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Ivanova I, Bogner C, Gronwald W, Kreutz M, Kurz B, Maisch T, Kamenisch Y, Berneburg M. UVA-induced metabolic changes in non-malignant skin cells and the potential role of pyruvate as antioxidant. Photochem Photobiol Sci 2023; 22:1889-1899. [PMID: 37193818 DOI: 10.1007/s43630-023-00419-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/04/2023] [Indexed: 05/18/2023]
Abstract
The exposure to UVA (320-400 nm) irradiation is a major threat to human skin concerning photoaging and carcinogenesis. It has been shown that UVA irradiation can induce reactive oxygen species (ROS) and DNA mutations, such as 8-hydroxydeoxyguanosine. Furthermore, UVA induces the expression of photoaging-associated matrix metalloproteases (MMPs), especially of matrix metalloprotease 1 (MMP 1) and matrix metalloprotease 3 (MMP 3). In addition to this, it was recently shown that UVA-induced ROS also increase glucose metabolism of melanoma cells, however, the influence of UVA on the glucose metabolism of non-malignant cells of the human skin has, so far, not been investigated in detail. Here, we investigated the UVA-induced changes in glucose metabolism and the functional relevance of these changes in primary fibroblasts-normal non-malignant cells of the skin. These cells showed an UVA-induced enhanced glucose consumption and lactate production and changes in pyruvate production. As it has been proposed that pyruvate could have antioxidant properties we tested the functional relevance of pyruvate as protective agent against UVA-induced ROS. Our initial experiments support earlier publications, demonstrating that pyruvate treated with H2O2 is non-enzymatically transformed to acetate. Furthermore, we show that this decarboxylation of pyruvate to acetate also occurs upon UVA irradiation. In addition to this, we could show that in fibroblasts pyruvate has antioxidant properties as enhanced levels of pyruvate protect cells from UVA-induced ROS and partially from a DNA mutation by the modified base 8-hydroxydeoxyguanosine. Furthermore, we describe for the first time, that the interaction of UVA with pyruvate is relevant for the regulation of photoaging-associated MMP 1 and MMP 3 expression.
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Affiliation(s)
- I Ivanova
- Department of Dermatology, University Hospital Regensburg, 93042, Regensburg, Germany.
| | - C Bogner
- Institute of Functional Genomics, University of Regensburg, Am BioPark 9, 93053, Regensburg, Germany
| | - W Gronwald
- Institute of Functional Genomics, University of Regensburg, Am BioPark 9, 93053, Regensburg, Germany
| | - M Kreutz
- Department of Internal Medicine III, Molecular Oncology, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, 93042, Regensburg, Germany
| | - B Kurz
- Department of Dermatology, University Hospital Regensburg, 93042, Regensburg, Germany
| | - T Maisch
- Department of Dermatology, University Hospital Regensburg, 93042, Regensburg, Germany
| | - Y Kamenisch
- Department of Dermatology, University Hospital Regensburg, 93042, Regensburg, Germany.
| | - M Berneburg
- Department of Dermatology, University Hospital Regensburg, 93042, Regensburg, Germany.
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Hebestreit H, Ullrich M, Graeßner H, Rashid A, Ertl M, Maisch T. Digitale Systeme für Konsile und Fallkonferenzen bei Seltenen Erkrankungen. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01225-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Goeth H, Koller M, Hegemann MV, Drexler K, Zeman F, Huppertz G, Berneburg M, Maisch T. Active vs. standard sun protection in patients with melanoma stage I or II: a randomized controlled feasibility trial assessing compliance with sun protection and quality of life. Br J Dermatol 2020; 183:1132-1134. [PMID: 32652591 DOI: 10.1111/bjd.19395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- H Goeth
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - M Koller
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - M-V Hegemann
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - K Drexler
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - F Zeman
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - G Huppertz
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - M Berneburg
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - T Maisch
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
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Maisch T, Bosserhoff AK, Unger P, Heider J, Shimizu T, Zimmermann JL, Morfill GE, Landthaler M, Karrer S. Investigation of toxicity and mutagenicity of cold atmospheric argon plasma. Environ Mol Mutagen 2017; 58:172-177. [PMID: 28370324 DOI: 10.1002/em.22086] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 02/16/2017] [Accepted: 02/16/2017] [Indexed: 06/07/2023]
Abstract
Cold atmospheric argon plasma is recognized as a new contact free approach for the decrease of bacterial load on chronic wounds in patients. So far very limited data are available on its toxicity and mutagenicity on eukaryotic cells. Thus, the toxic/mutagenic potential of cold atmospheric argon plasma using the MicroPlaSter β® , which has been used efficiently in humans treating chronic and acute wounds, was investigated using the XTT assay in keratinocytes and fibroblasts and the HGPRT (hypoxanthine guanine phosphoribosyl transferase) assay with V79 Chinese hamster cells. The tested clinical parameter of a 2 min cold atmospheric argon plasma treatment revealed no relevant toxicity on keratinocytes (viability: 76% ± 0.17%) and on fibroblasts (viability: 81.8 ± 0.10) after 72 hr as compared to the untreated controls. No mutagenicity was detected in the HGPRT assay with V79 cells even after repetitive CAP treatments of 2-10 min every 24 hr for up to 5 days. In contrast, UV-C irradiation of V79 cells, used as a positive control in the HGPRT test, led to DNA damage and mutagenic effects. Our findings indicate that cold atmospheric plasma using the MicroPlaSter β® shows negligible effects on keratinocytes and fibroblasts but no mutagenic potential in the HGPRT assay, indicating a new contact free safe technology. Environ. Mol. Mutagen. 58:172-177, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- T Maisch
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - A K Bosserhoff
- Institute of Biochemistry, Emil-Fischer Zentrum, Friedrich-Alexander-University of Erlangen-Nuernberg, Germany
- Comprehensive Cancer Center Erlangen, CCC-ENM, Friedrich-Alexander University of Erlangen-Nürnberg, Germany
| | - P Unger
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - J Heider
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - T Shimizu
- Formerly Max-Planck Institute for Extraterrestrial Physics, Garching, Germany
- Terraplasma GmbH, Garching, Germany
| | - J L Zimmermann
- Formerly Max-Planck Institute for Extraterrestrial Physics, Garching, Germany
- Terraplasma GmbH, Garching, Germany
| | - G E Morfill
- Formerly Max-Planck Institute for Extraterrestrial Physics, Garching, Germany
- Terraplasma GmbH, Garching, Germany
| | - M Landthaler
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - S Karrer
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
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Tabenski L, Maisch T, Santarelli F, Hiller KA, Schmalz G. Individual growth detection of bacterial species in an in vitro oral polymicrobial biofilm model. Arch Microbiol 2014; 196:819-28. [DOI: 10.1007/s00203-014-1021-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 07/24/2014] [Accepted: 07/25/2014] [Indexed: 01/11/2023]
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Boxhammer V, Li Y, Köritzer J, Shimizu T, Maisch T, Thomas H, Schlegel J, Morfill G, Zimmermann J. Investigation of the mutagenic potential of cold atmospheric plasma at bactericidal dosages. Mutation Research/Genetic Toxicology and Environmental Mutagenesis 2013; 753:23-8. [DOI: 10.1016/j.mrgentox.2012.12.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 10/23/2012] [Accepted: 12/15/2012] [Indexed: 10/27/2022]
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Späth A, Felgenträger A, Maisch T, Bäumler W. Novel cationic-charged methylene blue derivatives for antimicrobial PDT. Photodiagnosis Photodyn Ther 2011. [DOI: 10.1016/j.pdpdt.2011.03.323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gonzales F, Felgentraeger A, Maisch T. Comparison of photodynamic inactivation of Candida albicans biofilm cells by two distinct porphyrin derivatives and blue light. Photodiagnosis Photodyn Ther 2011. [DOI: 10.1016/j.pdpdt.2011.03.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lehner K, Santarelli F, Penning R, Vasold R, Engel E, Maisch T, Gastl K, König B, Landthaler M, Bäumler W. The decrease of pigment concentration in red tattooed skin years after tattooing. J Eur Acad Dermatol Venereol 2011; 25:1340-5. [DOI: 10.1111/j.1468-3083.2011.03987.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pereira Gonzales F, Maisch T. Photodynamic inactivation of microorganisms as an innovative approach to kill mucocutaneous and skin microorganisms. GIORN ITAL DERMAT V 2010; 145:477-489. [PMID: 20823791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In 2002, the first documented case of a vancomycin-resistant S. aureus strain (MIC>or=32 microg/mL) was reported. Nowadays approximately 20% of S. aureus isolates in Europe are reported as methicillin-resistant. Besides bacteria infections, the emergence of fungal infections has increased considerably due factors such as immunosuppressive medications, broad-spectrum antibiotics, neutropenia and HIV infections. These tremendous effects underline the importance and the urgency to develop new alternative treatment approaches that are effective against infections caused by multi-resistant pathogens. Photodynamic inactivation of microorganisms (PDIM) is considered as a new approach, which utilizes a photoactive dye, oxygen and visible light to generate reactive oxygen species, which damage irreversible the pathogens during illumination. Cutaneous diseases caused by methicillin-resistant S. aureus or by fungal species are ideally suited to the treatment by PDIM for eradicating localized infections and for modulating wound healing due to the ability to deliver photosensitizer and light with topical application. The challenge of PDIM is to find a therapeutic window in vivo where multi-resistant microorganisms can be killed efficiently, thereby not harming the surrounding tissue or disturbing the residual bacteria-flora of the tissue. Different chemical classes of photosensitizers have demonstrate their potential to photoinactive Gram(+), Gram(-) and fungal cells. This review will focus on general photobiological and photochemical aspects of microbial inactivation by the photodynamic effect as well as to summarize the current knowledge about the possible application modalities of PDIM on localized infectious diseases in dermatology.
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Affiliation(s)
- F Pereira Gonzales
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
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Maisch T, Wagner J, Papastamou V, Nerl HJ, Hiller KA, Szeimies RM, Schmalz G. Combination of 10% EDTA, Photosan, and a blue light hand-held photopolymerizer to inactivate leading oral bacteria in dentistryin vitro. J Appl Microbiol 2009; 107:1569-78. [DOI: 10.1111/j.1365-2672.2009.04342.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Babilas P, Knobler R, Hummel S, Gottschaller C, Maisch T, Koller M, Landthaler M, Szeimies RM. Variable pulsed light is less painful than light-emitting diodes for topical photodynamic therapy of actinic keratosis: a prospective randomized controlled trial. Br J Dermatol 2007; 157:111-7. [PMID: 17542980 DOI: 10.1111/j.1365-2133.2007.07959.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) of actinic keratosis (AK) using methylaminolaevulinate (MAL) is an effective and safe treatment option, but the procedure is painful. OBJECTIVES To evaluate the efficacy and pain associated with variable pulsed light (VPL), a prospective, randomized, controlled split-face study was performed. METHODS Topical MAL-PDT was conducted in 25 patients with AK (n = 238) who were suitable for two-sided comparison. After incubation with MAL, irradiation was performed with a light-emitting diode (LED) (50 mW cm(-2); 37 J cm(-2)) vs. VPL (80 J cm(-2), double pulsed at 40 J cm(-2), pulse train of 15 impulses each with a duration of 5 ms, 610-950 nm filtered hand piece) followed by re-evaluation up to 3 months. RESULTS The pain during and after therapy was significantly lower with VPL irradiation [t (d.f. = 24) = 4.42, P < 0.001]. The overall mean +/- SD infiltration and keratosis score at 3 months after treatment was 0.86 +/- 0.71 (LED system) vs. 1.05 +/- 0.74 (VPL device) (no statistically significant difference; P = 0.292). Patient satisfaction following both treatment modalities did not significantly differ at the 3-month follow up (P = 0.425). CONCLUSIONS VPL used for MAL-PDT is an efficient alternative for the treatment of AK that results in complete remission and cosmesis equivalent to LED irradiation but causes significantly less pain.
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Affiliation(s)
- P Babilas
- Department of Dermatology, University of Regensburg, Regensburg, Germany
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Maisch T, Bosl C, Szeimies RM, Love B, Abels C. Determination of the antibacterial efficacy of a new porphyrin-based photosensitizer against MRSA ex vivo. Photochem Photobiol Sci 2007; 6:545-51. [PMID: 17487307 DOI: 10.1039/b614770d] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Following extensive in vitro screening of new photosensitizers the purpose of the present study was to examine penetration as well as antibacterial efficacy of a lead photosensitizer against MRSA using an ex vivo porcine skin model. Two different applications were performed: (i) preincubation of bacteria in solution with a porphyrin-based photosensitizer XF73 and subsequent application on the ex vivo porcine skin; (ii) application of pure bacteria on the explants followed by an incubation with XF73 in a water-ethanol formulation for up to 60 min under occlusion. The localisation of XF73 was restricted to the stratum corneum. Different concentrations (0-10 microM) of XF73 and different incubation times (5-60 min) were used to determine phototoxicity against methicillin-resistant and methicillin-sensitive S. aureus, which was applied on the explants. Preincubation of S. aureus with 0.1 microM XF73 in solution prior to the application of these XF73-incubated bacteria on the skin demonstrates a higher efficacy (>3 log10) after irradiation. Antibacterial photodynamic inactivation resulted in a approximately 1 log10 (0.1 microM)-3.64+/-0.035 (10 microM) log10 growth reduction independently of the antibiotic resistance pattern of used S. aureus strains. Irradiation of applied bacteria without photosensitizer incubation did not show any marked decrease (<1 log10) of bacteria cell number, indicating a significant phototoxicity of the XF73. Histological evaluations of untreated and treated skin areas upon irradiation within 24 h showed no significant degree of necrosis or apoptosis determined by TUNEL-assay indicating that the porcine skin is still vital. This study demonstrates that this XF73 porphyrin-based photosensitizer had concentration-dependent differences in killing efficacy of MRSA in comparison to skin cells using an ex vivo porcine skin model. The results described here imply that topical delivery of XF73 may be considered as a possible treatment in patients with superficial infections of the skin.
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Affiliation(s)
- T Maisch
- Department of Dermatology, University of Regensburg, Klinik und Poliklinik für Dermatologie, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
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Babilas P, Kohl E, Maisch T, Bäcker H, Gross B, Branzan AL, Bäumler W, Landthaler M, Karrer S, Szeimies RM. In vitro and in vivo comparison of two different light sources for topical photodynamic therapy. Br J Dermatol 2006; 154:712-8. [PMID: 16536815 DOI: 10.1111/j.1365-2133.2006.07143.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) with 5-aminolaevulinic acid (ALA) is an effective and safe treatment option for the treatment of actinic keratosis (AK). Incoherent lamps are often used, matching the absorption maxima of ALA. OBJECTIVES A comparative trial was performed to evaluate the efficacy of recently developed light-emitting diodes (LEDs). METHODS Human epidermal keratinocytes were incubated for 24 h with ALA (100, 200, 300, 400 or 500 micromol L(-1)) and irradiated consecutively using either an incoherent halogen lamp (lambda(em) = 580-750 nm; 24 J cm(-2); 40 mW cm(-2)) or an LED system (lambda(em) = 633 +/- 3 nm; 3, 6, 12 or 24 J cm(-2); 40 mW cm(-2)). Topical ALA-PDT was performed on 40 patients with AK (n = 584) in a symmetrical distribution suitable for two-sided comparison. After incubation with ALA (20% in cream base) irradiation was performed with the incoherent lamp (100 J cm(-2); 160 mW cm(-2)) on one side and the LED system (40 J cm(-2); 80 mW cm(-2)) on the opposite side followed by re-evaluation up to 6 months. RESULTS No significant differences between the LED system (3, 6, 12 or 24 J cm(-2)) and the incoherent light source (24 J cm(-2)) regarding cytotoxicity was found in vitro. The complete remission rate yielded in the in vivo investigation was also not significantly different at 6 weeks (P = 0.95), 3 months (P = 0.75) and 6 months (P = 0.61) following therapy. Six weeks following therapy complete remission rates of 84.3% (LED system) and 82.8% (incoherent lamp) were achieved. There was also no significant difference between both light sources regarding pain during light treatment (P = 0.67), patient satisfaction (P = 1.0) or cosmesis (P = 1.0) following therapy. CONCLUSIONS These results show the efficacy of an LED system for ALA-PDT both in vitro and in vivo. ALA-PDT with the LED system showed a noninferiority regarding the clinical outcome in the treatment of AK compared with the incoherent lamp.
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Affiliation(s)
- P Babilas
- Department of Dermatology, University of Regensburg, Regensburg, Germany.
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Abstract
The basis of "antibacterial photodynamic therapy" involves the killing of bacteria by reactive oxygen species in the presence of a photosensitizer and light. Possible dermatologic indications include inactivation of bacteria in skin and wound infections and reduction in density of nosocomial multi-resistant infections. The chief advantage of antibacterial photodynamic therapy is that regardless of the resistance pattern of a bacteria, inactivation can be achieved, analogous to the use of antiseptics. The aim of the present review is to describe the physicochemical and biological mechanisms of antibacterial photodynamic therapy as well as possible clinical indications in dermatology.
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Affiliation(s)
- T Maisch
- Klinik und Poliklinik für Dermatologie, Klinikum der Universität Regensburg.
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Maisch T, Bosl C, Szeimies RM, Lehn N, Abels C. Photodynamic effects of novel XF porphyrin derivatives on prokaryotic and eukaryotic cells. Antimicrob Agents Chemother 2005; 49:1542-52. [PMID: 15793136 PMCID: PMC1068608 DOI: 10.1128/aac.49.4.1542-1552.2005] [Citation(s) in RCA: 183] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The worldwide rise in the rates of antibiotic resistance of bacteria underlines the need for alternative antibacterial agents. A promising approach to the killing of gram-positive antibiotic-resistant bacteria of the skin uses light in combination with a photosensitizer to induce a phototoxic reaction. Different concentrations (0 to 100 microM) of porphyrin-based photosensitizers (CTP1, XF70, and XF73) and different incubation times (5 min, 1 h, and 4 h) were used to determine phototoxicity against two methicillin-resistant Staphylococcus aureus strains, one methicillin-sensitive S. aureus strain, one methicillin-resistant Staphylococcus epidermidis strain, one Escherichia coli strain, and human keratinocytes and fibroblasts. Incubation with 0.005 microM XF70 or XF73, followed by illumination, yielded a 3-log10 (> or = 99.9%) decrease in the viable cell numbers of all staphylococcal strains, indicating that the XF drugs have high degrees of potency against gram-positive bacteria and also that the activities of these novel drugs are independent of the antibiotic resistance pattern of the staphylococci examined. CTP1 was less potent against the staphylococci under the same conditions. At 0.005 microM, XF70 and XF73 demonstrated no toxicity toward fibroblasts or keratinocytes. No inactivation of E. coli was detected at this concentration. XF73 was confirmed to act via a reactive oxygen species from the results of studies with sodium azide (a quencher of singlet oxygen), which reduced the killing of both eukaryotic and prokaryotic cells. When a quencher of superoxide anion and the hydroxyl radical was used, cell killing was not inhibited. These results demonstrate that the porphyrin-based photosensitizers had concentration-dependent differences in their efficacies of killing of methicillin-resistant staphylococcal strains via reactive oxygen species without harming eukaryotic cells at the same concentrations.
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Affiliation(s)
- T Maisch
- Department of Dermatology, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
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