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da Rocha VP, Mansano BSDM, Dos Santos CFC, Teixeira ILA, de Oliveira HA, Vieira SS, Antonio EL, Izar MCDO, Fonseca FAH, Serra AJ. How long does the biological effect of a red light-emitting diode last on adipose-derived mesenchymal stem cells? Photochem Photobiol 2024. [PMID: 38888236 DOI: 10.1111/php.13983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/16/2024] [Accepted: 06/04/2024] [Indexed: 06/20/2024]
Abstract
This research investigated the duration of the influence of red light-emitting diodes (LED, 630 nm; output power: 2452.5 mW; laser beam: 163.5 cm2; irradiance: 15 mW/cm2; radiant exposure: 4 J/cm2) on different periods after irradiation (6, 12, 24, 48, and 72 h) on adipose-derived mesenchymal stem cells' (AdMSCs) metabolism and paracrine factors. AdMSCs were irradiated three times every 48 h. Twenty-four hours after the last irradiation, there was a higher MTT absorbance, followed by a decrease after 48 h. The cells' secretome showed increased levels of IL-6 and VEGF after 12 and 24 h, but this was reversed after 48 h. Additionally, LED irradiation resulted in higher levels of nitrite and did not affect oxidative stress markers. LED irradiation had significant effects on AdMSCs after 24 h compared to other groups and its control group.
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Affiliation(s)
- Vitor Pocani da Rocha
- Department of Medicine, Cardiology Division, Federal University of Sao Paulo, São Paulo, SP, Brazil
| | | | | | | | | | - Stella Sousa Vieira
- Department of Medicine, Cardiology Division, Federal University of Sao Paulo, São Paulo, SP, Brazil
| | - Ednei Luiz Antonio
- Department of Medicine, Cardiology Division, Federal University of Sao Paulo, São Paulo, SP, Brazil
| | | | | | - Andrey Jorge Serra
- Department of Medicine, Cardiology Division, Federal University of Sao Paulo, São Paulo, SP, Brazil
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Stem Cell-Based Therapeutic Strategies for Premature Ovarian Insufficiency and Infertility: A Focus on Aging. Cells 2022; 11:cells11233713. [PMID: 36496972 PMCID: PMC9738202 DOI: 10.3390/cells11233713] [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: 10/26/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Reproductive aging is on the rise globally and inseparable from the entire aging process. An extreme form of reproductive aging is premature ovarian insufficiency (POI), which to date has mostly been of idiopathic etiology, thus hampering further clinical applications and associated with enormous socioeconomic and personal costs. In the field of reproduction, the important functional role of inflammation-induced ovarian deterioration and therapeutic strategies to prevent ovarian aging and increase its function are current research hotspots. This review discusses the general pathophysiology and relative causes of POI and comprehensively describes the association between the aging features of POI and infertility. Next, various preclinical studies of stem cell therapies with potential for POI treatment and their molecular mechanisms are described, with particular emphasis on the use of human induced pluripotent stem cell (hiPSC) technology in the current scenario. Finally, the progress made in the development of hiPSC technology as a POI research tool for engineering more mature and functional organoids suitable as an alternative therapy to restore infertility provides new insights into therapeutic vulnerability, and perspectives on this exciting research on stem cells and the derived exosomes towards more effective POI diagnosis and treatment are also discussed.
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Muneekaew S, Wang MJ, Chen SY. Control of stem cell differentiation by using extrinsic photobiomodulation in conjunction with cell adhesion pattern. Sci Rep 2022; 12:1812. [PMID: 35110659 PMCID: PMC8811059 DOI: 10.1038/s41598-022-05888-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/20/2022] [Indexed: 02/07/2023] Open
Abstract
The induction and direction of stem cell differentiation into needed cell phenotypes is the central pillar of tissue engineering for repairing damaged tissues or organs. Conventionally, a special recipe of chemical factors is formulated to achieve this purpose for each specific target cell type. In this work, it is demonstrated that the combination of extrinsic photobiomodulation and collagen-covered microislands could be used to induce differentiation of Wharton’s jelly mesenchymal stem cells (WJ-MSCs) with the differentiation direction dictated by the specific island topography without use of chemical factors. Both neurogenic differentiation and adipogenic differentiation could be attained with a rate surpassing that using chemical factors. Application of this method to other cell types is possible by utilizing microislands with a pattern tailored particularly for each specific cell type, rendering it a versatile modality for initiating and guiding stem cell differentiation.
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Affiliation(s)
- Saitong Muneekaew
- Department of Chemical Engineering, National Taiwan University of Science and Technology, Taipei City, 106, Taiwan
| | - Meng-Jiy Wang
- Department of Chemical Engineering, National Taiwan University of Science and Technology, Taipei City, 106, Taiwan.
| | - Szu-Yuan Chen
- Institute of Atomic and Molecular Sciences, Academia Sinica, Taipei City, 106, Taiwan. .,Department of Physics, National Central University, Taoyuan City, 320, Taiwan.
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Souza C, Jayme CC, Rezende N, Tedesco AC. Synergistic effect of photobiomodulation and phthalocyanine photosensitizer on fibroblast signaling responses in an in vitro three-dimensional microenvironment. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2021; 222:112256. [PMID: 34330080 DOI: 10.1016/j.jphotobiol.2021.112256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/12/2021] [Accepted: 07/04/2021] [Indexed: 12/22/2022]
Abstract
Photobiomodulation (PBM) is a promising medical treatment modality in the area of photodynamic therapy (PDT). In this study, we investigated the effect of combined therapy in a 3D microenvironment using aluminum chloride phthalocyanines (AlClPc) as the photosensitizing agent. Normal human fibroblast-containing collagen biomatrix was prepared and treated with an oil-in-water (o/a) AlClPc-loaded nanoemulsion (from 0.5 to 3.0 μM) and irradiated at a range of fluences (from 0.1 to 3.0 J/cm2) using a continuous-wave light-emitting diode (LED) irradiation system (660 nm). PBM at 1.2 J/cm2 and AlClPc/NE at 0.5 μM modified the fibroblast signaling response under 3D conditions, promoting collagen synthesis, ROS production, MMP-9 secretion, proliferation of the actin network, and facile myofibroblastic differentiation. PBM alone (at 1.2 J/cm2 and 0.3 J/cm2) had no significant effect on any of these parameters. The combined therapy affected myofibroblastic differentiation, inflammatory response, and extracellular matrix pliability, and should thus be examined further in subsequent studies considering that no side effects of PBM have been reported. Even though significant progress has been made in the field of phototherapy in recent years, it is necessary to further elucidate the detailed mechanisms underlying its effects already shown in 2D conditions to increase the acceptance of this beneficial and non-invasive therapeutic approach.
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Affiliation(s)
- Carla Souza
- Department of Chemistry, Center of Nanotechnology and Tissue Engineering -Photobiology and Photomedicine Research Group, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto-FFCLRP, University of São Paulo, Ribeirão Preto, São Paulo 14040-901, Brazil
| | - Cristiano Ceron Jayme
- Department of Chemistry, Center of Nanotechnology and Tissue Engineering -Photobiology and Photomedicine Research Group, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto-FFCLRP, University of São Paulo, Ribeirão Preto, São Paulo 14040-901, Brazil
| | - Nayara Rezende
- Department of Chemistry, Center of Nanotechnology and Tissue Engineering -Photobiology and Photomedicine Research Group, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto-FFCLRP, University of São Paulo, Ribeirão Preto, São Paulo 14040-901, Brazil
| | - Antonio Claudio Tedesco
- Department of Chemistry, Center of Nanotechnology and Tissue Engineering -Photobiology and Photomedicine Research Group, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto-FFCLRP, University of São Paulo, Ribeirão Preto, São Paulo 14040-901, Brazil.
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Schneider C, Dungel P, Priglinger E, Danzer M, Schädl B, Nürnberger S. The impact of photobiomodulation on the chondrogenic potential of adipose-derived stromal/stem cells. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2021; 221:112243. [PMID: 34217028 DOI: 10.1016/j.jphotobiol.2021.112243] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/23/2021] [Accepted: 06/16/2021] [Indexed: 01/11/2023]
Abstract
Due to their capacity to differentiate into the chondrogenic lineage, adipose-derived stromal/stem cells (ASC) are a promising source of therapeutically relevant cells for cartilage tissue regeneration. Their differentiation potential, however, varies between patients. In our study, we aim to stimulate ASC towards a more reliable chondrogenic phenotype using photobiomodulation (PBM). LED devices of either blue (475 nm), green (516 nm) or red (635 nm) light were used to treat human ASC from donors of varying chondrogenic potential. The treatment was applied either once during the 2D expansion phase or repeatedly during the 3D differentiation phase. Chondrogenic differentiation was assessed via pellet size, GAG/DNA content, histology and gene expression analysis. Reactions to PBM were found to be wavelength-dependent and more pronounced when the treatment was applied during expansion. Donors were assigned to responder categories according to their response to the treatment during expansion, whereby good responders were mainly donors with low intrinsic chondrogenic potential. Exposed to light, they revealed a particularly high relative increase in pellet size (more than twice the size of untreated controls after red light PBM), intense collagen type II immunostaining (low/absent in untreated controls) and activation of otherwise absent COL2A1 expression. Conversely, on a donor with high intrinsic chondrogenic potential, light had adverse effects. When applied with shorter wavelengths (blue, green), it led to reduced pellet size, GAG/DNA content and collagen type II immunostaining. However, when PBM was applied in 3D, the same donor was the only one to react with increased differentiation to all three wavelengths. We were able to demonstrate that PBM can be used to enhance or hamper chondrogenesis of ASC, and that success depends on treatment parameters and intrinsic cellular potential. The improvement of chondrogenesis in donors with low intrinsic potential highlights PBM as potent tool for cell-based cartilage regeneration. Its cost-effectiveness and ease of use make for an attractive treatment option to enhance the performance of ASC in cartilage tissue engineering.
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Affiliation(s)
- C Schneider
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Center, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - P Dungel
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Center, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria.
| | - E Priglinger
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Center, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - M Danzer
- Austrian Red Cross Blood Transfusion Service of Upper Austria, Linz, Austria
| | - B Schädl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Center, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria; University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - S Nürnberger
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Center, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria; Department of Orthopedics and Trauma-Surgery, Division of Trauma-Surgery, Medical University of Vienna, Vienna, Austria
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6
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Enhancing the Therapeutic Potential of Mesenchymal Stem Cells with Light-Emitting Diode: Implications and Molecular Mechanisms. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6663539. [PMID: 33623634 PMCID: PMC7875639 DOI: 10.1155/2021/6663539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/05/2021] [Accepted: 01/22/2021] [Indexed: 01/08/2023]
Abstract
This study evaluated the effects of light-emitting diode (LED) on mesenchymal stem cells (MSCs). An electronic search was conducted in PubMed/MEDLINE, Scopus, and Web of Science database for articles published from 1980 to February 2020. Ten articles met the search criteria and were included in this review. The risk of bias was evaluated to report quality, safety, and environmental standards. MSCs were derived from adipose tissue, bone marrow, dental pulp, gingiva, and umbilical cord. Protocols for cellular irradiation used red and blue light spectrum with variations of the parameters. The LED has been shown to induce greater cellular viability, proliferation, differentiation, and secretion of growth factors. The set of information available leads to proposing a complex signaling cascade for the action of photobiomodulation, including angiogenic factors, singlet oxygen, mitogen-activated protein kinase/extracellular signal-regulated protein kinase, Janus kinase/signal transducer, and reactive oxygen species. In conclusion, although our results suggest that LED can boost MSCs, a nonuniformity in the experimental protocol, bias, and the limited number of studies reduces the power of systematic review. Further research is essential to find the optimal LED irradiation parameters to boost MSCs function and evaluate its impact in the clinical setting.
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Kim YJ, Jeon HR, Kim SW, Kim YH, Im GB, Im J, Um SH, Cho SM, Lee JR, Kim HY, Joung YK, Kim DI, Bhang SH. Lightwave-reinforced stem cells with enhanced wound healing efficacy. J Tissue Eng 2021; 12:20417314211067004. [PMID: 34987748 PMCID: PMC8721371 DOI: 10.1177/20417314211067004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/29/2021] [Indexed: 12/20/2022] Open
Abstract
Comprehensive research has led to significant preclinical outcomes in modified human adipose-derived mesenchymal stem cells (hADSCs). Photobiomodulation (PBM), a technique to enhance the cellular capacity of stem cells, has attracted considerable attention owing to its effectiveness and safety. Here, we suggest a red organic light-emitting diode (OLED)-based PBM strategy to augment the therapeutic efficacy of hADSCs. In vitro assessments revealed that hADSCs basked in red OLED light exhibited enhanced angiogenesis, cell adhesion, and migration compared to naïve hADSCs. We demonstrated that the enhancement of cellular capacity was due to an increased level of intracellular reactive oxygen species. Furthermore, accelerated healing and regulated inflammatory response was observed in mice transplanted with red light-basked hADSCs. Overall, our findings suggest that OLED-based PBM may be an easily accessible and attractive approach for tissue regeneration that can be applied to various clinical stem cell therapies.
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Affiliation(s)
- Yu-Jin Kim
- School of Chemical Engineering,
Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Hye Ran Jeon
- Department of Health Sciences and
Technology, SAIHST, Sungkyunkwan University, Gangnam-gu, Seoul, Republic of
Korea
- Division of Vascular Surgery,
Samsung Medical Center, Sungkyunkwan University School of Medicine,
Gangnam-gu, Seoul, Republic of Korea
| | - Sung-Won Kim
- School of Chemical Engineering,
Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Yeong Hwan Kim
- School of Chemical Engineering,
Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Gwang-Bum Im
- School of Chemical Engineering,
Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Jisoo Im
- School of Chemical Engineering,
Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Soong Ho Um
- School of Chemical Engineering,
Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Sung Min Cho
- School of Chemical Engineering,
Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Ju-Ro Lee
- Center for Biomaterials,
Biomedical Research Institute, Korea Institute of Science and Technology,
Seoungbuk-gu, Seoul, Republic of Korea
| | - Han Young Kim
- Department of Biomedical-Chemical
Engineering, The Catholic University of Korea, Bucheon, Gyeonggi, Republic
of Korea
| | - Yoon Ki Joung
- Center for Biomaterials,
Biomedical Research Institute, Korea Institute of Science and Technology,
Seoungbuk-gu, Seoul, Republic of Korea
- Division of Bio-Medical Science
& Technology, University of Science and Technology, Yuseong-gu, Daejeon,
Republic of Korea
| | - Dong-Ik Kim
- Department of Health Sciences and
Technology, SAIHST, Sungkyunkwan University, Gangnam-gu, Seoul, Republic of
Korea
- Division of Vascular Surgery,
Samsung Medical Center, Sungkyunkwan University School of Medicine,
Gangnam-gu, Seoul, Republic of Korea
| | - Suk Ho Bhang
- School of Chemical Engineering,
Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
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Ahrabi B, Rezaei Tavirani M, Khoramgah MS, Noroozian M, Darabi S, Khoshsirat S, Abbaszadeh HA. The Effect of Photobiomodulation Therapy on the Differentiation, Proliferation, and Migration of the Mesenchymal Stem Cell: A Review. J Lasers Med Sci 2019; 10:S96-S103. [PMID: 32021681 DOI: 10.15171/jlms.2019.s17] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction: The purpose of this study is to investigate the effect of a low-power laser on the proliferation, migration, differentiation of different types of mesenchymal stem cells (MSCs) in different studies. Methods: The relevant articles that were published from 2004 to 2019 were collected from the sources of PubMed, Scopus, and only the articles specifically examining the effect of a lowpower laser on the proliferation, differentiation, and migration of the MSCs were investigated. Results: After reviewing the literature, only 42 articles were found relevant. Generally, most of the studies demonstrated that different laser parameters increased the proliferation, migration, and differentiation of the MSCs, except the results of two studies which were contradictory. In fact, changing the parameters of a low-power laser would affect the results. On the other hand, the source of the stem cells was reported as a key factor. In addition, the combination of lasers with other therapeutic approaches was found to be more effective. Conclusion: The different parameters of lasers has been found to be effective in the proliferation, differentiation, and migration of the MSCs and in general, a low-power laser has a positive effect on the MSCs, helping to improve different disease models.
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Affiliation(s)
- Behnaz Ahrabi
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Rezaei Tavirani
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Sadat Khoramgah
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Noroozian
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Darabi
- Cellular and Molecular Research Center, Qazvin University of Medical Science, Qazvin, Iran
| | - Shahrokh Khoshsirat
- Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hojjat Allah Abbaszadeh
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Huang TC, Chen CJ, Chen CC, Ding SJ. Enhancing osteoblast functions on biofilm-contaminated titanium alloy by concentration-dependent use of methylene blue-mediated antimicrobial photodynamic therapy. Photodiagnosis Photodyn Ther 2019; 27:7-18. [PMID: 31117001 DOI: 10.1016/j.pdpdt.2019.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/07/2019] [Accepted: 05/17/2019] [Indexed: 02/06/2023]
Abstract
The concentration of methylene blue (MB) photosensitizer could affect the eradication efficacy of antimicrobial photodynamic therapy (aPDT) in the treatment of contaminated implants, which is linked to the osseointegration of the implant. We evaluated osteoblast functions on the contaminated SLA (sandblasting, large-grit and acid-etching) Ti alloy surfaces after the concentration-dependent use of MB-aPDT. Totally 1164 SLA discs were randomly distributed for the analyses of antibacterial efficacy and osteoblast functions. Gram-negative (Aggregatibacter actinomycetemcomitans; A. actinomycetemcomitans) or Gram-positive (Streptococcus mutans; S. mutans) adhered on disc samples was subjected to aPDT with different MB concentrations (200, 250, 300, 350, and 400 μg/mL) using 660 nm diode laser with maximum output 80 mW for 1 min irradiation (4.8 J/cm2). Bactericidal effect was examined by viability, morphology, and lipopolysaccharide (LPS) assays. The disinfected disc surfaces by MB-aPDT to support osteoblast-like MG63 attachment, proliferation, differentiation, and mineralization were assessed for the predetermined culture time intervals. The statistical differences between the means were performed using a one-way analysis of variance (ANOVA) with a post hoc Scheffe test. The results of the morphology observation and bacterial survival examination consistently indicated a remarkably lower quantity of bacterial colonies on biofilm-contaminated surfaces after the aPDT treatment with higher MB concentration. Similarly, the higher MB concentration in aPDT resulted in the lower LPS amounts remaining on the A. actinomycetemcomitans-contaminated surfaces. Intriguingly, the expression of osteoblast cultured on disinfected surfaces using aPDT with higher MB concentration was comparable to the control without contamination. Within the limits of this in vitro model, this formulation of 400 μg/mL MB used in aPDT may be not only the lethal concentration against the 2 bacteria-contaminated implants, but it could also enhance the osteoblast functions on the contaminated implants. Nevertheless, the efficacy in the clinical practice for peri-implantitis therapy remains to be studied.
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Affiliation(s)
- Tsun-Chin Huang
- Institute of Oral Science, Chung Shan Medical University, Taichung City 402, Taiwan
| | - Chun-Ju Chen
- Institute of Oral Science, Chung Shan Medical University, Taichung City 402, Taiwan
| | - Chun-Cheng Chen
- Department of Stomatology, Chung Shan Medical University Hospital, Taichung City 402, Taiwan; School of Dentistry, Chung Shan Medical University, Taichung City 402, Taiwan.
| | - Shinn-Jyh Ding
- Institute of Oral Science, Chung Shan Medical University, Taichung City 402, Taiwan; Department of Stomatology, Chung Shan Medical University Hospital, Taichung City 402, Taiwan.
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