Positive effects of low-dose photodynamic therapy with aminolevulinic acid or its methyl ester in skin rejuvenation and wound healing: An update

Role of fibroblast autophagy and proliferation in skin anti-aging

Skin, as the outermost protective barrier of the body, becomes damaged with age and exposure to external stimuli. Dermal fibroblasts age and undergo apoptosis, which decreases collagen, collagen fibers, elastic fibers, hyaluronic acid, etc., leading skin to loss of elasticity and appearance of wrinkles. Skin aging is complex, involving several biological reactions，and various treatment methods are used to treat it. This review focuses on the importance of autophagy and cell proliferation in skin anti-aging, summarizes research progress on skin anti-aging by regulating autophagy and promoting the proliferation of dermal fibroblasts, and discusses future directions on skin anti-aging research.

Expected role of photodynamic therapy to relieve skin damage in nuclear or radiological emergency: Review

Nuclear and radiological accidents can occur due to poor management, in transportation, radiation therapy and nuclear wards in hospitals, leading to extreme radiation exposure and serious consequences for human health. Additionally, in many of previous radiological accidents, skin damage was observed in patients and survivors due to the high radiation exposure. However, as part of a medical countermeasures in a nuclear/radiological emergency, it is critical to plan for the treatment of radiation-induced skin damage. Hence, the new, non-invasive technology of photodynamic therapy (PDT) is projected to be more effectively used for treating skin damage caused by high-dose radiation. PDT plays an important role in treating, repairing skin damage and promoting wound healing as evidenced by research. This review, highlighted and recommended potential impacts of PDT to repair and decrease radiation-induced skin tissue damage. Moreover, we have suggested some photosensitizer (PS) agent as radio-mitigator drugs to decrease radiobiological effects.

Photodynamic treatment increases the lifespan and oxidative stress resistance of Caenorhabditis elegans

Photodynamic therapy is a noninvasive treatment in which specific photosensitizers and light are used to produce high amounts of reactive oxygen species (ROS), which can be employed for targeted tissue destruction in cancer treatment or antimicrobial therapy. However, it remains unknown whether lower amounts of ROS produced by mild photodynamic therapy increase lifespan and stress resistance at the organism level. Here, we introduce a novel photodynamic treatment (PDTr) that uses 20 μM hypericin, a photosensitizer that originates from Hypericum perforatum, and orange light (590 nm, 5.4 W/m2, 1 min) to induce intracellular ROS formation (ROS), thereby resulting in lifespan extension and improved stress resistance in C. elegans. The PDTr-induced increase in longevity was abrogated by N-acetyl cysteine, suggesting the hormetic response was driven by prooxidative mechanisms. PDTr activated the translocation of SKN-1/NRF-2 and DAF-16/FOXO, leading to elevated expression of downstream oxidative stress-responsive genes, including ctl-1, gst-4, and sod-3. In summary, our findings suggest a novel PDTr method that extends the lifespan of C. elegans under both normal and oxidative stress conditions through the activation of SKN-1 and DAF-16 via the involvement of many antioxidant genes.

Photodynamic Therapy Healing a Refractory Radiation-Induced Ulcer on the Chest Wall Postmastectomy Radiotherapy for Breast Cancer: A Case Report and Literature Overview

Photodynamic therapy (PDT) has been used to treat cancers. It has also been used to treat infectious diseases and inflammatory conditions. PDT promotes wound healing, while clinical use of PDT for wound healing is uncommon and not thoroughly investigated. We report a 75-year-old female with a radiation-induced non-healing ulcer for five years on the chest wall postmastectomy radiotherapy. Biopsy showed epidermal erosion with dermal inflammation but no recurrent cancer. She was referred from the wound care clinic after multiple unsuccessful attempts to manage wound healing for two years involving daily home nursing visits. PDT was discussed with the patient who consented to PDT instead of hyperbaric oxygen therapy (HBOT) for fear of its side effects. Her wound improved after a total of three treatments and the process of wound healing continued for 14 months since her first treatment session. The presented case supports the beneficial effects of PDT on chronic ulceration impeding healing of a postmastectomy radiotherapy wound. To our knowledge, this report is unique in documenting details of PDT healing a chronic refractory ulcer of five years, which developed after cancer therapy (mastectomy and radiotherapy). Further clinical study of PDT is needed on wound healing post-surgery and radiation in cancer patients. An overview of HBOT in comparison with PDT for wound healing is presented.

Clinical trial of two-step photodynamic therapy for reduced pain in the treatment of precancerous squamous lesions (Actinic keratoses)

BACKGROUND

Pain associated with aminolevulinic acid photodynamic therapy (ALA-PDT) for the treatment of facial dermatoses results in low patient compliance. Two-step photodynamic therapy (two-step PDT) may improve comfort by optimizing light amplitude and exposure time.

OBJECTIVE

To investigate the efficacy of two-step PDT in reducing the pain generated during the treatment of facial skin disorders.

METHODS

Twenty-six patients with AK were randomly divided into two groups; the experimental group was treated with two-step photodynamic therapy and the control group was treated with conventional photodynamic therapy. The pain intensity of the patients at different times was assessed using the pain numerical rating scale (NRS).

RESULTS

A total of 26 patients completed three ALA-PDT treatments, 13 and 13 patients in each group, respectively. The mean NRS scores of patients in the experimental group (3.28±1.41, 3.33±1.43, 3.42±1.78) were lower than those of the control group (5.00±1.94, 5.09±1.86, 4.86±1.64) on each occasion. The incidence of certain adverse reactions was lower in the experimental group than in the control group. There was no difference between the two groups in terms of clinical outcome, recurrence rate and patient satisfaction.

CONCLUSION

Two-step photodynamic therapy can reduce pain and the incidence of some adverse reactions, but does not affect clinical efficacy, recurrence rate and patient satisfaction.

5-aminolevulinic acid photodynamic therapy protects against UVB-induced skin photoaging: A DNA-repairing mechanism involving the BER signalling pathway

Low-dose 5-aminolevulinic acid photodynamic therapy (ALA-PDT) has been used to cope with skin photoaging, and is thought to involve DNA damage repair responses. However, it is still unknown how low-dose ALA-PDT regulates DNA damage repair to curb skin photoaging. We established a photoaging model using human dermal fibroblasts (HDFs) and rat skin. RNA-sequencing (RNA-seq) analysis was conducted to identify differentially expressed genes (DEGs) in HDFs before and after low-dose ALA-PDT treatment, followed by bioinformatics analysis. Senescence-associated β-galactosidase (SA-β-gal) staining was employed to assess skin aging-related manifestations and Western blotting to evaluate the expression of associated proteins. A comet assay was used to detect cellular DNA damage, while immunofluorescence to examine the expression of 8-hydroxy-2'-deoxyguanosine (8-oxo-dG) in cells and skin tissues. In both in vivo and in vitro models, low-dose ALA-PDT alleviated the manifestations of ultraviolet B (UVB)-induced skin photoaging. Low-dose ALA-PDT significantly reduced DNA damage in photoaged HDFs. Furthermore, low-dose ALA-PDT accelerated the clearance of the photoproduct 8-oxo-dG in photoaged HDFs and superficial dermis of photoaged rat skin. RNA-seq analysis suggested that low-dose ALA-PDT upregulated the expression of key genes in the base excision repair (BER) pathway. Further functional validation showed that inhibition on BER expression by using UPF1069 significantly suppressed SA-β-gal activity, G2/M phase ratio, expression of aging-associated proteins P16, P21, P53, and MUTYH proteins, as well as clearance of the photoproduct 8-oxo-dG in photoaged HDFs. Low-dose ALA-PDT exerts anti-photoaging effects by activating the BER signalling pathway.

Anti-aging Effects of Tirbanibulin 1% Ointment: A Real-Life Experience

INTRODUCTION

Tirbanibulin 1% ointment has been licensed to treat non-hyperkeratotic actinic keratosis (AKs) on the face and scalp in adults to ensure excellent patient tolerability due to the mild side effects and the brief application time compared to other topical therapies on the market. A growing body of evidence suggests that, beyond their primary function, the treatments for AKs and the cancerization field may inadvertently confer substantial cosmetic benefits to patients.

METHODS

We report a single-center retrospective case series of patients referred to the Dermatology Unit of the University Hospital of Messina, Italy, between February and December 2023 seeking treatment for AKs in the context of photodamaged areas in which the application of tirbanibulin 1% ointment induced, besides clearance of AKs, anti-aging effects on both skin texture and solar lentigos.

RESULTS

Seven patients affected by Olsen grade 1-2 AKs experienced a powerful rejuvenating effect in the treated areas, with a marked efficacy in skin lightening and clearance of solar lentigo.

CONCLUSIONS

Tirbanibulin 1% ointment seems able to improve skin aging as a desirable side effect at the site of application for AKs on chronic photodamaged skin. Such preliminary observation needs further confirmation in real-life studies on larger cohorts of patients, to explain the pathogenic mechanisms responsible for such aesthetically relevant results.

Low-level photodynamic therapy in chronic wounds

BACKGROUND

Chronic wounds refer to those that can't reconstruct anatomical and physical functional integrity, and are usually associated with signs of microbial infection. Current therapies include debridement and dressing change, local or systemic application of antibiotics, and medical dressing care, which are not ideal for the healing of chronic wounds.

OBJECTIVE

To explore the efficacy and safety of photodynamic therapy (ALA-PDT) for the treatment of chronic infectious wounds.

MATERIALS AND METHODS

ALA-PDT was used in ten patients with persistent wound infections and systemic complications who did not respond to conventional treatment. 5 % ALA solution was applied to the wound surface after debridement, incubated for 3 h with light protection, and then irradiated with red light for 20 min. This procedure was repeated every two weeks, and any adverse reactions were recorded. After the end of three treatments, the patients were followed up for 3 months.

RESULTS

Patients who exhibit resistance to traditional therapies demonstrate a favorable therapeutic outcome with ALA-PDT, although complications may impede wound healing. All participants successfully underwent ALA-PDT treatment and subsequent monitoring, with 90 % achieving complete healing. Common adverse reactions to ALA-PDT encompass treatment-related pain, temporary erythema, and swelling, all of which are well-tolerated by patients without enduring severe consequences.

CONCLUSIONS

ALA-PDT proves to be an efficacious intervention for managing chronic wounds, irrespective of the presence of localized infections or systemic complications.

Autofluorescence spectroscopy in photodynamic therapy for skin rejuvenation: A theranostic approach in aesthetic medicine

BACKGROUND

The method of photodynamic therapy for skin rejuvenation (PDT-SR) provides an improvement in appearance with a safe and painless effect. The quality of treatment is most often assessed subjectively. The most informative morphological control methods are rarely used due to the invasiveness of the sampling procedure.

AIM

This study aimed to find out the possibility of using skin autofluorescence spectroscopy (SAF) for an objective assessment of changes occurring in the skin during PDT-SR.

METHODS

This study included 12 volunteers (10 women, 2 men) aged 32 to 79 years. Two (n = 6) or three (n = 6) PDT sessions were performed at intervals of 13-30 days. Photosensitizer chlorin e6, exposure 20 min, energy density 18-24 J/cm2 were used. SAF spectra were recorded using a two-wavelength fiber optic spectrometer under excitation at wavelengths (λex) of 365 nm and 440 nm. Measurements were made both before and after each PDT session and up to 25-238 days from the start of treatment. For the evaluation, we used the spectra AF365(λ) and AF440(λ) averaged over 40 points corrected for diffuse reflection at λex=440 nm in the range λem= 460-700 nm, as well as the spectra of the ratios AFN365(λ) and AFN440(λ), which were obtained by dividing the intensities of the current spectra by the intensities collected before PDT-SR.

RESULTS

PDT-SR led to changes in both the intensity and shape of the spectra. Analysis of the spectra using numerical fitting of the spectra showed that the main changes can be explained by changes in the content of advanced glycation end products (AGEs), as well as lipofuscin-like lipopigments (LPs) and porphyrins (PPs). The spectra of AGEs upon excitation at wavelengths of 365 and 440 nm differ, which may be due to the formation of two types of bonds, with collagen and elastin. By the end of the study, the vast majority of the examined volunteers showed a significant decrease of the parameters characterizing both of these types of AGEs, AGE365 (0.56-1.2) and AGE440 (0.58-1.01), relative to the beginning of the study. In most cases, a decrease was also noted for LPs and PPs. AGE365 and AGE440 were positively correlated with the age of the volunteers (r2 = 0.26-0.46 %). A steady decrease in the content of AGEs occurred approximately on the 40th day.

CONCLUSION

SAF spectroscopy makes it possible to assess changes in the content of AGEs, LPs, and PPs in the skin during PDT-SR. The method has great potential for non-invasive monitoring of the treatment process, as well as its improvement, including through its personalization. In addition, the method can be used to study the mechanisms of age-related skin changes at the molecular level and to study the processes of rejuvenation.

Encapsulation in Oxygen-Loaded Nanobubbles Enhances the Antimicrobial Effectiveness of Photoactivated Curcumin

In both healthcare and agriculture, antibiotic resistance is an alarming issue. Biocompatible and biodegradable ingredients (e.g., curcumin) are given priority in "green" criteria supported by the Next Generation EU platform. The solubility and stability of curcumin would be significantly improved if it were enclosed in nanobubbles (NB), and photoactivation with the correct wavelength of light can increase its antibacterial efficacy. A continuous release of curcumin over a prolonged period was provided by using innovative chitosan-shelled carriers, i.e., curcumin-containing nanobubbles (Curc-CS-NBs) and oxygen-loaded curcumin-containing nanobubbles (Curc-Oxy-CS-NBs). The results demonstrated that after photoactivation, both types of NBs exhibited increased effectiveness. For Staphylococcus aureus, the minimum inhibitory concentration (MIC) for Curc-CS-NBs remained at 46 µg/mL following photodynamic activation, whereas it drastically dropped to 12 µg/mL for Curc-Oxy-CS-NBs. Enterococcus faecalis shows a decreased MIC for Curc-CS-NB and Curc-Oxy-CS-NB (23 and 46 µg/mL, respectively). All bacterial strains were more effectively killed by NBs that had both oxygen and LED irradiation. A combination of Curc-Oxy-CS-NB and photodynamic stimulation led to a killing of microorganisms due to ROS-induced bacterial membrane leakage. This approach was particularly effective against Escherichia coli. In conclusion, this work shows that Curc-CS-NBs and Curc-Oxy-CS-exhibit extremely powerful antibacterial properties and represent a potential strategy to prevent antibiotic resistance and encourage the use of eco-friendly substitutes in agriculture and healthcare.

Research progress and insights on the role of ferroptosis in wound healing

Ferroptosis is a newly discovered cell death type which is different from apoptosis, autophagy, pyroptosis as well as necrosis in the following aspects: morphology, biochemistry, gene and regulatory mechanisms. Ferroptosis is regulated by multiples of mechanisms such as system Xc- mechanism, glutathione peroxidase 4 (GPX4) mechanism, iron metabolism and lipid metabolism. Currently, ferroptosis has been revealed to be significant in wound healing such as diabetic wound, irradiated wound and ultraviolet (UV)-driven wound. Hence, how to intervene in the pathogenesis as well as the development of wounds and promote the wound healing by the regulation of ferroptosis have become a research hotspot. This review systematically summarises the latest scientific advances of ferroptosis and wound healing fields, with hoping to propose a new insight and advance in the wound treatment.