Antifungal effect of photodynamic therapy mediated by curcumin on Candida albicans biofilms in vitro

Development of photodynamic therapy in treating oral diseases

The morbidity of oral disorders, including gingivitis, caries, endodontic-periodontal diseases, and oral cancer, is relatively high globally. Pathogenic cells are the root cause of many oral disorders, and oral therapies depend on eradicating them. Photodynamic therapy (PDT) has been established as a potential and non-invasive local adjuvant treatment for oral disorders. PDT consists of three essential components: photosensitizer (PS), a light source with a certain wavelength, and oxygen dissolved in the cells. These three components can interact to cause damage to proteins, lipids, nucleic acids, and other biological components within diseased tissues. Herein, we aimed to provide a detailed understanding of PDT and how it can treat oral diseases. Concerns about PDT and potential remedies are also a factor. PDT has been shown in numerous clinical studies to be an efficient supplementary therapy that can reduce pathogenic cells. The PDT has great potential for dental applications, including treating bacterial and fungal infections during root canal therapy and preventing oral cancer, potentially malignant disorders, periodontitis, dental caries, and peri-implant disorders. Although PDT has been promoted as having significant potential and utility in dentistry, more clinical research must be conducted before being used broadly.

Reduction of biofilm and pathogenic microorganisms using curcumin-mediated photodynamic inactivation to prolong food shelf-life

Pathogenic microbial contamination (bacteria and fungi) in food products during production poses a significant global health risk, leading to food waste, greenhouse gas emissions, and aesthetic and financial losses. Bacteria and fungi, by forming solid biofilms, enhance their resistance to antimicrobial agents, thereby increasing the potential for cross-contamination of food products. Curcumin molecule-mediated photodynamic inactivation (Cur-m-PDI) technology has shown promising results in sterilizing microbial contaminants and their biofilms, significantly contributing to food preservation without compromising quality. Photosensitizers (curcumin) absorb light, leading to a chemical reaction with oxygen and producing reactive oxygen species (ROS) that effectively reduce bacteria, fungi, and biofilms. The mechanism of microorganism inhibition is caused by exposure to ROS generated via the type 1 pathway involving electron transfer (such as O2•-, H2O2, -OH•, and other radicals), the type 2 pathway involving energy transfer (such as 1O2), secondary ROS, and weakening of antioxidant enzymes. The effectiveness of the inactivation of microorganisms is influenced by the concentration of curcumin, light (source type and energy density), oxygen availability, and duration of exposure. This article reviews the mechanism of reducing microbial food contamination and inhibiting their biofilms through Cur-m-PDI. It also highlights future directions, challenges, and considerations related to the effects of ROS in oxidizing food, the toxicity of PDI to living cells and tissues, conditions/types of food products, and the stability and degradation of curcumin.

Effects of photodynamic therapy using bisdemethoxycurcumin combined with melatonin or acetyl-melatonin on C. Albicans

The current study aims to explore the efficacy of antifungal photodynamic therapy (PDT) on C. albicans biofilms by combining photosensitizers, bisdemethoxycurcumin (BDMC), and melatonin (MLT) or acetyl-melatonin (AcO-MLT). Additionally, the relationship between different types of reactive oxygen species and PDT's antifungal efficacy was investigated. BDMC, MLT and AcO-MLT were applied, alone and in combination, to 48-hour C. albicans biofilm cultures (n = 6/group). Blue and red LED light (250 mW/cm2 with 37.5 J/cm2 for single or 75 J/cm2 for dual photosensitizer groups) were used to irradiate BDMC groups and MLT/AcO-MLT groups, respectively. For combination groups, blue LEDs and subsequently red LEDs were used. Drop plate assays were performed at 0, 1 and 6 h post-treatment. Colony forming units (CFUs) were then counted after 48 h. Hydroxyl radicals and singlet oxygen were measured using fluorescence spectroscopy and electron spin resonance (ESR) spectroscopy. Additionally, cell cytotoxicity was tested on human oral keratinocytes. Significant CFU reductions were observed with combinations 20 µM BDMC + 20 µM AcO-MLT and 60 µM BDMC + 20 µM MLT at 0 and 1 h post-treatment, respectively. Singlet oxygen production increased with the addition of MLT/AcO-MLT and had moderate-substantial correlations with inhibition at all times. Hydroxyl radical production was not significantly different from the control. Additionally, BDMC exhibited subtle cytotoxicity on human oral keratinocytes. PDT using BDMC + MLT or AcO-MLT, with blue and red LED light, effectively inhibits C. albicans biofilm through singlet oxygen generation. Melatonin acts as a photosensitizer in PDT to inhibit fungal infection.

Synergic Effect of the Antimicrobial Peptide ToAP2 and Fluconazole on Candida albicans Biofilms

Candida albicans is one of the agents of invasive candidiasis, a life-threatening disease strongly associated with hospitalization, particularly among patients in intensive care units with central venous catheters. This study aimed to evaluate the synergistic activity of the antifungal peptide ToAP2 combined with fluconazole against C. albicans biofilms grown on various materials. We tested combinations of different concentrations of the peptide ToAP2 with fluconazole on C. albicans biofilms. These biofilms were generated on 96-well plates, intravenous catheters, and infusion tubes in RPMI medium at two maturation stages. Scanning electron microscopy and atomic force microscopy were employed to assess the biofilm structure. We also evaluated the expression of genes previously proven to be involved in C. albicans biofilm formation in planktonic and biofilm cells after treatment with the peptide ToAP2 using qPCR. ToAP2 demonstrated a synergistic effect with fluconazole at concentrations up to 25 µM during both the early and mature stages of biofilm formation in 96-well plates and on medical devices. Combinations of 50, 25, and 12.5 µM of ToAP2 with 52 µM of fluconazole significantly reduced the biofilm viability compared to individual treatments and untreated controls. These results were supported by substantial structural changes in the biofilms observed through both scanning and atomic force microscopy. The gene expression analysis of C. albicans cells treated with 25 µM of ToAP2 revealed a decrease in the expression of genes associated with membrane synthesis, along with an increase in the expression of genes involved in efflux pumps, adhesins, and filamentation. Our results highlight the efficacy of the combined ToAP2 and fluconazole treatment against C. albicans biofilms. This combination not only shows therapeutic potential but also suggests its utility in developing preventive biofilm tools for intravenous catheters.

Comparative Transcriptome Analysis of T. rubrum, T. mentagrophytes, and M. gypseum Dermatophyte Biofilms in Response to Photodynamic Therapy

Dermatophyte biofilms frequently count for inadequate responses and resistance to standard antifungal treatments, resulting in refractory chronic onychomycosis infection. Although antimicrobial photodynamic therapy (aPDT) has clinically proven to exert significant antifungal effects or even capable of eradicating dermatophyte biofilms, considerably less is known about the molecular mechanisms underlying aPDT and the potential dysregulation of signaling networks that could antagonize its action. The aim of this study is to elucidate the molecular mechanisms underlining aPDT combat against dermatophyte biofilm in recalcitrant onychomycosis and to decipher the potential detoxification processes elicited by aPDT, facilitating the development of more effective photodynamic interventions. We applied genome-wide comparative transcriptome analysis to investigate how aPDT disrupting onychomycosis biofilm formed by three distinct dermatophytes, including Trichophyton rubrum, Trichophyton mentagrophytes, and Microsporum gypseum, the most frequently occurring pathogenic species. In total, 352.13 Gb of clean data were obtained for the transcriptomes of dermatophyte biofilms with or without aPDT treatment, resulting in 2,422.42 million reads with GC content of 51.84%, covering 99.9%, 98.5% and 99.4% of annotated genes of T. rubrum, T. mentagrophytes, and M. gypseum, respectively. The genome-wide orthologous analysis identified 6624 transcribed single-copy orthologous genes in all three species, and 36.5%, 6.8% and 17.9% of which were differentially expressed following aPDT treatment. Integrative orthology analysis demonstrated the upregulation of oxidoreductase activities is a highly conserved detoxification signaling alteration in response to aPDT across all investigated dermatophyte biofilms. This study provided new insights into the molecular mechanisms underneath anti-dermatophyte biofilm effects of aPDT and successfully identified a conserved detoxification regulation upon the aPDT application.

Evaluation of antifungal activity of visible light-activated doped TiO2 nanoparticles

Titanium dioxide (TiO2) is a well-known material for its biomedical applications, among which its implementation as a photosensitizer in photodynamic therapy has attracted considerable interest due to its photocatalytic properties, biocompatibility, high chemical stability, and low toxicity. However, the photoactivation of TiO2 requires ultraviolet light, which may lead to cell mutation and consequently cancer. To address these challenges, recent research has focused on the incorporation of metal dopants into the TiO2 lattice to shift the band gap to lower energies by introducing allowed energy states within the band gap, thus ensuring the harnessing of visible light. This study presents the synthesis, characterization, and application of TiO2 nanoparticles (NPs) in their undoped, doped, and co-doped forms for antimicrobial photodynamic therapy (APDT) against Candida albicans. Blue light with a wavelength of 450 nm was used, with doses ranging from 20 to 60 J/cm2 and an NP concentration of 500 µg/ml. It was observed that doping TiO2 with Cu, Fe, Ag ions, and co-doping Cu:Fe into the TiO2 nanostructure enhanced the visible light photoactivity of TiO2 NPs. Experimental studies were done to investigate the effects of different ions doped into the TiO2 crystal lattice on their structural, optical, morphological, and chemical composition for APDT applications. In particular, Ag-doped TiO2 emerged as the best candidate, achieving 90-100% eradication of C. albicans.

Methylene blue@silver nanoprisms conjugates as a strategy against Candida albicans isolated from balanoposthitis using photodynamic inactivation

Balanoposthitis can affect men in immunocompromised situations, such as HIV infection and diabetes. The main associated microorganism is Candida albicans, which can cause local lesions, such as the development of skin cracks associated with itching. As an alternative to conventional treatment, there is a growing interest in the photodynamic inactivation (PDI). It has been shown that the association of photosensitizers with metallic nanoparticles may improve the effectiveness of PDI via plasmonic effect. We have recently shown that the association of methylene blue (MB), a very known photosensitizer, with silver prismatic nanoplatelets (AgNPrs) improved PDI of a resistant strain of Staphylococcus aureus. To further investigate the experimental conditions involved in PDI improvement, in the present study, we studied the effect of MB concentration associated with AgNPrs exploring spectral analysis, zeta potential measurements, and biological assays, testing the conjugated system against C. albicans isolated from a resistant strain of balanoposthitis. The AgNPrs were synthesized through silver anisotropic seed growth induced by the anionic stabilizing agent poly(sodium 4-styrenesulfonate) and showed a plasmon band fully overlapping the MB absorption band. MB and AgNPrs were conjugated through electrostatic association and three different MB concentrations were tested in the nanosystems. Inactivation using red LED light (660 nm) showed a dose dependency in respect to the MB concentration in the conjugates. Using the highest MB concentration (100 µmol⋅L-1) with AgNPr, it was possible to completely inactivate the microorganisms upon a 2 min irradiation exposure. Analyzing optical changes in the conjugates we suggest that these results indicate that AgNPrs are enhancers of MB photodynamic action probably by a combined mechanism of plasmonic effect and reduction of MB dimerization. Therefore, MBAgNPrs can be considered a suitable choice to be applied in PDI of resistant microorganisms.

5-aminolevulinic acid-photodynamic therapy for a refractory severe kerion: A case report

Kerion is a subtype of tinea capitis with a severe inflammatory response, requiring early diagnosis to prevent secondary bacterial infection, folliculitis and permanent alopecia. Oral antifungal drugs are considered the first-line treatment for tinea capitis; however, drugs therapy is challenged by the long treatment duration, side effects, and drug resistance. Photodynamic therapy (PDT) has been widely used to treat dermatomycosis and has shown significant efficacy in recent years. We report the case of a girl who presented with refractory severe kerion following unregulated treatment and insensitivity to itraconazole; however,she was cured with 5-aminolevulinic acid-PDT. The case showed that PDT is a potentially promising alternative treatment for cutaneous fungal infections.

The effect of photodynamic therapy in controlling the oral biofilm: A comprehensive overview

Several resistance mechanisms are involved in dental caries, including oral biofilms. An accumulation of bacteria on the surface of teeth is called plaque. Periodontitis and gingivitis are caused by dental plaque. In this review article, we aimed to review the studies associated with the application of photodynamic therapy (PDT) to prevent and treat various microbial biofilm-caused oral diseases in recent decades. There are several studies published in PubMed that have described antimicrobial photodynamic therapy (APDT) effects on microorganisms. Several in vitro and in vivo studies have demonstrated the potential of APDT for treating endodontic, periodontal, and mucosal infections caused by bacteria as biofilms. Reactive oxygen species (ROS) are activated in the presence of oxygen by integrating a nontoxic photosensitizer (PS) with appropriate wavelength visible light. By causing irreversible damage to microorganisms, ROS induces some biological and photochemical events. Testing several wavelengths has been conducted to identify potential PS for APDT. A standard protocol is not yet available, and the current review summarizes findings from dental studies on APDT.

Nanoparticle-Based Photodynamic Inhibition of Candida albicans Biofilms with Interfering Quorum Sensing

Biofilm formation is a critical event in the pathogenesis and virulence of fungal infections caused by Candida albicans, giving rise to about a 1000-fold increase in the resistance to antifungal agents. Although photodynamic treatment (PDT) has been excellently implicated in bacterial infections, studies on its potential against fungal infection through the clearance of fungal biofilm formation remain at its infancy stage. Here, we have designed photodynamic nanoparticles with different sizes, modifications, and the ability of generating reactive oxygen species (ROS) to examine their effects on inhibiting biofilm formation and destructing mature biofilms of C. albicans. We found that the nanoparticles modified with oligo-chitosan exhibited a better binding efficiency for planktonic cells, leading to stronger inhibitory efficacy of the filamentation and the early-stage biofilm formation. However, for mature biofilms, the nanoparticles with the smallest size (∼15 nm) showed the fastest penetration speed and a pronounced destructing effect albeit conferring the lowest ROS-producing capability. The inhibitory effect of photodynamic nanoparticles was dependent on the disruption of fungal quorum sensing (QS) by the upregulation of QS molecules, farnesol and tyrosol, mediated through the upregulation of ARO 8 and DPP 3 expression. Our findings provide a powerful strategy of nanoparticulate PDT to combat fungal infections through the inhibition of both hyphal and biofilm formation by disrupting QS.

In silico and in vitro insights into the prediction and analysis of natural photosensitive compounds targeting Acinetobacter baumannii biofilm-associated protein

BACKGROUND

The spread of Acinetobacter baumannii strains has become a global concern due to its extensive antibiotic resistance and biofilm formation. To overcome it, new antimicrobial strategies have been needed. Among them, antimicrobial photodynamic therapy (aPDT) is an efficient approach against various microorganisms. This study was focused on the use of curcumin (Cur) and quercetin (Qct) as natural photosensitive compounds to improve the activity of aPDT against A. baumannii biofilm-associated protein (Bap).

MATERIALS AND METHODS

In this in silico and in vitro study, after determining drug-likeness property, ADME/Toxicity profile, and pharmacological activity of Cur and Qct, virtual screening and molecular docking were assessed to determine the potential binding modes of Cur and Qct to Bap. Then, the anti-biofilm potential of natural photosensitizers-mediated aPDT against A. baumannii was evaluated after the determination of minimum inhibitory concentration (MIC). Subsequently, reverse transcription-quantitative real-time PCR (RT-qPCR) was used to exhibit the anti-virulent effect of aPDT against the gene involved in the biofilm formation of A. baumannii RESULTS: Cur and Qct showed almost similar pharmacokinetic and pharmacodynamics properties. These natural photosensitizers obeyed all the criteria of Lipinski's rule of five principles. According to the molecular docking analysis of protein-ligand complexes, Qct and Cur with a high affinity for Bap showed binding affinity of -6.34 and -6.98 kcal/mol, respectively. According to the findings, aPDT using 4 ×, and 8 × MIC of Cur and Qct could significantly reduce A. baumannii growth in biofilm structures in comparison with the control group (P < 0.05). Also, a significant downregulation by 3.7-, and 5.2-fold in gene expression of bap was observed after treatment with sub-MIC doses of Cur- and Qct-mediated aPDT, respectively (P < 0.05).

CONCLUSIONS

In summary, the in silico analysis showed that Cur and Qct had strong binding affinity with Bap as a stable protein of A. baumannii. Furthermore, in vitro results displayed that targeted aPDT based on these natural photosensitizers can be considered a treatment against A. baumannii infections by reducing the growth of microbial biofilm and reducing the expression of bap as a gene involved in A. baumannii biofilm formation.

Natural Compounds: A Hopeful Promise as an Antibiofilm Agent Against Candida Species

The biofilm communities of Candida are resistant to various antifungal treatments. The ability of Candida to form biofilms on abiotic and biotic surfaces is considered one of the most important virulence factors of these fungi. Extracellular DNA and exopolysaccharides can lower the antifungal penetration to the deeper layers of the biofilms, which is a serious concern supported by the emergence of azole-resistant isolates and Candida strains with decreased antifungal susceptibility. Since the biofilms' resistance to common antifungal drugs has become more widespread in recent years, more investigations should be performed to develop novel, inexpensive, non-toxic, and effective treatment approaches for controlling biofilm-associated infections. Scientists have used various natural compounds for inhibiting and degrading Candida biofilms. Curcumin, cinnamaldehyde, eugenol, carvacrol, thymol, terpinen-4-ol, linalool, geraniol, cineole, saponin, camphor, borneol, camphene, carnosol, citronellol, coumarin, epigallocatechin gallate, eucalyptol, limonene, menthol, piperine, saponin, α-terpineol, β-pinene, and citral are the major natural compounds that have been used widely for the inhibition and destruction of Candida biofilms. These compounds suppress not only fungal adhesion and biofilm formation but also destroy mature biofilm communities of Candida. Additionally, these natural compounds interact with various cellular processes of Candida, such as ABC-transported mediated drug transport, cell cycle progression, mitochondrial activity, and ergosterol, chitin, and glucan biosynthesis. The use of various drug delivery platforms can enhance the antibiofilm efficacy of natural compounds. Therefore, these drug delivery platforms should be considered as potential candidates for coating catheters and other medical material surfaces. A future goal will be to develop natural compounds as antibiofilm agents that can be used to treat infections by multi-drug-resistant Candida biofilms. Since exact interactions of natural compounds and biofilm structures have not been elucidated, further in vitro toxicology and animal experiments are required. In this article, we have discussed various aspects of natural compound usage for inhibition and destruction of Candida biofilms, along with the methods and procedures that have been used for improving the efficacy of these compounds.

Photodynamic therapy-a promising treatment of oral mucosal infections

The treatment of oral mucosal infections is increasingly challenging owing to antibiotic resistance. Therefore, alternative antimicrobial strategies are urgently required. Photodynamic therapy (PDT) has attracted attention for the treatment of oral mucosal infections because of its ability to effectively inactivate drug-resistant bacteria, completely heal clinical infectious lesions and usually offers only mild adverse reactions. This review briefly summarizes relevant scientific data and published papers and discusses the potential mechanism and application of PDT in the treatment of oral mucosal infections.

Curcuma longa L. Extract and Photodynamic Therapy are Effective against Candida spp. and Do Not Show Toxicity In Vivo

Radiotherapy induces a higher level of Candida spp. colonization, resulting in oral candidiasis. This study aimed to evaluate the phototransformation potential of the glycolic extract of Curcuma longa (C. longa); the antifungal activity of C. longa, curcumin, and antifungal photodynamic therapy (aPDT) with blue light-emitting diodes "LED" on Candida albicans and Candida tropicalis in vitro; and the toxicity of C. longa and curcumin in Galleria mellonella model. In order to confirm the light absorption capacity of the C. longa extract, its phototransformation potential was evaluated. The antifungal effect of C. longa, curcumin, and aPDT was evaluated over Candida spp. Finally, the toxicity of C. longa and curcumin was evaluated on the Galleria mellonella model. The data were analyzed using the GraphPad Prism 5.0 software considering α = 5%. It was found that C. longa, curcumin, and aPDT using blue LED have an antifungal effect over C. albicans and C. tropicalis. The extract of C. longa 100 mg/mL and curcumin 200 μg/mL do not show toxicity on Galleria mellonella model.

The Potential Application of Natural Photosensitizers Used in Antimicrobial Photodynamic Therapy against Oral Infections

Oral health problems and the emergence of antimicrobial resistance among pathogenic bacterial strains have become major global challenges and are essential elements that negatively affect general well-being. Antimicrobial photodynamic therapy (APDT) is based on a light source and oxygen that activates a nontoxic photosensitizer, resulting in microbial destruction. Synthetic and natural products can be used to help the APDT against oral microorganisms. The undesirable consequences of conventional photosensitizers, including toxicity, and cost encourage researchers to explore new promising photosensitizers based on natural compounds such as curcumin, chlorella, chlorophyllin, phycocyanin, 5-aminolevulinic acid, and riboflavin. In this review, we summarize in vitro studies describing the potential use of APDT therapy conjugated with some natural products against selected microorganisms that are considered to be responsible for oral infections.

Photoinactivation of Yeast and Biofilm Communities of Candida albicans Mediated by ZnTnHex-2-PyP4+ Porphyrin

Candida albicans is the main cause of superficial candidiasis. While the antifungals available are defied by biofilm formation and resistance emergence, antimicrobial photodynamic inactivation (aPDI) arises as an alternative antifungal therapy. The tetracationic metalloporphyrin Zn(II) meso-tetrakis(N-n-hexylpyridinium-2-yl)porphyrin (ZnTnHex-2-PyP⁴⁺) has high photoefficiency and improved cellular interactions. We investigated the ZnTnHex-2-PyP⁴⁺ as a photosensitizer (PS) to photoinactivate yeasts and biofilms of C. albicans strains (ATCC 10231 and ATCC 90028) using a blue light-emitting diode. The photoinactivation of yeasts was evaluated by quantifying the colony forming units. The aPDI of ATCC 90028 biofilms was assessed by the MTT assay, propidium iodide (PI) labeling, and scanning electron microscopy. Mammalian cytotoxicity was investigated in Vero cells using MTT assay. The aPDI (4.3 J/cm²) promoted eradication of yeasts at 0.8 and 1.5 µM of PS for ATCC 10231 and ATCC 90028, respectively. At 0.8 µM and same light dose, aPDI-treated biofilms showed intense PI labeling, about 89% decrease in the cell viability, and structural alterations with reduced hyphae. No considerable toxicity was observed in mammalian cells. Our results introduce the ZnTnHex-2-PyP⁴⁺ as a promising PS to photoinactivate both yeasts and biofilms of C. albicans, stimulating studies with other Candida species and resistant isolates.

Photodynamic disinfection and its role in controlling infectious diseases

Photodynamic therapy is witnessing a revival of its origins as a response to the rise of multi-drug resistant infections and the shortage of new classes of antibiotics. Photodynamic disinfection (PDDI) of microorganisms is making progresses in preclinical models and in clinical cases, and the perception of its role in the clinical armamentarium for the management of infectious diseases is changing. We review the positioning of PDDI from the perspective of its ability to respond to clinical needs. Emphasis is placed on the pipeline of photosensitizers that proved effective to inactivate biofilms, showed efficacy in animal models of infectious diseases or reached clinical trials. Novel opportunities resulting from the COVID-19 pandemic are briefly discussed. The molecular features of promising photosensitizers are emphasized and contrasted with those of photosensitizers used in the treatment of solid tumors. The development of photosensitizers has been accompanied by the fabrication of a variety of affordable and customizable light sources. We critically discuss the combination between photosensitizer and light source properties that may leverage PDDI and expand its applications to wider markets. The success of PDDI in the management of infectious diseases will ultimately depend on the efficacy of photosensitizers, affordability of the light sources, simplicity of the procedures, and availability of fast and efficient treatments.

Photosensitizers Mediated Photodynamic Inactivation against Fungi

Superficial and systemic fungal infections are essential problems for the modern health care system. One of the challenges is the growing resistance of fungi to classic antifungals and the constantly increasing cost of therapy. These factors force the scientific world to intensify the search for alternative and more effective methods of treatment. This paper presents an overview of new fungal inactivation methods using Photodynamic Antimicrobial Chemotherapy (PACT). The results of research on compounds from the groups of phenothiazines, xanthanes, porphyrins, chlorins, porphyrazines, and phthalocyanines are presented. An intensive search for a photosensitizer with excellent properties is currently underway. The formulation based on the existing ones is also developed by combining them with nanoparticles and common antifungal therapy. Numerous studies indicate that fungi do not form any specific defense mechanism against PACT, which deems it a promising therapeutic alternative.

Antimicrobial Activity of Curcumin in Nanoformulations: A Comprehensive Review

Curcumin (CUR) is a natural substance extracted from turmeric that has antimicrobial properties. Due to its ability to absorb light in the blue spectrum, CUR is also used as a photosensitizer (PS) in antimicrobial Photodynamic Therapy (aPDT). However, CUR is hydrophobic, unstable in solutions, and has low bioavailability, which hinders its clinical use. To circumvent these drawbacks, drug delivery systems (DDSs) have been used. In this review, we summarize the DDSs used to carry CUR and their antimicrobial effect against viruses, bacteria, and fungi, including drug-resistant strains and emergent pathogens such as SARS-CoV-2. The reviewed DDSs include colloidal (micelles, liposomes, nanoemulsions, cyclodextrins, chitosan, and other polymeric nanoparticles), metallic, and mesoporous particles, as well as graphene, quantum dots, and hybrid nanosystems such as films and hydrogels. Free (non-encapsulated) CUR and CUR loaded in DDSs have a broad-spectrum antimicrobial action when used alone or as a PS in aPDT. They also show low cytotoxicity, in vivo biocompatibility, and improved wound healing. Although there are several in vitro and some in vivo investigations describing the nanotechnological aspects and the potential antimicrobial application of CUR-loaded DDSs, clinical trials are not reported and further studies should translate this evidence to the clinical scenarios of infections.

The inhibitory activity of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) on Candida albicans biofilms

BACKGROUND

Biofilm-associated Candida albicans (C. albicans) infections are hard to cure due to their high levels of resistance to antifungal agents. Photodynamic therapy (PDT) is a promising approach for controlling infections caused by C. albicans. This study was designed to explore the inhibitory activity of PDT using 5-aminolevulinic acid (ALA) as photosensitizer against C. albicans biofilms.

METHODS

C. albicans cell suspensions were incubated for 48 h to form mature biofilms. ALA solution was diluted to 15 mM and incubated with C. albicans biofilms for 5 h before irradiated by red light semiconductor laser under the light intensity of 300 J/cm² and fluence rate of 100 mW/cm² for 50 min. The inhibitory activity was evaluated from subcellular level, molecular level and transcriptional level using transmission electron microscopy (TEM) observation, flow cytometry analysis and quantitative Real-Time Polymerase Chain Reaction (qRT-PCR) assays, respectively.

RESULTS

From subcellular level, the degraded content of the cytoplasm, nuclear condensation and mitochondrial swelling were observed after ALA-PDT. From molecular level, ALA-PDT resulted in 19.4 % cell apoptosis. From transcriptional level, ALA-PDT significantly reduced the mRNA expressions of hyphae-specific genes (HWP1 and ALS3) and long-term biofilm maintenance genes (UME6 and HGC1), whereas ALA or red light alone had no significant effect.

CONCLUSIONS

The inhibitory activity indicated that ALA-PDT may have the potential to serve as an antifungal strategy in eliminatingC. albicans biofilms.

Curcumin-loaded Pluronic® F-127 Micelles as a Drug Delivery System for Curcumin-mediated Photodynamic Therapy for Oral Application

Antimicrobial photodynamic therapy (aPDT) is promising for oral decontamination. Curcumin has been used as photosensitizer; however, the hydrophobic properties can negatively affect aPDT. This study evaluated the aPDT efficacy using Cur-loaded Pluronic^® F-127 micelles against Streptococcus mutans and Candida albicans biofilms. Micelles characterization was performed by zeta potential, dynamic light scattering, transmission electron microscopy, absorption and fluorescence spectroscopy. Cur concentrations, cell viability by CFU mL^-1 and confocal microscopy were determined. Data were analyzed by parametric and nonparametric tests under 5%. Cur-loaded Pluronic^® F-127 exhibited spherical shape, suitable particle size (≤100 nm), adequate polydispersity index, best stability, lower photodegradation and autoaggregation compared to unloaded-Cur. Both microorganisms were sensitive to Cur-loaded Pluronic^® F-127 micelles aPDT, with minimum inhibitory concentration (MIC) of 270 μm and 2.1093 μm for S. mutans and C. albicans suspended culture, respectively. Cur-loaded Pluronic^® F-127 aPDT exhibited antibacterial/antifungal effect against the biofilms (~3 log₁₀ reduction; P ≤ 0.05); however, similar to unloaded (P ≥ 0.05). Confocal images confirmed these results. Cur-loaded Pluronic^® F-127 micelles exhibited good photo-chemical properties and may be a viable alternative to deliver Cur and to improve aPDT effect during the treatment of dental caries. Moreover, Pluronic^® micelles can enhance the solubility, stability, permeability and control the release of Cur.

Photodynamic Therapy by Diaryl-Porphyrins to Control the Growth of Candida albicans

Candida albicans is an opportunistic pathogen that often causes skin infections such as oral thrush, nail fungus, athlete’s foot, and diaper rash. Under particular conditions, C. albicans alters the natural balance of the host microbiota, and as a result, the skin or its accessory structures lose their function and appearance. Conventional antimycotic drugs are highly toxic to host tissues, and long-lasting drug administration induces the arising of resistant strains that make the antimycotic therapy ineffective. Among new antimicrobial approaches to combine with traditional drugs, light-based techniques are very promising. In this study, a panel of dyes was considered for photodynamic therapy (PDT) applications to control the growth of the model strain C. albicans ATCC 14053. The chosen photosensitizers (PSs) belong to the family of synthetic porphyrins, and in particular, they are diaryl-porphyrins. Among these, two monocationic PSs were shown to be particularly efficient in killing C. albicans upon irradiation with light at 410 nm, in a light-dose-dependent manner. The elicited photo-oxidative stress induced the loss of the internal cellular architecture and death. The photodynamic treatment was also successful in inhibiting the biofilm formation of clinical C. albicans strains. In conclusion, this study supports the great potential of diaryl-porphyrins in antimicrobial PDT to control the growth of yeasts on body tissues easily reachable by light sources, such as skin and oral cavity.

Effectiveness of mechanical debridement with and without antimicrobial photodynamic therapy against oral yeasts in children with gingivitis undergoing fixed orthodontic therapy

OBJECTIVE

The aim was to assess the effectiveness of mechanical debridement (MD) and antimicrobial photodynamic therapy (aPDT) against oral yeasts in children with gingivitis undergoing fixed orthodontic therapy (FOT).

METHODS

Individuals undergoing orthodontic treatment were included. Patients were randomly divided into 2-groups. In the test-group, patients underwent MD with adjuvant aPDT; and in the control-group, patients underwent MD alone. Demographic information was recorded using a questionnaire. An ultrasonic scaler was used to perform MD and aPDT was done using methylene blue and visible light. In both groups, gingival index, unstimulated whole salivary flow rate and oral yeasts counts were measured at baseline and compared at 6-months' follow-up. Group comparisons were performed and P < 0.05 was selected as an indicator of statistical significance.

RESULTS

Eighteen (10 males and 8 females) and 18 individuals (9 males and 9 females) were included in the test- and control groups. The mean age of individuals in the test and control groups were 16.6 ± 0.5 and 16.8 ± 0.4 years, respectively. At 6-months' follow-up, the GI was comparable among patients in the test- and control-group. In the test-group, the CFU/ml of oral yeasts were significantly higher at baseline compared with 6-months' follow-up (P < 0.05). In the control-group, there was no statistically significant difference in the CFU/ml of oral yeasts at baseline and 6-months' follow-up.

CONCLUSION

aPDT is a useful adjuvant to MD in reducing whole salivary oral yeasts counts among adolescents undergoing orthodontic treatment. In the sort-term, MD with and without aPDT is useful in reducing GI in adolescents undergoing orthodontic treatment.

Antibacterial effect of chitosan and its derivative on Enterococcus faecalis associated with endodontic infection

Chitosan and its derivatives have been increasingly used for bacteriostasis. To date, the effect of chitosan and N-(2-hydroxyl) propyl-3-trimethyl ammonium chitosan chloride (HTCC) on Enterococcus faecalis (E. faecalis) associated with endodontic infection has remained to be determined. Chitosan and HTCC were serially diluted with double-distilled water (DDW) or PBS at concentrations of 20-2,500 µg/ml. Various strains of E. faecalis (American Type Tissue Collection no. 29212, as well as isolated strains P25RC and P52Sa) in plankton were adjusted to an optical density at 600 nm of 0.10 and treated with chitosan or HTCC. A colony-forming unit assay was used to determine the concentration of residual bacteria after treatment. Furthermore, E. faecalis biofilms were cultured on coverslips and treated with chitosan or HTCC. The coverslips were rinsed, stained using Live/dead^® BacLight™ bacterial viability kit and observed under an inverted fluorescence microscope. In addition, biofilms on dentine blocks were prepared and observed under a scanning electron microscope. MC3T3-E1 pre-osteoblasts were seeded on 96-well plates and treated with chitosan or HTCC at various concentrations. The cytotoxicity of chitosan and HTCC on MC3T3-E1 pre-osteoblasts was detected using a Cell Counting Kit-8 assay after 24, 48 and 72 h of treatment. The results revealed that the final minimum bactericidal concentrations (MBC) of chitosan and HTCC dissolved in DDW were 70 and 140 µg/ml, respectively. Chitosan and HTCC in DDW exerted a significantly greater antibacterial effect as compared with that in PBS (P<0.05). At the MBC, chitosan and HTCC in DDW, but particularly chitosan, had a significant antibacterial effect on E. faecalis biofilm. Chitosan exhibited no cytotoxicity to MC3T3-E1 pre-osteoblasts at a concentration of <625 µg/ml, while HTCC inhibited the proliferation of the cells in the concentration range of 39-10,000 µg/ml. In conclusion, chitosan and HTCC exhibited prominent antibacterial properties on E. faecalis in the planktonic state and as a biofilm via charge interaction, indicating their potential for application in root canal disinfection and fillings.