significantly suppressed E. faecalis. Additional application of TroloxTM showed only minor enhancement. Future studies should also address the effects of TroloxTM on other photodynamic systems.

Ruthenium-Based Photoactivated Chemotherapy

Ruthenium(II) polypyridyl complexes form a vast family of molecules characterized by their finely tuned photochemical and photophysical properties. Their ability to undergo excited-state deactivation via photosubstitution reactions makes them quite unique in inorganic photochemistry. As a consequence, they have been used, in general, for building dynamic molecular systems responsive to light but, more particularly, in the field of oncology, as prodrugs for a new cancer treatment modality called photoactivated chemotherapy (PACT). Indeed, the ability of a coordination bond to be selectively broken under visible light irradiation offers fascinating perspectives in oncology: it is possible to make poorly toxic agents in the dark that become activated toward cancer cell killing by simple visible light irradiation of the compound inside a tumor. In this Perspective, we review the most important concepts behind the PACT idea, the relationship between ruthenium compounds used for PACT and those used for a related phototherapeutic approach called photodynamic therapy (PDT), and we discuss important questions about real-life applications of PACT in the clinic. We conclude this Perspective with important challenges in the field and an outlook.

Elimination of Human Papillomavirus and Cervical Pathological Microbiota with Photodynamic Therapy in Women from Mexico City with Cervical Intraepithelial Neoplasia I

Cervical carcinoma (CC) is the second cause of cancer death in Mexican women. It starts with premalignant lesions known as Intraepithelial Cervical Neoplasia (CIN) that can develop due to infection by Human Papillomavirus (HPV) and other microorganisms. Current CIN therapy involves invasive methods that affect cervix integrity and fertility; we propose the use of photodynamic therapy (PDT) as a strategy with few side effects. In this work, the effectiveness of PDT for CIN I, HPV and pathogenic vaginal microbiota elimination in 29 women of Mexico City with CIN I, CIN I + HPV and HPV diagnosis was determined. After 6 months of PDT application, HPV infection was eliminated in 100% of the patients (P < 0.01), CIN I + HPV in 64.3% (P < 0.01) and CIN I in 57.2% (P > 0.05). PDT also eliminated pathogenic microorganisms: Chlamydia trachomatis in 81% of the women (P < 0.001) and Candida albicans in 80% (P < 0.05), without affecting normal microbiota since Lactobacillus iners was eliminated only in 5.8% of patients and the opportunistic Gardnerella vaginalis in 20%. These results show that PDT was highly effective in eradicating HPV and pathogenic microorganisms, suggesting that PDT is a promising therapy for cervical infections.

Photosensitizers combination approach to enhance photodynamic inactivation of planktonic and biofilm bacteria

To improve bacterial photodynamic inactivation (PDI), this work analyzes the photodynamic effect caused by the combination of photosensitizers (PSs) on two bacterial models and different growth mode. Simultaneous administration of PSs from different families, zinc(II) 2,9,16,23-tetrakis[4-(N-methylpyridyloxy)]phthalocyanine (ZnPPc4+), 5,10,15,20-tetra(4-N,N,N-trimethylammonium phenyl)porphyrin (TMAP4+), meso-tetrakis(9-ethyl-9-methyl-3-carbazoyl)chlorin (TEMCC4+) and 5,10,15,20-tetrakis[4-(3-N,N-dimethylaminopropoxy)phenyl] chlorin (TAPC) was investigated against Staphylococcus aureus and Escherichia coli, in planktonic form, biofilm and growth curve. Various PSs combinations showed greater inactivation compared to when used separately under the same conditions but at twice the concentration. However, differences were found in the effectiveness of the PSs combinations on Gram positive and negative bacteria, as well as in planktonic or biofilm form. Likewise, the combination of three PSs completely stopped E. coli growth under optimal nutritional conditions. PSs combination allows extending the range of light absorption by agents that absorb in different areas of the visible spectrum. Therefore, PDI with combined PSs increases its antimicrobial capacity using agents' concentrations and light fluences lower than those necessary to cause the same effect as single PS. These advances represent a starting point for future research on the potentiation of PDI promoted by the combined use of PSs.

Fabrication, Characterization, and In Vitro Cytotoxicity Assessment of Tri-Layered Multifunctional Scaffold for Effective Chronic Wound Healing

Chronic wounds have been a global health risk that demands intensive exploration. A tri-layered biomaterial scaffold has been developed for skin wounds. The top layer of the scaffold is superhydrophobic, and the bottom layer is hydrophilic, both of which were electrospun using recycled expanded polystyrene (EPS) and monofilament fishing line (MFL), respectively. The intermediate layer of the scaffold comprised hydrogel by cross-linking chitosan (CS) with polyethylene glycol. The surface morphology, surface chemistry, thermal degradation, and wettability characteristics of each layer of the scaffold were examined. Also, the antibacterial activity and in vitro cytotoxicity study on the combined tri-layered scaffold were assessed against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus). Data revealed exceptional water repellency of the heat-treated electrospun top superhydrophobic layer (TSL) with a high-water contact angle (WCA) of 172.44°. A TSL with 15 wt% of micro-/nano-inclusions had the best thermal stability above 400 °C. The bottom hydrophilic layer (BHL) displayed a WCA of 9.91°. Therapeutically, the synergistic effect of the combined tri-layered scaffold significantly inhibited bacteria growth by 70.5% for E. coli and 68.6% for S. aureus. Furthermore, cell viability is enhanced when PEG is included as part of the intermediate CS hydrogel layer (ICHL) composition.

Anti-multispecies microbial biofilms and anti-inflammatory effects of antimicrobial photo-sonodynamic therapy based on acrylic resin containing nano-resveratrol

BACKGROUND

Polymethylmethacrylate (PMMA)-based removable orthodontic appliances are susceptible to microbial colonization due to the surface porosity, and accumulating the biofilms causes denture stomatitis. the present study evaluated the anti-biofilm and antiinflammatory effects of antimicrobial photo-sonodynamic therapy (aPSDT) against multispecies microbial biofilms (Candida albicans, Staphylococcus aureus, Streptococcus sobrinus, and Actinomyces naeslundii) formed on acrylic resin modified with nanoresveratrol (NR).

MATERIALS AND METHODS

Following the determination of the minimum biofilm inhibitory concentration (MBIC) of NR, in vitro anti-biofilm activity of NR was evaluated. The antibiofilm efficacy against multispecies microbial biofilm including C. albicans, S. aureus, S. sobrinus, and A. naeslundii, were assessed by biofilm inhibition test and the results were measured. To reveal the anti-inflammatory effects of aPSDT on human gingival fibroblast (HGF) cells, the gene expression levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were evaluated via quantitative real-time polymerase chain reaction (qRT-PCR).

RESULTS

According to the results, the MBIC dose of NR against multispecies microbial biofilm was considered 512 µg/mL. The highest biofilm reduction activity was observed in MBIC treated with aPSDT and 2 × MBIC exposed to light emitting diode (LED) and ultrasound waves (UW). The expression level of TNF-α and IL-6 genes were significantly increased when HGF cells were exposed to multispecies microbial biofilms (P<0.05), while after treatment with aPSDT, the expression levels of genes were significantly downregulated in all groups (P<0.05).

CONCLUSION

Overall, NR-mediated aPSDT reduced the growth of the multispecies microbial biofilm and downregulated the expression of TNF-α and IL-6 genes. Therefore, modified PMMA with NR can be serving as a promising new orthodontic acrylic resin against multispecies microbial biofilms and the effect of this new material is amplified when exposed to LED and UW.

Precise Molecular Engineering of Type I Photosensitizer with Aggregation-Induced Emission for Image-Guided Photodynamic Eradication of Biofilm

Biofilm-associated infections exert more severe and harmful attacks on human health since they can accelerate the generation and development of the antibiotic resistance of the embedded bacteria. Anti-biofilm materials and techniques that can eliminate biofilms effectively are in urgent demand. Therefore, we designed a type I photosensitizer (TTTDM) with an aggregation-induced emission (AIE) property and used F-127 to encapsulate the TTTDM into nanoparticles (F-127 AIE NPs). The NPs exhibit highly efficient ROS generation by enhancing intramolecular D-A interaction and confining molecular non-radiative transitions. Furthermore, the NPs can sufficiently penetrate the biofilm matrix and then detect and eliminate mature bacterial biofilms upon white light irradiation. This strategy holds great promise for the rapid detection and eradication of bacterial biofilms.

Infections associated with SARS-CoV-2 exploited via nanoformulated photodynamic therapy

Background and purpose

The pandemic of COVID-19 has highlighted the need for managing infectious diseases, which spreads by airborne transmission leading to serious health, social, and economic issues. SARS-CoV-2 is an enveloped virus with a 60-140 nm diameter and particle-like features, which majorly accounts for this disease. Expanding diagnostic capabilities, developing safe vaccinations with long-lasting immunity, and formulating effective medications are the strategies to be investigated.

Experimental approach

For the literature search, electronic databases such as Scopus, Google Scholar, MEDLINE, Embase, PubMed, and Web of Science were used as the source. Search terms like 'Nano-mediated PDT,' 'PDT for SARS-CoV-2', and 'Nanotechnology in treatment for SARS-CoV-2' were used. Out of 275 initially selected articles, 198 were chosen after the abstract screening. During the full-text screening, 80 papers were excluded, and 18 were eliminated during data extraction. Preference was given to articles published from 2018 onwards, but a few older references were cited for their valuable information.

Key results

Synthetic nanoparticles (NPs) have a close structural resemblance to viruses and interact greatly with their proteins due to their similarities in the configurations. NPs had previously been reported to be effective against a variety of viruses. In this way, with nanoparticles, photodynamic therapy (PDT) can be a viable alternative to antibiotics in fighting against microbial infections. The protocol of PDT includes the activation of photosensitizers using specific light to destroy microorganisms in the presence of oxygen, treating several respiratory diseases.

Conclusion

The use of PDT in treating COVID-19 requires intensive investigations, which has been reviewed in this manuscript, including a computational approach to formulating effective photosensitizers.

Combinations of Photodynamic Therapy with Other Minimally Invasive Therapeutic Technologies against Cancer and Microbial Infections

The rapid rise in research and development following the discovery of photodynamic therapy to establish novel photosensitizers and overcome the limitations of the technology soon after its clinical translation has given rise to a few significant milestones. These include several novel generations of photosensitizers, the widening of the scope of applications, leveraging of the offerings of nanotechnology for greater efficacy, selectivity for the disease over host tissue and cells, the advent of combination therapies with other similarly minimally invasive therapeutic technologies, the use of stimulus-responsive delivery and disease targeting, and greater penetration depth of the activation energy. Brought together, all these milestones have contributed to the significant enhancement of what is still arguably a novel technology. Yet the major applications of photodynamic therapy still remain firmly located in neoplasms, from where most of the new innovations appear to launch to other areas, such as microbial, fungal, viral, acne, wet age-related macular degeneration, atherosclerosis, psoriasis, environmental sanitization, pest control, and dermatology. Three main value propositions of combinations of photodynamic therapy include the synergistic and additive enhancement of efficacy, the relatively low emergence of resistance and its rapid development as a targeted and high-precision therapy. Combinations with established methods such as chemotherapy and radiotherapy and demonstrated applications in mop-up surgery promise to enhance these top three clinical tools. From published in vitro and preclinical studies, clinical trials and applications, and postclinical case studies, seven combinations with photodynamic therapy have become prominent research interests because they are potentially easily applied, showing enhanced efficacy, and are rapidly translating to the clinic. These include combinations with chemotherapy, photothermal therapy, magnetic hyperthermia, cold plasma therapy, sonodynamic therapy, immunotherapy, and radiotherapy. Photochemical internalization is a critical mechanism for some combinations.

Ruthenium(II) Polypyridyl Complexes and Metronidazole Derivatives: A Powerful Combination in the Design of Photoresponsive Antibacterial Agents Effective under Hypoxic Conditions

Ruthenium(II) polypyridyl complexes (RPCs) are gaining momentum in photoactivated chemotherapy (PACT), thanks to the possibility of overcoming the classical reliance on molecular oxygen of photodynamic therapy while preserving the selective drug activation by using light. However, notwithstanding the intriguing perspectives, the translation of such an approach in the development of new antimicrobials has been only barely considered. Herein, MTZH-1 and MTZH-2, two novel analogues of metronidazole (MTZ), a mainstay drug in the treatment of anaerobic bacterial infections, were designed and inserted in the strained ruthenium complexes [Ru(tpy)(dmp)(MTZ-1)]PF₆ (Ru2) and [Ru(tpy)(dmp)(MTZ-2)]PF₆ (Ru3) (tpy = terpyridine, dmp = 2,9-dimethyl-1,10-phenanthroline) (Chart 1). Analogously to the parental compound [Ru(tpy)(dmp)(5NIM)]PF₆ (Ru1) (5-nitroimidazolate), the Ru(II)-imidazolate coordination of MTZ derivatives resulted in promising Ru(II) photocages, capable to easily unleash the bioactive ligands upon light irradiation and increase the antibacterial activity against Bacillus subtilis, which was chosen as a model of Gram-positive bacteria. The photoreleased 5-nitroimidazole-based ligands led to remarkable phototoxicities under hypoxic conditions (<1% O₂), with the lead compound Ru3 that exhibited the highest potency across the series, being comparable to the one of the clinical drug MTZ. Besides, the chemical architectures of MTZ derivatives made their interaction with NimAunfavorable, being NimA a model of reductases responsible for bacterial resistance against 5-nitroimidazole-based antibiotics, thus hinting at their possible use to combat antimicrobial resistance. This work may therefore provide fundamental knowledge in the design of novel photoresponsive tools to be used in the fight against infectious diseases. For the first time, the effectiveness of the "photorelease antimicrobial therapy" under therapeutically relevant hypoxic conditions was demonstrated.

Photomodulation Approaches to Overcome Antimicrobial Resistance

Photopharmacology is an approach that aims to be an alternative to classical chemotherapy. Herein, the different classes of photoswitches and photocleavage compounds and their biological applications are described. Proteolysis targeting chimeras (PROTACs) containing azobenzene moieties (PHOTACs) and photocleavable protecting groups (photocaged PROTACs) are also mentioned. Furthermore, porphyrins are referenced as successful photoactive compounds in a clinical context, such as in the photodynamic therapy of tumours as well as preventing antimicrobial resistance, namely in bacteria. Porphyrins combining photoswitches and photocleavage systems are highlighted, taking advantage of both photopharmacology and photodynamic action. Finally, porphyrins with antibacterial activity are described, taking advantage of the synergistic effect of photodynamic treatment and antibiotic therapy to overcome bacterial resistance.