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Chhabrani A, Avinash BS, Bharadwaj RS, Gupta M. Laser light: Illuminating the path to enhanced periodontal care. Photodiagnosis Photodyn Ther 2024; 46:104036. [PMID: 38438004 DOI: 10.1016/j.pdpdt.2024.104036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/03/2024] [Accepted: 03/01/2024] [Indexed: 03/06/2024]
Abstract
The utilisation of laser technology in the realm of periodontal care represents a significant advancement in clinical practice. This article delves into the historical context of laser therapy in medicine, from its inception in 1960 to its evolution into low-level laser therapy (LLLT). LLLT, often referred to as photobiomodulation (PBM), has garnered attention due to its potential to enhance periodontal treatment outcomes. The article thoroughly examines the mechanisms of action of photobiomodulation therapy PBM(T), covering its impact on cellular and tissue levels. The authors explore the evidence-based recommendations for the use of PBM(T) in periodontal care, shedding light on its potential to improve periodontal conditions, especially when applied as an adjunct to conventional treatments. They investigate the role of PBM(T) in individuals and its possible contribution to periodontal health. Additionally, the article delves into its application in periodontal regenerative procedures and its ability to expedite soft tissue wound healing and the effects of PBM(T) in reducing periodontal inflammation and mitigating post-periodontal surgery discomfort. In conclusion, the article calls for enhanced clinical research to streamline laser procedures, develop antimicrobial photodynamic therapy, and conduct well-designed randomised controlled trials (RCTs). It also emphasises the importance of understanding the impact of laser therapy on therapeutic and biological goals, the potential to reduce invasive procedures, and the necessity of adequate research funding.
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Affiliation(s)
- Ankita Chhabrani
- Department of Periodontology, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Room No-09, Mysuru, Karnataka 570015, India
| | - B S Avinash
- Department of Periodontology, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Room No-09, Mysuru, Karnataka 570015, India.
| | - R Sumukh Bharadwaj
- Department of Periodontology, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Room No-09, Mysuru, Karnataka 570015, India
| | - Muskan Gupta
- Department of Periodontology, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Room No-09, Mysuru, Karnataka 570015, India
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Tsuge AT, Pereira JDJ, Vollet-Filho JD, Kubrusly MS, Galvão FHF, Ribeiro ON, Moreno CR, Ikegami RN, Chaib E, Castro E Silva OD. Study of laser fluorescence spectroscopy in livers of rats with hypothermic ischemia. Acta Cir Bras 2023; 38:e386023. [PMID: 38055396 DOI: 10.1590/acb386023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/09/2023] [Indexed: 12/08/2023] Open
Abstract
PURPOSE After partial hepatectomy (PH), the remaining liver (RL) undergoes regenerative response proportional to the host. Limited literature exists on hepatic viability after tissue injury during hypothermic preservation. Spectroscopy measures cellular fluorescence and is explored for tissue characterization and parameter investigation. This study aimed to assess fluorescence analysis (spectroscopy) in evaluating liver viability and its relationship with hepatic tissue regeneration 24 hours after PH. Additionally, we analyzed liver regeneration in RL after 70% partial hepatectomy under hypothermic conditions with laser irradiation. METHODS Fifty-six Wistar rats were divided into four groups: total non-perfused liver (control), total perfused liver, partial hepatectomy "in situ", and partial hepatectomy "ex situ". Tissue analysis was performed at 0 and 24 hours using spectroscopy with laser devices emitting at 532 (green) and 405 nm (violet). RESULTS Spectroscopy identified tissue viability based on consistent results with Ki67 staining. The fluorescence spectra and Ki67 analysis displayed similar patterns, linking proliferative activity and absorption intensity. CONCLUSIONS Fluorescence spectroscopy proves to be promising for real-time analysis of cellular activity and viability. Metabolic activity was observed in groups of live animals and hypothermically preserved samples, indicating cellular function even under blood deprivation and hypothermic conditions.
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Affiliation(s)
- Allison Takeo Tsuge
- Universidade de São Paulo - Faculdade de Medicina de Ribeirão Preto - Departamento de Cirurgia e Anatomia -São Paulo(São Paulo), Brazil
| | | | | | - Márcia Saldanha Kubrusly
- Universidade de São Paulo - Hospital das Clínicas - Departamento de Gastroenterologia - São Paulo (SP), Brazil
| | - Flávio Henrique Ferreira Galvão
- Universidade de São Paulo - Hospital das Clínicas - Laboratório de Transplante e Cirurgia de Fígado - São Paulo (SP), Brazil
| | | | - Camila Rodrigues Moreno
- Universidade de São Paulo - Hospital das Clínicas - Instituto do Coração - São Paulo (SP), Brazil
| | - Renata Nishiyama Ikegami
- Universidade de São Paulo - Hospital das Clínicas - Instituto do Coração - São Paulo (SP), Brazil
| | - Eleazar Chaib
- Universidade de São Paulo - Hospital das Clínicas - Laboratório de Transplante e Cirurgia de Fígado - São Paulo (SP), Brazil
| | - Orlando de Castro E Silva
- Universidade de São Paulo - Faculdade de Medicina de Ribeirão Preto - Departamento de Cirurgia e Anatomia -São Paulo(São Paulo), Brazil
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Araújo TG, Oliveira AG, Franchi Teixeira AR. Low-Power Laser Irradiation (LPLI): A Clinical Point of View on a Promising Strategy to Improve Liver Regeneration. J Lasers Med Sci 2018; 9:223-227. [PMID: 31119014 DOI: 10.15171/jlms.2018.40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The capacity of the liver to regenerate is an important clinical issue after major hepatectomies and makes the difference between life and death in some cases of post-operative malfunction when the liver remnant is too small or has an impaired regenerative capacity. Several approaches have been tested to stimulate hepatic regeneration after post-operative hepatic failure syndrome; however, they have produced controversial results. A quick, simple, and harmless method that can be used intraoperatively and capable of promoting an increased regenerative capacity of the remaining liver would be very welcome. Thus, based on the data in the literature, we presented low-power laser irradiation (LPLI) as a quick, simple, and harmless method to improve liver regeneration after major hepatectomies. This article highlights the current evidence about the effects of LPLI on liver regeneration, and also suggests laser therapy as an important tool for regenerative stimulation in clinical practice.
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Affiliation(s)
- Tiago Gomes Araújo
- Department of Internal Medicine, State University of Campinas (UNICAMP), Campinas, SP, Brazil.,Department of Physiology and Pharmacology, Federal University of Pernambuco (UFPE), Recife, PE, Brazil
| | - Alexandre Gabarra Oliveira
- Department of Internal Medicine, State University of Campinas (UNICAMP), Campinas, SP, Brazil.,Institute of Biosciences Institute, São Paulo State University (UNESP), Rio Claro, SP, Brazil
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Effect of photobiomodulation on ischemia/reperfusion-induced renal damage in diabetic rats. Lasers Med Sci 2016; 31:1943-1948. [DOI: 10.1007/s10103-016-2073-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/05/2016] [Indexed: 10/24/2022]
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Mumic FT, Silveira MRGD, Vilalva KH, Jordani ME, Gomes MCJ, Vanni JC, Vollet Filho JD, Kurachi C, Bagnato VS, Silva ODCE. Effect of irradiation with different laser wavelengths on oxidative stress of non-hepatectomized rats. Acta Cir Bras 2016; 31 Suppl 1:40-4. [DOI: 10.1590/s0102-86502016001300009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Marques JM, Pacheco-Soares C, Da Silva NS. Evaluation of the photobiomodulation in L929 cell culture. Exp Biol Med (Maywood) 2014; 239:1638-43. [PMID: 25092826 DOI: 10.1177/1535370214542070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Low-level laser therapy has become an important tool for bio-modulation process. It can induce stimulatory or inhibitory effects according to cell behavior at specific irradiation. Our objective was to determine L929 cell line response to irradiation at λ 685 and 830 nm, concentrations of 5 and 10% fetal bovine serum and different energy densities of 0.1, 0.5, 1, 2, 3, 5, 7, 10, 20, and 30 J/cm(2). Thus, cells were plated at 1 × 10(5) cells/mL and irradiated with semiconductor laser As-Ga-Al. Twenty-four hours after irradiation, cells were subjected to MTT, neutral red, crystal violet tests, and cell staining was performed using the kit Alexa Fluor 488 Annexin V-FITC and propidium iodide. Our results showed that low-level laser therapy stimulates effect when the energy density is 5 to 3030 J/cm(2) and inhibits effects on energy density 0.1 to 3 J/cm(2). This inhibitory effect was evidenced by the absence of dead cells labeled, decreased cell density, and by the absorption of neutral red in intact cells. The study also demonstrated that fetal bovine serum, at different concentrations, did not affect response of the cells after irradiation.
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Affiliation(s)
- Juliana Mangolin Marques
- Laboratory of Tissue and Cell Biology, Development and Research Institute, Universidade do Vale do Paraíba (UNIVAP), Urbanova, 12244-000 São José dos Campos, Brazil Laboratory of Dynamics of Cellular Compartments, Development and Research Institute, Universidade do Vale do Paraíba (UNIVAP), Urbanova, 12244-000 São José dos Campos, Brazil
| | - Cristina Pacheco-Soares
- Laboratory of Dynamics of Cellular Compartments, Development and Research Institute, Universidade do Vale do Paraíba (UNIVAP), Urbanova, 12244-000 São José dos Campos, Brazil
| | - Newton Soares Da Silva
- Laboratory of Tissue and Cell Biology, Development and Research Institute, Universidade do Vale do Paraíba (UNIVAP), Urbanova, 12244-000 São José dos Campos, Brazil
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Low-power laser irradiation fails to improve liver regeneration in elderly rats at 48 h after 70 % resection. Lasers Med Sci 2014; 30:2003-8. [PMID: 24880927 DOI: 10.1007/s10103-014-1598-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 05/20/2014] [Indexed: 01/17/2023]
Abstract
The liver regeneration is an important clinical issue after major hepatectomies. Unfortunately, many organs (including the liver) exhibit age-related impairments regarding their regenerative capacity. Recent studies found that low-power laser irradiation (LPLI) has a stimulatory effect on the liver regeneration process. However, its effects in elderly remain unknown. Thus, this study aimed to investigate the main molecular mechanisms involved in liver regeneration of partially hepatectomized elderly rats exposed to LPLI. The effects of 15 min of LPLI (wavelength of 632.8 nm; fluence of 0.97 J/cm(2); total energy delivered of 3.6 J) were evaluated in hepatectomized elderly Wistar male rats. Afterwards, through immunoblotting approaches, the protein expression and phosphorylation levels of hepatocyte growth factor (HGF), Met, Akt and Erk 1/2 signaling pathways as well as the proliferating cell nuclear antigen (PCNA) were investigated. It was observed that LPLI was not able to improve liver regeneration in elderly rats as evidenced by the lack of improvement of HGF and PCNA protein expression or phosphorylation levels of Met, Akt and Erk 1/2 in the remnant livers. In sum, this study demonstrated that the main molecular pathway, i.e. HGF/Met → Akt and Erk 1/2 → PCNA, involved in the hepatic regeneration process was not improved by LPLI in elderly hepatectomized rats, which in turn rules out LPLI as an adjuvant therapy, as observed in this protocol of liver regeneration evaluation (i.e. at 48 h after 70 % resection), in elderly.
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Liver regeneration following partial hepatectomy is improved by enhancing the HGF/Met axis and Akt and Erk pathways after low-power laser irradiation in rats. Lasers Med Sci 2013; 28:1511-7. [PMID: 23334786 DOI: 10.1007/s10103-013-1264-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 01/02/2013] [Indexed: 12/29/2022]
Abstract
A simple, easy, and safe procedure aiming to improve liver regeneration could be of great clinical benefit in critical situations such as major hepatectomy, trauma, or hemorrhage. Low-power laser irradiation (LPLI) has come into a wide range of use in clinical practice by inducing regeneration in healthy and injured tissues. However, the effect of LPLI on the process of liver regeneration, especially those related to the molecular mechanisms, is not fully understood. Thus, the aim of the present study was to investigate the main molecular mechanisms involved in liver regeneration of partially hepatectomized rats exposed to LPLI. We used Wistar male rats, which had their remaining liver irradiated or not with LPLI (wavelength of 632.8 nm and fluence of 65 mW/cm(2)) for 15 min after a 70% hepatectomy. We subsequently investigated hepatocyte growth factor (HGF), Met, Akt, and Erk 1/2 signaling pathways through protein expression and phosphorylation analyses along with cell proliferation (proliferating cell nuclear antigen (PCNA) and Ki-67) using immunoblotting and histological studies. Our results show that LPLI can improve liver regeneration as shown by increased HGF protein expression and the phosphorylation levels of Met, Akt, and Erk 1/2 accompanied by higher levels of the PCNA and Ki-67 protein in the remnant livers. In summary, our results suggest that LPLI may play a clinical role as a simple, fast, and easy-to-perform strategy in order to enhance the liver regenerative capacity of a small liver remnant after hepatectomy.
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Oliveira FAM, Moraes ACM, Paiva AP, Schinzel V, Correa-Costa M, Semedo P, Castoldi A, Cenedeze MA, Oliveira RSMF, Bastos MG, Câmara NOS, Sanders-Pinheiro H. Low-level laser therapy decreases renal interstitial fibrosis. Photomed Laser Surg 2012; 30:705-13. [PMID: 23134313 DOI: 10.1089/pho.2012.3272] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE the purpose of this study was to investigate the effect of low-level laser therapy (LLLT) on chronic kidney disease (CKD) in a model of unilateral ureteral obstruction (UUO). BACKGROUND DATA Regardless of the etiology, CKD involves progressive widespread tissue fibrosis, tubular atrophy, and loss of kidney function. This process also occurs in kidney allograft. At present, effective therapies for this condition are lacking. We investigated the effects of LLLT on the interstitial fibrosis that occurs after experimental UUO in rats. METHODS The occluded kidney of half of the 32 Wistar rats that underwent UUO received a single intraoperative dose of LLLT (AlGaAs laser, 780 nm, 22.5 J/cm(2), 30 mW, 0.75 W/cm(2), 30 sec on each of nine points). After 14 days, renal fibrosis was assessed by Sirius red staining under polarized light. Immunohistochemical analyses quantitated the renal tissue cells that expressed fibroblast (FSP-1) and myofibroblast (α-SMA) markers. Reverse transcriptase polymerase chain reaction (RT-PCR) was performed to determine the mRNA expression of interleukin (IL)-6, monocyte chemotactic protein-1 (MCP-1), transforming growth factor (TGF)-β1 and Smad3. RESULTS The UUO and LLLT animals had less fibrosis than the UUO animals, as well having decreased expression inflammatory and pro-fibrotic markers. CONCLUSIONS For the first time, we showed that LLLT had a protective effect regarding renal interstitial fibrosis. It is conceivable that by attenuating inflammation, LLLT can prevent tubular activation and transdifferentiation, which are the two processes that mainly drive the renal fibrosis of the UUO model.
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Oliveira-Junior MC, Monteiro AS, Leal-Junior ECP, Munin E, Osório RAL, Ribeiro W, Vieira RP. Low-level Laser Therapy Ameliorates CCl4-induced Liver Cirrhosis in Rats. Photochem Photobiol 2012; 89:173-8. [PMID: 22827550 DOI: 10.1111/j.1751-1097.2012.01211.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 07/16/2012] [Indexed: 01/12/2023]
Affiliation(s)
| | - Aldaíza Salomão Monteiro
- Laboratory of Physiology and Pharmacodynamics; Institute of Research and Development; University of Vale do Paraíba; São José dos Campos; SP; Brazil
| | | | - Egberto Munin
- Núcleo do Parque Tecnológico de São José dos Campos; University Camilo Castelo Branco; São José dos Campos; SP; Brazil
| | - Rodrigo Aléxis Lazo Osório
- Laboratory of Physiology and Pharmacodynamics; Institute of Research and Development; University of Vale do Paraíba; São José dos Campos; SP; Brazil
| | - Wellington Ribeiro
- Laboratory of Physiology and Pharmacodynamics; Institute of Research and Development; University of Vale do Paraíba; São José dos Campos; SP; Brazil
| | - Rodolfo Paula Vieira
- Post-graduation Program in Biophotonics Applied to Health Sciences; Nove de Julho University; São Paulo; SP; Brazil
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Lapchak PA. Transcranial near-infrared laser therapy applied to promote clinical recovery in acute and chronic neurodegenerative diseases. Expert Rev Med Devices 2012; 9:71-83. [PMID: 22145842 DOI: 10.1586/erd.11.64] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
One of the most promising methods to treat neurodegeneration is noninvasive transcranial near-infrared laser therapy (NILT), which appears to promote acute neuroprotection by stimulating mitochondrial function, thereby increasing cellular energy production. NILT may also promote chronic neuronal function restoration via trophic factor-mediated plasticity changes or possibly neurogenesis. Clearly, NILT is a treatment that confers neuroprotection or neurorestoration using pleiotropic mechanisms. The most advanced application of NILT is for acute ischemic stroke based upon extensive preclinical and clinical studies. In laboratory settings, NILT is also being developed to treat traumatic brain injury, Alzheimer's disease and Parkinson's disease. There is some intriguing data in the literature that suggests that NILT may be a method to promote clinical improvement in neurodegenerative diseases where there is a common mechanistic component, mitochondrial dysfunction and energy impairment. This article will analyze and review data supporting the continued development of NILT to treat neurodegenerative diseases.
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Affiliation(s)
- Paul A Lapchak
- Cedars-Sinai Medical Center, Department of Neurology, Los Angeles, CA 90048, USA.
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Barbosa AJ, Santana ACDA, Castro e Silva T, Kurachi C, Inada N, Bagnato VS, Silva ODCE. Effect of laser on the remnant liver after the first 24 hours following 70% hepatectomy in rats. Acta Cir Bras 2012; 26:470-4. [PMID: 22042110 DOI: 10.1590/s0102-86502011000600011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
PURPOSE To evaluate the mitochondrial function of the remnant liver (RL) in the early phase of liver regeneration in rats after 70% partial hepatectomy (PH). METHODS Sixty male Wistar rats (200-250g) submitted to 70% PH were divided into five groups according to the time of euthanasia and application or not of laser light: C = Control, time zero; 2 minutes, 4, 6 and 24 hours after PH. The dose of laser radiation was 22.5 J/cm(2), wavelength of 660 nm (visible/red), in the remnant liver. We studied the respiration activated by ADP (state 3), basal mitochondrial respiration (state 4), respiratory control ratio (RCR) and mitochondrial membrane potential (MMP). RESULTS The mitochondrial function of RL changed at 4 and 6 hours after PH, with a significant increase in state 3 and a concomitant increase in state 4 and with maintenance of RCR. MMP differed significantly between the groups biostimulated with laser radiation and the control group 4 hours after HP, with a substantial reduction in the non-laser groups. CONCLUSION The laser light at the dose used in this study did not induce additional damage to the RL and seems to have delayed the hepatocellular metabolic overload of the remnant liver.
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Affiliation(s)
- Ailton Jose Barbosa
- Division of Digestive Surgery, Department of Surgery and Anatomy, FMRP, USP, Ribeirao Preto, SP, Brazil
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Ando T, Xuan W, Xu T, Dai T, Sharma SK, Kharkwal GB, Huang YY, Wu Q, Whalen MJ, Sato S, Obara M, Hamblin MR. Comparison of therapeutic effects between pulsed and continuous wave 810-nm wavelength laser irradiation for traumatic brain injury in mice. PLoS One 2011; 6:e26212. [PMID: 22028832 PMCID: PMC3196530 DOI: 10.1371/journal.pone.0026212] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 09/22/2011] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Transcranial low-level laser therapy (LLLT) using near-infrared light can efficiently penetrate through the scalp and skull and could allow non-invasive treatment for traumatic brain injury (TBI). In the present study, we compared the therapeutic effect using 810-nm wavelength laser light in continuous and pulsed wave modes in a mouse model of TBI. STUDY DESIGN/MATERIALS AND METHODS TBI was induced by a controlled cortical-impact device and 4-hours post-TBI 1-group received a sham treatment and 3-groups received a single exposure to transcranial LLLT, either continuous wave or pulsed at 10-Hz or 100-Hz with a 50% duty cycle. An 810-nm Ga-Al-As diode laser delivered a spot with diameter of 1-cm onto the injured head with a power density of 50-mW/cm(2) for 12-minutes giving a fluence of 36-J/cm(2). Neurological severity score (NSS) and body weight were measured up to 4 weeks. Mice were sacrificed at 2, 15 and 28 days post-TBI and the lesion size was histologically analyzed. The quantity of ATP production in the brain tissue was determined immediately after laser irradiation. We examined the role of LLLT on the psychological state of the mice at 1 day and 4 weeks after TBI using tail suspension test and forced swim test. RESULTS The 810-nm laser pulsed at 10-Hz was the most effective judged by improvement in NSS and body weight although the other laser regimens were also effective. The brain lesion volume of mice treated with 10-Hz pulsed-laser irradiation was significantly lower than control group at 15-days and 4-weeks post-TBI. Moreover, we found an antidepressant effect of LLLT at 4-weeks as shown by forced swim and tail suspension tests. CONCLUSION The therapeutic effect of LLLT for TBI with an 810-nm laser was more effective at 10-Hz pulse frequency than at CW and 100-Hz. This finding may provide a new insight into biological mechanisms of LLLT.
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Affiliation(s)
- Takahiro Ando
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Electronics and Electrical Engineering, Keio University, Yokohama, Japan
| | - Weijun Xuan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Otolaryngology, Traditional Chinese Medical University of Guangxi, Nanning, China
| | - Tao Xu
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, United States of America
- Laboratory of Anesthesiology, Shanghai Jiaotong University, Shanghai, China
| | - Tianhong Dai
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sulbha K. Sharma
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Gitika B. Kharkwal
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ying-Ying Huang
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, United States of America
- Aesthetic and Plastic Center, Guangxi Medical University, Nanning, China
| | - Qiuhe Wu
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Burns and Plastic Surgery, Shandong University, Jinan Central Hospital, Jinan, China
| | - Michael J. Whalen
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Shunichi Sato
- Division of Biomedical Information Sciences, National Defense Medical College Research Institute, Tokorozawa, Japan
| | - Minoru Obara
- Department of Electronics and Electrical Engineering, Keio University, Yokohama, Japan
| | - Michael R. Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, United States of America
- Harvard-MIT Division of Health Sciences and Technology, Harvard University, Cambridge, Massachusetts, United States of America
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Lapchak PA. Taking a light approach to treating acute ischemic stroke patients: transcranial near-infrared laser therapy translational science. Ann Med 2010; 42:576-86. [PMID: 21039081 PMCID: PMC3059546 DOI: 10.3109/07853890.2010.532811] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Transcranial near-infrared laser therapy (NILT) has been investigated as a novel neuroprotective treatment for acute ischemic stroke (AIS), for approximately 10 years. Two clinical trials, NeuroThera Effectiveness and Safety Trial (NEST)-1 and NEST-2, have evaluated the use of NILT to promote clinical recovery in patients with AIS. This review covers preclinical, translational, and clinical studies documented during the period 1997-2010. The primary aim of this article is to detail the development profile of NILT to treat AIS. Secondly, insight into possible mechanisms involved in light therapy will be presented. Lastly, possible new directions that should be considered to improve the efficacy profile of NILT in AIS patients will be discussed. The use of NILT was advanced to clinical trials based upon extensive translational research using multiple species. NILT, which may promote functional and behavioral recovery via a mitochondrial mechanism and by enhancing cerebral blood flow, may eventually be established as an Food and Drug Administration (FDA)-approved treatment for stroke. The NEST-3 trial, which is the pivotal trial for FDA approval, should incorporate hypotheses derived from translational studies to ensure efficacy in patients. Future NILT studies should consider administration of a thrombolytic to enhance cerebral reperfusion alongside NILT neuroprotection.
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Affiliation(s)
- Paul A Lapchak
- Cedars-Sinai Medical Center, Department of Neurology, 110 North George Burns Road, Los Angeles, CO 90048, USA.
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Lapchak PA, De Taboada L. Transcranial near infrared laser treatment (NILT) increases cortical adenosine-5'-triphosphate (ATP) content following embolic strokes in rabbits. Brain Res 2009; 1306:100-5. [PMID: 19837048 DOI: 10.1016/j.brainres.2009.10.022] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 10/08/2009] [Accepted: 10/09/2009] [Indexed: 11/25/2022]
Abstract
Transcranial near infrared laser therapy (NILT) improves behavioral outcome following embolic strokes in embolized rabbits and clinical rating scores in acute ischemic stroke (AIS) patients; however, the cellular mechanism(s) involved in NILT neuroprotection have not been elucidated. It has been proposed that mitochondrial energy production may underlie a response to NILT, but this has not been demonstrated using an in vivo embolic stroke model. Thus, we evaluated the effect of NILT on cortical ATP content using the rabbit small clot embolic stroke model (RSCEM), the model originally used to demonstrate NILT efficacy and initiate the NEST-1 clinical trial. Five minutes following embolization, rabbits were exposed to 2 min of NILT using an 808 nm laser source, which was driven to output either continuous wave (CW), or pulsed wave modes (PW). Three hours after embolization, the cerebral cortex was excised and processed for the measurement of ATP content using a standard luciferin-luciferase assay. NILT-treated rabbits were directly compared to sham-treated embolized rabbits and naïve control rabbits. Embolization decreased cortical ATP content in ischemic cortex by 45% compared to naive rabbits, a decrease that was attenuated by CW NILT which resulted in a 41% increase in cortical ATP content compared to the sham embolized group (p>0.05). The absolute increase in ATP content was 22.5% compared to naive rabbits. Following PW NILT, which delivered 5 (PW1) and 35 (PW2) times more energy than CW, we measured a 157% (PW1 p=0.0032) and 221% (PW2 p=0.0001) increase in cortical ATP content, respectively, compared to the sham embolized group. That represented a 41% and 77% increase in ATP content compared to naive control rabbits. This is the first demonstration that embolization can decrease ATP content in rabbit cortex and that NILT significantly increases cortical ATP content in embolized rabbits, an effect that is correlated with cortical fluence and the mode of NILT delivery. The data provide new insight into the molecular mechanisms associated with clinical improvement following NILT.
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Affiliation(s)
- Paul A Lapchak
- University of California San Diego, Department of Neuroscience, 9500 Gilman Drive MTF316, La Jolla, CA 92093-0624, USA.
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Moges H, Vasconcelos OM, Campbell WW, Borke RC, McCoy JA, Kaczmarczyk L, Feng J, Anders JJ. Light therapy and supplementary Riboflavin in the SOD1 transgenic mouse model of familial amyotrophic lateral sclerosis (FALS). Lasers Surg Med 2009; 41:52-9. [PMID: 19143012 DOI: 10.1002/lsm.20732] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVE Familial amyotrophic lateral sclerosis (FALS) is a neurodegenerative disease characterized by progressive loss of motor neurons and death. Mitochondrial dysfunction and oxidative stress play an important role in motor neuron loss in ALS. Light therapy (LT) has biomodulatory effects on mitochondria. Riboflavin improves energy efficiency in mitochondria and reduces oxidative injury. The purpose of this study was to examine the synergistic effect of LT and riboflavin on the survival of motor neurons in a mouse model of FALS. STUDY DESIGN/MATERIALS AND METHODS G93A SOD1 transgenic mice were divided into four groups: Control, Riboflavin, Light, and Riboflavin+Light (combination). Mice were treated from 51 days of age until death. A single set of LT parameters was used: 810 nm diode laser, 140-mW output power, 1.4 cm(2) spot area, 120 seconds treatment duration, and 12 J/cm(2) energy density. Behavioral tests and weight monitoring were done weekly. At end stage of the disease, mice were euthanized, survival data was collected and immunohistochemistry and motor neuron counts were performed. RESULTS There was no difference in survival between groups. Motor function was not significantly improved with the exception of the rotarod test which showed significant improvement in the Light group in the early stage of the disease. Immunohistochemical expression of the astrocyte marker, glial fibrilary acidic protein, was significantly reduced in the cervical and lumbar enlargements of the spinal cord as a result of LT. There was no difference in the number of motor neurons in the anterior horn of the lumbar enlargement between groups. CONCLUSIONS The lack of significant improvement in survival and motor performance indicates study interventions were ineffective in altering disease progression in the G93A SOD1 mice. Our findings have potential implications for the conceptual use of light to treat other neurodegenerative diseases that have been linked to mitochondrial dysfunction.
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Affiliation(s)
- Helina Moges
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA
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Castro-e-Silva T, Castro-e-Silva O, Kurachi C, Ferreira J, Zucoloto S, Bagnato VS. The use of light-emitting diodes to stimulate mitochondrial function and liver regeneration of partially hepatectomized rats. Braz J Med Biol Res 2007; 40:1065-9. [PMID: 17665042 DOI: 10.1590/s0100-879x2007000800006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Accepted: 05/18/2007] [Indexed: 11/21/2022] Open
Abstract
The biostimulating effect of laser radiation has been observed in many areas of Medicine. However, there are still several questions to be answered, among them the importance of light coherence in the stimulatory process. In the present study, we used light-emitting diodes (LED) to promote the stimulation of liver regeneration after partial hepatectomy in rats. Fourteen male Wistar rats weighing 200-250 g were submitted to partial hepatectomy (70%) followed by LED light irradiation (630 nm) of the remaining part of the liver at two doses, i.e., 10 (N = 7) and 140 (N = 7) J/cm(2). A group irradiated with laser, 590 nm (N = 7, 15 J/cm(2)) was performed for the study of proliferating cell nuclear antigen-labeling index. Data are reported as mean +/- SEM. Statistical comparisons of the groups were performed by analysis of variance for parametric measurements followed by the Bonferroni post-test, with the level of significance set at P < 0.05. Respiratory mitochondrial activity was increased in the irradiated groups (states 3 and 4; P < 0.05), with better results for the group exposed to the lower LED dose (10 J/cm(2)). The proliferating cell nuclear antigen-labeling index, by immunohistochemical staining, was similar for both LED-exposed groups (P > 0.05) and higher than for the control group (P < 0.05). The cell proliferation index obtained with LED and laser were similar (P > 0.05). In conclusion, the present results suggest that LED irradiation promotes biological stimulatory effects during the early stage of liver regeneration and that LED is as effective as laser light, independent of the coherence, divergence and cromaticity.
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Affiliation(s)
- T Castro-e-Silva
- Instituto de Física de São Carlos, Universidade de São Paulo, São Carlos, SP, Brazil.
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Liu YH, Ho CC, Cheng CC, Hsu YH, Lai YS. Photoradiation could influence the cytoskeleton organization and inhibit the survival of human hepatoma cells in vitro. Lasers Med Sci 2006; 21:42-8. [PMID: 16570120 DOI: 10.1007/s10103-005-0369-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2005] [Accepted: 11/22/2005] [Indexed: 11/29/2022]
Abstract
Low-power laser therapy has become popular in clinical applications including promoting wound healing and pain relief. However, effects of this photoradiation on human hepatoma cells are rarely studied. Previously, we found 808 nm gallium aluminum arsenide (GaAlAs) continuous wave laser had an inhibitory effect on the proliferation of human hepatoma cell lines HepG2 and J-5 at the energy density of 5.85 and 11.7 J/cm(2), respectively. The aim of the present study was to evaluate the possible mechanism of action of this photoradiation on HepG2 and J-5 cells. HepG2 and J-5 cells were cultured in 24-well plates for 24 h. After photoradiation by 130 mW 808 nm GaAlAs continuous wave laser for different time intervals (0, 30, 60, 90, 120, 150, and 180 s), Western blot and immunofluorescent staining were used to examine the expression and distribution of histone and cytoskeletal proteins. The cell counts as well as histone and synemin expression of HepG2 and J-5 cells were reduced by photoradiation at the energy density of 5.85 and 11.7 J/cm(2), respectively. Furthermore, the architecture of cytoskeletons and the distribution of intermediate filament-associated proteins (plectin and synemin) were disorganized by photoradiation. Photoradiation by 808 nm GaAlAs continuous wave laser at the energy density of 5.85 and 7.8 J/cm(2) inhibited the survival of human hepatoma cell lines. The mechanism might reduce synthesis of histone and synemin. Reduced histone synthesis might further reduce the proliferation rate of these cells. Reduced synemin synthesis might result in the destruction of the cytoskeleton. Therefore, the net effects by this photoradiation were reduced cell survival.
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Affiliation(s)
- Yi-Hsiang Liu
- Department of Pathology, Tzu Chi Hospital and University, Hualien, Taiwan
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Melo GB, Silva RL, Melo VA, Antoniolli AR, Michellone PRT, Zucoloto S, Souza MEJD, Gomes MCJ, Correia RB, Silva ODCE. Proliferative effect of the aqueous extract of Hyptis pectinata on liver regeneration after partial hepatectomy in rats. Acta Cir Bras 2006; 21 Suppl 1:33-6. [PMID: 17013510 DOI: 10.1590/s0102-86502006000700008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
PURPOSE: This study was carried out to assess the effects of the aqueous extract of Hyptis pectinata leaves on liver regeneration and on serum enzymes (AST, ALT and gamma-GT) after 67% partial hepatectomy in rats. METHODS: AST, ALT and gamma-GT, were determined by conventional procedures using a spectrophotometer (Model E2250-CELM). Liver regeneration was evaluated by immunohistochemical staining for proliferating cell nuclear antigen (PCNA). RESULTS:Oral pretreatment during 4 days at 100 mg/kg increased liver regeneration index. At 200 mg/kg, AST level was statistically decreased in comparison to the group submited to distilled water administration. The other enzymes assessed disclosed no difference when all groups were compared. CONCLUSION: The present study shows that the aqueous extract of Hyptis pectinata leaves contains some biological active principles that stimulate liver regeneration at 100 mg/kg and cause slight hepatic protection at 200 mg/kg.
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Byrnes KR, Waynant RW, Ilev IK, Wu X, Barna L, Smith K, Heckert R, Gerst H, Anders JJ. Light promotes regeneration and functional recovery and alters the immune response after spinal cord injury. Lasers Surg Med 2005; 36:171-85. [PMID: 15704098 DOI: 10.1002/lsm.20143] [Citation(s) in RCA: 206] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Photobiomodulation (PBM) has been proposed as a potential therapy for spinal cord injury (SCI). We aimed to demonstrate that 810 nm light can penetrate deep into the body and promote neuronal regeneration and functional recovery. STUDY DESIGN/MATERIALS AND METHODS Adult rats underwent a T9 dorsal hemisection, followed by treatment with an 810 nm, 150 mW diode laser (dosage = 1,589 J/cm2). Axonal regeneration and functional recovery were assessed using single and double label tract tracing and various locomotor tasks. The immune response within the spinal cord was also assessed. RESULTS PBM, with 6% power penetration to the spinal cord depth, significantly increased axonal number and distance of regrowth (P < 0.001). PBM also returned aspects of function to baseline levels and significantly suppressed immune cell activation and cytokine/chemokine expression. CONCLUSION Our results demonstrate that light, delivered transcutaneously, improves recovery after injury and suggests that light will be a useful treatment for human SCI.
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Affiliation(s)
- Kimberly R Byrnes
- Department of Anatomy, Physiology & Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA.
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Melo GB, Silva RL, Melo VA, Lima SO, Antoniolli AR, Castro-E-silva T, Marcassa LG, Bagnato VS, Zucoloto S, Ramalho LNZ, Ramalho FS, Castro-E-silva O. Enhancement of liver regeneration by the association of Hyptis pectinata with laser therapy. Dig Dis Sci 2005; 50:949-54. [PMID: 15906774 DOI: 10.1007/s10620-005-2670-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Since new molecules that normally would accelerate regeneration can also be potentialized by light, the use of new substances combined with laser therapy seems to be a natural type of experiment. Therefore, the purpose of this study was to assess the effects of Hyptis pectinata leaves on liver regeneration after partial hepatectomy (PH) associated with laser therapy. Twenty-four rats were divided into four groups--PH(control), PHL (laser therapy), PH200 (200 mg/kg of Hyptispectinata), and PHL200 (200 mg/kg of the plant and laser)--which were submitted to 67% hepatectomy. Laser treatment consisted of focusing the light on the remaining liver after hepatectomy. The data analyzed were serum levels of aminotransferases, liver regeneration, and mitochondrial function. Group PH200 showed a statistically significant decrease in AST levels, and PHL200 disclosed an augmentation in ALT levels. The liver regeneration index was significantly increased in group PHL200. Concerning liver mitochondrial respiratory assay, groups PH200 and PHL200 showed lower state 3 levels than groups PH and PHL. Group PHL showed an increase in state 4 levels and a reduction in membrane potential and RCR. The present study shows that the association of the aqueous extract of Hyptis pectinata leaves at 200 mg/kg with intraoperative laser therapy can stimulate liver regeneration and cause a reduction in liver mitochondrial respiratory function without altering its phosphorylative activity.
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Affiliation(s)
- Gustavo B Melo
- Department of Medicine, Universidade Federal de Sergipe, Sergipe, Brazil
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Melo GB, Silva RL, Melo VA, Antoniolli AR, Souza MEJ, Jordani MC, Castro-e-Silva O. Effect of the aqueous extract of Hyptis pectinata on liver mitochondrial respiration. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2005; 12:359-62. [PMID: 15957370 DOI: 10.1016/j.phymed.2004.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Some studies have indicated that mitochondria may be the target organelle of plants. We therefore decided to assess the effects of the aqueous extract of Hyptis pectinata leaves on liver mitochondrial respiratory function in vitro. Eight rat livers were subjected to isolation of mitochondria by differential centrifugation. In an adequate medium, the plant extract was added at different concentrations. The analyzed data were: state 3, state 4 and respiratory control ratio (RCR). H. pectinata extract caused a statistically significant decrease in state 3 (at 0.05, 0.1 and 0.2 mg/mg protein) and RCR (at 0.05, 0.1 and 0.2 mg/mg protein). Respiratory state 4 was not altered by the increasing concentrations. In conclusion, the aqueous extract of H. pectinata leaves may not injure the mitochondrial inner membrane but decreases significantly the oxidative phosphorylation.
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Affiliation(s)
- G B Melo
- Department of Medicine, Universidade Federal de Sergipe, Aracaju, Brazil
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Eichler M, Lavi R, Shainberg A, Lubart R. Flavins are source of visible-light-induced free radical formation in cells. Lasers Surg Med 2005; 37:314-9. [PMID: 16196041 DOI: 10.1002/lsm.20239] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES It has been hypothesized that reactive oxygen species (ROS) are created by an endogenous photosensitizer during low energy visible light illumination of tissue, and these ROS are responsible for reported biostimulative effects. This study aims to identify the endogenous photosensitizer responsible for ROS production by visible light. STUDY DESIGN/MATERIALS AND METHODS Electron paramagnetic resonance (EPR) spectroscopy was used to detect oxyradicals produced in cardiac and sperm cells during illumination by a halogen lamp. Oxyradical production was determined as a function of illumination wavelength, cell fraction, and molecular weight. RESULTS Oxyradicals were created solely by the 400-500 nm range of visible light. The endogenous photosensitizer is found predominantly in the cytosol and is smaller than 12 kD. Flavin mononucleotide produces the same signal at concentrations consistent with reported intracellular free flavin concentrations. CONCLUSIONS A small, water soluble photosensitizer active only at wavelengths shorter than 500 nm is consistent with a flavin, which reproduces cellular signals at physiological concentrations. Thus, flavins are responsible for the photosensitization of the observed oxyradicals in cells.
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Affiliation(s)
- Maor Eichler
- Department of Chemistry, Bar-Ilan University, Ramat Gan 52900, Israel.
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Byrnes KR, Wu X, Waynant RW, Ilev IK, Anders JJ. Low power laser irradiation alters gene expression of olfactory ensheathing cells in vitro. Lasers Surg Med 2005; 37:161-71. [PMID: 16037971 DOI: 10.1002/lsm.20202] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Both photobiomodulation (PBM) and olfactory ensheathing cells (OECs) transplantation improve recovery following spinal cord injury. However, neither the combination of these two therapies nor the effect of light on OECs has been reported. The purpose of this study was to determine the effect of light on OEC activity in vitro. MATERIALS AND METHODS OECs were purified from adult rat olfactory bulbs and exposed to 810 nm light (150 mW; 0, 0.2, or 68 J/cm(2)). After 7-21 days in vitro, cells underwent immunocytochemistry or RNA extraction and RT-PCR. RESULTS Analysis of immunolabeling revealed a significant decrease in fibronectin expression in the cultures receiving 68 J/cm(2). Analysis of gene expression revealed a significant (P < 0.05) increase in brain derived neurotrophic factor (BDNF), glial derived neurotrophic factor (GDNF), and collagen expression in the 0.2 J/cm(2) group in comparison to the non-irradiated and 68 J/cm(2) groups. OEC proliferation was also found to significantly increase in both light treated groups in comparison to the control group (P < 0.001). CONCLUSIONS These results demonstrate that low and high dosages of PBM alter OEC activity, including upregulation of a number of neurotrophic growth factors and extracellular matrix proteins known to support neurite outgrowth. Therefore, the application of PBM in conjunction with OEC transplantation warrants consideration as a potential combination therapy for spinal cord injury.
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Affiliation(s)
- Kimberly R Byrnes
- Department of Neuroscience, Georgetown University, 3970 Reservoir Road NW, Washington, DC 20057, USA.
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