Effects of low-level laser therapy (LLLT) of 810 nm upon in vitro growth of bacteria: relevance of irradiance and radiant exposure

A novel chlorin derivative Shengtaibufen (STBF) mediated photodynamic therapy combined with iodophor for the treatment of chronic superficial leg wounds infected with methicillin-resistant Staphylococcus aureus: A retrospective clinical study

OBJECTIVE

Chronic wounds are costly and difficult to treat, resulting in morbidity and even mortality in some cases due to a high methicillin-resistant Staphylococcus aureus (MRSA) burden contributing to chronicity. We aimed to observe the antimicrobial activity and healing-promoting effect of a novel photosensitizer Shengtaibufen (STBF)-mediated antibacterial photodynamic therapy (PDT) on MRSA-infected chronic leg ulcers.

PATIENTS AND METHODS

This was a retrospective, comparative, single-center clinical study. A total of 32 patients with chronic lower limb wounds infected with MRSA from January 2022 to December 2023 were finally included in this study by searching the electronic medical records of the dermatology department of Huadong Hospital, including a group of red light combined with iodophor (control+iodophor, n=16, receiving red light once a week for 8 weeks and routine dressing change with iodophor once a day) and a group of STBF-mediated PDT (STBF-PDT) combined with iodophor (STBF-PDT+iodophor, n=16, receiving STBF-PDT and routine dressing change with iodophor once a day). STBF-PDT was performed once a week (1 mg/ml STBF, 1 h incubation, 630 nm red light, 80 J/cm2) for 8 weeks. The primary endpoints included wound clinical signs, wound size, wound-related pain, re-epithelialization score, MRSA load and wound-related quality of life (wound-QoL). Any adverse events were also recorded.

RESULTS

We found that STBF-PDT+iodophor could effectively alleviate clinical infection symptoms, accelerate wound closure, reduce average biological burden and improve wound-QoL without severe adverse events in comparison to the control+iodophor group. The STBF-PDT+iodophor group obtained a mean percentage reduction of 65.22% in wound size (from 18.96±11.18 cm2 to 6.59±7.94 cm2) and excellent re-epithelialization scores, as compared with a decrease of 30.17% (from 19.23±9.80 cm2 to 13.43±9.32 cm2) for the control+iodophor group. Significant differences in wound area were observed at week 6 (p=0.028*) and week 8 (p=0.002**). The bacterial load decreased by 99.86% (from 6.45 × 107±2.69 × 107 to 8.94 × 104±1.92 × 105 CFU/cm2, p<0.0001) in the STBF-PDT+iodophor group and 1.82% (from 6.61 × 107±2.13 × 107 to 6.49 × 107±2.01 × 107 CFU/cm2, p=0.029) in the control+iodophor group. The wound-QoL in STBF-PDT+iodophor group had a 51.62% decrease in overall score (from 29.65±9.33 at the initial to 14.34±5.17 at week 8, p<0.0001) compared to those receiving red light and routine wound care (from 30.73±17.16 to 29.32±15.89 at week 8, p=0.003). Moreover, patients undergoing STBF-PDT+iodophor exhibited great improvements in all domains of wound-QoL (physical, psychological and everyday-life), whereas the control+iodophor group ameliorated in only one field (everyday-life).

CONCLUSION

Our data confirmed that a novel photosensitizer, STBF-mediated PDT, when combined with iodophor, served as a potential modality for MRSA infection and a possible therapy for other drug-resistant microorganisms, and as a promising alternative for chronic cutaneous infectious diseases.

Photobiomodulation: The Clinical Applications of Low-Level Light Therapy

BACKGROUND

Low-level light therapy (LLLT) is a recent addition to the pantheon of light-based therapeutic interventions. The absorption of red/near-infrared light energy, a process termed "photobiomodulation," enhances mitochondrial ATP production, cell signaling, and growth factor synthesis, and attenuates oxidative stress. Photobiomodulation is now highly commercialized with devices marketed directly to the consumer. In the gray area between the commercial and therapeutic sectors, harnessing the clinical potential in reproducible and scientifically measurable ways remains challenging.

OBJECTIVES

The aim of this article was to summarize the clinical evidence for photobiomodulation and discuss the regulatory framework for this therapy.

METHODS

A review of the clinical literature pertaining to the use of LLLT for skin rejuvenation (facial rhytids and dyschromias), acne vulgaris, wound healing, body contouring, and androgenic alopecia was performed.

RESULTS

A reasonable body of clinical trial evidence exists to support the role of low-energy red/near-infrared light as a safe and effective method of skin rejuvenation, treatment of acne vulgaris and alopecia, and, especially, body contouring. Methodologic flaws, small patient cohorts, and industry funding mean there is ample scope to improve the quality of evidence. It remains unclear if light-emitting diode sources induce physiologic effects of compararable nature and magnitude to those of the laser-based systems used in most of the higher-quality studies.

CONCLUSIONS

LLLT is here to stay. However, its ubiquity and commercial success have outpaced empirical approaches on which solid clinical evidence is established. Thus, the challenge is to prove its therapeutic utility in retrospect. Well-designed, adequately powered, independent clinical trials will help us answer some of the unresolved questions and enable the potential of this therapy to be realized.

Efficacy of single versus multiple exposure by electromagnetic modalities on gram-negative and positive bacterial strains in an in-vitro model

OBJECTIVES

The primary purpose of the recent experiment was to scrutinize the dissimilarity between single and multiple exposures by electrotherapeutic modalities to determine the development of Gram-positive and Gram negative bacteria spectrum.

MATERIAL AND METHODS

Bacterial strains employed in this study were Gram-negative bacteria such as Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumonae and Gram-positive bacteria such as Staphylococcus aureus, Staphylococcus saprophyticus and Streptococcus pyogenes. Fluence for Low level laser therapy (LLLT) (810 nm) was 40 J/cm2 for 80 s, for microwave (MWD) a dosage of 100-Watt with duration of 5 min and for magnetic field therapy (MT) duration of 30 min with 100% intensity was used.

RESULTS

Repeated Measures of analysis of variances (RANOVA) for within-subject effects was used to detect a global significant change within the means at dissimilar time points. The experiments of within-subjects revealed a significant difference within groups, df of (3, 40), F value of 39.38 and a p value less than 0.001, representing a significant variation between the three groups between pre and post exposures. There was a significant variation between single exposure and multiple exposures in the experimental sample's pre-post between the four groups with df (1, 40) f value of 2943.69 and p value less than 0.001. Scanning and Transmission electron microscopy images were also taken into account to determine the extent of damage caused to the bacterial cells surface topography in Gram negative and Gram positive spectrums.

CONCLUSION

The study demonstrated that single high exposure with the LLLT appears to have the most emphatic effect followed by exposure by MWD and MT.

Therapy of infected wounds: overcoming clinical challenges by advanced drug delivery systems

In recent years, the incidence of infected wounds is steadily increasing, and so is the clinical as well as economic interest in effective therapies. These combine reduction of pathogen load in the wound with general wound management to facilitate the healing process. The success of current therapies is challenged by harsh conditions in the wound microenvironment, chronicity, and biofilm formation, thus impeding adequate concentrations of active antimicrobials at the site of infection. Inadequate dosing accuracy of systemically and topically applied antibiotics is prone to promote development of antibiotic resistance, while in the case of antiseptics, cytotoxicity is a major problem. Advanced drug delivery systems have the potential to enable the tailor-made application of antimicrobials to the side of action, resulting in an effective treatment with negligible side effects. This review provides a comprehensive overview of the current state of treatment options for the therapy of infected wounds. In this context, a special focus is set on delivery systems for antimicrobials ranging from semi-solid and liquid formulations over wound dressings to more advanced carriers such as nano-sized particulate systems, vesicular systems, electrospun fibers, and microneedles, which are discussed regarding their potential for effective therapy of wound infections. Further, established and novel models and analytical techniques for preclinical testing are introduced and a future perspective is provided.

Low-power lasers on bacteria: stimulation, inhibition, or effectless?

Clinical protocols based on low-power lasers have been widely used for inflammation process resolution improvement, pain relief, wound healing, and nerve regeneration. However, there are concerns if exposure to such lasers could have negative effects on infected organs and tissues. There are experimental data suggesting exposure to radiations emitted by low-power lasers either induces stimulation, inhibition, or it is effectless on bacterial cultures. Thus, this review aimed to carry out a review of studies and to propose a hypothesis to explain why exposure to low-power lasers could stimulate, inhibit, or have no effect on bacteria. A literature search was carried out for assessment of published reports on effect of low-power lasers on bacteria. The experimental data suggest that keys for determining laser-induced effects on bacteria are specific physical laser and biological parameters. Final consequence on bacterial cells could depend on exposure to low-power laser which could either cause more stimulation of endogenous photoacceptors, more excitation of endogenous photosensitizers, or a balance between such effects.

Laser Light Therapy in Inflammatory, Musculoskeletal, and Autoimmune Disease

PURPOSE OF REVIEW

The goal of this review is to summarize the field to date and to discuss strengths and limitations of low-level laser (light) therapy (LLLT) for the future investigation as a treatment of inflammatory disease.

RECENT FINDINGS

LLLT is a promising therapeutic, particularly for those diseases of skin and joints because they are most accessible to treatment. Indeed, the known mechanisms of LLLT support its use for anti-inflammatory purposes, as well as stimulation of tissue growth and repair. Although the standard of care for the majority of inflammatory diseases is immunosuppressive agents such as corticosteroids with undesirable toxicities, LLLT offers a unique approach by being non-invasive and incurring minimal side effects. It is also relatively inexpensive and accessible and even has the possibility to be patient directed at home. There is evidence that LLLT is able to modulate the immune system at the skin and joint, and it has been shown to be efficacious in humans by affecting bacterial colonization as it may pertain to chronic rhinosinusitis. However, there is variability in the methods of laser application as well as a lack of evidence for laser type, dose-ranging studies, and wavelength selection that create barriers to the implementation of LLLT without further more rigorous and standardized study. The heterogeneity makes it difficult to draw strong conclusions about the efficacy of LLLT and its mechanisms.

Non-mammalian Hosts and Photobiomodulation: Do All Life-forms Respond to Light?

Photobiomodulation (PBM), also known as low-level laser (light) therapy, was discovered over 50 years ago, but only recently has it been making progress toward wide acceptance. PBM originally used red and near-infrared (NIR) lasers, but now other wavelengths and non-coherent light-emitting diodes (LEDs) are being explored. The almost complete lack of side effects makes the conduction of controlled clinical trials relatively easy. Laboratory research has mainly concentrated on mammalian cells (normal or cancer) in culture, and small rodents (mice and rats) as models of different diseases. A sizeable body of work was carried out in the 1970s and 1980s in Russia looking at various bacterial and fungal cells. The present review covers some of these studies and a recent number of papers that have applied PBM to so-called "model organisms." These models include flies (Drosophila), worms (Caenorhabditis elegans), fish (zebrafish) and caterpillars (Galleria). Much knowledge about the genomics and proteomics, and many reagents for these organisms already exist. They are inexpensive to work with and have lower regulatory barriers compared to vertebrate animals. Other researchers have studied different models (snails, sea urchins, Paramecium, toads, frogs and chickens). Plants may respond to NIR light differently from visible light (photosynthesis and photomorphogenesis) but PBM in plants has not been much studied. Veterinarians routinely use PBM to treat non-mammalian patients. The conclusion is that red or NIR light does indeed have significant biologic effects conserved over many different kingdoms, and perhaps it is true that "all life-forms respond to light."

New microorganism isolation techniques with emphasis on laser printing

The study of biodiversity, growth, development, and metabolism of cultivated microorganisms is an integral part of modern microbiological, biotechnological, and medical research. Such studies require the development of new methods of isolation, cultivation, manipulation, and study of individual bacterial cells and their consortia. To this end, in recent years, there has been an active development of different isolation and three-dimensional cell positioning methods. In this review, the optical tweezers, surface heterogeneous functionalization, multiphoton lithography, microfluidic techniques, and laser printing are reviewed. Laser printing is considered as one of the most promising techniques and is discussed in detail.

Laser printing of microbial systems: effect of absorbing metal film

Recently, it was shown that laser-induced forward transfer (LIFT) technology and the laser engineering of microbial systems (LEMS) technique (based on LIFT method) are effective for isolation of micro-organisms from different complex substrates. These techniques frequently utilize Au as an absorbing layer material. The purpose of this study was to investigate the influence of absorbing film materials (Au, Ti and Cr) on the effectiveness of laser printing of micro-organisms to improve LEMS and LIFT techniques. It was shown that application of Ti and Cr absorbing layers activates bacterial growth after laser printing and is significantly more effective in comparison to Au films, which actually show a suppressing effect on bacterial cells. Results of this study can be applied for LEMS and LIFT protocols for improving bacterial isolation and microbial growth. SIGNIFICANCE AND IMPACT OF THE STUDY: Laser-induced forward transfer technique (LIFT) is currently used for printing of micro-organisms and in biosensor techniques, for single-cell isolation, and for culturing of micro-organisms from complex substrates. We have studied the influence of absorbing film materials (Au, Ti and Cr) on the effectiveness laser printing of micro-organisms. It was shown that application of Ti and Cr absorbing layers activates bacterial growth and is more effective in LIFT compared to Au films, which actually have a suppressive effect on bacteria cells. The results can improve LIFT protocols for bacteria isolation and culturing of microbial systems.

Photobiomodulation Therapy in Veterinary Medicine: A Review

Laser therapy, or photobiomodulation, has rapidly grown in popularity in human and veterinary medicine. With a number of proposed indications and broad, sometimes anecdotal, use in practice, research interest has expanded aimed at providing scientific support. Recent studies have shown that laser therapy alters the inflammatory and immune response as well as promotes healing for a variety of tissue types. This review will cover the history of the modality, basic principles, proposed mechanisms of action, evidence-based clinical indications, and will guide the practitioner through its application in practice.

A novel management of streptococcal pharyngotonsillar infections by laser-activated silver nanoparticles and methylene blue conjugate, in vitro study

INTRODUCTION

Species of Streptococcus are classified based on their hemolytic properties into alpha and beta types. And, since antimicrobial drug resistance is an increasingly problematic issue, the efforts to develop modalities that would overcome this obstacle and avoid antibiotic side effects is an ongoing challenge.

METHODS AND MATERIALS

20 patients from both sexes were selected. The isolated organisms were identified according to standard laboratory methods. Bacterial Cultures were subjected to the low-level diode laser (660 nm), methylene blue (MB) as a photosensitizing agent and for silver nanoparticles.

RESULTS

All the experimental groups showed statistically lower values of CFU/ml than the positive control group.

CONCLUSION

The photoactivated MB, silver nanoparticles conjugate showed the maximum inhibitory effect on Streptococci, which opens a gate to further investigation of such a promising protocol to establish a safe and efficient method of management for resistant cases of streptococcal tonsillar infections.

Er:YAG Laser Irradiation Induces Behavioral Changes in V. harveyi

OBJECTIVE

Laser technologies have many different applications in medical, agricultural, and industrial fields. Studies have shown several effects of laser energy on different bacterial species, in a wide variety of settings. Recent reports have found that one of the unique features of bacteria is their ability to communicate among themselves (quorum sensing). We sought to investigate whether low-energy laser irradiation affects bacterial behavior, which is regulated by quorum sensing.

METHODS

Laser irradiations were performed using Er:YAG laser (2940 nm wavelength) at output powers of 0.5, 1.5, 2.5, and 4 W on wild-type Vibrio harveyi. Bioluminescence, motility, and biofilm forming capability were assessed on the bacteria after irradiation.

RESULTS

After irradiation of bacteria, positive dose/output power dependencies were found in the bioluminescence omitted from tested experimental groups. Motility of colonies on semi-solid media was inhibited as irradiation output power was increased. However, after irradiation, biomass analysis of biofilm samples showed negligible differences between the irradiated samples and controls.

CONCLUSIONS

Results indicate the impact of low-energy laser irradiation on bacterial behavior such as quorum sensing and motility, without affecting bacterial growth patterns.

The in vitro effect of antimicrobial photodynamic therapy with indocyanine green on Enterococcus faecalis: Influence of a washing vs non-washing procedure

INTRODUCTION

The purpose of this study was to evaluate the in vitro effect of washing and non-washing of indocyanine green (ICG) as photosensitizer (PS) on bacterial count, biofilm formation, development and degradation of Enterococcus faecalis.

METHODS

The anti-bacterial, anti-biofilm formation, anti-biofilm development and biofilm degradation of anti-microbial photodynamic therapy (aPDT) against E. faecalis was determined at concentrations of 3 to 2000μg/mL of ICG, subject to 18J/cm² dose of diode laser (808nm) in washing and non-washing producers. Bacterial viability measurements and biofilm assays were evaluated by broth microdilution method and crystal violet assays, respectively.

RESULTS

ICG-mediated aPDT, using 25 to 2000μg/mL and 50 to 2000μg/mL showed significant reduction in E. faecalis growth when compared to the control in non-washing and washing producers, respectively (P<0.05). Also, ICG-mediated aPDT showed a significantly inhibitory effect on biofilm formation of E. faecalis in concentration of 6 to 2000μg/mL and 100 to 2000μg/mL in non-washing and washing groups (P<0.05). The biofilm development was inhibited by concentrations of 12 to 2000μg/mL and 100 to 2000μg/mL in non-washing and washing groups. The biofilm degradation increased from concentrations of 12 to 2000μg/mL and 250 to 2000μg/mL in non-washing and washing groups, respectively.

CONCLUSION

This study shows that the application of ICG should be accompanied by laser irradiation without being washed out to achieve better result for bacterial count reduction and anti-biofilm effects.

Murine Model Imitating Chronic Wound Infections for Evaluation of Antimicrobial Photodynamic Therapy Efficacy

It is generally acknowledged that the age of antibiotics could come to an end, due to their widespread, and inappropriate use. Particularly for chronic wounds alternatives are being thought. Antimicrobial Photodynamic Therapy (APDT) is a potential candidate, and while approved for some indications, such as periodontitis, chronic sinusitis and other niche indications, its use in chronic wounds is not established. To further facilitate the development of APDT in chronic wounds we present an easy to use animal model exhibiting the key hallmarks of chronic wounds, based on full-thickness skin wounds paired with an optically transparent cover. The moisture-retaining wound exhibited rapid expansion of pathogen colonies up to 8 days while not jeopardizing the host survival. Use of two bioluminescent pathogens; methicillin resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa permits real time monitoring of the pathogens. The murine model was employed to evaluate the performance of four different photosensitizers as mediators in Photodynamic Therapy. While all four photosensitizers, Rose Bengal, porphyrin TMPyP, New Methylene Blue, and TLD1411 demonstrated good to excellent antimicrobial efficacy in planktonic solutions at 1 to 50 μM concentrations, whereas in in vivo the growth delay was limited with 24–48 h delay in pathogen expansion for MRSA, and we noticed longer growth suppression of P. aeruginosa with TLD1411 mediated Photodynamic Therapy. The murine model will enable developing new strategies for enhancement of APDT for chronic wound infections.

Evaluation of laser bacterial anti-fouling of transparent nanocrystalline yttria-stabilized-zirconia cranial implant

BACKGROUND AND OBJECTIVE

The development and feasibility of a novel nanocrystalline yttria-stabilized-zirconia (nc-YSZ) cranial implant has been recently established. The purpose of what we now call "window to the brain (WttB)" implant (or platform), is to improve patient care by providing a technique for delivery and/or collection of light into/from the brain, on demand, over large areas, and on a chronically recurring basis without the need for repeated craniotomies. WttB holds the transformative potential for enhancing light-based diagnosis and treatment of a wide variety of brain pathologies including cerebral edema, traumatic brain injury, stroke, glioma, and neurodegenerative diseases. However, bacterial adhesion to the cranial implant is the leading factor for biofilm formation (fouling), infection, and treatment failure. Escherichia coli (E. coli), in particular, is the most common isolate in gram-negative bacillary meningitis after cranial surgery or trauma. The transparency of our WttB implant may provide a unique opportunity for non-invasive treatment of bacterial infection under the implant using medical lasers.

STUDY DESIGN/MATERIALS AND METHODS

A drop of a diluted overnight culture of BL21-293 E. coli expressing luciferase was seeded between the nc-YSZ implant and the agar plate. This was followed by immediate irradiation with selected laser. After each laser treatment the nc-YSZ was removed, and cultures were incubated for 24 hours at 37 °C. The study examined continuous wave (CW) and pulsed wave (PW) modes of near-infrared (NIR) 810 nm laser wavelength with a power output ranging from 1 to 3 W. During irradiation, the temperature distribution of nc-YSZ surface was monitored using an infrared thermal camera. Relative luminescence unit (RLU) was used to evaluate the viability of bacteria after the NIR laser treatment.

RESULTS

Analysis of RLU suggests that the viability of E. coli biofilm formation was reduced with NIR laser treatment when compared to the control group (P < 0.01) and loss of viability depends on both laser fluence and operation mode (CW or PW). The results demonstrate that while CW laser reduces the biofilm formation more than PW laser with the same power, the higher surface temperature of the implant generated by CW laser limits its medical efficacy. In contrast, with the right parameters, PW laser produces a more moderate photothermal effect which can be equally effective at controlling bacterial growth.

CONCLUSIONS

Our results show that E. coli biofilm formation across the thickness of the nc-YSZ implant can be disrupted using NIR laser treatment. The results of this in vitro study suggest that using nc-YSZ as a cranial implant in vivo may also allow for locally selective, non-invasive, chronic treatment of bacterial layers (fouling) that might form under cranial implants, without causing adverse thermal damage to the underlying host tissue when appropriate laser parameters are used. Lasers Surg. Med. 48:782-789, 2016. © 2016 Wiley Periodicals, Inc.

Sub-lethal doses of photodynamic therapy affect biofilm formation ability and metabolic activity of Enterococcus faecalis

BACKGROUND

During photodynamic therapy (PDT) in the treatment of a primary endodontic infection, it is extremely likely that microorganisms would be exposed to sub-lethal doses of PDT (sPDT). Although sPDT cannot kill microorganisms, it can considerably influence microbial virulence. This study was conducted to characterize the effect of sPDT using toluidine blue O (TBO), methylene blue (MB), and indocyanine green (ICG) on biofilm formation ability and metabolic activity of Enterococcus faecalis.

METHODS

The antimetabolic and antibiofilm potential of ICG-, TBO-, and MB-sPDT against E. faecalis was analyzed at sub-lethal doses (1/2-1/64 minimum inhibitory concentration) using the XTT reduction assay, crystal violet assay, and scanning electron microscopy.

RESULTS

Higher doses of sPDT adversely affected biofilm formation ability and metabolic activity. ICG-, TBO-, and MB-PDT at a maximum sub-lethal dose markedly reduced the formation of biofilm up to 42.8%, 22.6%, and 19.5%, respectively. ICG-, TBO-, and MB-sPDT showed a marked reduction in bacterial metabolic activity by 98%, 94%, and 82%, respectively. ICG-PDT showed a stronger inhibitory effect on biofilm formation in E. faecalis than MB- and TBO-PDT at sub-lethal levels. Interestingly, a gradual increase in metabolic activity and biofilm formation upon exposure to a lower dose of test sPDT were observed.

CONCLUSION

sPDT showed dual effect on biofilm formation ability and metabolic activity of E. faecalis. High doses revealed antimetabolic and antibiofilm potential activity, whereas lower doses had conflicting results. Hence, when PDT is prescribed in clinical settings, the dose of PDT used in vivo should be taken into consideration.

The dark art of light measurement: accurate radiometry for low-level light therapy

Lasers and light-emitting diodes are used for a range of biomedical applications with many studies reporting their beneficial effects. However, three main concerns exist regarding much of the low-level light therapy (LLLT) or photobiomodulation literature; (1) incomplete, inaccurate and unverified irradiation parameters, (2) miscalculation of ‘dose,’ and (3) the misuse of appropriate light property terminology. The aim of this systematic review was to assess where, and to what extent, these inadequacies exist and to provide an overview of ‘best practice’ in light measurement methods and importance of correct light measurement. A review of recent relevant literature was performed in PubMed using the terms LLLT and photobiomodulation (March 2014–March 2015) to investigate the contemporary information available in LLLT and photobiomodulation literature in terms of reporting light properties and irradiation parameters. A total of 74 articles formed the basis of this systematic review. Although most articles reported beneficial effects following LLLT, the majority contained no information in terms of how light was measured (73 %) and relied on manufacturer-stated values. For all papers reviewed, missing information for specific light parameters included wavelength (3 %), light source type (8 %), power (41 %), pulse frequency (52 %), beam area (40 %), irradiance (43 %), exposure time (16 %), radiant energy (74 %) and fluence (16 %). Frequent use of incorrect terminology was also observed within the reviewed literature. A poor understanding of photophysics is evident as a significant number of papers neglected to report or misreported important radiometric data. These errors affect repeatability and reliability of studies shared between scientists, manufacturers and clinicians and could degrade efficacy of patient treatments. Researchers need a physicist or appropriately skilled engineer on the team, and manuscript reviewers should reject papers that do not report beam measurement methods and all ten key parameters: wavelength, power, irradiation time, beam area (at the skin or culture surface; this is not necessarily the same size as the aperture), radiant energy, radiant exposure, pulse parameters, number of treatments, interval between treatments and anatomical location. Inclusion of these parameters will improve the information available to compare and contrast study outcomes and improve repeatability, reliability of studies.

Red and infrared laser therapy inhibits in vitro growth of major bacterial species that commonly colonize skin ulcers

Low-level laser therapy (LLLT) is used in chronic wounds due to its healing effects. However, bacterial species may colonize these wounds and the optimal parameters for effective bacterial inhibition are not clear. The aim of this study was to analyze the effect of LLLT on bacterial growth in vitro. Bacterial strains including Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa were suspended in saline solution at a concentration of 10(3) cells/ml and exposed to laser irradiation at wavelengths of 660, 830, and 904 nm at fluences of 0 (control), 3, 6, 12, 18, and 24 J/cm(2). An aliquot of the irradiated suspension was spread on the surface of petri plates and incubated at 37 °C for quantification of colony-forming unit after 24, 48, and 72 h. Laser irradiation inhibited the growth of S. aureus at all wavelengths and fluences higher than 12 J/cm(2), showing a strong correlation between increase in fluence and bacterial inhibition. However, for P. aeruginosa, LLLT inhibited growth at all wavelengths only at a fluence of 24 J/cm(2). E. coli had similar growth inhibition at a wavelength of 830 nm at fluences of 3, 6, 12, and 24 J/cm(2). At wavelengths of 660 and 904 nm, growth inhibition was only observed at fluences of 12 and 18 J/cm(2), respectively. LLLT inhibited bacterial growth at all wavelengths, for a maximum of 72 h after irradiation, indicating a correlation between bacterial species, fluence, and wavelength.

[Importance of modern treatment procedures for infected and colonized wounds in dermatology]

In the coming years increasing numbers of patients with chronic ulcers and tumor wounds are to be expected, both of which are typically multifaceted diseases requiring complex and increasingly long-term ambulatory therapy. Therefore, in recent years special medical emphasis has been placed on efficacious therapies with good tolerability and also suitability regarding feasibility for outpatient treatment. Some of these methods, such as cold plasma therapy, extracorporeal shock wave therapy (ESWT), water-filtered infrared therapy (wIRA), electrostimulation (ES) and low level laser therapy (LLLT) have a good chance of success when applied as an adjuvant method in the multimodal treatment concept for patients with recalcitrant wounds. All of these methods have at least indirect antimicrobial properties which can be advantageous in cases of microbial infiltration of wounds. As for all other methods for treating recalcitrant wounds, the promising application of the aforementioned methods requires great expertise in wound healing together with a broad and continuous interdisciplinary diagnostics and therapy (wound center).

Novel strategies to fight Candida species infection

In recent years, there has been a significant increase in the incidence of human fungal infections. The increase in cases of infection caused by Candida species, and the consequent excessive use of antimicrobials, has favored the emergence of resistance to conventional antifungal agents over the past decades. Consequently, Candida infections morbidity and mortality are also increasing. Therefore, new approaches are needed to improve the outcome of patients suffering from Candida infections, because it seems unlikely that the established standard treatments will drastically lower the morbidity of mucocutaneous Candida infections and the high mortality associated with invasive candidiasis. This review aims to present the last advances in the traditional antifungal therapy, and present an overview of novel strategies that are being explored for the treatment of Candida infections, with a special focus on combined antifungal agents, antifungal therapies with alternative compounds (plant extracts and essential oils), adjuvant immunotherapy, photodynamic therapy and laser therapy.

A possible mechanism for the bactericidal effect of visible light

Visible light at high intensity was found to kill bacteria while low-power light in the visible and near infrared region enhances bacterial proliferation. The present review summarizes evidence demonstrating that the mechanism of visible light- bacteria interaction involves reactive oxygen species (ROS) generation. The ROS are photo induced by bacterial endogenous photosensitizers. Phototoxic effects were found to involve induction of high amounts of reactive oxygen species (ROS) by the bacteria while low amounts of ROS may promote their proliferation. Intense blue light, preferably at 415nm, is better than red light for bacteria killing.

Effects of low intensity laser in in vitro bacterial culture and in vivo infected wounds

OBJECTIVE: to compare the effects of low intensity laser therapy on in vitro bacterial growth and in vivo in infected wounds, and to analyze the effectiveness of the AsGa Laser technology in in vivo wound infections. METHODS: in vitro: Staphylococcus aureus were incubated on blood agar plates, half of them being irradiated with 904 nm wavelength laser and dose of 3J/cm2 daily for seven days. In vivo: 32 male Wistar rats were divided into control group (uninfected) and Experimental Group (Infected). Half of the animals had their wounds irradiated. RESULTS: in vitro: there was no statistically significant variation between the experimental groups as for the source plates and the derived ones (p>0.05). In vivo: there was a significant increase in the deposition of type I and III collagen in the wounds of the infected and irradiated animals when assessed on the fourth day of the experiment (p=0.034). CONCLUSION: low-intensity Laser Therapy applied with a wavelength of 904nm and dose 3J/cm2 did not alter the in vitro growth of S. aureus in experimental groups; in vivo, however, it showed significant increase in the deposition of type I and III collagen in the wound of infected and irradiated animals on the fourth day of the experiment.

In Vitro effect of low-level laser therapy on typical oral microbial biofilms

The aim of this study was to evaluate the effect of specific parameters of low-level laser therapy (LLLT) on biofilms formed by Streptococcus mutans, Candida albicans or an association of both species. Single and dual-species biofilms--SSB and DSB--were exposed to laser doses of 5, 10 or 20 J/cm(2) from a near infrared InGaAsP diode laser prototype (LASERTable; 780 ± 3 nm, 0.04 W). After irradiation, the analysis of biobilm viability (MTT assay), biofilm growth (cfu/mL) and cell morphology (SEM) showed that LLLT reduced cell viability as well as the growth of biofilms. The response of S. mutans (SSB) to irradiation was similar for all laser doses and the biofilm growth was dose dependent. However, when associated with C. albicans (DSB), S. mutans was resistant to LLLT. For C. albicans, the association with S. mutans (DSB) caused a significant decrease in biofilm growth in a dose-dependent fashion. The morphology of the microorganisms in the SSB was not altered by LLLT, while the association of microbial species (DSB) promoted a reduction in the formation of C. albicans hyphae. LLLT had an inhibitory effect on the microorganisms, and this capacity can be altered according to the interactions between different microbial species.

In vitro analysis of bacterial morphology by atomic force microscopy of low level laser therapy 660, 830 and 904 nm

OBJECTIVE

The objective of this study was to analyze the bacterial morphology by atomic force microscopy (AFM) after the application of low-level laser therapy (LLLT) in in vitro culture of Staphylococcus aureus ATCC 29213.

BACKGROUND DATA

Infections caused by S. aureus are among the highest occurring in hospitals and can often colonize pressure ulcers. LLLT is among the methods used to accelerate the healing of ulcers. However, there is no consensus on its effect on bacteria.

MATERIALS AND METHODS

After being cultivated and seeded, the cultures were irradiated using wavelengths of 660, 830, and 904 nm at fluences of 0, 1, 2, 3, 4, 5, and 16 J/cm(2). Viable cells of S. aureus strain were counted after 24 h incubation. To analyze the occurrence of morphological changes, the topographical measurement of bacterial cells was analyzed using the AFM.

RESULTS

The overall assessment revealed that the laser irradiation reduced the S. aureus growth using 830 and 904 nm wavelengths; the latter with the greatest inhibition of the colony-forming units (CFU/mL) (331.1±38.19 and 137.38±21.72). Specifically with 660 nm, the statistical difference occurred only at a fluence of 3 J/cm(2). Topographical analysis showed small changes in morphological conformity of the samples tested.

CONCLUSIONS

LLLT reduced the growth of S. aureus with 830 and 904 nm wavelengths, particularly with 904 nm at a fluence of 3 J/cm(2), where the greatest topographical changes of the cell structure occurred.

How to report low-level laser therapy (LLLT)/photomedicine dose and beam parameters in clinical and laboratory studies

BACKGROUND

Dose and beam parameters are critical for successful laser, LED, and other light therapy treatments; however, in our experience, researchers frequently make critical errors and omissions when submitting papers for publication. Journals frequently publish studies with missing data, mathematical errors, and no reported verification of beam parameters. This makes reproducibility impossible, and further confounds an already complex subject.

OBJECTIVE

This article is intended to be a reference document for non-physicist researchers conducting low-level laser therapy (LLLT) laboratory studies and clinical trials to help them design and report the beam and dose aspects of their trials.

RECOMMENDATIONS

It provides a checklist to help LLLT researchers understand and report all the necessary parameters for a repeatable scientific study. It includes the eight most important beam parameters to report, which are: wavelength, power, irradiation time, beam area at the skin or culture surface (this is not necessarily the same as the aperture size), pulse parameters, anatomical location, number of treatments, and interval between treatments. The three commonly used dose parameters are time, energy, and energy density. In addition, more thorough reporting would include coherence, application technique (contact, projection, scanning, pressure), beam profile, and spectral width, as these may also be considered important. Beam power often decreases as the device warms up and as the device ages; therefore, this should be checked routinely during an experiment/trial. Measurements of beam area and beam power require special instruments and trained technicians to operate them. Power measurements should be taken before, after, and at frequent intervals during research trials.

CONCLUSION

Reviewers should insist that the minimum eight most important beam parameters are included, and authors should take care to measure and record these accurately before, during, and after an experiment or clinical trial.

Laser disruption and killing of methicillin-resistant Staphylococcus aureus biofilms

OBJECTIVE

The aim of the study was to study the efficacy of 2 different lasers in vitro, in disrupting biofilm and killing planktonic pathogenic bacteria.

MATERIALS AND METHODS

Biofilms of a stable bioluminescent of Staphylococcus aureus Xen 31 were grown in a 96-well microtiter plate for 3 days. The study included 7 arms: (a) control; (b) ciprofloxacin (3 mg/L, the established minimum inhibitory concentration [MIC]) alone; (c) shock wave (SW) laser alone; (d) near-infrared (NIR) laser alone; (e) SW laser and ciprofloxacin; (f) SW and NIR lasers; (g) SW, NIR lasers, and ciprofloxacin. The results were evaluated with an in vivo imaging system (IVIS) biophotonic system (for live bacteria) and optical density (OD) for total bacteria.

RESULTS

Without antibiotics, there was a 43% reduction in OD (P < .05) caused by the combination of SW and NIR suggesting that biofilm had been disrupted. There was an 88% reduction (P < .05) in live biofilm. Ciprofloxacin alone resulted in a decrease of 28% of total live cells (biofilm remaining attached) and 58% of biofilm cells (both P > .05). Ciprofloxacin in combination with SW and SW + NIR lasers caused a decrease of more than 60% in total live biomass and more than 80% of biofilm cells, which was significantly greater than ciprofloxacin alone (P < .05).

CONCLUSIONS

We have demonstrated an effective nonpharmacologic treatment method for methicillin-resistant Staphylococcus aureus (MRSA) biofilm disruption and killing using 2 different lasers. The preferred treatment sequence is a SW laser disruption of biofilm followed by NIR laser illumination. Treatment optimization of biofilm is possible with the addition of ciprofloxacin in concentrations consistent with planktonic MIC.

Phototherapy for chronic rhinosinusitis

OBJECTIVES

Near-infrared laser illumination (NILI), with or without photo-activated (PA) agents, has bactericidal and wound healing promoting effects. NILI may have a potential role managing chronic rhinosinusitis (CRS).

METHODS

A prospective randomized study with 23 symptomatic post-surgical CRS patients with positive cultures was conducted. Two groups (GR1 and GR2) were treated with NILI. Objective nasal endoscopic scoring (NES) was elaborated. GR1 was treated with a 940 nm laser, while GR2 was treated with a topical PA agent, indocyanine-green, followed with 810 nm laser. SNOT20 scores, NES, and cultures were obtained prior to illumination. Saccharin test was performed 1 week following treatment.

RESULTS

Some cultures remained positive through treatment, with Staph. aureus predominating. Both therapy arms demonstrated clinical efficacy. The SNOT20 score change was 0.9, 0.8 for GR1 and GR2, respectively (P < 0.05). Improvement (P < 0.05) was observed based on NES. No significant difference was observed between two treatment groups. All passed the saccharin test. Therapeutic effect was sustained for a minimum of 2 months. Side effects were minimal.

CONCLUSIONS

NILI was objectively and subjectively beneficial in managing CRS, safe, reproducible, sustained and appeared not to interfere with ciliary motility. CRS exacerbation was avoided without using antibiotics or steroids.

Biophoton detection and low-intensity light therapy: a potential clinical partnership

Low-intensity light therapy (LILT) is showing promise in the treatment of a wide variety of medical conditions. Concurrently, our knowledge of LILT mechanisms continues to expand. We are now aware of LILT's potential to induce cellular effects through, for example, accelerated ATP production and the mitigation of oxidative stress. In clinical use, however, it is often difficult to predict patient response to LILT. It appears that cellular reduction/oxidation (redox) state may play a central role in determining sensitivity to LILT and may help explain variability in patient responsiveness. In LILT, conditions associated with elevated reactive oxygen species (ROS) production, e.g. diabetic hyperglycemia, demonstrate increased sensitivity to LILT. Consequently, assessment of tissue redox conditions in vivo may prove helpful in identifying responsive tissues. A noninvasive redox measure may be useful in advancing investigation in LILT and may one day be helpful in better identifying responsive patients. The detection of biophotons, the production of which is associated with cellular redox state and the generation of ROS, represents just such an opportunity. In this review, we will present the case for pursuing further investigation into the potential clinical partnership between biophoton detection and LILT.

Lethal photosensitization of wound-associated microbes using indocyanine green and near-infrared light

Background

The increase in resistance to antibiotics among disease-causing bacteria necessitates the development of alternative antimicrobial approaches such as the use of light-activated antimicrobial agents (LAAAs). Light of an appropriate wavelength activates the LAAA to produce cytotoxic species which can then cause bacterial cell death via loss of membrane integrity, lipid peroxidation, the inactivation of essential enzymes, and/or exertion of mutagenic effects due to DNA modification. In this study, the effect of the LAAA indocyanine green excited with high or low intensity light (808 nm) from a near-infrared laser (NIR) on the viability of Staphylococcus aureus, Streptococcus pyogenes and Pseudomonas aeruginosa was investigated.

Results

All species were susceptible to killing by the LAAA, the bactericidal effect being dependent on both the concentration of indocyanine green and the light dose. Indocyanine green photosensitization using both high (1.37 W cm^-2) and low (0.048 W cm^-2) intensity NIR laser light was able to achieve reductions of 5.6 log₁₀ (>99.99%) and 6.8 log₁₀ (>99.99%) in the viable counts of Staph. aureus and Strep. pyogenes (using starting concentrations of 10⁶–10⁷ CFU ml^-1). Kills of 99.99% were obtained for P. aeruginosa (initial concentration 10⁸–10⁹ CFU ml^-1) photosensitized by the high intensity light (1.37 W cm^-2); while a kill of 80% was achieved using low intensity irradiation (0.07 W cm^-2). The effects of L-tryptophan (a singlet oxygen scavenger) and deuterium oxide (as an enhancer of the life span of singlet oxygen) on the survival of Staph. aureus was also studied. L-tryptophan reduced the proportion of Staph. aureus killed; whereas deuterium oxide increased the proportion killed suggesting that singlet oxygen was involved in the killing of the bacteria.

Conclusion

These findings imply that indocyanine green in combination with light from a near-infrared laser may be an effective means of eradicating bacteria from wounds and burns.

Efeitos da terapia fotodinâmica e de uma única aplicação de laser de baixa potência em bactérias in vitro

O laser de baixa potência vem sendo usado para acelerar a cicatrização em úlceras de pressão devido a seus efeitos cicatrizante, antiinflamatório, antiedematoso e analgésico. No entanto, não há consenso quanto a seu efeito em úlceras infectadas. O objetivo deste estudo foi verificar o efeito bactericida da laserterapia e da terapia fotodinâmica (TFD) com laser de baixa potência, InGaP, 670 nm, em doses de 2, 4 e 6 J/cm², em bactérias gram-positivas e gram-negativas in vitro. Foram preparadas 32 placas de Petri com bactérias, 16 com Pseudomonas aeruginosa e 16 com Staphilococcus aureus. Aleatoriamente dividiu-se cada grupo em oito subgrupos (duas placas cada): três subgrupos tratados só com laserterapia, em doses de 2 J/cm², 4 J/cm² e 6 J/cm²; três subgrupos tratados com TFD, em doses de 2 J/cm², 4 J/cm² e 6 J/cm²; um tratado apenas com fotossensibilizante (azul de metileno a 0,1 µg/ml); e um subgrupo não tratado (controle). Os subgrupos laser e TFD foram irradiados uma única vez e incubados por 24 horas. Os outros dois subgrupos não receberam irradiação. As culturas foram analisadas visualmente para verificação ou não do halo de inibição. Em todos os subgrupos, de ambas as bactérias, não foi observado qualquer halo de inibição nem de crescimento. Conclui-se que a terapia a laser e a fotodinâmica de baixa potência (InGaP, 670 nm) não produziram efeitos bactericidas e/ou bacteriostáticos, tampouco tendo havido efeito bioestimulante sobre as bactérias.

Effects of Combined 405-nm and 880-nm Light on Staphylococcus aureus and Pseudomonas aeruginosa in Vitro

OBJECTIVE

The aim of this study was to determine the effect of a combination of 405-nm blue light and 880-nm infrared light on Staphylococcus aureus and Pseudomonas aeruginosa in vitro.

BACKGROUND DATA

Reports indicate that certain wavelengths and treatment parameters of light promote the growth of bacteria, but our earlier study indicates that light at specific wavelengths and intensities are bactericidal for specific organisms (1).

METHODS

Two common aerobes, Staphylococcus aureus and Pseudomonas aeruginosa were tested because of their frequent isolation from skin infections and wounds. Each organism was treated simultaneously with a combination of 405-nm and 880-nm light emitted by a cluster of Super Luminous Diodes (SLDs). Doses of 1, 3, 5, 10, and 20 Jcm2 were used. Colony counts were performed and compared to untreated controls using Student t tests and one-way ANOVA with Tukey and Scheffe post hoc analyses.

RESULTS

The results revealed significant dose-dependent bactericidal effects of the combined blue and infrared light on Staphylococcus aureus (F 4,94 = 5.38, p = 0.001) and Pseudomonas aeruginosa (F 4,95 = 21.35, p < 0.001). With P. aeruginosa, the treatment reduced the number of bacteria colonies at all doses, achieving statistical significance at 1, 3, and 20 J cm2 doses and reducing bacterial colony by as much as 93.8%; the most effective dose being 20 J cm2. Irradiation of S. aureus resulted in statistically significant decreases in bacterial colonies at all dose levels; the most decrease, 72%, was also achieved with 20 Jcm2.

CONCLUSION

Appropriate doses of combined 405-nm and 880-nm phototherapy can kill Staphylococcus aureus and Pseudomonas aeruginosa in vitro, suggesting that a similar effect may be produced in clinical cases of bacterial infection.

In Vitro Bactericidal Effects of 405-nm and 470-nm Blue Light

OBJECTIVE

The aim of this study was to determine the bactericidal effect of 405- and 470-nm light on two bacteria, Staphylococcus aureus and Pseudomonas aeruginosa, in vitro.

BACKGROUND DATA

It is well-known that UV light kills bacteria, but the bactericidal effects of UV may not be unique since recent studies indicate that blue light produces a somewhat similar effect. The effects of blue light seem varied depending on wavelength, dose and the nature of the bacteria, hence this study.

METHODS

Two common aerobes, Staphylococcus aureus and Pseudomonas aeruginosa, and anaerobic Propionibacterium acnes were tested. Each organism was treated with Super Luminous Diode probes with peak emission at 405 and 470 nm. Treatment was timed to yield 1, 3, 5, 10, and 15 Jcm2 doses. Colony counts were performed and compared to untreated controls.

RESULTS

The 405-nm light produced a dose dependent bactericidal effect on Pseudomonas aeruginosa and Staphylococcus aureus (p < .05), achieving as much as 95.1% and nearly 90% kill rate for each, respectively. The 470-nm light effectively killed Pseudomonas aeruginosa at all dose levels, but only killed Staphylococcus aureus at 10 and 15 J cm2. With this wavelength, as much as 96.5% and 62% reduction of Pseudomonas aeruginosa and Staphylococcus aureus was achieved, respectively. Neither of the two wavelengths proved bactericidal with anaerobic Propionibacterium acnes.

CONCLUSION

The results indicate that, in vitro, 405- and 470-nm blue light produce dose dependent bactericidal effects on Pseudomonas aeruginosa and Staphylococcus aureus but not Propionibacterium acnes.

Functions and Possible Provenance of Primordial Proteins

Nanobacteria or living nanovesicles are of great interest to the scientific community because of their dual nature: on the one hand, they appear as primal biosystems originating life; on the other hand, they can cause severe diseases. Their survival as well as their pathogenic potential is apparently linked to a self-synthesized protein-based slime, rich in calcium and phosphate (when available). Here, we provide challenging evidence for the occurrence of nanobacteria in the stratosphere, reflecting a possibly primordial provenance of the slime. An analysis of the slime's biological functions may lead to novel strategies suitable to block adhesion modalities in modern bacterial populations.