Can light-based approaches overcome antimicrobial resistance?

maxPIE: An innovative high throughput approach to enhance pathogen inactivation practices

Effective pathogen inactivation is highly desired in public health but limited by existing methods each capable of assessing pathogen inactivation effectiveness (PIE) only in a specific condition. We therefore developed a novel method maxPIE designed to identify maximal PIEs across inactivation conditions by leveraging the power of massive array technologies. maxPIE implements a three-step algorithm to quickly identify maximal PIEs of inactivation treatments: (1) dilute pathogens into different initial titers each stored in an array well, (2) submit one sorted array to one treatment, (3) scan the treated array to find the maximum. maxPIE outperformed the conventional methods in (a) inactivating S. aureus using ultraviolet light of different wavelengths with different durations; (b) antibiotic treatment of S. aureus, E. coli, and multidrug-resistant E. coli; (c) inactivating S. aureus in plasma using ultraviolet light in different wavelengths with and without riboflavin. maxPIE was easy to understand and interpret and was robust in situations where conventional PIE methods would suffer. Hence, maxPIE can serve as an innovative and high throughput approach that can be widely used to enhance pathogen inactivation practices.

Synergizing Nanomaterials and Artificial Intelligence in Advanced Optical Biosensors for Precision Antimicrobial Resistance Diagnosis

Antimicrobial resistance (AMR) poses a critical global One Health concern, ensuing from unintentional and continuous exposure to antibiotics, as well as challenges in accurate contagion diagnostics. Addressing AMR requires a strategic approach that emphasizes early stage prevention through screening in clinical, environmental, farming, and livestock settings to identify nonvulnerable antimicrobial agents and the associated genes. Conventional AMR diagnostics, like antibiotic susceptibility testing, possess drawbacks, including high costs, time-consuming processes, and significant manpower requirements, underscoring the need for intelligent, prompt, and on-site diagnostic techniques. Nanoenabled artificial intelligence (AI)-supported smart optical biosensors present a potential solution by facilitating rapid point-of-care AMR detection with real-time, sensitive, and portable capabilities. This Review comprehensively explores various types of optical nanobiosensors, such as surface plasmon resonance sensors, whispering-gallery mode sensors, optical coherence tomography, interference reflection imaging sensors, surface-enhanced Raman spectroscopy, fluorescence spectroscopy, microring resonance sensors, and optical tweezer biosensors, for AMR diagnostics. By harnessing the unique advantages of these nanoenabled smart biosensors, a revolutionary paradigm shift in AMR diagnostics can be achieved, characterized by rapid results, high sensitivity, portability, and integration with Internet-of-Things (IoT) technologies. Moreover, nanoenabled optical biosensors enable personalized monitoring and on-site detection, significantly reducing turnaround time and eliminating the human resources needed for sample preservation and transportation. Their potential for holistic environmental surveillance further enhances monitoring capabilities in diverse settings, leading to improved modern-age healthcare practices and more effective management of antimicrobial treatments. Embracing these advanced diagnostic tools promises to bolster global healthcare capacity to combat AMR and safeguard One Health.

Synergistic photogeneration of nitric oxide and singlet oxygen by nanofiber membranes via blue and/or red-light irradiation: Strong antibacterial action

New functionalities were added to biocompatible polycaprolactone nanofiber materials through the co-encapsulation of chlorin e6 trimethyl ester (Ce6) photogenerating singlet oxygen and absorbing light both in the blue and red regions, and using 4-(N-(aminopropyl)-3-(trifluoromethyl)-4-nitrobenzenamine)-7-nitrobenzofurazan, NO-photodonor (NOP), absorbing light in the blue region of visible light. Time-resolved and steady-state luminescence, as well as absorption spectroscopy, were used to monitor both photoactive compounds. The nanofiber material exhibited photogeneration of antibacterial species, specifically nitric oxide and singlet oxygen, upon visible light excitation. This process resulted in the efficient photodynamic inactivation of E. coli not only close to nanofiber material surfaces due to short-lived singlet oxygen, but even at longer distances due to diffusion of longer-lived nitric oxide. Interestingly, nitric oxide was also formed by processes involving photosensitization of Ce6 during irradiation by red light. This is promising for numerous applications, especially in the biomedical field, where strictly local photogeneration of NO and its therapeutic benefits can be applied using excitation in the "human body phototherapeutic window" (600-850 nm). Generally, due to the high permeability of red light, the photogeneration of NO can be achieved in any aqueous environment where direct excitation of NOP to its absorbance in the blue region is limited.

Efficacy of 233 nm LED far UV-C-radiation against clinically relevant bacterial strains in the phase 2/ step 2 in vitro test on basis of EN 14561 and on an epidermis cell model

INTRODUCTION

Healthcare-acquired infections and overuse of antibiotics are a common problem. Rising emergence of antibiotic and antiseptic resistances requires new methods of microbial decontamination or decolonization as the use of far-UV-C radiation.

METHODS

The microbicidal efficacy of UV-C radiation (222 nm, 233 nm, 254 nm) was determined in a quantitative carrier test and on 3D-epidermis models against Staphylococcus (S.) aureus, S.epidermidis, S.haemolyticus, S.lugdunensis, Klebsiella pneumoniae, and Pseudomonas aeruginosa. To mimic realistic conditions, sodium chloride solution, mucin, albumin, artificial saliva, artificial wound exudate and artificial sweat were used.

RESULTS

In sodium chloride solution, irradiation with a dose of 40 mJ/cm2 (233 nm) was sufficient to achieve 5 lg reduction independent of bacteria genus or species. In artificial sweat, albumin and artificial wound exudate, a reduction >3 lg was reached for most of the bacteria. Mucin and artificial saliva decreased the reduction to <2 lg. On 3D epidermis models, reduction was lower than in the carrier test.

CONCLUSION

UV-C radiation at 233 nm was proven to be efficient in bacteria inactivation independent of genus or species thus being a promising candidate for clinical use in the presence of humans and on skin/mucosa.

Unlocking the Power of Light on the Skin: A Comprehensive Review on Photobiomodulation

Photobiomodulation (PBM) is a procedure that uses light to modulate cellular functions and biological processes. Over the past decades, PBM has gained considerable attention for its potential in various medical applications due to its non-invasive nature and minimal side effects. We conducted a narrative review including articles about photobiomodulation, LED light therapy or low-level laser therapy and their applications on dermatology published over the last 6 years, encompassing research studies, clinical trials, and technological developments. This review highlights the mechanisms of action underlying PBM, including the interaction with cellular chromophores and the activation of intracellular signaling pathways. The evidence from clinical trials and experimental studies to evaluate the efficacy of PBM in clinical practice is summarized with a special emphasis on dermatology. Furthermore, advancements in PBM technology, such as novel light sources and treatment protocols, are discussed in the context of optimizing therapeutic outcomes and improving patient care. This narrative review underscores the promising role of PBM as a non-invasive therapeutic approach with broad clinical applicability. Despite the need for further research to develop standard protocols, PBM holds great potential for addressing a wide range of medical conditions and enhancing patient outcomes in modern healthcare practice.

Mechanisms of antifungal resistance and developments in alternative strategies to combat Candida albicans infection

Candida albicans is a commensal fungus that infects the humans and becomes an opportunistic pathogen particularly in immuno-compromised patients. Among the Candida genus, yeast C. albicans is the most frequently incriminated species and is responsible for nearly 50-90% of human candidiasis, with vulvovaginal candidiasis alone, affecting about 75% of the women worldwide. One of the significant virulence traits in C. albicans is its tendency to alternate between the yeast and hyphae morphotypes, accounting for the development of multi-drug resistance in them. Thus, a thorough comprehension of the decision points and genes controlling this transition is necessary, to understand the pathogenicity of this, naturally occurring, pernicious fungus. Additionally, the formation of C. albicans biofilm is yet another pathogenesis trait and a paramount cause of invasive candidiasis. Since 1980 and in 90 s, wide spread use of immune-suppressing therapies and over prescription of fluconazole, a drug used to treat chronic fungal infections, triggered the emergence of novel anti-fungal drug development. Thus, this review thoroughly elucidates the diseases associated with C. albicans infection as well as the anti-fungal resistance mechanism associated with them and identifies the emerging therapeutic agents, along with a rigorous discussion regarding the future strategies that can possibly be adopted for the cure of this deleterious pathogen.

DNase improves the efficacy of antimicrobial photodynamic therapy in the treatment of candidiasis induced with Candida albicans

The study evaluated the association of DNase I enzyme with antimicrobial photodynamic therapy (aPDT) in the treatment of oral candidiasis in mice infected with fluconazole-susceptible (CaS) and -resistant (CaR) Candida albicans strains. Mice were inoculated with C. albicans, and after the infection had been established, the tongues were exposed to DNase for 5 min, followed by photosensitizer [Photodithazine®(PDZ)] and light (LED), either singly or combined. The treatments were performed for 5 consecutive days. Treatment efficacy was evaluated by assessing the tongues via fungal viable population, clinical evaluation, histopathological and fluorescence microscopy methods immediately after finishing treatments, and 7 days of follow-up. The combination of DNase with PDZ-aPDT reduced the fungal viability in mice tongues immediately after the treatments by around 4.26 and 2.89 log10 for CaS and CaR, respectively (versus animals only inoculated). In the fluorescence microscopy, the polysaccharides produced by C. albicans and fungal cells were less labeled in animals treated with the combination of DNase with PDZ-aPDT, similar to the healthy animals. After 7 days of the treatment, DNase associated with PDZ-aPDT maintained a lower count, but not as pronounced as immediately after the intervention. For both strains, mice treated with the combination of DNase with PDZ-aPDT showed remission of oral lesions and mild inflammatory infiltrate in both periods assessed, while animals treated only with PDZ-aPDT presented partial remission of oral lesions. DNase I enzyme improved the efficacy of photodynamic treatment.

Minimally invasive management of vital teeth requiring root canal therapy

The present study aimed to investigate the possible use of a non-instrumentation technique including blue light irradiation for root canal cleaning. Extracted human single rooted teeth were selected. Nine different groups included distilled water, NaOCl, intra-canal heated NaOCl, and NaOCl + EDTA irrigation after either instrumentation or non-instrumentation, and a laser application group following non-instrumentation technique. The chemical assessment of the root canal dentine was evaluated using energy dispersive spectroscopy (EDS) and Fourier transform infrared (FT-IR) spectroscopy. Surface microstructural analyses were performed by using scanning electron microscopy (SEM). The antimicrobial efficacy of different preparation techniques was evaluated using microbial tests. Light application didn't change the calcium/phosphorus, carbonate/phosphate and amide I/phosphate ratios of the root canal dentin. The root canal dentin preserved its original chemistry and microstructure after light application. The instrumentation decreased the carbonate/phosphate and amide I/phosphate ratios of the root canal dentin regardless of the irrigation solution or technique (p < 0.05). The application of light could not provide antibacterial efficacy to match the NaOCl irrigation. The NaOCl irrigation both in the non-instrumentation and instrumentation groups significantly reduced the number of bacteria (p < 0.05). The use of minimally invasive root canal preparation techniques where the root canal is not instrumented and is disinfected by light followed by obturation with a hydraulic cement sealer reduced the microbial load and preserved the dentin thus may be an attractive treatment option for management of vital teeth needing root canal therapy.

Wirelessly Powered Drug-Free and Anti-Infective Smart Bandage for Chronic Wound Care

We present a wirelessly powered ultraviolet-C (UVC) radiation-based disinfecting bandage for sterilization and treatment in chronic wound care and management. The bandage contains embedded low-power UV light-emitting diodes (LEDs) in the 265 to 285 nm range with the light emission controlled via a microcontroller. An inductive coil is seamlessly concealed in the fabric bandage and coupled with a rectifier circuit to enable 6.78 MHz wireless power transfer (WPT). The maximum WPT efficiency of the coils is 83% in free space and 75% on the body at a coupling distance of 4.5 cm. Measurements show that the UVC LEDs are emitting radiant power of about 0.6 mW and 6.8 mW with and without fabric bandage, respectively, when wirelessly powered. The ability of the bandage to inactivate microorganisms was examined in a laboratory which shows that the system can effectively eradicate Gram-negative bacteria, Pseudoalteromonas sp. D41 strain, on surfaces in six hours. The proposed smart bandage system is low-cost, battery-free, flexible and can be easily mounted on the human body and, therefore, shows great promise for the treatment of persistent infections in chronic wound care.

Light-induced antifungal activity of nanoparticles with an encapsulated porphyrin photosensitizer

The strong antifungal effect of sulfonated polystyrene nanoparticles (NPs) with an encapsulated tetraphenylporphyrin (TPP) photosensitizer is reported here. TPP is activated by visible light, resulting in the generation of singlet oxygen. Its antifungal action is potentiated in the presence of potassium iodide, yielding I₂/I₃⁻, another antifungal species. The NPs exhibit no dark toxicity, but a broad spectrum of antifungal photodynamic effects. The efficiency of this rapid killing (on the order of minutes) depends on the concentration of TPP NPs, potassium iodide, yeast species and temperature. A strong antifungal activity of TPP NPs is demonstrated on eleven pathogenic and opportunistic pathogenic yeast species (six Candida species and other yeast species, including melanized Hortaea werneckii). The composition and architecture of yeast cell envelope structures clearly influence the efficacy of photodynamic therapy. Candida krusei is the most sensitive to photodynamic therapy. Despite expectations, melanin does not provide Hortaea cells with marked resistance compared to white yeast species. The kinetics of the interaction of NPs with yeast cells is also described. This study may inspire and promote the fabrication of a new type of antiseptic for various skin injuries in clinical medicine.

Metals to combat antimicrobial resistance

Bacteria, similar to most organisms, have a love-hate relationship with metals: a specific metal may be essential for survival yet toxic in certain forms and concentrations. Metal ions have a long history of antimicrobial activity and have received increasing attention in recent years owing to the rise of antimicrobial resistance. The search for antibacterial agents now encompasses metal ions, nanoparticles and metal complexes with antimicrobial activity ('metalloantibiotics'). Although yet to be advanced to the clinic, metalloantibiotics are a vast and underexplored group of compounds that could lead to a much-needed new class of antibiotics. This Review summarizes recent developments in this growing field, focusing on advances in the development of metalloantibiotics, in particular, those for which the mechanism of action has been investigated. We also provide an overview of alternative uses of metal complexes to combat bacterial infections, including antimicrobial photodynamic therapy and radionuclide diagnosis of bacterial infections.

Organization of the Interfacial Film of Nanoemulsions Stabilized by Porphyrin Derivatives

Photodynamic therapies combining the action of a photosensitizer (PS), molecular oxygen, and light make it possible to destroy certain infectious sites and tumors. The incorporation of photosensitizers in nanocarriers allows for better control of their distribution in tissues and increases their concentration in the area that will be then illuminated. Nanoemulsions of glyceryl trioctanoate (GTO) have been designed in which pyropheophobide a (Pyro-A) or its lipid conjugate (Pyro-Lipid) are both stabilizing and photostimulable agents. In this work, we studied by surface pressure measurements and Brewster angle microscopy (BAM) analysis the organization of the interfacial films of nanodroplets. Comparison of preformed porphyrin nanoemulsions and two porphyrin-GTO mixtures, one mimicking the composition of the nanoemulsions and the other that of a porphyrin-rich interfacial film, highlighted the role of GTO and porphyrin derivatives in the formation, organization, and elasticity of the interfacial films in nanoemulsions. Pyro-Lipid and GTO can mix, and some of the GTO molecules remain inserted in the interfacial film at high surface pressures. In contrast, Pyro-A and GTO do not mix well and tend to segregate, leaving Pyro-A alone in the condensed interfacial film. The results of this study demonstrate the importance of characterizing the interfacial properties of porphyrin derivatives and their interaction with the oil to design stable nanoemulsions with well-controlled optical properties.

Tuning the Molecular Structure of Corroles to Enhance the Antibacterial Photosensitizing Activity

The increase in the antibiotic resistance of bacteria is a serious threat to public health. Photodynamic inactivation (PDI) of micro-organisms is a reliable antimicrobial therapy to treat a broad spectrum of complex infections. The development of new photosensitizers with suitable properties is a key factor to consider in the optimization of this therapy. In this sense, four corroles were designed to study how the number of cationic centers can influence the efficacy of antibacterial photodynamic treatments. First, 5,10,15-Tris(pentafluorophenyl)corrole (Co) and 5,15-bis(pentafluorophenyl)-10-(4-(trifluoromethyl)phenyl)corrole (Co-CF₃) were synthesized, and then derivatized by nucleophilic aromatic substitution with 2-dimethylaminoethanol and 2-(dimethylamino)ethylamine, obtaining corroles Co-3NMe₂ and Co-CF₃-2NMe₂, respectively. The straightforward synthetic strategy gave rise to macrocycles with different numbers of tertiary amines that can acquire positive charges in an aqueous medium by protonation at physiological pH. Spectroscopic and photodynamic studies demonstrated that their properties as chromophores and photosensitizers were unaffected, regardless of the substituent groups on the periphery. All tetrapyrrolic macrocycles were able to produce reactive oxygen species (ROS) by both photodynamic mechanisms. Uptake experiments, the level of ROS produced in vitro, and PDI treatments mediated by these compounds were assessed against clinical strains: methicillin-resistant Staphylococcus aureus and Klebsiella pneumoniae. In vitro experiments indicated that the peripheral substitution significantly affected the uptake of the photosensitizers by microbes and, consequently, the photoinactivation performance. Co-3NMe₂ was the most effective in killing both Gram-positive and Gram-negative bacteria (inactivation > 99.99%). This work lays the foundations for the development of new corrole derivatives having pH-activable cationic groups and with plausible applications as effective broad-spectrum antimicrobial photosensitizers.

The Effect of Sub-Lethal Successive Applications of Photodynamic Therapy on Candida albicans Biofilm Depends on the Photosensitizer

This study aimed to evaluate the potential of successive applications of sub-lethal doses of the antimicrobial photodynamic therapy (aPDT) mediated by Photodithazine^® (PDZ) and curcumin (CUR) associated with LED in the viability, reactive oxygen species (ROS) production, and gene expression of Candida albicans. The microbial assays were performed using planktonic cultures and biofilms. Ten successive applications (Apl#) were performed: aPDT (P+L+; C+L+), photosensitizer (P+L-; C+L-), and LED (P-L+; C-L+). Control groups were used (P-L-; C-L-). The viability of C. albicans was determined by cultivating treated cultures on agar plates with or without fluconazole (FLU). In addition, the ROS detection and expression of SOD1, CAP1, and ERG11 genes were determined. For planktonic cultures, no viable colonies were observed after Apl#3 (without FLU) and Apl#2 (with FLU) for either photosensitizer. Biofilm treated with P+L+ resulted in the absence of cell viability after Apl#7, while C+L+ showed ~1.40 log₁₀ increase in cell viability after Apl#2, regardless of FLU. For both photosensitizers, after the last application with viable colonies, the production of ROS was higher in the biofilms than in the planktonic cultures, and SOD1 expression was the highest in P+L+. A reduction of CAP1 and ERG11 expression occurred after P+L+, regardless of FLU. C+L+ had a higher level of ROS, and the treatments were non-significant for gene expression. Sub-lethal doses of aPDT mediated by CUR could induce C. albicans resistance in biofilms, while C. albicans cells in biofilms were susceptible to aPDT mediated by PDZ.

Hydrogen peroxide enhances the efficacy of photodynamic therapy against Candida albicans biofilms

The present study aimed to evaluate the effectiveness of hydrogen peroxide (H₂O₂) combined with antimicrobial photodynamic therapy (aPDT) on biofilms formed by Candida albicans strains which are either susceptible to or resistant to fluconazole. Biofilms were grown and treated with H₂O₂, followed by the application of Photodithazine® (P) and red light-emitting diode (LED) (L) either separately or combined (n = 12). After the treatment, biofilms were evaluated by estimating colony-forming unit ml^-1, extracellular matrix components [water -soluble and -insoluble polysaccharides, proteins, extracellular DNA (eDNA)], biomass (total and insoluble dry-weight), and protein concentration. Biofilms formed by both strains presented a significant reduction in cell viability, biomass, extracellular matrix components (both types of polysaccharides, eDNA), and proteins (in the soluble and insoluble portion of biofilms) compared to the control. Microscopy images of the biofilms after treatments showed disarticulation of the matrix and scattered fungal cells. The application of H₂O₂ can disturb the organization of the extracellular matrix, and its association with aPDT potentiated the effect of the treatment.

Magnetically Separable Photoactive Nanofiber Membranes for Photocatalytic and Antibacterial Applications

We have prepared photoactive multifunctional nanofiber membranes via the simple electrospinning method. The antibacterial and photocatalytic properties of these materials are based on the generation of singlet oxygen formed by processes photosensitized by the tetraphenylporphyrin encapsulated in the nanofibers. The addition of magnetic features in the form of magnetic maghemite (γ-Fe₂O₃) nanoparticles stabilized by polyethylenimine enables additional functionalities, namely, the postirradiation formation of hydrogen peroxide and improved photothermal properties. This hybrid material allows for remote manipulation by a magnetic field, even in hazardous and/or highly microbial contaminant environments.

Visible light-regulated cationic polymer coupled with photodynamic inactivation as an effective tool for pathogen and biofilm elimination

Background

Pathogenic microorganism pollution has been a challenging public safety issue, attracting considerable scientific interest. A more problematic aspect of this phenomenon is that planktonic bacteria exacerbate biofilm formation. There is an overwhelming demand for developing ultra-efficient, anti-drug resistance, and biocompatibility alternatives to eliminate stubborn pathogenic strains and biofilms.

Results

The present work aims to construct a visible light-induced anti-pathogen agents to ablate biofilms using the complementary merits of ROS and cationic polymers. The photosensitizer chlorin e6-loaded polyethyleneimine-based micelle (Ce6-TPP-PEI) was constructed by an amphiphilic dendritic polymer (TPP-PEI) and physically loaded with photosensitizer chlorin e6. Cationic polymers can promote the interaction between photosensitizer and Gram-negative bacteria, resulting in enhanced targeting of PS and lethality of photodynamic therapy, and remain active for a longer duration to prevent bacterial re-growth when the light is turned off. As expected, an eminent antibacterial effect was observed on the Gram-negative Escherichia coli, which is usually insensitive to photosensitizers. Surprisingly, the cationic polymer and photodynamic combination also exert significant inhibitory and ablative effects on fungi and biofilms. Subsequently, cell hemolysis assessments suggested its good biocompatibility.

Conclusions

Given the above results, the platform developed in this work is an efficient and safe tool for public healthcare and environmental remediation.

Effect of Berberine and Blue LED Irradiation on Combating Biofilm of Pseudomonas aeruginosa and Staphylococcus aureus

Nowadays, with increasing resistance of microorganisms to drugs, it is necessary to look for new solutions beside antibiotic therapy. One of these effective approaches is the use of plant compounds and blue LED Irradiation. Berberine (an alkaloid compound) has several properties, including antibacterial effect. This compound destroys bacterial cells by producing reactive oxygen species (ROS). In this study, the combined effect of blue LED Irradiation and berberine on Pseudomonas aeruginosa (Gram-negatives) and Staphylococcus aureus (Gram-positive) and also their effect on human dermal fibroblast (HDF) cells were investigated. The obtained results showed that the combination of berberine and blue light irradiation had a better effect on both bacteria and this antimicrobial effect was higher in Gram-positive bacteria. These compounds also prevented the formation of biofilms and were able to destroy the created biofilms. Therefore, this method can be suggested to treat infection in chronic wounds, such as diabetic wounds.

Efficacy of Antimicrobial Photodynamic Therapy Mediated by Photosensitizers Conjugated with Inorganic Nanoparticles: Systematic Review and Meta-Analysis

Antimicrobial photodynamic therapy (aPDT) is a method that does not seem to promote antimicrobial resistance. Photosensitizers (PS) conjugated with inorganic nanoparticles for the drug-delivery system have the purpose of enhancing the efficacy of aPDT. The present study was to perform a systematic review and meta-analysis of the efficacy of aPDT mediated by PS conjugated with inorganic nanoparticles. The PubMed, Scopus, Web of Science, Science Direct, Cochrane Library, SciELO, and Lilacs databases were searched. OHAT Rob toll was used to assess the risk of bias. A random effect model with an odds ratio (OR) and effect measure was used. Fourteen articles were able to be included in the present review. The most frequent microorganisms evaluated were Staphylococcus aureus and Escherichia coli, and metallic and silica nanoparticles were the most common drug-delivery systems associated with PS. Articles showed biases related to blinding. Significant results were found in aPDT mediated by PS conjugated with inorganic nanoparticles for overall reduction of microorganism cultured in suspension (OR = 0.19 [0.07; 0.67]/p-value = 0.0019), E. coli (OR = 0.08 [0.01; 0.52]/p-value = 0.0081), and for Gram-negative bacteria (OR = 0.12 [0.02; 0.56/p-value = 0.0071). This association approach significantly improved the efficacy in the reduction of microbial cells. However, additional blinding studies evaluating the efficacy of this therapy over microorganisms cultured in biofilm are required.

The Effects of Blue Light on Human Fibroblasts and Diabetic Wound Healing

Diabetes is a serious threat to global health and is among the top 10 causes of death. The Diabetic foot ulcer (DFU) is among the most common and severe complications of the disease. Bacterial infections are common; therefore, timely aggressive management, using multidisciplinary management approaches is needed to prevent complications, morbidity, and mortality, particularly in view of the growing cases of antibiotic-resistant bacteria. Photobiomodulation (PBM) involves the application of low-level light at specific wavelengths to induce cellular photochemical and photophysical responses. Red and near-infrared (NIR) wavelengths have been shown to be beneficial, and recent studies indicate that other wavelengths within the visible spectrum could be helpful as well, including blue light (400–500 nm). Reports of the antimicrobial activity and susceptibility of blue light on several strains of the same bacterium show that many bacteria are less likely to develop resistance to blue light treatment, meaning it is a viable alternative to antibiotic therapy. However, not all studies have shown positive results for wound healing and fibroblast proliferation. This paper presents a critical review of the literature concerning the use of PBM, with a focus on blue light, for tissue healing and diabetic ulcer care, identifies the pros and cons of PBM intervention, and recommends the potential role of PBM for diabetic ulcer care.

Development of a Polymeric Film Entrapping Rose Bengal and Iodide Anion for the Light-Induced Generation and Release of Bactericidal Hydrogen Peroxide

A series of poly(2-hydroxyethyl methacrylate) (PHEMA) thin films entrapping photosensitizer Rose Bengal (RB) and tetrabutylammonium iodide (TBAI) have been synthetized. The materials have been characterized by means of Thermogravimetric Analysis (TGA), Attenuated Total Reflectance Fourier Transform Infrared Spectroscopy (ATR-FTIR) and UV-vis Absorption spectroscopy. Irradiation of the materials with white light led to the generation of several bactericidal species, including singlet oxygen (¹O₂), triiodide anion (I₃^-) and hydrogen peroxide (H₂O₂). ¹O₂ production was demonstrated spectroscopically by reaction with the chemical trap 2,2'-(anthracene-9,10-diylbis(methylene))dimalonic acid (ABDA). In addition, the reaction of iodide anion with ¹O₂ yielded I₃^- inside the polymeric matrix. This reaction is accompanied by the formation of H₂O₂, which diffuses out the polymeric matrix. Generation of both I₃^- and H₂O₂ was demonstrated spectroscopically (directly in the case of triiodide by the absorption at 360 nm and indirectly for H₂O₂ using the xylenol orange test). A series of photodynamic inactivation assays were conducted with the synthesized polymers against Gram-negative bacteria Escherichia coli and Pseudomonas aeruginosa. Complete eradication (7 log₁₀ CFU/mL) of both bacteria occurred after only 5 min of white light irradiation (400-700 nm; total energy dose 24 J/cm²) of the polymer containing both RB and TBAI. The control polymer without embedded iodide (only RB) showed only marginal reductions of ca. 0.5 log₁₀ CFU/mL. The main novelty of the present investigation is the generation of three bactericidal species (¹O₂, I₃^- and H₂O₂) at the same time using a single polymeric material containing all the elements needed to produce such a bactericidal cocktail, although the most relevant antimicrobial activity is shown by H₂O₂. This experimental approach avoids multistep protocols involving a final step of addition of I^-, as described previously for other assays in solution.

Photodynamic inactivation of pathogenic Gram-negative and Gram-positive bacteria mediated by Si(IV) phthalocyanines bearing axial ammonium units

The photodynamic inactivation (PDI) of microorganisms has gained interest as an efficient option for conventional antibiotic treatments. Recently, Si(IV) phthalocyanines (SiPcs) have been highlighted as promising photosensitizers (PSs) to the PDI of microorganisms due to their remarkable absorption and emission features. To increase the potential of cationic SiPcs as PS drugs, one novel (1a) and two previously described (2a and 3a) axially substituted PSs with di-, tetra-, and hexa-ammonium units, respectively, were synthesized and characterized. Their PDI effect was evaluated for the first time against Escherichia coli and Staphylococcus aureus, a Gram-negative and a Gram-positive bacterium, respectively. The photodynamic treatments were conducted with PS concentrations of 3.0 and 6.0 μM under 60 min of white light irradiation (150 mW.cm^-2). The biological results show high photodynamic efficiency for di- and tetra-cationic PSs 1a and 2a (6.0 μM), reducing the E. coli viability in 5.2 and 3.9 log, respectively (after 15 min of dark incubation before irradiation). For PS 3a, a similar bacterial reduction (3.6 log) was achieved but only with an extended dark incubation period (30 min). Under the same experimental conditions, the photodynamic effect of cationic PSs 1a-3a on S. aureus was even more promising, with abundance reductions of ca. 8.0 log after 45-60 min of PDI treatment. These results reveal the high PDI efficiency of PSs bearing ammonium groups and suggest their promising application as a broad-spectrum antimicrobial to control infections caused by Gram-negative and Gram-positive bacteria.

Photoinactivation of Salmonella enterica exposed to 5-aminolevulinic acid: Impact of sensitization conditions and irradiation time

The photodynamic inactivation (PDI) represents the potential alternative to traditional antibiotic therapy, and can be applied to treat various bacterial infections, including those caused by Gram-negative bacterial strains. One of the treatment modalities is based on the capacity of bacterial cells to synthesize the excess amounts of porphyrins after exposure to an externally applied 5-aminolevulinic acid (5-ALA), which makes them photosensitive and leads to reduced survival after irradiation with an appropriately selected light source. This study focuses on the sensitization and the photoinduced inactivation of Salmonella enterica cells in PBS containing 0.5 mM 5-ALA, incubated at 37 °C for 4 h or for 20 h and afterwards irradiated with violet LED light (11.1 mW/cm², a peak at 400 nm). It has been found that both amounts and composition of endogenous porphyrins not only depended on the incubation duration, but also were affected by externally induced photo- and chemo-oxidation reactions. The application of different sensitization conditions has revealed that the increasing amounts of endogenously produced porphyrins do not ensure the proportional reduction of bacterial cell survival numbers. The comparative investigations also demonstrated that the presence of endogenously produced porphyrins in the medium results in secondary sensitization of bacterial cells and causes a notably stronger photoinactivation effect in comparison to their externally applied standards.

A study of the effect of reactive oxygen species induced by violet and blue light from oxytetracycline on the deactivation of Escherichia coli

Oxytetracycline (OTC), a tetracycline antibiotic, is a broad-spectrum antibacterial agent. In this investigation, liquid chromatography-mass spectrometry (LC-MS) is utilized to determine the effects of blue light (λ = 448 nm) illumination (BLIA) and violet light (λ = 403 nm) illumination (VLIA) on conformational changes in OTC at pH 7.8. The photochemical effect of OTC that is exposed to BLIA and VLIA on the deactivation of Escherichia coli (E. coli) is studied. The deactivation of E. coli has an insignificant effect on treatment with OTC alone. OTC is relatively unstable under BLIA and VLIA illumination in an alkaline solution, and OTC has been shown to inactivate E. coli by generating reactive oxygen species (ROS). Less anionic superoxide radicals (O₂^•-) are generated from OTC that is treated with BLIA than that from VLIA treatment, so OTC is more efficient in inactivating E. coli under VLIA. Inactivation of reduction rates of 0.51 and 3.65 logs in E. coli are achieved using 0.1 mM OTC under BLIA for 120 min and VLIA for 30 min, respectively, under the same illumination intensity (20 W/m²). Two photolytic products of OTC (PPOs) are produced when OTC is exposed to BLIA and VLIA, with molecular ions at m/z 447 and 431, molecular formulae C₂₁H₂₂N₂O₉ and C₂₁H₂₂N₂O₈, and masses of 446.44 and 430.44 g/mol, respectively. The results show that when exposed to VLIA, OTC exhibits enhanced inactivation of E. coli, suggesting that the photochemical treatment of OTC is a potential supplement in a hygienic process.

Nuclease-like metalloscissors: Biomimetic candidates for cancer and bacterial and viral infections therapy

Despite the extensive and rapid discovery of modern drugs for treatment of cancer, microbial infections, and viral illnesses; these diseases are still among major global health concerns. To take inspiration from natural nucleases and also the therapeutic potential of metallopeptide antibiotics such as the bleomycin family, artificial metallonucleases with the ability of promoting DNA/RNA cleavage and eventually affecting cellular biological processes can be introduced as a new class of therapeutic candidates. Metal complexes can be considered as one of the main categories of artificial metalloscissors, which can prompt nucleic acid strand scission. Accordingly, biologists, inorganic chemists, and medicinal inorganic chemists worldwide have been designing, synthesizing and evaluating the biological properties of metal complexes as artificial metalloscissors. In this review, we try to highlight the recent studies conducted on the nuclease-like metalloscissors and their potential therapeutic applications. Under the light of the concurrent Covid-19 pandemic, the human need for new therapeutics was highlighted much more than ever before. The nuclease-like metalloscissors with the potential of RNA cleavage of invading viral pathogens hence deserve prime attention.

EFFICACY OF CURCUMIN-MEDIATED ANTIBACTERIAL PHOTODYNAMIC THERAPY FOR ORAL ANTISEPSIS: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS

BACKGROUND

currently, the presence of oral microorganisms resistant to traditional treatment is increasing, thus search for new modalities of therapies is needed. In this context, antimicrobial photodynamic therapy (aPDT) is an alternative approach for the treatment of resistant or not resistant microorganisms. Therefore, the aim of the present study was to conduct a systematic review and meta-analysis of randomized clinical trials of aPDT for oral antisepsis against oral polymicrobial biofilms.

METHODS

PubMed, Science Direct, Scopus, SciELO, Lilacs, Cochrane Library and Embase databases were searched. In total, five articles were included for qualitative analysis and four articles were used for quantitative analyses. Bias assessment of the eligible articles was made using the RoB 2 criteria. Network meta-analysis was performed using the random-effect model. Subgroup's analysis was also conducted. The groups evaluated were aPDT, exposure to light only and no treatment at all (control group). The quality of evidence was accessed by CINeMA approach.

RESULTS

aPDT mediated by curcumin had significant results in the reducing bacterial load (0.31-0.49 log₁₀ UFC/ I²=0%) when compared with the control group. The included articles were classified as low risk of bias, despite biases detected by allocation and blinding. Moreover, quantitative analysis between aPDT and control group and between light and control group were classified with low risk of confidence rating, while the results from aPDT versus light were classified as moderate risk of confidence rating.

CONCLUSION

aPDT has significant efficacy for oral antisepsis, however more randomized clinical trials will be needed to validate the present results.

Gallium Mesoporphyrin IX-Mediated Photodestruction: A Pharmacological Trojan Horse Strategy To Eliminate Multidrug-Resistant Staphylococcus aureus

One of the factors determining efficient antimicrobial photodynamic inactivation (aPDI) is the accumulation of a light-activated compound, namely, a photosensitizer (PS). Targeted PS recognition is the approach based on the interaction between the membrane receptor on the bacterial surface and the PS, whereas the compound is efficiently accumulated by the same mechanism as the natural ligand. In this study, we showed that gallium mesoporphyrin IX (Ga³⁺MPIX) provided dual functionality—iron metabolism disruption and PS properties in aPDI. Ga³⁺MPIX induced efficient (>5log₁₀ reduction in CFU/mL) bacterial photodestruction with excitation in the area of Q band absorption with relatively low eukaryotic cytotoxicity and phototoxicity. The Ga³⁺MPIX is recognized by the same systems as haem by the iron-regulated surface determinant (Isd). However, the impairment in the ATPase of the haem detoxification efflux pump was the most sensitive to the Ga³⁺MPIX-mediated aPDI phenotype. This indicates that changes within the metalloporphyrin structure (vinyl vs ethyl groups) did not significantly alter the properties of recognition of the compound but influenced its biophysical properties.

DNase enhances photodynamic therapy against fluconazole-resistant Candida albicans biofilms

OBJECTIVE

This study evaluated the effectiveness of DNase I combined with antimicrobial photodynamic therapy, mediated by Photodithazine^® and light-emitting diode light, against biofilms formed by a fluconazole-resistant Candida albicans strain (ATCC 96901) and two clinical isolates (R14 and R70).

MATERIALS AND METHODS

Biofilms were grown for 48 h and exposed to DNase for 5 min, followed by application of a photosensitizer (P) and light (L), either singly or combined (P+L+, P-L+, P+L-, P-L-, P-L-DNase, P+L+DNase, P+L-DNase, and P-L+DNase; n = 12). Biofilm analysis included quantification of extracellular matrix components (water-soluble and insoluble proteins and polysaccharides, and extracellular DNA), and biomass (total and insoluble), as well as enumeration of colony-forming units. The data were analyzed using three-way analysis of variance with Bonferroni's post-hoc test.

RESULTS

The DNase treatment combined with aPDT showed a reduction of 1.92, 1.65, and 1.29 log₁₀ of cell viability compared with untreated controls for ATCC 96901, R14, and R70 strains, respectively. It also reduced extracellular matrix contents of water-soluble polysaccharides (36.3%) and extracellular DNA (72.3%), as well as insoluble biomass content (43.3%).

CONCLUSION

The three strains showed similar behavior when treated with DNase, and the extracellular matrix components were affected, improving the effectiveness of antimicrobial photodynamic therapy.

Photodynamic therapy for treatment of bacterial keratitis

Microbial keratitis is the main cause of corneal opacification and the fourth leading cause of blindness worldwide, with bacteria the major infectious agent. Recently, bacterial keratitis has become a serious threat due to routine use of antibiotics leading to selection of resistant and multidrug-resistant bacteria strains. New approaches for treatment of bacterial keratitis are necessary to outcome the increasing antibiotic resistance. Antimicrobial photodynamic therapy is based on three agents: photosensitizer, oxygen, and light radiation. This therapy has been successful for treatment of infections in different tissues and organs as well as against different type of infectious agents and no resistance development. Also, new photosensitizers are being developed that has increased the spectrum of therapeutic protocols for treatment of a number of infectious diseases. Thus, antimicrobial photodynamic therapy has an extraordinary potential for treatment of those bacterial keratitis cases that actually are not solved by traditional antibiotic therapy.

The effects of violet and blue light irradiation on ESKAPE pathogens and human cells in presence of cell culture media

Bacteria belonging to the group of ESKAPE pathogens are responsible for the majority of nosocomial infections. Due to the increase of antibiotic resistance, alternative treatment strategies are of high clinical relevance. In this context visible light as disinfection technique represents an interesting option as microbial pathogens can be inactivated without adjuvants. However cytotoxic effects of visible light on host cells have also been reported. We compared the cytotoxicity of violet and blue light irradiation on monocytic THP-1 and alveolar epithelium A549 cells with the inactivation effect on ESKAPE pathogens. THP-1 cells displayed a higher susceptibility to irradiation than A549 cells with first cytotoxic effects occurring at 300 J cm⁻² (405 nm) and 400 J cm⁻² (450 nm) in comparison to 300 J cm⁻² and 1000 J cm⁻², respectively. We could define conditions in which a significant reduction of colony forming units for all ESKAPE pathogens, except Enterococcus faecium, was achieved at 405 nm while avoiding cytotoxicity. Irradiation at 450 nm demonstrated a more variable effect which was species and medium dependent. In summary a significant reduction of viable bacteria could be achieved at subtoxic irradiation doses, supporting a potential use of visible light as an antimicrobial agent in clinical settings.

Interdental Plaque Microbial Community Changes under In Vitro Violet LED Irradiation

Oral microbiome dysbiosis has important links to human health and disease. Although photodynamic therapy influences microbiome diversity, the specific effect of violet light irradiation remains largely unknown. In this study, we analyzed the effect of violet light-emitting diode (LED) irradiation on interdental plaque microbiota. Interdental plaque was collected from 12 human subjects, exposed to violet LED irradiation, and cultured in a specialized growth medium. Next-generation sequencing of the 16S ribosomal RNA genes revealed that α-diversity decreased, whereas β-diversity exhibited a continuous change with violet LED irradiation doses. In addition, we identified several operational taxonomic units that exhibited significant shifts during violet LED irradiation. Specifically, violet LED irradiation led to a significant reduction in the relative abundance of Fusobacterium species, but a significant increase in several species of oral bacteria, such as Veillonella and Campylobacter. Our study provides an overview of oral plaque microbiota changes under violet LED irradiation, and highlights the potential of this method for adjusting the balance of the oral microbiome without inducing antibiotic resistance.

The use of light in the treatment of acne vulgaris-a review

Topical and oral antibiotic therapy is also a popular method of treatment. The effectiveness of this method is limited by the increasing resistance of bacteria to antibiotics. Over the decades since the introduction of antibiotics to treat acne, the resistance levels of bacteria have changed. This defense mechanism is developed evolutionarily. Modifications of antibiotic receptor sites, alteration of drug influx/efflux, or enzymatic degradation are common mechanisms used by bacteria to initiate and strengthen internal antibiotic resistance. The basic chromophores used in light therapy are hemoglobin, melanin, water bound to proteins, and porphyrins. Hemoglobin absorbs light mainly at 580 nm, while melanin absorbs the entire visible spectral range (400-750 nm). Porphyrins are aromatic compounds, classified as photosensitizing substances, intensively absorbing blue light, and to a lesser extent in long visible bands, such as orange and red light. Using IPL makes it possible to cover the maximum light absorption of porphyrins and hemoglobin, therefore it can be an effective tool in the treatment of inflammatory lesions in acne vulgaris. In view of the effectiveness of light therapy and its effect even on antibiotic-resistant bacteria, it is worth considering the possibility of using light therapy instead of antibiotic therapy. Due to the increasing resistance of bacteria to antimicrobials, they should be used with caution and as a last resort. The high-energy light treatment act only locally (unlike with antibiotics taken orally) and on a chromophore, such as melanin, hemoglobin, or porphyrins.

Complex Electromagnetic Fields Reduce Candida albicans Planktonic Growth and Its Adhesion to Titanium Surfaces

This study evaluates the effects of different programs of complex electromagnetic fields (C.M.F.s) on Candida albicans, in planktonic and sessile phase and on human gingival fibroblasts (HGF cells). In vitro cultures of C. albicans ATCC 10231 and HGF cells were exposed to different cycles of C.M.F.s defined as: oxidative stress, oxidative stress/antibacterial, antibacterial, antibacterial/oxidative stress. Colony forming units (CFUs), metabolic activity, cells viability (live/dead), cell morphology, filamentation analysis, and cytotoxicity assay were performed. The broth cultures, exposed to the different C.M.F.s, were grown on titanium discs for 48 h. The quantity comparisons of adhered C. albicans on surfaces were determined by CFUs and scanning electron microscopy. The C. albicans growth could be readily controlled with C.M.F.s reducing the number of cultivable planktonic cells vs. controls, independently by the treatment applied. In particular, the antibacterial program was associated with lower levels of CFUs. The quantification of the metabolic activity was significantly lower by using the oxidative stress program. Live/dead images showed that C.M.F.s significantly decreased the viability of C. albicans. C.M.F.s inhibited C. albicans virulence traits reducing hyphal morphogenesis, adhesion, and biofilm formation on titanium discs. The MTS assay showed no negative effects on the viability of HGF. Independent of the adopted protocol, C.M.F.s exert antifungal and anti-virulence action against C. albicans, no cytotoxicity effects on HGF and can be useful in the prevention and treatment of yeast biofilm infections.

Can microorganisms develop resistance against light based anti-infective agents?

Recently, there have been increasing numbers of publications illustrating the potential of light-based antimicrobial therapies to combat antimicrobial resistance. Several modalities, in particular, which have proven antimicrobial efficacy against a wide range of pathogenic microbes include: photodynamic therapy (PDT), ultraviolet light (UVA, UVB and UVC), and antimicrobial blue light (aBL). Using these techniques, microbial cells can be inactivated rapidly, either by inducing reactive oxygen species that are deleterious to the microbial cells (PDT, aBL and UVA) or by causing irreversible DNA damage via direct absorption (UVB and UVC). Given the multi-targeted nature of light-based antimicrobial modalities, it has been hypothesised that resistance development to these approaches is highly unlikely. Furthermore, with the exception of a small number of studies, it has been found that resistance to light based anti-infective agents appears unlikely, irrespective of the modality in question. The concurrent literature however stipulates, that further studies should incorporate standardised microbial tolerance assessments for light-based therapies to better assess the reproducibility of these observations.

Photosensitization With Supramolecular Arrays for Enhanced Antimicrobial Photodynamic Treatments

Microbial infections represent a silent threat to health that has worsened in recent decades due to microbial resistance to multiple drugs, preventing the fight against infectious diseases. Therefore, the current postantibiotic era forces the search for new microbial control strategies. In this regard, antimicrobial photodynamic therapy (aPDT) using supramolecular arrays with photosensitizing capabilities showed successful emerging applications. This exciting field makes it possible to combine applied aspects of molecular photochemistry and supramolecular chemistry, together with the development of nano- and biomaterials for the design of multifunctional or "smart" supramolecular photosensitizers (SPS). This minireview aims to collect the concepts of the photosensitization process and supramolecular chemistry applied to the development of efficient applications of aPDT, with a brief discussion of the most recent literature in the field.

Photodynamic Inactivation of Pseudomonas aeruginosa by PHEMA Films Loaded with Rose Bengal: Potentiation Effect of Potassium Iodide

Four formulations have been used to produce different poly(2-hydroxyethyl methacrylate) (PHEMA) thin films, containing singlet oxygen photosensitizer Rose Bengal (RB). The polymers have been characterized employing Thermogravimetric Analysis (TGA), Attenuated Total Reflectance Fourier Transform Infrared Spectroscopy (ATR-FTIR) and UV-vis Absorption Spectroscopy. When irradiated with white light (400-700 nm) films generated singlet oxygen (1O2), as demonstrated by the reactivity with 1O2 trap 9,10-dimethylanthracene (DMA). Material with the highest RB loading (polymer A4, 835 nmol RB/g polymer) was able to perform up to ten cycles of DMA oxygenation reactions at high conversion rates (ca. 90%). Polymer A4 was also able to produce the complete eradication of a Pseudomonas aeruginosa planktonic suspension of 8 log10 CFU/mL, when irradiated with white light (total dose 72 J/cm2). The antimicrobial photodynamic effect was remarkably enhanced by adding potassium iodide (100 mM). In such conditions the complete bacterial reduction occurred with a total light dose of 24 J/cm2. Triiodide anion (I3-) generation was confirmed by UV-vis absorption spectroscopy. This species was detected inside the PHEMA films after irradiation and at concentrations ca. 1 M. The generation of this species and its retention in the matrix imparts long-lasting bactericidal effects to the RB@PHEMA polymeric hydrogels. The polymers here described could find potential applications in the medical context, when optimized for their use in everyday objects, helping to prevent bacterial contagion by contact with surfaces.

Photoinactivation of Pseudomonas aeruginosa Biofilm by Dicationic Diaryl-Porphyrin

In recent years, antimicrobial photodynamic therapy (aPDT) has received increasing attention as a promising tool aimed at both treating microbial infections and sanitizing environments. Since biofilm formation on biological and inert surfaces makes difficult the eradication of bacterial communities, further studies are needed to investigate such tricky issue. In this work, a panel of 13 diaryl-porphyrins (neutral, mono- and di-cationic) was taken in consideration to photoinactivate Pseudomonas aeruginosa. Among cationic photosensitizers (PSs) able to efficiently bind cells, in this study two dicationic showed to be intrinsically toxic and were ruled out by further investigations. In particular, the dicationic porphyrin (P11) that was not toxic, showed a better photoinactivation rate than monocationic in suspended cells. Furthermore, it was very efficient in inhibiting the biofilms produced by the model microorganism Pseudomonas aeruginosa PAO1 and by clinical strains derived from urinary tract infection and cystic fibrosis patients. Since P. aeruginosa represents a target very difficult to inactivate, this study confirms the potential of dicationic diaryl-porphyrins as photo-activated antimicrobials in different applicative fields, from clinical to environmental ones.

Silver nanoprisms as plasmonic enhancers applied in the photodynamic inactivation of Staphylococcus aureus isolated from bubaline mastitis

Mastitis is a bacterial infection that affects all lactating mammals, and in dairy cattle, it leads to a reduction in their milk production and, in worse cases, it may lead to animal death. One viable therapeutic modality for overcoming bacterial resistance can be photodynamic inactivation (PDI), a therapeutic modality for bacterial infection treatment. One of the main factors that can lead to an efficient PDI process is the association of metallic nanoparticles in the close vicinity of photosensitizers, which has shown promising results due to localized surface plasmon resonance phenomena. In this work, methylene blue (MB) molecules were associated with Ag prismatic nanoplatelets (AgNPrs) to use as PDI photosensitizer against Staphylococcus aureus isolated from bubaline mastitis. The optical plasmonic activity of AgNPrs was tuned to the MB absorption region (600-700 nm) by inducing their growth into prismatic shapes by a seed-mediated procedure, using poly (sodium 4-styrene sulfonate) as the surfactant. A simulation on the plasmonic properties of the nanoprisms, applying particle size within the dimensions determined by TEM image analysis (d = 32 ± 6 nm), showed a 30 % increase of the incident field on the prismatic tips. Photodynamic results showed that the electrostatic AgNPr-MB conjugates promoted enhancement (ca. 15 %) of the reactive oxygen species production. Besides, PDI mediated by AgNPrs-MB led to the complete inactivation of the mastitis S. aureus strain after 6 min inactivation, in contrast to PDI mediated by MB, which reduced less than a 0.5 bacterial log. Thus, the results show this plasmonic enhanced photodynamic tool's potential to be applied in the inactivation of multi-resistant bacterial strains.

Caffeic Acid and Its Derivatives: Antimicrobial Drugs toward Microbial Pathogens

Caffeic acid is a plant-derived compound that is classified as hydroxycinnamic acid which contains both phenolic and acrylic functional groups. Caffeic acid has been greatly employed as an alternative strategy to combat microbial pathogenesis and chronic infection induced by microbes such as bacteria, fungi, and viruses. Similarly, several derivatives of caffeic acid such as sugar esters, organic esters, glycosides, and amides have been chemically synthesized or naturally isolated as potential antimicrobial agents. To overcome the issue of water insolubility and poor stability, caffeic acid and its derivative have been utilized either in conjugation with other bioactive molecules or in nanoformulation. Besides, caffeic acid and its derivatives have also been applied in combination with antibiotics or photoirradiation to achieve a synergistic mode of action. The present review describes the antimicrobial roles of caffeic acid and its derivatives exploited either in free form or in combination or in nanoformulation to kill a diverse range of microbial pathogens along with their mode of action. The chemistry employed for the synthesis of the caffeic acid derivatives has been discussed in detail as well.

Modulating photochemical reactions in Langmuir monolayers of Escherichia coli lipid extract with the binding mechanisms of eosin decyl ester and toluidine blue-O photosensitizers

Photodynamic damage to the cell envelope can inactivate microorganisms and may be applied to combat super-resistance phenomenon, empowered by the indiscriminate use of antibiotics. Efficiency in microbial inactivation is dependent on the incorporation of photosensitizers (PS) into the bacterial membranes to trigger oxidation reactions under illumination. Herein, Langmuir monolayers of Escherichia coli lipid extract were built to determine the binding mechanisms and oxidation outcomes induced by eosin decyl ester (EosDEC) and toluidine blue-O (TBO) PSs. Surface-pressure isotherms of the E. coli monolayers were expanded upon EosDEC and TBO, suggesting incorporation of both PSs. Fourier-transform infrared spectroscopy (FTIR) of Langmuir-Schaefer (LS) films reveled that the EosDEC and TBO binding mechanisms are dominated by electrostatic interactions with the anionic polar groups, with limited penetration into the chains. Light-irradiation reduced the relative area of E. coli monolayer on TBO, indicating an increased loss of material to the subphase owing to the chain cleavage, generated by contact-dependent reactions with excited states of TBO. In contrast, the increased relative area of E. coli monolayers containing EosDEC suggests lipid hydroperoxidation, which is PS contact-independent. Even considering a small chain penetration, the saturated EosDEC may have partitioned towards saturated reach domains, avoiding direct contact with membrane unsaturations.

Turning Photons into Drugs: Phthalocyanine-Based Photosensitizers as Efficient Photoantimicrobials

One of the most promising alternatives for treating bacterial infections is antimicrobial photodynamic therapy (aPDT), making the synthesis and application of new photoactive compounds called photosensitizers (PS) a dynamic research field. In this regard, phthalocyanine (Pc) derivatives offer great opportunities due to their extraordinary light-harvesting and tunable electronic properties, structural versatility, and stability. This Review, rather than focusing on synthetic strategies, intends to overview current progress in the structural design strategies for Pcs that could achieve effective photoinactivation of microorganisms. In addition, the Review provides a concise look into the recent developments and applications of nanocarrier-based Pc delivery systems.

Inactivation Effect of Violet and Blue Light on ESKAPE Pathogens and Closely Related Non-pathogenic Bacterial Species - A Promising Tool Against Antibiotic-Sensitive and Antibiotic-Resistant Microorganisms

Due to the globally observed increase in antibiotic resistance of bacterial pathogens and the simultaneous decline in new antibiotic developments, the need for alternative inactivation approaches is growing. This is especially true for the treatment of infections with the problematic ESKAPE pathogens, which include Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species, and often exhibit multiple antibiotic resistances. Irradiation with visible light from the violet and blue spectral range is an inactivation approach that does not require any additional supplements. Multiple bacterial and fungal species were demonstrated to be sensitive to this disinfection technique. In the present study, pathogenic ESKAPE organisms and non-pathogenic relatives are irradiated with visible blue and violet light with wavelengths of 450 and 405 nm, respectively. The irradiation experiments are performed at 37°C to test a potential application for medical treatment. For all investigated microorganisms and both wavelengths, a decrease in colony forming units is observed with increasing irradiation dose, although there are differences between the examined bacterial species. A pronounced difference can be observed between Acinetobacter, which prove to be particularly light sensitive, and enterococci, which need higher irradiation doses for inactivation. Differences between pathogenic and non-pathogenic bacteria of one genus are comparatively small, with the tendency of non-pathogenic representatives being less susceptible. Visible light irradiation is therefore a promising approach to inactivate ESKAPE pathogens with future fields of application in prevention and therapy.

Insights on recent approaches in drug discovery strategies and untapped drug targets against drug resistance

BACKGROUND

Despite the various strategies undertaken in the clinical practice, the mortality rate due to antibiotic-resistant microbes has been markedly increasing worldwide. In addition to multidrug-resistant (MDR) microbes, the "ESKAPE" bacteria are also emerging. Of course, the infection caused by ESKAPE cannot be treated even with lethal doses of antibiotics. Now, the drug resistance is also more prevalent in antiviral, anticancer, antimalarial and antifungal chemotherapies.

MAIN BODY

To date, in the literature, the quantum of research reported on the discovery strategies for new antibiotics is remarkable but the milestone is still far away. Considering the need of the updated strategies and drug discovery approaches in the area of drug resistance among researchers, in this communication, we consolidated the insights pertaining to new drug development against drug-resistant microbes. It includes drug discovery void, gene paradox, transposon mutagenesis, vitamin biosynthesis inhibition, use of non-conventional media, host model, target through quorum sensing, genomic-chemical network, synthetic viability to targets, chemical versus biological space, combinational approach, photosensitization, antimicrobial peptides and transcriptome profiling. Furthermore, we optimally briefed about antievolution drugs, nanotheranostics and antimicrobial adjuvants and then followed by twelve selected new feasible drug targets for new drug design against drug resistance. Finally, we have also tabulated the chemical structures of potent molecules against antimicrobial resistance.

CONCLUSION

It is highly recommended to execute the anti-drug resistance research as integrated approach where both molecular and genetic research needs to be as integrative objective of drug discovery. This is time to accelerate new drug discovery research with advanced genetic approaches instead of conventional blind screening.

Photodynamic inactivation of Staphylococcus aureus using tetraethylene glycol-substituted Zn(II) phthalocyanine

Methicillin resistant Staphylococcus aureus infections are increasing, especially in intensive care units. A new method for photodynamic inactivation (PDI) generates reactive oxygen species by photosensitization to kill bacteria. We investigated the PDI effect of tetraethylene glycol-substituted Zn(II) phthalocyanine (TEG-P) on S. aureus strains including two standards (ATCC 25923 and ATCC 43400) and 20 clinically isolated methicillin sensitive and 20 methicillin resistance strains. We also investigated three treated groups: 650 nm laser only, TEG-P only and TEG-P + laser, plus one control group. Treatments included 0.5, 1, 2, 4, 8, 16, 32 µg/ml concentrations of TEG-P. No suppression of bacterial growth was observed in the control, laser only and TEG-P only groups whether or not S. aureus was methicillin resistant. Bacterial growth was suppressed by 85% using 8 µg/ml TEG-P and completely suppressed by 32 µg/ml TEG-P in the TEG-P + laser group. A combination of TEG-P + laser treatment may be an alternative to conventional antibiotics for routine treatment of S. aureus infections, although further investigation of the effect at the tissue level is required.

Photodynamic therapy of tumour cells mediated by the natural anthraquinone parietin and blue light

Photodynamic therapy (PDT) is a treatment for superficial tumours involving the administration of a photosensitiser followed by irradiation. The potential of the natural anthraquinone parietin (PTN) in PDT is still relatively unexploited. In the present work, PTN isolated from the lichen Teoloschistes nodulifer (Nyl.) Hillman (Telochistaceae) was evaluated as a potential photosensitiser on tumour cells employing UVA-Vis and blue light. Blue light of 2 J/cm² induced 50% death of K562 leukaemic cells treated 1 h with 30 μM PTN (Protocol a). Higher light doses (8 J/cm²) were needed to achieve the same percentage of cell death employing lower PTN concentrations (3 μM) and higher exposure times (24 h) (Protocol b). Cell cycle analysis after both protocols of PTN-PDT revealed a high percentage of sub-G1 cells. PTN was found to be taken up by K562 cells mainly by passive diffusion. Other tumour cells such as ovary cancer IGROV-1 and LM2 mammary carcinoma, as well as the normal keratinocytes HaCaT, were also photosensitised with PTN-PDT. We conclude that PTN is a promising photosensitiser for PDT of superficial malignancies and purging of leukaemic cells, when illuminated with blue light. Thus, this light wavelength is proposed to replace the Vis-UVA lamps generally employed for the photosensitisation of anthraquinones.

Antimicrobial Activity of an Implantable Wireless Blue Light-Emitting Diode Against Root Canal Biofilm In Vitro

Objective: We developed an implantable wireless blue micro light-emitting diode (micro-LED) device and evaluated the utility of continuous antimicrobial blue light (aBL) irradiation emitted from this micro-LED for root canal disinfection. Methods: An implantable wireless blue micro-LED device (peak wavelength: 410 nm, maximum power: 15 mW) was developed to be placed in the root canal. Optical transmission of the device in human dentin tissue was simulated using Monte Carlo ray-tracing method. The bactericidal effect of low-level aBL on planktonic root canal infection-related bacteria [Enterococcus faecalis, methicillin-resistant Streptococcus aureus (MRSA), and Prevotella intermedia] was evaluated by colony counting. The biocompatibility of continuous low-level aBL exposure was evaluated by infrared thermal imaging and cell viability tests. Thirty extracted intact human single-rooted teeth were prepared and the root canals were infected with E. faecalis for 14 days to form biofilm. The infected root canals were randomly divided into three groups (n = 10), and treated with normal saline (group NS), calcium hydroxide (group CH), and micro-LED device (group aBL) for 3 and 7 days. The bactericidal effect of each group was evaluated by confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). Results: Monte Carlo simulation showed that blue light irradiation of the micro-LED device decreased exponentially with the light transmission distance through human dentin tissue. Planktonic E. faecalis, MRSA, and P. intermedia were significantly eliminated after irradiation with 432, 36, and 1.35 J/cm² aBL, respectively (p < 0.05). Infrared thermal imaging and cell viability tests showed that continuous aBL exposure is biocompatible in vitro. CLSM and SEM analyses revealed that the micro-LED device had a greater antimicrobial effect than CH on E. faecalis biofilm in the root canal. Conclusions: The wireless blue micro-LED device is a promising and user-friendly approach for root canal disinfection that will facilitate infection control in the root canal using aBL.

Photoinactivation results of Enterococcus moraviensis with blue and violet light suggest the involvement of an unconsidered photosensitizer

Microorganisms can be photoinactivated with 405 and 450 nm irradiation, due to endogenous photosensitizers, which absorb light of these wavelengths and generate reactive oxygen species that destroy the cells from within. The photosensitizers assumed to be responsible are porphyrins in the spectral region around 405 nm and flavins at about 450 nm. The aim of this study was to investigate this hypothesis on enterococci, considering that they do not contain porphyrins. In photoinactivation experiments with Enterococcus moraviensis, 405 nm and 450 nm irradiation both led to a reduction of the bacterial concentration by several orders of magnitude with 405 nm irradiation being much more efficient. The measurement and analysis of the fluorescence spectra revealed no signs of porphyrins whereas flavins seemed to be rapidly converted to lumichrome by 405 nm radiation. Therefore, probably none of the usual suspects, porphyrins and flavins, was responsible for the photoinactivation of Enterococcus moraviensis during 405 nm irradiation. Fluorescence experiments revealed the spectra of lumichrome and NADH, which are both known photosensitizers. Presumably, one of them or both were actually involved here. As NADH and flavins (and therefore their photodegradation product lumichrome) are abundant in all microorganisms, they are probably also involved in 405 nm photoinactivation processes of other species.

Photobiomodulation Enhances the Healing of Postextraction Alveolar Sockets: A Randomized Clinical Trial With Histomorphometric Analysis and Immunohistochemistry

PURPOSE

Wound healing of postextraction sockets is a complex process that permits to reach the bone reformation in about 3 months, and that could be characterized by the presence of some complications, mainly dependent on the duration of the surgery. The aim of this study is to evaluate the impact of photobiomodulation (PBMT) on the healing processes of mucosa overlying postextraction alveolus and on related complications.

METHODS

Twenty systemically healthy patients who needed to extract both lower third molars were selected in a private clinic and included in this prospective split-mouth randomized clinical trial. Inclusion criteria were no smokers subjects with the necessity to extract both lower third molars with surgeries overlapping for duration and difficulty. A computer-based randomization procedure was permitted to choose the side, subject to PBMT, by means of a neodymium-doped YAG (Nd: YAG) laser (test) and controls. Both surgeries were performed by the same operator with a gap of 40 days. Twenty-two days after each surgery, a biopsy in correspondence to the alveolar mucosa of the socket was obtained from both sites and observed with an optical microscope and analyzed with histomorphometric analysis and immunohistochemistry.

RESULTS

Each of the 20 participants included in this study (11 women and 9 men, nonsmokers, mean age 16 years in the range of 15 to 17 years) were subjected to the extraction of both lower third molars, and a side was treated as control, the other, as the test. The histomorphometric analysis and immunohistochemistry showed that the tested sites, contrary to controls, were characterized by a lower presence of inflammatory cells, a more mature epithelium and myofibroblasts incorporated in a network of fibers parallel to the basal membrane, with little positivity to alpha-SMA antibodies and anti-myosin but positivity to anti-desmin.

CONCLUSIONS

In conclusion, PBMT accelerates the healing process of postextraction alveolus after third molar extraction.