Reactive Oxygen Species Generated by Cold Atmospheric Plasmas in Aqueous Solution: Successful Electrochemical Monitoring in Situ under a High Voltage System

Opportunities of Electronic and Optical Sensors in Autonomous Medical Plasma Technologies

Low temperature plasma technology is proving to be at the frontier of emerging medical technologies with real potential to overcome escalating healthcare challenges including antimicrobial and anticancer resistance. However, significant improvements in efficacy, safety, and reproducibility of plasma treatments need to be addressed to realize the full clinical potential of the technology. To improve plasma treatments recent research has focused on integrating automated feedback control systems into medical plasma technologies to maintain optimal performance and safety. However, more advanced diagnostic systems are still needed to provide data into feedback control systems with sufficient levels of sensitivity, accuracy, and reproducibility. These diagnostic systems need to be compatible with the biological target and to also not perturb the plasma treatment. This paper reviews the state-of-the-art electronic and optical sensors that might be suitable to address this unmet technological need, and the steps needed to integrate these sensors into autonomous plasma systems. Realizing this technological gap could facilitate the development of next-generation medical plasma technologies with strong potential to yield superior healthcare outcomes.

Human Trial for the Effect of Plasma-Activated Water Spray on Vaginal Cleaning in Patients with Bacterial Vaginosis

Underwater plasma discharge temporally produces several reactive radicals and/or free chlorine molecules in water, which is responsible for antimicrobial activity. Hence, it can simply sanitize tap water without disinfectant treatment. Additionally, the spraying technique using cleaning water exploits deep application in the narrow and curved vaginal tract of patients. Herein, we attempted a clinical trial to evaluate the vaginal cleaning effect of spraying plasma-activated water (PAW) to patients with vaginitis (46 patients). The efficacy was compared with treatment with betadine antiseptics used to treat bacterial vaginosis (40 patients). To evaluate the cleaning effect, Gram staining of the vaginal secretions was conducted before and after spraying PAW or betadine treatment (BT). Consequently, PAW-sprayed (PAWS) patients (22.3%) showed a better vaginal cleaning effect against Gram-positive and -negative bacteria than BT patients (14.4%). Moreover, 18 patients in the BT group showed worsened vaginal contamination, whereas five patients in the PAWS group showed worsened vaginal contamination. Taken together, the noncontact method of spraying cleaning water to the vagina exhibited a reliable vaginal cleaning effect without further bacterial infection compared with BT. Therefore, we suggest a clinical application of the spraying method using PAW for vaginal cleaning to patients with vaginitis without disinfectants and antibiotics.

Electrodes and electrocatalysts for electrochemical hydrogen peroxide sensors: a review of design strategies

H₂O₂ sensing is required in various biological and industrial applications, for which electrochemical sensing is a promising choice among various sensing technologies. Electrodes and electrocatalysts strongly influence the performance of electrochemical H₂O₂ sensors. Significant efforts have been devoted to electrode nanostructural designs and nanomaterial-based electrocatalysts. Here, we review the design strategies for electrodes and electrocatalysts used in electrochemical H₂O₂ sensors. We first summarize electrodes in different structures, including rotation disc electrodes, freestanding electrodes, all-in-one electrodes, and representative commercial H₂O₂ probes. Next, we discuss the design strategies used in recent studies to increase the number of active sites and intrinsic activities of electrocatalysts for H₂O₂ redox reactions, including nanoscale pore structuring, conductive supports, reducing the catalyst size, alloying, doping, and tuning the crystal facets. Finally, we provide our perspectives on the future research directions in creating nanoscale structures and nanomaterials to enable advanced electrochemical H₂O₂ sensors in practical applications.

Direct Sensing of Superoxide and Its Relatives Reactive Oxygen and Nitrogen Species in Phosphate Buffers during Cold Atmospheric Plasmas Exposures

This study aims at sensing in situ reactive oxygen and nitrogen species (RONS) and specifically superoxide anion (O₂^•-) in aqueous buffer solutions exposed to cold atmospheric plasmas (CAPs). CAPs were generated by ionizing He gas shielded with variable N₂/O₂ mixtures. Thanks to ultramicroelectrodes protected against the high electric fields transported by the ionization waves of CAPs, the production of superoxide and several RONS was electrochemically directly detected in liquids during their plasma exposure. Complementarily, optical emissive spectroscopy (OES) was used to study the plasma phase composition and its correlation with the chemistry in the exposed liquid. The specific production of O₂^•-, a biologically reactive redox species, was analyzed by cyclic voltammetry (CV), in both alkaline (pH 11), where the species is fairly stable, and physiological (pH 7.4) conditions, where it is unstable. To understand its generation with respect to the plasma chemistry, we varied the shielding gas composition of CAPs to directly impact on the RONS composition at the plasma-liquid interface. We observed that the production and accumulation of RONS in liquids, including O₂^•-, depends on the plasma composition, with N₂-based shieldings providing the highest superoxide concentrations (few 10s of micromolar at most) and of its derivatives (hundreds of micromolar). In situ spectroscopic and electrochemical analyses provide a high resolution kinetic and quantitative understanding of the interactions between CAPs and physiological solutions for biomedical applications.

Imaging the oxygen wave with a single bioluminescent bacterium

We developed a capability of a monolayer of bioluminescent (BL) bacteria for spatiotemporally visualizing the heterogeneous distribution and dynamic evolution of interfacial oxygen concentration, resulting in the discovery of spontaneous and stochastic oxygen waves at the interface between the substrate and an undisturbed, apparently still solution. Wild type bacteria, P. phosphoreum, spontaneously emit light during the native metabolism processes, i.e., bioluminescence. The emission intensity is sensitively regulated by oxygen concentration. By taking the electrolysis of water as a model, it was demonstrated that time-lapsed BL imaging of a bacterial monolayer allowed for visualizing the dynamic distribution of oxygen. The results were quantitatively understood with a physical model involving the diffusion equation and Michaelis-Menten equation. Unexpectedly, further study uncovered a spontaneous and stochastic oxygen wave in a standard well of a microtiter plate, which was subsequently attributed to the inevitable micro-convections induced by inhomogeneous evaporation and thermal fluctuation. Because of the wide application of microtiter plates, this study sheds new light to better understand the apparent heterogeneity in cell-culture and bio-assays.

Dynamics of Singlet Oxygen-Triggered, RONS-Based Apoptosis Induction after Treatment of Tumor Cells with Cold Atmospheric Plasma or Plasma-Activated Medium

Treatment of tumor cells with cold atmospheric plasma (CAP) or with plasma-activated medium (PAM) leads to a biochemical imprint on these cells. This imprint is mediated by primary singlet oxygen, which is mainly generated through the interaction between CAP-derived H2O2 and NO2-. This imprint is induced with a low efficiency as local inactivation of a few membrane-associated catalase molecules. As sustained generation of secondary singlet oxygen by the tumor cells is activated at the site of the imprint, a rapid bystander effect-like spreading of secondary singlet oxygen generation and catalase inactivation within the cell population is thus induced. This highly dynamic process is essentially driven by NOX1 and NOS of the tumor cells, and finally leads to intercellular RONS-driven apoptosis induction. This dynamic process can be studied by kinetic analysis, combined with the use of specific inhibitors at defined time intervals. Alternatively, it can be demonstrated and quantified by transfer experiments, where pretreated cells are mixed with untreated cells and bystander signaling is determined. These studies allow to conclude that the specific response of tumor cells to generate secondary singlet oxygen is the essential motor for their self-destruction, after a singlet oxygen-mediated triggering process by CAP or PAM.

The synergistic effect between hydrogen peroxide and nitrite, two long-lived molecular species from cold atmospheric plasma, triggers tumor cells to induce their own cell death

Nitrite and H₂O₂ are long-lived species in cold atmospheric plasma and plasma-activated medium. It is known that their synergistic interaction is required for selective apoptosis induction in tumor cells that are treated with plasma-activated medium. This study shows that the interaction between nitrite and H₂O₂ leads to the formation of peroxynitrite, followed by singlet oxygen generation through the interaction between peroxynitrite and residual H₂O₂. This primary singlet oxygen causes local inactivation of few catalase molecules on the surface of tumor cells. As a consequence, H₂O₂ and peroxynitrite that are constantly produced by tumor cells and are usually decomposed by their protective membrane-associated catalase, are surviving at the site of locally inactivated catalase. This leads to the generation of secondary singlet oxygen through the interaction between tumor cell-derived H₂O₂ and peroxynitrite. This selfsustained process leads to autoamplification of secondary singlet oxygen generation and catalase inactivation. Inactivation of catalase allows the influx of H₂O₂ through aquaporins, leading to intracellular glutathione depletion and sensitization of the cells for apoptosis induction through lipid peroxidation. It also allows to establish intercellular apoptosis-inducing HOCl signaling, driven by active NOX1 and finalized by lipid peroxidation through hydroxyl radicals that activates the mitochondrial pathway of apoptosis. This experimentally established model is based on a triggering function of CAP and PAM-derived H₂O₂/nitrite that causes selective cell death in tumor cells based on their own ROS and RNS. This model explains the selectivity of CAP and PAM action towards tumor cells and is in contradiction to previous models that implicated that ROS/RNS from CAP or PAM were sufficient to directly cause cell death of tumor cells.

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H₂O₂ and nitrite generate peroxynitrite, followed by primary singlet oxygen formation.

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Primary singlet oxygen causes local inactivation of tumor cell protective catalase.

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Amplificatory generation of secondary singlet oxygen and catalase inactivation are established.

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Inactivation of catalase allows aquaporin-mediated influx of H₂O₂ and glutathione depletion.

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In this way, CAP and PAM trigger tumor cells to contribute to their own cell death.