Antimicrobial photodynamic therapy in dentistry using an oil-in-water microemulsion with curcumin as a mouthwash

Efficacy of Curcumin-Mediated Antimicrobial Photodynamic Therapy on Candida spp.-A Systematic Review

Oral candidiasis is a common problem among immunocompetent patients. The frequent resistance of Candida strains to popular antimycotics makes it necessary to look for alternative methods of treatment. The authors conducted a systematic review following the PRISMA 2020 guidelines. The objective of this review was to determine if curcumin-mediated blue light could be considered as an alternative treatment for oral candidiasis. PubMed, Google Scholar, and Cochrane Library databases were searched using a combination of the following keywords: (Candida OR candidiasis oral OR candidiasis oral OR denture stomatitis) AND (curcumin OR photodynamic therapy OR apt OR photodynamic antimicrobial chemotherapy OR PACT OR photodynamic inactivation OR PDI). The review included in vitro laboratory studies with Candida spp., in vivo animal studies, and randomized control trials (RCTs) involving patients with oral candidiasis or prosthetic stomatitis, published only in English. The method of elimination of Candida species in the studies was curcumin-mediated aPDT. A total of 757 studies were identified. Following the analysis of the titles and abstracts of the studies, only 42 studies were selected for in-depth screening, after which 26 were included in this study. All studies evaluated the antifungal efficacy of curcumin-mediated aPDT against C. albicans and non-albicans Candida. In studies conducted with planktonic cells solutions, seven studies demonstrated complete elimination of Candida spp. cells. The remaining studies demonstrated only partial elimination. In all cases, experiments on single-species yeast biofilms demonstrated partial, statistically significant inhibition of cell growth and reduction in biofilm mass. In vivo, curcumin-mediated aPDT has shown good antifungal activity against oral candidiasis also in an animal model. However, its clinical efficacy as a potent therapeutic strategy for oral candidiasis requires few further RCTs.

The Role of Curcumin in Oral Health and Diseases: A Systematic Review

Curcumin (Curcumin) belongs to the polyphenol family. It is extracted by drying the root of a plant of Asian origin, belonging to the Zingiberaceae family. The best-known species is Curcumincuma Longa. Curcumin has been recognized as having great therapeutic powers since ancient times. Studies on curcumin have since confirmed its powerful antioxidant properties, preventing both the formation of free radicals and their neutralization, having anti-inflammatory, antibacterial, immunological, and neuroprotective properties, as well as being a regulator of the intestinal microbiota with beneficial effects on the clinical manifestations of metabolic syndrome. Our study aimed to highlight how all these therapeutic aspects could benefit oral health, both preventing and improving the course of pathological processes. The effect of mouthwashes, and curcumin-based gels on the regulation of bacterial plaque and in the control of gingivitis, was largely comparable to that of using 0.20% chlorhexidine, with fewer side effects. Being a highly hydrophobic substance, it has a high permeability to cross the cell membrane. Bioavailability increases when combined with liposoluble substances (e.g., olive oil) and piperine, which improves absorption. Curcumin also has a negligible degree of toxicity, making it an excellent alternative to the use of gold standard products for oral disinfection.

The effects of antimicrobial photodynamic therapy (aPDT) with nanotechnology-applied curcumin and 450nm blue led irradiation on multi-species biofilms in root canals

This study aimed to evaluate the effectiveness of antimicrobial photodynamic therapy (aPDT) utilizing nanotechnology-applied curcumin activated by blue LED (450 nm) on the elimination of microorganisms arranged in multispecies biofilms inside the root canals of extracted human teeth. Forty single-rooted human teeth were used; these were randomized into four experimental groups, each comprising 10 teeth: control group, no treatment; photosensitizer (PS) group, nanotechnology-applied curcumin alone; light group, blue LED used separately; and aPDT group, nanotechnology-applied curcumin activated by blue LED. To carry out the tests, the interiors of the root canals were inoculated with species of Candida albicans (ATCC 90029), Enterococcus faecalis (ATCC 29212), Escherichia coli (ATCC 25922), and methicillin-resistant Staphylococcus aureus (MRSA) (ATCC 43300), using a multispecies biofilm. After the incubation period, the canals were treated according to the experimental groups, with no treatment given in the control group. Studied inasmuch as the antimicrobial effectiveness of aPDT was concerned, it was observed that the greatest reduction in microbial counts using aPDTs was achieved against MRSA (mean reduction = 2.48 Log10 CFU/mL), followed by Escherichia coli (mean reduction = 1.72), and Enterococcus faecalis (mean reduction = 1.65); a reduction greater than 1.5 Log10 CFU/mL showed relevant effectiveness of aPDT against these microorganisms. Of note, aPDT has also shown considerable effectiveness against Candida albicans (mean reduction = 0.71), with a statistical difference in the reduction between the groups. aPDT was effective in reducing all microorganisms examined. The average reduction was greater than 1.5 Log10 in all microorganisms except for Candida albicans. HIGHLIGHTS: • aPDT was a viable treatment for root canals; • Nanotechnological curcumin aPDT was effective in reducing multispecies biofilm microorganisms; • aPDT technique showed efficacy under the worst microbiological conditions , such as mature multispecies biofilm; • Nanotechnological curcumin aPDT was able to reduce Gram positive, negative bacterial and yeasts in root canals.

Nanoemulsion: A novel delivery approach for thermosensitive IgG on inhibiting milk fat oxidation

IgG, a biologically active substance in bovine colostrum, is easily inactivated during heat treatment and edible process to lose its biological activity. Nanoemulsion can effectively protect IgG to maintain its biological activity from injurious treatment. In this study, a food-grade nanoemulsion system was developed to protect IgG from heat and acid damage. It can be found that the residual rate of nanoemulsion-protected IgG reaches 87.1 % after 10 min at 72 °C. After 5 min at 82 °C, the residual rate of IgG in nanoemulsion was 18.7 % higher than that in PBS. In the simulated gastric fluid at pH 2.0, the residual rate of IgG in the nanoemulsion reacted for 4 h was 21.5 % higher than that in PBS. It indicated that nanoemulsion system can improve the heat and acid resistance of IgG compared with others, which is attributed to the lowest water activity of nanoemulsion. The contents of hydroperoxide and malondialdehyde in the milk after storage for 72 h with nanoemulsion-protected IgG were 0.12 meq/kg and 0.04 mg/kg, respectively, less than that of PBS-protected IgG. IgG is protected by nanoemulsion can effectively protect its activity during processing, which provides a theoretical basis for its direct application in liquid milk.

Photodynamic inactivation of Staphylococcus aureus by ecological antibacterial solutions associating LED (ʎ 450 ± 10 nm) with curcumin and olive leaf extracts

Antimicrobial resistance is a problem in contemporary society, with Staphylococcus aureus standing out as a threat due to its ability to colonize, its pathogenicity, and its expression of several virulence factors. In this context, antimicrobial photodynamic inactivation (aPDI) emerges as an alternative to conventional microbicidal or microbiostatic systems, enabling numerous and successive applications without developing side effects and microbial resistance. In this context, an aPDI system against cultures of S. aureus based on a water-in-oil (W/O) emulsion incorporating curcumin as the photosensitizer (PS), with and without olive leaf extract (OLE), was developed and the antibacterial efficacy evaluated under LED activation (ʎ450 ± 10 nm) by depositing an energy density of 14 J/cm². The produced emulsified systems showed no significant differences in the droplet size and morphology, remaining stable along the tested period of 30 days. The bacterial reduction achieved after the first aPDI application for the emulsions added with curcumin and curcumin combined with the OLE was 5 log10 CFU.mL^-1 and 6 log10 CFU.mL^-1, respectively, revealing a significant difference between the two groups (p < 0.0001). After the second aPDI application, an increased microbial reduction (7 log10 CFU.mL^-1) was observed for both studied groups even with a low significant difference (p < 0.05). The PS loading through an emulsified system for aPDI obtained a bactericidal action against S. aureus, increased by applying two aPDI, showing a significant synergy between photodynamic inactivation, OLE delivery and antibacterial activity. In addition, the developed solutions were produced using natural products by an ecologically correct process.

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.

The application of photodynamic inactivation to microorganisms in food

Nowadays, food safety issues have drawn increased attention due to the continual occurrence of infectious diseases caused by foodborne pathogens, which is an important factor causing food safety hazard. Meanwhile, the emergence of an increasing number of antibiotic-resistant pathogens is a worrisome phenomenon. Therefore, it is imperative to find new technologies with low-cost to inactivate pathogenic microorganisms and prevent cross-contamination. Compared with traditional preservatives, photodynamic inactivation (PDI) has emerged as a novel and promising strategy to eliminate foodborne pathogens with advantages such as non-toxic and low microbial resistance, which also meets the demand of current consumers for green treatment. Over the past few years, reports of using this technology for food safety have increased rapidly. This review summarizes recent progresses in the development of photodynamic inactivation of foodborne microorganisms. The mechanisms, factors influencing PDI and the application of different photosensitizers (PSs) in different food substrates are reviewed.

Magnetic-Responsive Photosensitizer Nanoplatform for Optimized Inactivation of Dental Caries-Related Biofilms: Technology Development and Proof of Principle

Conventional antibiotic therapies for biofilm-trigged oral diseases are becoming less efficient due to the emergence of antibiotic-resistant bacterial strains. Antimicrobial photodynamic therapy (aPDT) is hampered by restricted access to bacterial communities embedded within the dense extracellular matrix of mature biofilms. Herein, a versatile photosensitizer nanoplatform (named MagTBO) was designed to overcome this obstacle by integrating toluidine-blue ortho (TBO) photosensitizer and superparamagnetic iron oxide nanoparticles (SPIONs) via a microemulsion method. In this study, we reported the preparation, characterization, and application of MagTBO for aPDT. In the presence of an external magnetic field, the MagTBO microemulsion can be driven and penetrate deep sites inside the biofilms, resulting in an improved photodynamic disinfection effect compared to using TBO alone. Besides, the obtained MagTBO microemulsions revealed excellent water solubility and stability over time, enhanced the aPDT performance against S. mutans and saliva-derived multispecies biofilms, and improved the TBO's biocompatibility. Such results demonstrate a proof-of-principle for using microemulsion as a delivery vehicle and magnetic field as a navigation approach to intensify the antibacterial action of currently available photosensitizers, leading to efficient modulation of pathogenic oral biofilms.

Antimicrobial Effect of Phytochemicals from Edible Plants

Current strategies of combating bacterial infections are limited and involve the use of antibiotics and preservatives. Each of these agents has generally inadequate efficacy and a number of serious adverse effects. Thus, there is an urgent need for new antimicrobial drugs and food preservatives with higher efficacy and lower toxicity. Edible plants have been used in medicine since ancient times and are well known for their successful antimicrobial activity. Often photosensitizers are present in many edible plants; they could be a promising source for a new generation of drugs and food preservatives. The use of photodynamic therapy allows enhancement of antimicrobial properties in plant photosensitizers. The purpose of this review is to present the verified data on the antimicrobial activities of photodynamic phytochemicals in edible species of the world’s flora, including the various mechanisms of their actions.

A pH-sensitive curcumin loaded microemulsion-filled alginate and porous starch composite gels: Characterization, in vitro release kinetics and biological activity

To improve the controlled release and stability of the loaded drug, the alginate-porous starch solution, as the gel matrix (GM), was prepared and added into curcumin-loaded microemulsion (CUR-ME) in a certain proportion, and then mixed with slow-gelling agents (CaCO₃ + d-glucono-δ-lactone) to prepared curcumin-loaded microemulsion gel (CUR-ME-G). With increasing the proportion of GM from 25% (CUR-ME₃G₁) to 83% (CUR-ME₁G₅), the drug loading efficiency increased from 24% to 98% and the maximum drug loading capacity (14.9 mg/g) was found in CUR-ME₁G₃ with 75% GM. Moreover, a denser structure that entrapped all microemulsion droplets was formed with increasing the proportion of microemulsion according to the observation of scanning electron microscopy. This was also confirmed by Fourier transform infrared spectroscopy and Raman spectroscopy that no new peaks appeared in CUR-ME-G, while the hydrogen bonding interactions might exist between curcumin and sodium alginate. The in vitro release of the CUR-ME-G followed diffusion-controlled mechanism that was consistent with the first-order kinetic model. The release rate depended on the components of the CUR-ME-G and the pH value of the release medium. CUR-ME-G with curcumin concentration of 0.20% exhibited the best biological activity. CUR-ME-G might provide a potential application in the smart drug delivery systems.

Nanotechnology-based lipid systems applied to resistant bacterial control: A review of their use in the past two decades

The rate of infections caused by resistant bacteria to the antimicrobials available for human use grows exponentially every year, which generates major impacts on human health and the world economy. In the last two decades, human beings can witness the expressive increase in the Science and Technology worldwide, and areas such as Health Sciences have benefited from these advances in favor of human health, such as the advent of Pharmaceutical Nanotechnology as an important approach applied for bacterial infections treatment with resistance profile to available antibiotics. This review of the scientific literature brings the applicability of nanotechnology-based lipid systems as an innovative tool in the improvement of bacterial infections treatment. Important studies involving the use of liposomes, solid lipid nanoparticles, nanostructured lipid carriers, nanoemulsions, microemulsions and lipid nanocapsules were verified in the period from 2000 to 2020, where important scientific results were found and will serve as a basis for the use of these systems to remain in constant updating. This manuscript shows the use of these drug delivery systems as potential vehicles for antibacterial compounds, which opens a new hope in the complement of the antibacterial therapeutic arsenal. Important studies developed in the last 20 years are present in this review, and thus guarantees an update on the use of these drug delivery systems for researchers from different areas of Health Sciences.

Curcumin: Modern Applications for a Versatile Additive

The recent development of several methods for extracting curcumin from the root of the plant Curcuma longa has led to intensified research on the properties of curcumin and its fields of application. Following the studies and the accreditation of curcumin as a natural compound with antifungal, antiviral, and antibacterial properties, new fields of application have been developed in two main directions—food and medical, respectively. This review paper aims to synthesize the fields of application of curcumin as an additive for the prevention of spoilage, safety, and quality of food. Simultaneously, it aims to present curcumin as an additive in products for the prevention of bacterial infections and health care. In both cases, the types of curcumin formulations in the form of (nano)emulsions, (nano)particles, or (nano)composites are presented, depending on the field and conditions of exploitation or their properties to be used. The diversity of composite materials that can be designed, depending on the purpose of use, leaves open the field of research on the conditioning of curcumin. Various biomaterials active from the antibacterial and antibiofilm point of view can be intuited in which curcumin acts as an additive that potentiates the activities of other compounds or has a synergistic activity with them.

Perspectives of photodynamic therapy in biotechnology

Photodynamic therapy (PDT) is a current and innovative technique that can be applied in different areas, such as medical, biotechnological, veterinary, among others, both for the treatment of different pathologies, as well as for diagnosis. It is based on the action of light to activate photosensitizers that will perform their activity on target tissues, presenting high sensitivity and less adverse effects. Therefore, knowing that biotechnology aims to use processes to develop products aimed at improving the quality of life of human and the environment, and optimizing therapeutic actions, researchers have been used PDT as a tool of choice. This review aims to identify the impacts and perspectives and challenges of PDT in different areas of biotechnology, such as health and agriculture and oncology. Our search demonstrated that PDT has an important impact around oncology, minimizing the adverse effects and resistance to chemotherapeutic to the current treatments available for cancer. Veterinary medicine is another area with continuous interest in this therapy, since studies have shown promising results for the treatment of different animal pathologies such as Bovine mastitis, Malassezia, cutaneous hemangiosarcoma, among others. In agriculture, PDT has been used, for example, to remove traces of antibiotics of milk. The challenges, in general, of PDT in the field of biotechnology are mainly the development of effective and non-toxic or less toxic photosensitizers for humans, animals and plants. We believe that there is a current and future potential for PDT in different fields of biotechnology due to the existing demand.