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Szymczak K, Woźniak-Pawlikowska A, Burzyńska N, Król M, Zhang L, Nakonieczna J, Grinholc M. Decrease of ESKAPE virulence with a cationic heme-mimetic gallium porphyrin photosensitizer: The Trojan horse strategy that could help address antimicrobial resistance. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2024; 256:112928. [PMID: 38723545 DOI: 10.1016/j.jphotobiol.2024.112928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/25/2024] [Accepted: 04/30/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Emerging antibiotic resistance among bacterial pathogens has forced an urgent need for alternative non-antibiotic strategies development that could combat drug resistant-associated infections. Suppression of virulence of ESKAPE pathogens' by targeting multiple virulence traits provides a promising approach. OBJECTIVES Here we propose an iron-blocking antibacterial therapy based on a cationic heme-mimetic gallium porphyrin (GaCHP), which antibacterial efficacy could be further enhanced by photodynamic inactivation. METHODS We used gallium heme mimetic porphyrin (GaCHP) excited with light to significantly reduce microbial viability and suppress both the expression and biological activity of several virulence traits of both Gram-positive and Gram-negative ESKAPE representatives, i.e., S. aureus and P. aeruginosa. Moreover, further improvement of the proposed strategy by combining it with routinely used antimicrobials to resensitize the microbes to antibiotics and provide enhanced bactericidal efficacy was investigated. RESULTS The proposed strategy led to substantial inactivation of critical priority pathogens and has been evidenced to suppress the expression and biological activity of multiple virulence factors in S. aureus and P. aeruginosa. Finally, the combination of GaCHP phototreatment and antibiotics resulted in promising strategy to overcome antibiotic resistance of the studied microbes and to enhance disinfection of drug resistant pathogens. CONCLUSION Lastly, considering high safety aspects of the proposed treatment toward host cells, i.e., lack of mutagenicity, no dark toxicity and mild phototoxicity, we describe an efficient alternative that simultaneously suppresses the functionality of multiple virulence factors in ESKAPE pathogens.
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Affiliation(s)
- Klaudia Szymczak
- Laboratory of Photobiology and Molecular Diagnostics, Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk, 80-307 Gdansk, Poland
| | - Agata Woźniak-Pawlikowska
- Laboratory of Photobiology and Molecular Diagnostics, Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk, 80-307 Gdansk, Poland
| | - Natalia Burzyńska
- Laboratory of Photobiology and Molecular Diagnostics, Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk, 80-307 Gdansk, Poland
| | - Magdalena Król
- Laboratory of Photobiology and Molecular Diagnostics, Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk, 80-307 Gdansk, Poland
| | - Lei Zhang
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), Tianjin University, Tianjin 300350, China
| | - Joanna Nakonieczna
- Laboratory of Photobiology and Molecular Diagnostics, Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk, 80-307 Gdansk, Poland.
| | - Mariusz Grinholc
- Laboratory of Photobiology and Molecular Diagnostics, Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk, 80-307 Gdansk, Poland.
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Surur AK, de Oliveira AB, De Annunzio SR, Ferrisse TM, Fontana CR. Bacterial resistance to antimicrobial photodynamic therapy: A critical update. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2024; 255:112905. [PMID: 38703452 DOI: 10.1016/j.jphotobiol.2024.112905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/06/2024] [Accepted: 04/04/2024] [Indexed: 05/06/2024]
Abstract
Bacterial antibiotic resistance is one of the most significant challenges for public health. The increase in bacterial resistance, mainly due to microorganisms harmful to health, and the need to search for alternative treatments to contain infections that cannot be treated by conventional antibiotic therapy has been aroused. An alternative widely studied in recent decades is antimicrobial photodynamic therapy (aPDT), a treatment that can eliminate microorganisms through oxidative stress. Although this therapy has shown satisfactory results in infection control, it is still controversial in the scientific community whether bacteria manage to develop resistance after successive applications of aPDT. Thus, this work provides an overview of the articles that performed successive aPDT applications in models using bacteria published since 2010, focusing on sublethal dose cycles, highlighting the main PSs tested, and addressing the possible mechanisms for developing tolerance or resistance to aPDT, such as efflux pumps, biofilm formation, OxyR and SoxRS systems, catalase and superoxide dismutase enzymes and quorum sensing.
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Affiliation(s)
- Amanda Koberstain Surur
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil.
| | - Analú Barros de Oliveira
- São Paulo State University (UNESP), School of Dentistry, Department of Dental Materials and Prosthodontics, Araraquara, São Paulo, Brazil.
| | - Sarah Raquel De Annunzio
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil.
| | - Túlio Morandin Ferrisse
- São Paulo State University (UNESP), School of Dentistry, Department of Dental Materials and Prosthodontics, Araraquara, São Paulo, Brazil.
| | - Carla Raquel Fontana
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Department of Clinical Analysis, Araraquara, São Paulo, Brazil.
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Piksa M, Lian C, Samuel IC, Pawlik KJ, Samuel IDW, Matczyszyn K. The role of the light source in antimicrobial photodynamic therapy. Chem Soc Rev 2023; 52:1697-1722. [PMID: 36779328 DOI: 10.1039/d0cs01051k] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Antimicrobial photodynamic therapy (APDT) is a promising approach to fight the growing problem of antimicrobial resistance that threatens health care, food security and agriculture. APDT uses light to excite a light-activated chemical (photosensitiser), leading to the generation of reactive oxygen species (ROS). Many APDT studies confirm its efficacy in vitro and in vivo against bacteria, fungi, viruses and parasites. However, the development of the field is focused on exploring potential targets and developing new photosensitisers. The role of light, a crucial element for ROS production, has been neglected. What are the main parameters essential for effective photosensitiser activation? Does an optimal light radiant exposure exist? And finally, which light source is best? Many reports have described the promising antibacterial effects of APDT in vitro, however, its application in vivo, especially in clinical settings remains very limited. The restricted availability may partially be due to a lack of standard conditions or protocols, arising from the diversity of selected photosensitising agents (PS), variable testing conditions including light sources used for PS activation and methods of measuring anti-bacterial activity and their effectiveness in treating bacterial infections. We thus sought to systematically review and examine the evidence from existing studies on APDT associated with the light source used. We show how the reduction of pathogens depends on the light source applied, radiant exposure and irradiance of light used, and type of pathogen, and so critically appraise the current state of development of APDT and areas to be addressed in future studies. We anticipate that further standardisation of the experimental conditions will help the field advance, and suggest key optical and biological parameters that should be reported in all APDT studies. More in vivo and clinical studies are needed and are expected to be facilitated by advances in light sources, leading to APDT becoming a sustainable, alternative therapeutic option for bacterial and other microbial infections in the future.
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Affiliation(s)
- Marta Piksa
- Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Science, Weigla 12, 53-114, Wroclaw, Poland
| | - Cheng Lian
- Organic Semiconductor Centre, SUPA, School of Physics and Astronomy, University of St Andrews, Fife, KY16 9SS, UK.
| | - Imogen C Samuel
- School of Medicine, University of Manchester, Manchester, M13 9PL, UK
| | - Krzysztof J Pawlik
- Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Science, Weigla 12, 53-114, Wroclaw, Poland
| | - Ifor D W Samuel
- Organic Semiconductor Centre, SUPA, School of Physics and Astronomy, University of St Andrews, Fife, KY16 9SS, UK.
| | - Katarzyna Matczyszyn
- Institute of Advanced Materials, Faculty of Chemistry, Wroclaw University of Science and Technology, Wyb. Wyspianskiego 27, 50-370 Wroclaw, Poland.
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Dias LM, Klein MI, Ferrisse TM, Medeiros KS, Jordão CC, Bellini A, Pavarina AC. The Effect of Sub-Lethal Successive Applications of Photodynamic Therapy on Candida albicans Biofilm Depends on the Photosensitizer. J Fungi (Basel) 2023; 9:jof9010111. [PMID: 36675932 PMCID: PMC9861309 DOI: 10.3390/jof9010111] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/07/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
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.
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Effective Biofilm Eradication on Orthopedic Implants with Methylene Blue Based Antimicrobial Photodynamic Therapy In Vitro. Antibiotics (Basel) 2023; 12:antibiotics12010118. [PMID: 36671319 PMCID: PMC9854686 DOI: 10.3390/antibiotics12010118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023] Open
Abstract
Periprosthetic joint infections (PJI) are difficult to treat due to biofilm formation on implant surfaces, often requiring removal or exchange of prostheses along with long-lasting antibiotic treatment. This in vitro study investigated the effect of methylene blue photodynamic therapy (MB-PDT) on PJI-causing biofilms on different implant materials. MB-PDT (664 nm LED, 15 J/cm2) was tested on different Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli and Cutibacterium acnes strains in both planktonic form and grown in early and mature biofilms on prosthetic materials (polyethylene, titanium alloys, cobalt-chrome-based alloys, and bone cement). The minimum bactericidal concentration with 100% killing (MBC100%) was determined. Chemical and topographical alterations were investigated on the prosthesis surfaces after MB-PDT. Results showed a MBC100% of 0.5-5 μg/mL for planktonic bacteria and 50-100 μg/mL for bacteria in biofilms-independent of the tested strain, the orthopedic material, or the maturity of the biofilm. Material testing showed no relevant surface modification. MB-PDT effectively eradicated common PJI pathogens on arthroplasty materials without damage to the materials, suggesting that MB-PDT could be used as a novel treatment method, replacing current, more invasive approaches and potentially shortening the antibiotic treatment in PJI. This would improve quality of life and reduce morbidity, mortality, and high health-care costs.
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Ryu V, Chuesiang P, Corradini MG, McLandsborough L, Jin T, Ngo H, Fan X. Synergistic photoinactivation of Escherichia coli and Listeria innocua by curcumin and lauric arginate ethyl ester micelles. Lebensm Wiss Technol 2022. [DOI: 10.1016/j.lwt.2022.114317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Feng Y, Tonon CC, Hasan T. Dramatic destruction of methicillin-resistant Staphylococcus aureus infections with a simple combination of amoxicillin and light-activated methylene blue. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2022; 235:112563. [PMID: 36099788 DOI: 10.1016/j.jphotobiol.2022.112563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Staphylococcus aureus is and continues to be a leading cause of bacterial infections throughout the world. Given the global dissemination of multi-drug resistant (MDR) S. aureus, particularly methicillin-resistant S. aureus (MRSA), novel solutions against S. aureus infections are urgently needed. In our study on the interactions between commonly used photosensitizers and antibiotics in the clinic, we discovered that MRSA can be dramatically destroyed by a simple combination of amoxicillin and light-activated methylene blue (MB). METHODS To guide the clinical application of this combination therapy, we quantitatively assessed the interaction between light-activated MB and amoxicillin against S. aureus and its treatment order, dosage, and time length dependence. Furthermore, we evaluated the efficacy of this combination therapy in treating and halting the progression of MRSA infections with the catheter biofilm infection model and the pig skin burn infection model. In the end, we disclosed the antimicrobial mechanisms of this combination therapy to further facilitate its clinical translation. RESULTS Amoxicillin and light-activated MB can mutually boost each other's uptake in S. aureus, producing up to 8 logs of reduction of MRSA infections when they are co-administrated. Such an anti-S. aureus synergy could be triggered with the currently used MB and amoxicillin clinical administration regimens. It is effective against S. aureus pathogens regardless of their antibiotic resistance backgrounds and does not create significant bacterial resistance with five days of continuous applications. It can lead to more than 99% of reduction of S. aureus infections established not only on the medical devices but also on the body surfaces. CONCLUSIONS Possessing a fusion of effectiveness, safety, sustainability, and broad applicability, this simple combination of light-activated MB and amoxicillin can ultimately reform our treatment against MDR S. aureus pathogens including MRSA, significantly alleviating the health and economic burden of S. aureus infections across the world.
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Affiliation(s)
- Yanfang Feng
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Tayyaba Hasan
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Harvard-MIT Health Sciences and Technology, Cambridge, MA, USA.
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8
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Manoil D, Parga A, Hellesen C, Khawaji A, Brundin M, Durual S, Özenci V, Fang H, Belibasakis GN. Photo-oxidative stress response and virulence traits are co-regulated in E. faecalis after antimicrobial photodynamic therapy. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2022; 234:112547. [PMID: 36030693 DOI: 10.1016/j.jphotobiol.2022.112547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/23/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
Knowledge of photo-oxidative stress responses in bacteria that survive antimicrobial photodynamic therapy (aPDT) is scarce. Whereas aPDT is attracting growing clinical interest, subsequent stress responses are crucial to evaluate as they may lead to the up-regulation of pathogenic traits. Here, we aimed to assess transcriptional responses to sublethal aPDT-stress and identify potential connections with virulence-related genes. Six Enterococcus faecalis strains were investigated; ATCC 29212, three dental root-canal isolates labelled UmID1, UmID2 and UmID3 and two vancomycin-resistant isolates labelled A1 and A2. TMPyP was employed as a photosensitiser. A viability dose-response curve to increasing concentrations of TMPyP was determined by culture plating. Differential expression of genes involved in oxidative stress responses (dps and hypR), general stress responses (dnaK, sigma-factorV and relA), virulence-related genes (ace, fsrC and gelE) and vancomycin-resistance (vanA) was assessed by reverse-transcription qPCR. TMPyP-mediated aPDT inactivated all strains with comparable efficiencies. TMPyP at 0.015 μM was selected to induce sublethal photo-oxidative stress. Despite heterogeneities in gene expression between strains, transcriptional profiles revealed up-regulations of transcripts dps, hypR as well as dnaK and sigma factorV after exposure to TMPyP alone and to light-irradiated TMPyP. Specifically, the alternative sigma factorV reached up to 39 ± 113-fold (median ± IQR) (p = 0.0369) in strain A2. Up-regulation of the quorum sensing operon, fsr, and its downstream virulence-related gelatinase gelE were also observed in strains ATCC-29212, A1, A2 and UmID3. Finally, photo-oxidative stress induced vanA-type vancomycin-resistance gene in both carrier isolates, reaching up to 3.3 ± 17-fold in strain A2 (p = 0.015). These findings indicate that, while aPDT successfully inactivates vancomycin-resistant and naïve strains of E. faecalis, subpopulations of surviving cells respond by co-ordinately up-regulating a network of genes involved in stress survival and virulence. This includes the induction of vancomycin-resistance genes in carrier isolates. These data may provide the mechanistic basis to circumvent bacterial responses and improve future clinical protocols.
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Affiliation(s)
- Daniel Manoil
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden; Division of Cariology and Endodontics, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Ana Parga
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden; Department of Microbiology and Parasitology, CIBUS-Faculty of Biology, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Cecilia Hellesen
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Arwa Khawaji
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Malin Brundin
- Division of Endodontics, Department of Odontology, Umeå University, Umeå, Sweden
| | - Stéphane Durual
- Biomaterials Laboratory, Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Volkan Özenci
- Department of Laboratory Medicine, Karolinska University Hospital Huddinge, Karolinska Institute, Huddinge, Stockholm, Sweden
| | - Hong Fang
- Department of Laboratory Medicine, Karolinska University Hospital Huddinge, Karolinska Institute, Huddinge, Stockholm, Sweden
| | - Georgios N Belibasakis
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
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Zinc(II), Palladium(II), and Metal-Free Phthalocyanines Bearing Nipagin-Functionalized Substituents against Candida auris and Selected Multidrug-Resistant Microbes. Pharmaceutics 2022; 14:pharmaceutics14081686. [PMID: 36015312 PMCID: PMC9416722 DOI: 10.3390/pharmaceutics14081686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022] Open
Abstract
Due to the rapidly increasing problem of antibiotic resistance in recent years, the use of phthalocyanines as photosensitizers with their superior properties in photodynamic antimicrobial therapy (PACT) applications has become important. In this study, magnesium(II) 1,4,8,11,15,18,22,25-octakis(4-[4-butoxycarbonylphenoxy]butyloxy)phthalocyanine was used in the demetalation reaction in trifluoroacetic acid, and subsequently subjected to metalation reaction in dimethylformamide with zinc(II) acetate and bis(benzonitrile)palladium(II) chloride towards zinc(II) and palladium(II) derivatives. Three phthalocyanines, including a demetalated one as well as two metalated, in the core with zinc(II) and palladium(II) were characterized using 1D and 2D NMR spectroscopy and mass spectrometry. In addition, all macrocycles were subjected to absorption and emission studies as well as photostability tests. In a photochemical study, zinc(II) and palladium(II) phthalocyanine complexes appeared to be efficient singlet oxygen generators. There were noted quantum yields of singlet oxygen generation for zinc(II) phthalocyanine derivative in DMF and DMSO at 0.55 and 0.72, whereas for palladium(II) complex at 0.73 and 0.77, respectively. Liposomal formulations of phthalocyanine derivatives were prepared, and their activity was evaluated against a broad spectrum of antibiotic-resistant microorganisms, such as methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli (ESBL+), Candida albicans resistant to fluconazole, C. auris, and against dermatophytes. Phthalocyanine palladium(II) complex showed the highest bactericidal activity against all antibiotic-resistant microorganisms, including reducing C. auris growth at 3.54 log.
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Songsantiphap C, Vanichanan J, Chatsuwan T, Asawanonda P, Boontaveeyuwat E. Methylene Blue-Mediated Antimicrobial Photodynamic Therapy Against Clinical Isolates of Extensively Drug Resistant Gram-Negative Bacteria Causing Nosocomial Infections in Thailand, An In Vitro Study. Front Cell Infect Microbiol 2022; 12:929242. [PMID: 35846758 PMCID: PMC9283779 DOI: 10.3389/fcimb.2022.929242] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/31/2022] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND/PURPOSE Some multidrug-resistant gram-negative bacteria as a global threat have been recently prioritized for research and development of new treatments. We studied the efficacy of methylene blue-mediated antimicrobial photodynamic therapy (MB-aPDT) for the reduction of extensively drug-resistant Acinetobacter baumannii (XDR-AB) and Pseudomonas aeruginosa (XDR-PS) and multidrug-resistant Klebsiella pneumoniae (MDR-KP) isolated in a university hospital setting in Thailand. METHOD Two isolates of each selected bacterium were collected, XDR-AB1 and AB2, XDR- PS1 and PS2, and MDR-KP1 and KP2. Three triplicate experiments using various MB concentrations alone, various red light fluences alone, as well as the selected non-toxic doses of MB and fluences of red light combined as MB-aPDT were applied on each selected isolate. The colonies were counted [colony forming units (CFU)/ml]. Estimation of the lethal treatment dose defined as reduction of > 2 log10 in CFU/ml compared with untreated bacteria. RESULT There were generally negligible changes in the viable counts of the bacterial suspensions treated with all the MB concentrations (p > 0.05). In the second experiment with the only red light treatments, at fluences higher than 2 J/cm, reduction trend in viable counts across all the isolates was observed. Only for MDR-KP1, however, the lethal dose was achieved with the highest fluence of red light (80 J/cm). With the concentration of MB, 50 and 150 mg/L in the third experiment (MB-aPDT), the greater bacterial reduction was observed in all clinical isolates leading to their lethal viable cell reduction when escalating the light fluence to 80 J/cm. CONCLUSIONS MB-aPDT evidently killed the selected XDR and MDR-gram negative bacteria. In highly drug-resistant crisis era, MB-aPDT could be a promising option, particularly for local infections and infection complicating chronic wounds.
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Affiliation(s)
- Chankiat Songsantiphap
- Photodermatology Unit, Division of Dermatology, Department of Medicine, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jakapat Vanichanan
- Division of Infectious Diseases, Department of Medicine, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tanittha Chatsuwan
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Antimicrobial Resistance and Stewardship Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pravit Asawanonda
- Photodermatology Unit, Division of Dermatology, Department of Medicine, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Einapak Boontaveeyuwat
- Photodermatology Unit, Division of Dermatology, Department of Medicine, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- *Correspondence: Einapak Boontaveeyuwat,
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Lin G, Hu M, Zhang R, Zhu Y, Gu K, Bai J, Li J, Dong X, Zhao W. Discovery of Meso-( meta-Pyridinium) BODIPY Photosensitizers: In Vitro and In Vivo Evaluations for Antimicrobial Photodynamic Therapy. J Med Chem 2021; 64:18143-18157. [PMID: 34881897 DOI: 10.1021/acs.jmedchem.1c01643] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Antimicrobial photodynamic therapy (aPDT) has emerged as a novel and promising approach for the treatment of pathogenic microorganism infections. The efficacy of aPDT depends greatly on the behavior of the photosensitizer. Herein, we report the design, preparation, antimicrobial photodynamic activities, as well as structure-activity relationships of a series of photosensitizers modified at the meso position of a 1,3,5,7-tetramethyl BODIPY scaffold with various pyridinyl and pyridinium moieties. The photodynamic antimicrobial activities of all photosensitizers have been tested against Staphylococcus aureus, Escherichia coli, Candida albicans, and Methicillin-resistant S. aureus (MRSA). The methyl meso-(meta-pyridinium) BODIPY photosensitizer (3c) possessed the highest phototoxicity against these pathogens at minimal inhibitory concentrations (MIC) ranging from 0.63 to 1.25 μM with a light dose of 81 J/cm2. Furthermore, 3c exhibited an impressive antimicrobial efficacy in S. aureus-infected mice wounds. Taken together, these findings suggest that 3c is a promising candidate as the antimicrobial photosensitizer for combating pathogenic microorganism infections.
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Affiliation(s)
- Guangyu Lin
- School of Pharmacy, Fudan University, Shanghai 201203, P. R. China
| | - Mei Hu
- School of Pharmacy, Fudan University, Shanghai 201203, P. R. China
| | - Rong Zhang
- School of Pharmacy, Fudan University, Shanghai 201203, P. R. China
| | - Yuanxing Zhu
- School of Pharmacy, Fudan University, Shanghai 201203, P. R. China
| | - Kedan Gu
- School of Pharmacy, Fudan University, Shanghai 201203, P. R. China
| | - Junping Bai
- School of Pharmacy, Fudan University, Shanghai 201203, P. R. China
| | - Jiyang Li
- School of Pharmacy, Fudan University, Shanghai 201203, P. R. China
| | - Xiaochun Dong
- School of Pharmacy, Fudan University, Shanghai 201203, P. R. China
| | - Weili Zhao
- School of Pharmacy, Fudan University, Shanghai 201203, P. R. China.,Key Laboratory for Special Functional Materials of the Ministry of Education, School of Materials Science and Engineering, Henan University, Kaifeng 475004, P. R. China
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Wainwright M. Anti-infective dyes in the time of COVID. DYES AND PIGMENTS : AN INTERNATIONAL JOURNAL 2021; 196:109813. [PMID: 34548711 PMCID: PMC8447552 DOI: 10.1016/j.dyepig.2021.109813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 06/13/2023]
Abstract
The phenomenal global upheaval caused by SARS-CoV-2 has produced amazing responses from science and healthcare, particularly in the rapid realisation and production of vaccines. However, until early 2020 global infection control research was highly focused on rapidly increasing rates of conventional antimicrobial resistance (AMR) and the supply of drugs to counter this. Antimicrobial dyes have been suggested by various authors for inclusion in this effort, usually with little return from responsible authorities, and normally on the basis of post-treatment staining or potential toxicity, but this does not deny the fact that such dyes, particularly with photoactivation, are the only class of agents with pan-microbial activity - i.e. against each of bacteria, viruses, fungi and protozoa - regardless of the organism's drug resistance status. Conventional antibacterials, antivirals etc. usually demonstrate activity against one particular section of pathogens only, and disinfectants such as chlorhexidine or benzalkonium salts are too toxic for internal use. This perspective reflects both the background utility of antimicrobial dyes and ways forward for their inclusion in 21st Century infection control protocols.
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Affiliation(s)
- Mark Wainwright
- School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University, Byrom St, Liverpool L3 3AF, United Kingdom
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13
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Digby EM, Ma T, Zipfel WR, Milstein JN, Beharry AA. Highly Potent Photoinactivation of Bacteria Using a Water-Soluble, Cell-Permeable, DNA-Binding Photosensitizer. ACS Infect Dis 2021; 7:3052-3061. [PMID: 34617443 DOI: 10.1021/acsinfecdis.1c00313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Antimicrobial photodynamic therapy (APDT) employs a photosensitizer, light, and molecular oxygen to treat infectious diseases via oxidative damage, with a low likelihood for the development of resistance. For optimal APDT efficacy, photosensitizers with cationic charges that can permeate bacteria cells and bind intracellular targets are desired to not limit oxidative damage to the outer bacterial structure. Here we report the application of brominated DAPI (Br-DAPI), a water-soluble, DNA-binding photosensitizer for the eradication of both Gram-negative and Gram-positive bacteria (as demonstrated on N99 Escherichia coli and Bacillus subtilis, respectively). We observe intracellular uptake of Br-DAPI, ROS-mediated bacterial cell death via one- and two-photon excitation, and selective photocytotoxicity of bacteria over mammalian cells. Photocytotoxicity of both N99 E. coli and B. subtilis occurred at submicromolar concentrations (IC50 = 0.2-0.4 μM) and low light doses (5 min irradiation times, 4.5 J cm-2 dose), making it superior to commonly employed APDT phenothiazinium photosensitizers such as methylene blue. Given its high potency and two-photon excitability, Br-DAPI is a promising novel photosensitizer for in vivo APDT applications.
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Affiliation(s)
- Elyse M. Digby
- Department of Chemical & Physical Sciences, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, Ontario L5L 1C6, Canada
- Department of Chemistry, University of Toronto, 80 St. George Street, Toronto, Ontario M5S 3H6, Canada
| | - Tianyi Ma
- Department of Chemical & Physical Sciences, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, Ontario L5L 1C6, Canada
- Department of Physics, University of Toronto, 60 St. George Street, Toronto, Ontario M5S 1A7, Canada
| | - Warren R. Zipfel
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York 14853, United States
| | - Joshua N. Milstein
- Department of Chemical & Physical Sciences, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, Ontario L5L 1C6, Canada
- Department of Physics, University of Toronto, 60 St. George Street, Toronto, Ontario M5S 1A7, Canada
| | - Andrew A. Beharry
- Department of Chemical & Physical Sciences, University of Toronto Mississauga, 3359 Mississauga Road North, Mississauga, Ontario L5L 1C6, Canada
- Department of Chemistry, University of Toronto, 80 St. George Street, Toronto, Ontario M5S 3H6, Canada
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Feng Y, Coradi Tonon C, Ashraf S, Hasan T. Photodynamic and antibiotic therapy in combination against bacterial infections: efficacy, determinants, mechanisms, and future perspectives. Adv Drug Deliv Rev 2021; 177:113941. [PMID: 34419503 DOI: 10.1016/j.addr.2021.113941] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/23/2021] [Accepted: 08/17/2021] [Indexed: 12/12/2022]
Abstract
Antibiotic treatment, the mainstay for the control of bacterial infections, is greatly hampered by the global prevalence of multidrug-resistant (MDR) bacteria. Photodynamic therapy (PDT) is effective against MDR infections, but PDT-induced bacterial inactivation is often incomplete, causing the relapse of infections. Combination of PDT and antibiotics is a promising strategy to overcome the limitation of both antibiotic treatment and PDT, exerting increased disinfection efficacy on MDR bacterial pathogens versus either of the monotherapies alone. In this review, we present an overview of the therapeutic effects of PDT/antibiotic combinations that have been developed. We further summarize the influencing factors and the governing molecular mechanisms of the therapeutic outcomes of PDT/antibiotic combinations. In the end, we provide concluding remarks on the strengths, limitations, and future research directions of PDT/antibiotic combination therapy to guide its appropriate usage and further development.
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Affiliation(s)
- Yanfang Feng
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Caroline Coradi Tonon
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Shoaib Ashraf
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Health Sciences and Technology (Harvard-MIT), Cambridge, MA, USA.
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15
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Zhang M, Cui Z, Wang Y, Ma W, Ji Y, Ye F, Feng Y, Liu C. Effects of sub-lethal antimicrobial photodynamic therapy mediated by haematoporphyrin monomethyl ether on polymyxin-resistant Escherichia coli clinical isolate. Photodiagnosis Photodyn Ther 2021; 36:102516. [PMID: 34469794 DOI: 10.1016/j.pdpdt.2021.102516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/20/2021] [Accepted: 08/27/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIM It is generally believed that bacteria can not develop resistance to antimicrobial photodynamic therapy (aPDT). This work employed a polymyxin-resistant Escherichia coli clinical isolate (E15017) to study whether it could become resistant to aPDT mediated by haematoporphyrin monomethyl ether (HMME) via consecutive photodynamic treatments at sub-lethal condition. METHODS The sub-lethal and lethal photodynamic treatment conditions for E15017 were determined by colony forming units (CFU) assay. Bacterial cells of E15017 were treated with 20 cycles of repeated sub-lethal HMME-mediated aPDT, and subsequently subjected to aPDT at lethal condition. The antibiotic susceptibility, zeta-potential and membrane integrity of sub-lethal aPDT treated E15017 cells were also investigated. RESULTS After 20 cycles of repeated HMME-mediated aPDT treatments at sub-lethal condition, E15017 cells didn't become more resistant to aPDT. Sub-lethal HMME-mediated aPDT decreased the MIC values of E15017 to ceftazidime and polymyxin E by 4 and 2-fold, respectively, and increased the electronegativity of bacterial surface and affected the bacterial membrane integrity. CONCLUSIONS The results obtained in this study confirmed that antibiotic-resistant bacteria could not develop resistance to aPDT, and HMME-mediated aPDT is an attractive potential treatment for MDR E. coli caused infections.
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Affiliation(s)
- Miaomiao Zhang
- Department of Pathogenic Microbiology & Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an, 710061, PR China
| | - Zixin Cui
- Department of Pathogenic Microbiology & Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an, 710061, PR China; Department of Infection, The First Affiliated Hospital of College of Medicine, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, PR China
| | - Yanli Wang
- The First Hospital of Weinan, 35 East Shengli Street, Weinan, 714000, PR China
| | - Wenpeng Ma
- Department of Pathogenic Microbiology & Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an, 710061, PR China
| | - Yanhong Ji
- Department of Pathogenic Microbiology & Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an, 710061, PR China
| | - Feng Ye
- Department of Infection, The First Affiliated Hospital of College of Medicine, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, PR China
| | - Youjun Feng
- Department of Pathogen Biology & Microbiology, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, PR China.
| | - Chengcheng Liu
- Department of Pathogenic Microbiology & Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an, 710061, PR China.
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16
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Marasini S, Leanse LG, Dai T. Can microorganisms develop resistance against light based anti-infective agents? Adv Drug Deliv Rev 2021; 175:113822. [PMID: 34089778 DOI: 10.1016/j.addr.2021.05.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/25/2021] [Accepted: 05/31/2021] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Sanjay Marasini
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand.
| | - Leon G Leanse
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Vaccine and Immunotherapy Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tianhong Dai
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Vaccine and Immunotherapy Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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17
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Shleeva M, Savitsky A, Kaprelyants A. Corynebacterium jeikeium Dormant Cell Formation and Photodynamic Inactivation. Front Microbiol 2020; 11:605899. [PMID: 33391228 PMCID: PMC7775403 DOI: 10.3389/fmicb.2020.605899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/30/2020] [Indexed: 11/18/2022] Open
Abstract
Pathogenic non-spore forming bacteria enter a dormant state under stressful conditions, which likely allows them to acquire resistance to various antibiotics. This work revealed the efficient formation of dormant "non-culturable" (NC) Corynebacterium jeikeium cells in stationary phase upon gradual acidification of the growth medium. Such cells were unable to form colonies and existed in a prolonged stationary phase. At an early stage of dormancy (approximately 14 days post-inoculation), dormant cells are able for resuscitation in liquid medium. However, those stored for long time in dormant state needed addition of supernatant taking from active C. jeikeium cultures for successful resuscitation. NC cells possessed low RNA synthesis and significant tolerance to antibiotics (rifampicin and vancomycin). They also accumulated free porphyrins, and 5-aminolevulinic acid addition enhanced free porphyrin accumulation which makes them potentially sensitive to photodynamic inactivation (PDI). PDI of dormant bacteria was accomplished by exposing cells to a 565 nm wavelength of light using a SOLIS-4C light-emitting diode for 60 min. This revealed that increased porphyrin concentrations were correlated with elevated PDI sensitivity. Results shown here demonstrate the potential utility of employing PDI to minimize levels of dormant, persistent corynebacteria and the C. jeikeium dormancy model developed here may be useful for finding new drugs and techniques for combatting persistent corynebacteria.
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Affiliation(s)
- Margarita Shleeva
- Federal Research Centre “Fundamentals of Biotechnology” of the Russian Academy of Sciences, A.N. Bach Institute of Biochemistry, Moscow, Russia
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18
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Fayyaz F, Rassa M, Rahimi R. Antibacterial Photoactivity and Thermal Stability of Tetra-cationic Porphyrins Immobilized on Cellulosic Fabrics. Photochem Photobiol 2020; 97:385-397. [PMID: 33152128 DOI: 10.1111/php.13353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Abstract
The thermal stability and photo-bactericidal effect of several tetra-cationic porphyrins and their zinc ion compounds immobilized onto cellulosic fabrics against S. aureus, P. aeruginosa, and E. coli were investigated and compared using a 100 W tungsten lamp. Immobilization of various concentrations of these photosensitizers onto cellulosic fabrics was carried out and characterized by ATR-FT-IR, DRS, TGA, and SEM. Applied cellulosic fabrics with the photosensitizers exhibited remarkable photo-stability, thermal stability, and antimicrobial activity against these studied strains.
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Affiliation(s)
- Fatemeh Fayyaz
- Bioinorganic Chemistry Laboratory, Department of Chemistry, Iran University of Science and Technology, Tehran, Iran
| | - Mehdi Rassa
- Department of Biology, Faculty of Science, University of Guilan, Rasht, Iran
| | - Rahmatollah Rahimi
- Bioinorganic Chemistry Laboratory, Department of Chemistry, Iran University of Science and Technology, Tehran, Iran
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19
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Garcez AS, Kaplan M, Jensen GJ, Scheidt FR, Oliveira EM, Suzuki SS. Effects of antimicrobial photodynamic therapy on antibiotic-resistant Escherichia coli. Photodiagnosis Photodyn Ther 2020; 32:102029. [PMID: 32980553 DOI: 10.1016/j.pdpdt.2020.102029] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 01/07/2023]
Abstract
This study used Electron Cryo-tomography (ECT) and fluorescent images to evaluate antimicrobial photodynamic therapy (aPDT) on the envelope architecture of a Gram-negative bacteria and the effects of combined therapy of aPDT and antibiotics. Standard and clinical suspension of Escherichia coli were submitted to photodynamic treatment with methylene blue solution (100μM) and a 100 mW LED emitting at 660 nm with 3 and 18 J of energy. As a control group, a suspension of E. coli was submitted to penicillin V for 60 min at 30 °C, to compare the damage in cell wall structure. After treatment, ECT images were collected and E. coli biofilms were grown in glass-cover slides and stained with live/dead staining for fluorescence analysis before and after treatments. Bacteria were also submitted to disc diffusion and MIC50 tests with Ampicillin, Amoxicillin + Clavulanic acid, Clindamycin and Erythromycin. For in vivo experiment Galleria mellonella larvae were infected with E. coli and treated with antibiotics, aPDT or combined therapy. ECT images presented damage to cell walls and vesicles structures inside and outside the bacteria and fluorescent images showed dose dependent effect of aPDT. Antibiotic or aPDT alone did not improve the survival of caterpillars, but the combined therapy significantly increased survival curve. ECT and fluorescent images shows that aPDT seems to promote micro-damages to cell envelope and causes the production of membrane vesicles permeabilizing cell membranes. The results showed that pre-treating bacterial cells with a photosensitizer and light make them more susceptible to antibiotics and could be an alternative to local infection treatment by resistant bacteria.
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Affiliation(s)
- Aguinaldo S Garcez
- Department of oral Microbiology, São Leopoldo Mandic Institute and Research Center, Campinas, Brazil.
| | - Mohammed Kaplan
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, USA
| | - Grant J Jensen
- Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, USA; Howard Hughes Medical Institute, California Institute of Technology, Pasadena, USA
| | - Fábio R Scheidt
- Department of oral Microbiology, São Leopoldo Mandic Institute and Research Center, Campinas, Brazil
| | - Eduardo M Oliveira
- Department of oral Microbiology, São Leopoldo Mandic Institute and Research Center, Campinas, Brazil
| | - Selly S Suzuki
- Department of oral Microbiology, São Leopoldo Mandic Institute and Research Center, Campinas, Brazil
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20
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Bohm GC, Gándara L, Di Venosa G, Mamone L, Buzzola F, Casas A. Photodynamic inactivation mediated by 5-aminolevulinic acid of bacteria in planktonic and biofilm forms. Biochem Pharmacol 2020; 177:114016. [PMID: 32387459 DOI: 10.1016/j.bcp.2020.114016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/04/2020] [Indexed: 11/24/2022]
Abstract
Bacterial photodynamic inactivation (PDI) employing endogenous production of porphyrins from 5-aminolevulinic acid (ALA) - named ALA-PDI-, is a new promising tool to achieve bacteria control in non-spread infections. The technique combines the action of the porphyrins acting as photosensitisers with light, to produce reactive oxygen species to target the pathogen. To date, some clinical applications of ALA-PDI have been reported although variable responses ranging from total eradication to absence of photokilling were found. ALA-PDI conducted at suboptimal conditions may lead to misleading results and the complexity of haem synthesis in bacteria hinders the optimization of the treatment. The present work aimed to gain insight on the variables affecting ALA-PDI in Gram-positives and Gram-negatives bacteria growing on planktonic and biofilm cultures and to correlate the degree of the response with the amount and type of porphyrin synthesised. Staphylococcus epidermidis and Escherichia coli clinical isolates and Pseudomonas aeruginosa ATCC27853 and Staphylococcus aureus ATCC25923 strains were utilised, and the optimal conditions of concentration and time exposure of ALA, and light dose were set. In both Gram-positive species analysed, a peak of porphyrin synthesis was observed at 1-2 mM ALA in biofilm and planktonic cultures, which fairly correlated with the decrease in the number of CFU after PDI (5 to 7 logs) and porphyrin content was in the same order of magnitude. In addition, ALA-PDI was similarly effective for planktonic and biofilm S. aureus cultures, and more effective in S. epidermidis planktonic cultures at low light doses. Beyond a certain light dose, it was not possible to achieve further photosensitization. Similarly, a plateau of cell death was attained at a certain ALA incubation time. Accumulation of hydrophilic porphyrins at longer incubation periods was observed. The proportion of porphyrins changed as a function of ALA concentration and incubation time in the Gram-positive bacteria, though we did not find a clear correlation between the porphyrin type and PDI response. As a salient feature was the presence of isococroporphyrin isoforms in both Gram-positive and Gram-negative bacteria. Gram-negative bacteria were quite refractory to the treatment: P. aeruginosa was slightly inactivated (4-logs reduction) at 40 mM ALA, whereas E. coli was not inactivated at all. These species accumulated high ALA quantities and the amount of porphyrins did not correlate with the degree of photoinactivation. Our microscopy studies show that porphyrins are not located in the envelopes of Gram-negative bacteria, reinforcing the hypothesis that endogenous porphyrins fail to attack these structures.
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Affiliation(s)
- Gabriela Cervini Bohm
- Centro de Investigaciones sobre Porfirinas y Porfirias (CIPYP), CONICET and Hospital de Clínicas José de San Martín, Universidad de Buenos Aires. Córdoba 2351 1er subsuelo, Ciudad de Buenos Aires CP1120AAF, Argentina
| | - Lautaro Gándara
- Centro de Investigaciones sobre Porfirinas y Porfirias (CIPYP), CONICET and Hospital de Clínicas José de San Martín, Universidad de Buenos Aires. Córdoba 2351 1er subsuelo, Ciudad de Buenos Aires CP1120AAF, Argentina
| | - Gabriela Di Venosa
- Centro de Investigaciones sobre Porfirinas y Porfirias (CIPYP), CONICET and Hospital de Clínicas José de San Martín, Universidad de Buenos Aires. Córdoba 2351 1er subsuelo, Ciudad de Buenos Aires CP1120AAF, Argentina
| | - Leandro Mamone
- Centro de Investigaciones sobre Porfirinas y Porfirias (CIPYP), CONICET and Hospital de Clínicas José de San Martín, Universidad de Buenos Aires. Córdoba 2351 1er subsuelo, Ciudad de Buenos Aires CP1120AAF, Argentina
| | - Fernanda Buzzola
- Universidad de Buenos Aires, CONICET, Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM), and Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Buenos Aires, Argentina
| | - Adriana Casas
- Centro de Investigaciones sobre Porfirinas y Porfirias (CIPYP), CONICET and Hospital de Clínicas José de San Martín, Universidad de Buenos Aires. Córdoba 2351 1er subsuelo, Ciudad de Buenos Aires CP1120AAF, Argentina.
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21
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Zhou K, Tian R, Li G, Qiu X, Xu L, Guo M, Chigan D, Zhang Y, Chen X, He G. Cationic Chalcogenoviologen Derivatives for Photodynamic Antimicrobial Therapy and Skin Regeneration. Chemistry 2019; 25:13472-13478. [DOI: 10.1002/chem.201903278] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Kun Zhou
- Frontier Institute of Science and TechnologyState Key Laboratory for Strength and Vibration of Mechanical StructuresXi'an Key Laboratory of Sustainable Energy Materials ChemistryXi'an Jiaotong University Xi'an Shaanxi Province 710054 China
| | - Ran Tian
- School of Chemical Engineering and TechnologyShaanxi Key Laboratory of Energy Chemical Process IntensificationInstitute of Polymer Science in Chemical EngineeringXi'an Jiaotong University Xi'an Shaanxi Province 710054 China
| | - Guoping Li
- Frontier Institute of Science and TechnologyState Key Laboratory for Strength and Vibration of Mechanical StructuresXi'an Key Laboratory of Sustainable Energy Materials ChemistryXi'an Jiaotong University Xi'an Shaanxi Province 710054 China
| | - Xinyu Qiu
- Center for Tissue Engineering, School of StomatologyFourth Military Medical University Xi'an Shaanxi Province 710032 China
| | - Letian Xu
- Frontier Institute of Science and TechnologyState Key Laboratory for Strength and Vibration of Mechanical StructuresXi'an Key Laboratory of Sustainable Energy Materials ChemistryXi'an Jiaotong University Xi'an Shaanxi Province 710054 China
| | - Mengying Guo
- Frontier Institute of Science and TechnologyState Key Laboratory for Strength and Vibration of Mechanical StructuresXi'an Key Laboratory of Sustainable Energy Materials ChemistryXi'an Jiaotong University Xi'an Shaanxi Province 710054 China
| | - Dongdong Chigan
- Frontier Institute of Science and TechnologyState Key Laboratory for Strength and Vibration of Mechanical StructuresXi'an Key Laboratory of Sustainable Energy Materials ChemistryXi'an Jiaotong University Xi'an Shaanxi Province 710054 China
| | - Yanfeng Zhang
- Frontier Institute of Science and TechnologyState Key Laboratory for Strength and Vibration of Mechanical StructuresXi'an Key Laboratory of Sustainable Energy Materials ChemistryXi'an Jiaotong University Xi'an Shaanxi Province 710054 China
| | - Xin Chen
- School of Chemical Engineering and TechnologyShaanxi Key Laboratory of Energy Chemical Process IntensificationInstitute of Polymer Science in Chemical EngineeringXi'an Jiaotong University Xi'an Shaanxi Province 710054 China
| | - Gang He
- Frontier Institute of Science and TechnologyState Key Laboratory for Strength and Vibration of Mechanical StructuresXi'an Key Laboratory of Sustainable Energy Materials ChemistryXi'an Jiaotong University Xi'an Shaanxi Province 710054 China
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22
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Porphyrinoid photosensitizers mediated photodynamic inactivation against bacteria. Eur J Med Chem 2019; 175:72-106. [PMID: 31096157 DOI: 10.1016/j.ejmech.2019.04.057] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/27/2018] [Accepted: 04/19/2019] [Indexed: 12/28/2022]
Abstract
The multi-drug resistant bacteria have become a serious problem complicating therapies to such a degree that often the term "post-antibiotic era" is applied to describe the situation. The infections with methicillin-resistant S. aureus, vancomycin-resistant E. faecium, third generation cephalosporin-resistant E. coli, third generation cephalosporin-resistant K. pneumoniae and carbapenem-resistant P. aeruginosa have become commonplace. Thus, the new strategies of infection treatment have been searched for, and one of the approaches is based on photodynamic antimicrobial chemotherapy. Photodynamic protocols require the interaction of photosensitizer, molecular oxygen and light. The aim of this review is to provide a comprehensive overview of photodynamic antimicrobial chemotherapy by porphyrinoid photosensitizers. In the first part of the review information on the mechanism of photodynamic action and the mechanism of the bacteria resistance to the photodynamic technique were described. In the second one, it was described porphyrinoids photosensitizers like: porphyrins, chlorins and phthalocyanines useable in photodynamic bacteria inactivation.
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23
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dos Santos DP, Soares Lopes DP, de Moraes RC, Vieira Gonçalves C, Pereira Rosa L, da Silva Rosa FC, da Silva RAA. Photoactivated resveratrol against Staphylococcus aureus infection in mice. Photodiagnosis Photodyn Ther 2019; 25:227-236. [DOI: 10.1016/j.pdpdt.2019.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/22/2018] [Accepted: 01/04/2019] [Indexed: 01/02/2023]
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24
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Hamblin MR, Abrahamse H. Can light-based approaches overcome antimicrobial resistance? Drug Dev Res 2019; 80:48-67. [PMID: 30070718 PMCID: PMC6359990 DOI: 10.1002/ddr.21453] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/06/2018] [Accepted: 07/07/2018] [Indexed: 01/10/2023]
Abstract
The relentless rise of antibiotic resistance is considered one of the most serious problems facing mankind. This mini-review will cover three cutting-edge approaches that use light-based techniques to kill antibiotic-resistant microbial species, and treat localized infections. First, we will discuss antimicrobial photodynamic inactivation using rationally designed photosensitizes combined with visible light, with the added possibility of strong potentiation by inorganic salts such as potassium iodide. Second, the use of blue and violet light alone that activates endogenous photoactive porphyrins within the microbial cells. Third, it is used for "safe UVC" at wavelengths between 200 nm and 230 nm that can kill microbial cells without damaging host mammalian cells. We have gained evidence that all these approaches can kill multidrug resistant bacteria in vitro, and they do not induce themselves any resistance, and moreover can treat animal models of localized infections caused by resistant species that can be monitored by noninvasive bioluminescence imaging. Light-based antimicrobial approaches are becoming a growing translational part of anti-infective treatments in the current age of resistance.
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Affiliation(s)
- Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts
| | - Heidi Abrahamse
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, South Africa
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Majiya H, Adeyemi OO, Herod M, Stonehouse NJ, Millner P. Photodynamic inactivation of non-enveloped RNA viruses. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2018; 189:87-94. [DOI: 10.1016/j.jphotobiol.2018.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/24/2018] [Accepted: 10/07/2018] [Indexed: 10/28/2022]
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Ilizirov Y, Formanovsky A, Mikhura I, Paitan Y, Nakonechny F, Nisnevitch M. Effect of Photodynamic Antibacterial Chemotherapy Combined with Antibiotics on Gram-Positive and Gram-Negative Bacteria. Molecules 2018; 23:E3152. [PMID: 30513653 PMCID: PMC6320794 DOI: 10.3390/molecules23123152] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/23/2018] [Accepted: 11/27/2018] [Indexed: 11/16/2022] Open
Abstract
The well-known and rapidly growing phenomenon of bacterial resistance to antibiotics is caused by uncontrolled, excessive and inappropriate use of antibiotics. One of alternatives to antibiotics is Photodynamic Antibacterial Chemotherapy (PACT). In the present study, the effect of PACT using a photosensitizer Rose Bengal alone and in combination with antibiotics including methicillin and derivatives of sulfanilamide synthesized by us was tested against antibiotic-sensitive and antibiotic-resistant clinical isolates of Gram-positive S. aureus and Gram-negative P. aeruginosa. Antibiotic-sensitive and resistant strains of P. aeruginosa were eradicated by Rose Bengal under illumination and by sulfanilamide but were not inhibited by new sulfanilamide derivatives. No increase in sensitivity of P. aeruginosa cells to sulfanilamide was observed upon a combination of Rose Bengal and sulfanilamide under illumination. All tested S. aureus strains (MSSA and MRSA) were effectively inhibited by PACT. When treated with sub-MIC concentrations of Rose Bengal under illumination, the minimum inhibitory concentrations (MIC) of methicillin decreased significantly for MSSA and MRSA strains. In some cases, antibiotic sensitivity of resistant strains can be restored by combining antibiotics with PACT.
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Affiliation(s)
- Yana Ilizirov
- Department of Chemical Engineering, Biotechnology and Materials, Ariel University, Ariel 4070000, Israel.
| | - Andrei Formanovsky
- Shemyakin⁻Ovchinnikov Institute of Bioorganic Chemistry Russian Academy of Sciences, 117977 Moscow, Russia.
| | - Irina Mikhura
- Shemyakin⁻Ovchinnikov Institute of Bioorganic Chemistry Russian Academy of Sciences, 117977 Moscow, Russia.
| | - Yossi Paitan
- Clinical Microbiology Laboratory, Meir Medical Center, Kfar Saba 4428164, Israel.
| | - Faina Nakonechny
- Department of Chemical Engineering, Biotechnology and Materials, Ariel University, Ariel 4070000, Israel.
| | - Marina Nisnevitch
- Department of Chemical Engineering, Biotechnology and Materials, Ariel University, Ariel 4070000, Israel.
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Al-Mutairi R, Tovmasyan A, Batinic-Haberle I, Benov L. Sublethal Photodynamic Treatment Does Not Lead to Development of Resistance. Front Microbiol 2018; 9:1699. [PMID: 30108561 PMCID: PMC6079231 DOI: 10.3389/fmicb.2018.01699] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/09/2018] [Indexed: 01/08/2023] Open
Abstract
A promising new alternative approach for eradication of antibiotic-resistant strains is to expose microbes to photosensitizers, which upon illumination generate reactive oxygen species. Among the requirements for a potent, medically applicable photosensitizer, are high efficacy in killing microbes and low toxicity to the host. Since photodynamic treatment is based on production of reactive species which are potentially DNA damaging and mutagenic, it might be expected that under selective pressure, microbes would develop resistance. The aim of this study was to determine if antibacterial photodynamic treatment with a highly photoefficient photosensitizer, Zn(II) meso-tetrakis(N-n-hexylpyridinium-2-yl)porphyrin would lead to development of resistance. To answer that question, bacterial cultures were subjected to multiple cycles of sublethal photodynamic stress and regrowth, and to continuous growth under photodynamic exposure. Antibiotic-resistant Staphylococcus aureus and Escherichia coli clinical isolates were also tested for susceptibility to photodynamic inactivation and for development of resistance. Results demonstrated that multiple photodynamic exposures and regrowth of surviving cells or continuous growth under sublethal photodynamic conditions, did not lead to development of resistance to photosensitizers or to antibiotics. Antibiotic-resistant E. coli and S. aureus were as sensitive to photodynamic killing as were their antibiotic-sensitive counterparts and no changes in their sensitivity to antibiotics or to photodynamic inactivation after multiple cycles of photodynamic treatment and regrowth were observed. In conclusion, photosensitizers with high photodynamic antimicrobial efficiency can be used successfully for eradication of antibiotic-resistant bacterial strains without causing development of resistance.
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Affiliation(s)
- Rawan Al-Mutairi
- Department of Biochemistry, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Artak Tovmasyan
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States
| | - Ines Batinic-Haberle
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States
| | - Ludmil Benov
- Department of Biochemistry, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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Cieplik F, Deng D, Crielaard W, Buchalla W, Hellwig E, Al-Ahmad A, Maisch T. Antimicrobial photodynamic therapy - what we know and what we don't. Crit Rev Microbiol 2018; 44:571-589. [PMID: 29749263 DOI: 10.1080/1040841x.2018.1467876] [Citation(s) in RCA: 454] [Impact Index Per Article: 75.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Considering increasing number of pathogens resistant towards commonly used antibiotics as well as antiseptics, there is a pressing need for antimicrobial approaches that are capable of inactivating pathogens efficiently without the risk of inducing resistances. In this regard, an alternative approach is the antimicrobial photodynamic therapy (aPDT). The antimicrobial effect of aPDT is based on the principle that visible light activates a per se non-toxic molecule, the so-called photosensitizer (PS), resulting in generation of reactive oxygen species that kill bacteria unselectively via an oxidative burst. During the last 10-20 years, there has been extensive in vitro research on novel PS as well as light sources, which is now to be translated into clinics. In this review, we aim to provide an overview about the history of aPDT, its fundamental photochemical and photophysical mechanisms as well as photosensitizers and light sources that are currently applied for aPDT in vitro. Furthermore, the potential of resistances towards aPDT is extensively discussed and implications for proper comparison of in vitro studies regarding aPDT as well as for potential application fields in clinical practice are given. Overall, this review shall provide an outlook on future research directions needed for successful translation of promising in vitro results in aPDT towards clinical practice.
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Affiliation(s)
- Fabian Cieplik
- a Department of Conservative Dentistry and Periodontology , University Medical Center Regensburg , Regensburg , Germany.,b Department of Preventive Dentistry , Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
| | - Dongmei Deng
- b Department of Preventive Dentistry , Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
| | - Wim Crielaard
- b Department of Preventive Dentistry , Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
| | - Wolfgang Buchalla
- a Department of Conservative Dentistry and Periodontology , University Medical Center Regensburg , Regensburg , Germany
| | - Elmar Hellwig
- c Department of Operative Dentistry and Periodontology, Faculty of Medicine , Center for Dental Medicine, University of Freiburg , Freiburg , Germany
| | - Ali Al-Ahmad
- c Department of Operative Dentistry and Periodontology, Faculty of Medicine , Center for Dental Medicine, University of Freiburg , Freiburg , Germany
| | - Tim Maisch
- d Department of Dermatology , University Medical Center Regensburg , Regensburg , Germany
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Wozniak A, Grinholc M. Combined Antimicrobial Activity of Photodynamic Inactivation and Antimicrobials-State of the Art. Front Microbiol 2018; 9:930. [PMID: 29867839 PMCID: PMC5952179 DOI: 10.3389/fmicb.2018.00930] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/20/2018] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial photodynamic inactivation (aPDI) is a promising tool for the eradication of life-threatening pathogens with different profiles of resistance. This study presents the state-of-the-art published studies that have been dedicated to analyzing the bactericidal effects of combining aPDI and routinely applied antibiotics in in vitro (using biofilm and planktonic cultures) and in vivo experiments. Furthermore, the current paper reviews the methodology used to obtain the published data that describes the synergy between these antimicrobial approaches. The authors are convinced that even though the combined efficacy of aPDI and antimicrobials could be investigated with the wide range of methods, the use of a unified experimental methodology that is in agreement with antimicrobial susceptibility testing (AST) is required to investigate possible synergistic cooperation between aPDI and antimicrobials. Conclusions concerning the possible synergistic activity between the two treatments can be drawn only when appropriate assays are employed. It must be noticed that some of the described papers were just aimed at determination if combined treatments exert enhanced antibacterial outcome, without following the standard methodology to evaluate the synergistic effect, but in most of them (18 out of 27) authors indicated the existence of synergy between described antibacterial approaches. In general, the increase in bacterial inactivation was observed when both therapies were used in combination.
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Affiliation(s)
- Agata Wozniak
- Laboratory of Molecular Diagnostics, Department of Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk, Gdansk, Poland
| | - Mariusz Grinholc
- Laboratory of Molecular Diagnostics, Department of Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk, Gdansk, Poland
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Eckl DB, Dengler L, Nemmert M, Eichner A, Bäumler W, Huber H. A Closer Look at Dark Toxicity of the Photosensitizer TMPyP in Bacteria. Photochem Photobiol 2017; 94:165-172. [PMID: 28940456 DOI: 10.1111/php.12846] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/10/2017] [Indexed: 12/24/2022]
Abstract
Photodynamic inactivation of bacteria (PIB) is based on photosensitizers which absorb light and generate reactive oxygen species (ROS), killing cells via oxidation. PIB is evaluated by comparing viability with and without irradiation, where reduction of viability in the presence of the photosensitizer without irradiation is considered as dark toxicity. This effect is controversially discussed for photosensitizers like TMPyP (5,10,15,20-Tetrakis(1-methyl-4-pyridinio)porphyrin tetra(p-toluensulfonate). TMPyP shows a high absorption coefficient for blue light and a high yield of ROS production, especially singlet oxygen. Escherichia coli and Bacillus atrophaeus were incubated with TMPyP and irradiated with different light sources at low radiant exposures (μW per cm²), reflecting laboratory conditions of dark toxicity evaluation. Inactivation of E. coli occurs for blue light, while no effect was detectable for wavelengths >450 nm. Being more susceptible toward PIB, growth of B. atrophaeus is even reduced for light with emission >450 nm. Decreasing the light intensities to nW per cm² for B. atrophaeus, application of TMPyP still caused bacterial killing. Toxic effects of TMPyP disappeared after addition of histidine, quenching residual ROS. Our experiments demonstrate that the evaluation of dark toxicity of a powerful photosensitizer like TMPyP requires low light intensities and if necessary additional application of substances quenching any residual ROS.
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Affiliation(s)
- Daniel B Eckl
- Institute for Microbiology and Archaea Center, University of Regensburg, Regensburg, Germany
| | - Linda Dengler
- Institute for Microbiology and Archaea Center, University of Regensburg, Regensburg, Germany
| | - Marina Nemmert
- Institute for Microbiology and Archaea Center, University of Regensburg, Regensburg, Germany
| | - Anja Eichner
- Department of Dermatology, University hospital Regensburg, Regensburg, Germany
| | - Wolfgang Bäumler
- Department of Dermatology, University hospital Regensburg, Regensburg, Germany
| | - Harald Huber
- Institute for Microbiology and Archaea Center, University of Regensburg, Regensburg, Germany
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Kashef N, Hamblin MR. Can microbial cells develop resistance to oxidative stress in antimicrobial photodynamic inactivation? Drug Resist Updat 2017; 31:31-42. [PMID: 28867242 DOI: 10.1016/j.drup.2017.07.003] [Citation(s) in RCA: 197] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/28/2017] [Accepted: 07/13/2017] [Indexed: 01/08/2023]
Abstract
Infections have been a major cause of disease throughout the history of humans on earth. With the introduction of antibiotics, it was thought that infections had been conquered. However, bacteria have been able to develop resistance to antibiotics at an exponentially increasing rate. The growing threat from multi-drug resistant organisms calls for intensive action to prevent the emergence of totally resistant and untreatable infections. Novel, non-invasive, non-antibiotic strategies are needed that act more efficiently and faster than current antibiotics. One promising alternative is antimicrobial photodynamic inactivation (APDI), an approach that produces reactive oxygen species when dyes and light are combined. So far, it has been questionable if bacteria can develop resistance against APDI. This review paper gives an overview of recent studies concerning the susceptibility of bacteria towards oxidative stress, and suggests possible mechanisms of the development of APDI-resistance that should at least be addressed. Some ways to potentiate APDI and also to overcome future resistance are suggested.
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Affiliation(s)
- Nasim Kashef
- Department of Microbiology, School of Biology, College of Science, University of Tehran, Tehran, Iran; Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, 02114, USA; Department of Dermatology, Harvard Medical School, Boston, MA, 02115, USA.
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, 02114, USA; Department of Dermatology, Harvard Medical School, Boston, MA, 02115, USA; Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, 02139, USA.
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Enhancement of photodynamic inactivation of Staphylococcus aureus biofilms by disruptive strategies. Lasers Med Sci 2017; 32:1757-1767. [PMID: 28612299 DOI: 10.1007/s10103-017-2253-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/05/2017] [Indexed: 01/10/2023]
Abstract
Photodynamic inactivation (PDI) has been used to inactivate microorganisms through the use of photosensitizers and visible light. On the one hand, near-infrared treatment (NIRT) has also bactericidal and dispersal effects on biofilms. In addition, dispersal biological tools such as enzymes have also been employed in antibiotic combination treatments. The aim of this work was to use alternative approaches to increase the PDI efficacy, employing combination therapies aimed at the partial disruption of the biofilms, thus potentially increasing photosensitizer or oxygen penetration and interaction with bacteria. To that end, we applied toluidine blue (TB)-PDI treatment to Staphylococcus aureus biofilms previously treated with NIRT or enzymes and investigated the outcome of the combined therapies. TB employed at 0.5 mM induced per se 2-log drop in S. aureus RN6390 biofilm viability. Each NIRT (980-nm laser) and PDI (635-nm laser) treatment induced a further reduction of 1-log of viable counts. The combination of successive 980- and 635-nm laser treatments on TB-treated biofilms induced additive effects, leading to a 4.5-log viable count decrease. Proteinase K treatment applied to S. aureus of the Newman strain induced an additive effect on PDI mortality, leading to an overall 4-log decrease in S. aureus viability. Confocal scanning laser microscopy after biofilm staining with a fluorescent viability test and scanning electron microscopy observations were correlated with colony counts. The NIRT dose employed (227 J/cm2) led to an increase from 21 to 47 °C in the buffer temperature of the biofilm system, and this NIRT dose also induced 100% keratinocyte death. Further work is needed to establish conditions under which biofilm dispersal occurs at lower NIRT doses.
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Li M, Mai B, Wang A, Gao Y, Wang X, Liu X, Song S, Liu Q, Wei S, Wang P. Photodynamic antimicrobial chemotherapy with cationic phthalocyanines against Escherichia coli planktonic and biofilm cultures. RSC Adv 2017. [DOI: 10.1039/c7ra06073d] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cationic phthalocyanines (Pcs) combine with photodynamic antimicrobial chemotherapy (PACT) presents excellent antibacterial activity to Gram-negative bacteriaE. coli.
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Fila G, Kasimova K, Arenas Y, Nakonieczna J, Grinholc M, Bielawski KP, Lilge L. Murine Model Imitating Chronic Wound Infections for Evaluation of Antimicrobial Photodynamic Therapy Efficacy. Front Microbiol 2016; 7:1258. [PMID: 27555843 PMCID: PMC4977341 DOI: 10.3389/fmicb.2016.01258] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 07/29/2016] [Indexed: 11/22/2022] Open
Abstract
It is generally acknowledged that the age of antibiotics could come to an end, due to their widespread, and inappropriate use. Particularly for chronic wounds alternatives are being thought. Antimicrobial Photodynamic Therapy (APDT) is a potential candidate, and while approved for some indications, such as periodontitis, chronic sinusitis and other niche indications, its use in chronic wounds is not established. To further facilitate the development of APDT in chronic wounds we present an easy to use animal model exhibiting the key hallmarks of chronic wounds, based on full-thickness skin wounds paired with an optically transparent cover. The moisture-retaining wound exhibited rapid expansion of pathogen colonies up to 8 days while not jeopardizing the host survival. Use of two bioluminescent pathogens; methicillin resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa permits real time monitoring of the pathogens. The murine model was employed to evaluate the performance of four different photosensitizers as mediators in Photodynamic Therapy. While all four photosensitizers, Rose Bengal, porphyrin TMPyP, New Methylene Blue, and TLD1411 demonstrated good to excellent antimicrobial efficacy in planktonic solutions at 1 to 50 μM concentrations, whereas in in vivo the growth delay was limited with 24–48 h delay in pathogen expansion for MRSA, and we noticed longer growth suppression of P. aeruginosa with TLD1411 mediated Photodynamic Therapy. The murine model will enable developing new strategies for enhancement of APDT for chronic wound infections.
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Affiliation(s)
- Grzegorz Fila
- Laboratory of Molecular Diagnostics, Department of Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk Gdansk, Poland
| | - Kamola Kasimova
- Princess Margaret Cancer Centre, University Health Network Toronto, ON, Canada
| | | | - Joanna Nakonieczna
- Laboratory of Molecular Diagnostics, Department of Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk Gdansk, Poland
| | - Mariusz Grinholc
- Laboratory of Molecular Diagnostics, Department of Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk Gdansk, Poland
| | - Krzysztof P Bielawski
- Laboratory of Molecular Diagnostics, Department of Biotechnology, Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk Gdansk, Poland
| | - Lothar Lilge
- Princess Margaret Cancer Centre, University Health NetworkToronto, ON, Canada; Department of Medical Biophysics, University of TorontoToronto, ON, Canada
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Rahimi R, Fayyaz F, Rassa M. The study of cellulosic fabrics impregnated with porphyrin compounds for use as photo-bactericidal polymers. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 59:661-668. [DOI: 10.1016/j.msec.2015.10.067] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/03/2015] [Accepted: 10/20/2015] [Indexed: 11/25/2022]
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Barra F, Roscetto E, Soriano AA, Vollaro A, Postiglione I, Pierantoni GM, Palumbo G, Catania MR. Photodynamic and Antibiotic Therapy in Combination to Fight Biofilms and Resistant Surface Bacterial Infections. Int J Mol Sci 2015; 16:20417-30. [PMID: 26343645 PMCID: PMC4613211 DOI: 10.3390/ijms160920417] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/18/2015] [Accepted: 08/20/2015] [Indexed: 11/22/2022] Open
Abstract
Although photodynamic therapy (PDT), a therapeutic approach that involves a photosensitizer, light and O2, has been principally considered for the treatment of specific types of cancers, other applications exist, including the treatment of infections. Unfortunately, PDT does not always guarantee full success since it exerts lethal effects only in cells that have taken up a sufficient amount of photosensitizer and have been exposed to adequate light doses, conditions that are not always achieved. Based on our previous experience on the combination PDT/chemotherapy, we have explored the possibility of fighting bacteria that commonly crowd infected surfaces by combining PDT with an antibiotic, which normally does not harm the strain at low concentrations. To this purpose, we employed 5-aminolevulinic acid (5-ALA), a pro-drug that, once absorbed by proliferating bacteria, is converted into the natural photosensitizer Protoporphyrin IX (PpIX), followed by Gentamicin. Photoactivation generates reactive oxygen species (ROS) which damage or kill the cell, while Gentamicin, even at low doses, ends the work. Our experiments, in combination, have been highly successful against biofilms produced by several Gram positive bacteria (i.e., Staphylococcus aureus, Staphylococcus epidermidis, etc.). This original approach points to potentially new and wide applications in the therapy of infections of superficial wounds and sores.
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Affiliation(s)
- Federica Barra
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples 80131, Italy.
| | - Emanuela Roscetto
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples 80131, Italy.
| | - Amata A Soriano
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples 80131, Italy.
| | - Adriana Vollaro
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples 80131, Italy.
| | - Ilaria Postiglione
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples 80131, Italy.
| | - Giovanna Maria Pierantoni
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples 80131, Italy.
- Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Naples 80131, Italy.
| | - Giuseppe Palumbo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples 80131, Italy.
| | - Maria Rosaria Catania
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples 80131, Italy.
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Gollmer A, Felgenträger A, Bäumler W, Maisch T, Späth A. A novel set of symmetric methylene blue derivatives exhibits effective bacteria photokilling – a structure–response study. Photochem Photobiol Sci 2015; 14:335-51. [DOI: 10.1039/c4pp00309h] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This study focuses on the structure–response relationship of symmetrically substituted phenothiazinium dyes.
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Affiliation(s)
- Anita Gollmer
- Department of Dermatology
- University Medical Center Regensburg
- Germany
| | | | - Wolfgang Bäumler
- Department of Dermatology
- University Medical Center Regensburg
- Germany
| | - Tim Maisch
- Department of Dermatology
- University Medical Center Regensburg
- Germany
| | - Andreas Späth
- Department of Organic Chemistry
- University of Regensburg
- Germany
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Shih MH, Huang FC. Repetitive methylene blue-mediated photoantimicrobial chemotherapy changes the susceptibility and expression of the outer membrane proteins of Pseudomonas aeruginosa. Photodiagnosis Photodyn Ther 2013; 10:664-71. [DOI: 10.1016/j.pdpdt.2013.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/17/2013] [Accepted: 07/20/2013] [Indexed: 01/09/2023]
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Kashef N, Akbarizare M, Kamrava SK. Effect of sub-lethal photodynamic inactivation on the antibiotic susceptibility and biofilm formation of clinical Staphylococcus aureus isolates. Photodiagnosis Photodyn Ther 2013; 10:368-73. [DOI: 10.1016/j.pdpdt.2013.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 02/19/2013] [Accepted: 02/23/2013] [Indexed: 01/22/2023]
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Kato IT, Prates RA, Sabino CP, Fuchs BB, Tegos GP, Mylonakis E, Hamblin MR, Ribeiro MS. Antimicrobial photodynamic inactivation inhibits Candida albicans virulence factors and reduces in vivo pathogenicity. Antimicrob Agents Chemother 2013; 57:445-51. [PMID: 23129051 PMCID: PMC3535901 DOI: 10.1128/aac.01451-12] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 10/29/2012] [Indexed: 01/01/2023] Open
Abstract
The objective of this study was to evaluate whether Candida albicans exhibits altered pathogenicity characteristics following sublethal antimicrobial photodynamic inactivation (APDI) and if such alterations are maintained in the daughter cells. C. albicans was exposed to sublethal APDI by using methylene blue (MB) as a photosensitizer (0.05 mM) combined with a GaAlAs diode laser (λ 660 nm, 75 mW/cm(2), 9 to 27 J/cm(2)). In vitro, we evaluated APDI effects on C. albicans growth, germ tube formation, sensitivity to oxidative and osmotic stress, cell wall integrity, and fluconazole susceptibility. In vivo, we evaluated C. albicans pathogenicity with a mouse model of systemic infection. Animal survival was evaluated daily. Sublethal MB-mediated APDI reduced the growth rate and the ability of C. albicans to form germ tubes compared to untreated cells (P < 0.05). Survival of mice systemically infected with C. albicans pretreated with APDI was significantly increased compared to mice infected with untreated yeast (P < 0.05). APDI increased C. albicans sensitivity to sodium dodecyl sulfate, caffeine, and hydrogen peroxide. The MIC for fluconazole for C. albicans was also reduced following sublethal MB-mediated APDI. However, none of those pathogenic parameters was altered in daughter cells of C. albicans submitted to APDI. These data suggest that APDI may inhibit virulence factors and reduce in vivo pathogenicity of C. albicans. The absence of alterations in daughter cells indicates that APDI effects are transitory. The MIC reduction for fluconazole following APDI suggests that this antifungal could be combined with APDI to treat C. albicans infections.
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Affiliation(s)
- Ilka Tiemy Kato
- Center for Lasers and Applications, IPEN-CNEN/SP, São Paulo, Brazil
| | - Renato Araujo Prates
- Center for Lasers and Applications, IPEN-CNEN/SP, São Paulo, Brazil
- Dentistry School, Health Division and Biophotonics Program of UNINOVE, São Paulo, São Paulo, Brazil
| | | | - Beth Burgwyn Fuchs
- Harvard Medical School, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - George P. Tegos
- Department of Pathology, School of Medicine, and Center for Molecular Discovery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
| | - Eleftherios Mylonakis
- Harvard Medical School, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael R. Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
- Harvard—MIT Division of Health Sciences and Technology, Cambridge, Massachusetts, USA
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Hydrogen bond acceptors and additional cationic charges in methylene blue derivatives: photophysics and antimicrobial efficiency. BIOMED RESEARCH INTERNATIONAL 2012; 2013:482167. [PMID: 23509728 PMCID: PMC3591237 DOI: 10.1155/2013/482167] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 09/21/2012] [Indexed: 01/04/2023]
Abstract
Photodynamic inactivation of bacteria (PIB) by efficient singlet oxygen photosensitizers might be a beneficial alternative to antibiotics in the struggle against multiresistant bacteria. Phenothiazinium dyes belong to the most prominent classes of such sensitizers due to their intense absorption in the red-light region (λabs, max ca. 600–680 nm, ε > 50000 L mol−1 cm−1), their low toxicity, and their attachment/penetration abilities. Except simple substituents like alkyl or hydroxyalkyl residues, nearly no modifications of the phenothiaziniums have been pursued at the auxochromic sites. By this, the properties of methylene blue derivatives and their fields of application are limited; it remains unclear if their potential antimicrobial efficacy may be enhanced, also to compete with porphyrins. We prepared a set of six mainly novel methylene blue derivatives with the ability of additional hydrogen bonding and/or additional cationic charges to study the substituents' effect on their activity/toxicity profiles and photophysical properties. Direct detection of singlet oxygen was performed at 1270 nm and the singlet oxygen quantum yields were determined. In suspensions with both, Gram-positive and Gram-negative bacteria, some derivatives were highly active upon illumination to inactivate S. aureus and E. coli up to 7 log10 steps (99.99999%) without inherent toxicities in the nonirradiated state.
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Photodynamic Antimicrobial Chemotherapy (PACT) in combination with antibiotics for treatment of Burkholderia cepacia complex infection. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2011; 106:95-100. [PMID: 22079165 DOI: 10.1016/j.jphotobiol.2011.10.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 10/07/2011] [Accepted: 10/25/2011] [Indexed: 11/23/2022]
Abstract
This study aimed to determine if Photodynamic Antimicrobial Chemotherapy (PACT) was effective in the treatment of Burkholderia cepacia complex infection and whether a synergistic effect was evident if PACT was used in combination with antibiotics. The susceptibility of both planktonic and biofilm cultures of B. cepacia complex strains to methylene blue (MB) and meso-tetra(n-methyl-4-pyridyl)porphine tetra-tosylate (TMP)-mediated PACT was determined alone and in combination with antibiotics used in the treatment of Cystic Fibrosis pulmonary infection caused by these bacteria. When B. cepacia complex strains were grown planktonically, high levels of kill of were achieved with both TMP and MB-mediated PACT with strain and photosensitizer specific differences apparent. When strains were grown in biofilm, antibiotic treatment alone was bactericidal in 17/36 (47%) strain/antibiotic combinations tested. When antibiotic treatment was combined with PACT, bactericidal activity was apparent for 33/36 (92%) strain/antibiotic combinations. No antagonism was detected between PACT and antibiotic treatment with the combination synergistic for 6/36 (17%) and indifferent for 30/36 (83%) strain/antibiotic combinations. PACT could be a viable treatment option, either alone or in combination with antibiotics for treatment of B. cepacia complex pulmonary infection.
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St Denis TG, Huang L, Dai T, Hamblin MR. Analysis of the bacterial heat shock response to photodynamic therapy-mediated oxidative stress. Photochem Photobiol 2011; 87:707-13. [PMID: 21261628 DOI: 10.1111/j.1751-1097.2011.00902.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Antimicrobial photodynamic therapy (PDT) has recently emerged as an effective modality for the selective destruction of bacteria and other pathogenic microorganisms. We investigated whether PDT induced protective responses such as heat shock proteins (HSPs) in bacteria. Using the photosensitizer Toluidine Blue O (TBO) at sublethal PDT conditions, a seven-fold increase in bacterial HSP GroEL and a three-fold increase in HSP DnaK were observed in Escherichia coli post PDT. Pretreatment with 50°C heat for 30 min reduced PDT killing in both E. coli and in Enterococcus faecalis, with the most pronounced inhibition occurring at 50 μm TBO with 5 J cm(-2) 635 nm light, where E. coli killing was reduced by 2 log(10) and E. faecalis killing was reduced by 4 log(10). Finally, inhibition of the highly conserved chaperone DnaK using a small molecule benzylidene lactam HSP inhibitor potentiated (but not significantly) the effect of PDT at a TBO concentration of 2.5 μm in E. faecalis; however, this effect was not observed in E. coli presumably because inhibitor could not gain access due to Gram-negative permeability barrier. Induction of HSPs may be a mechanism whereby bacteria could become resistant to PDT and warrants the need for further study in the application of dual PDT-HSP-inhibition therapies.
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