Effects of photodynamic therapy on Gram-positive and Gram-negative bacterial biofilms by bioluminescence imaging and scanning electron microscopic analysis

Exploring the multifaceted role of pehR in Ralstonia solanacearum pathogenesis: enzyme activity, motility, and biofilm formation

PehR is a transcriptional regulator among the various response regulators found in Ralstonia solanacearum, a bacterium that causes lethal wilt disease in over 450 plant species worldwide, including economically important crops such as tomato, chilli, and brinjal. PehR regulates the production of polygalacturonase, an extracellular enzyme that degrades plant cell walls, playing a significant role in bacterial wilt. Despite its significance, the precise function and regulatory mechanism of PehR in R. solanacearum are yet to be thoroughly investigated. The goal of this research is to better understand the role of PehR in R. solanacearum pathogenicity by identifying the genes and pathways that it regulates. By disrupting the pehR gene, we created the ΔpehR mutant of R. solanacearum F1C1, a strain isolated from Tezpur, Assam, India. Transcriptomic analysis revealed 667 differentially expressed genes (DEGs) in the ΔpehR mutant, with 320 upregulated and 347 downregulated compared to the wild-type F1C1 strain. GO and KEGG analyses indicated the downregulation of genes related to flagellum-dependent cell motility, membrane function, and amino acid degradation pathways in the ΔpehR mutant. EPS estimation, biochemical assays for biofilm production, motility, and enzymatic assays for cellulase and pectinase production were all used in the further characterization process. The ΔpehR mutant showed lower virulence in tomato seedlings compared to the wild-type F1C1 strain. The findings suggest that PehR could be a promising target for bacterial wilt disease control, as well as provide critical information for ensuring crop production safety around the world.

Photodynamic therapy: An emerging therapeutic modality in dentistry

Photodynamic Therapy (PDT) is a rapidly evolving, non-invasive treatment modality with considerable promise in dental pharmacotherapeutics. This review article comprehensively examines PDT, beginning with its principles and then delving into its diverse applications in dentistry, including periodontal disease, endodontics, oral cancer, dental implants, and dental caries. Each area presents the latest research and discusses the potential benefits and challenges. The unique advantages of PDT are highlighted, such as selective targeting, broad-spectrum antimicrobial effect, lack of resistance development, and its synergistic effect with other treatments. However, challenges such as photosensitizer delivery, light penetration, oxygen availability, and the need to standardize protocols are also acknowledged. The review further explores future perspectives of PDT in dentistry, including advancements in photosensitizer design, overcoming hypoxic limitations, personalized protocols, integration with other therapies, and standardization and regulation. The potential of advanced technologies, such as nanotechnology and synthetic biology, to improve PDT outcomes is also discussed. The review concludes that while PDT has shown immense potential to revolutionize dental pharmacotherapeutics, further high-quality research is needed to translate this potential into everyday dental practice. The promising future of PDT in dentistry suggests a more effective and less invasive treatment option for a range of dental conditions.

Modified experimental adhesive with sepiolite nanoparticles on caries dentin treated with femtosecond laser and photodynamic activated erythrosine. An in vitro study

AIM

To assess the effect of CAD surface conditioners and their effect on Ra and SBS of tooth-colored filling material adhered to CAD surface with adhesive modified with 1 % Sep-NPs. Also, the DC of modified EA and its effect on the rheological properties.

METHODS

Ninety human molars with carious extension up to the middle third of occlusal dentin were included. The teeth were then arbitrarily allocated into three groups based on the type of surface conditioning received (n = 30) Group 1 (PA), Group 2 (FS laser), and Group 3 (Ery PS). Ten samples from each group underwent Ra analysis using a stylus profiler. Twenty samples from each cohort were distributed into two subcategories based on the application of unmodified EA (A) and Sep-infiltrated EA (B). Composite restoration was built followed by SBS and failure mode analysis. Scanning electron microscopy and Energy dispersive X-ray EDX were assessed of sepiolite NPs. Degree of conversion (DC) and rheological analysis of the modified adhesive and unmodified adhesive were also performed. One-way analysis of variance (ANOVA) and the Tukey post hoc test were employed to conduct comparisons between the different groups.

RESULTS

The highest score of Ra and bond strength were displayed by Group 1B (PA + Sep-NPs filled EA) (17.32 ± 1.43 MPa) samples. Nevertheless, the lowest values were established by Group 3A (Ery-PS + EA) (13.45 ± 0.80 MPa) treated teeth. An increase in Ra resulted in a rise in SBS.DC decreased with the incorporation of 1 % Sep-NPs in EA compared to unmodified EA.

CONCLUSION

Conditioning of CAD with PA and FS laser shows high surface roughness and favorable adhesion to experimental adhesive modified with 1 % Sep-NPs. Modified adhesive with 1 % Sep-NPs decreases DC and rheological properties.

How to study biofilms: technological advancements in clinical biofilm research

Biofilm formation is an important survival strategy commonly used by bacteria and fungi, which are embedded in a protective extracellular matrix of organic polymers. They are ubiquitous in nature, including humans and other animals, and they can be surface- and non-surface-associated, making them capable of growing in and on many different parts of the body. Biofilms are also complex, forming polymicrobial communities that are difficult to eradicate due to their unique growth dynamics, and clinical infections associated with biofilms are a huge burden in the healthcare setting, as they are often difficult to diagnose and to treat. Our understanding of biofilm formation and development is a fast-paced and important research focus. This review aims to describe the advancements in clinical biofilm research, including both in vitro and in vivo biofilm models, imaging techniques and techniques to analyse the biological functions of the biofilm.

Photodynamic therapy for the treatment of Pseudomonas aeruginosa infections: A scoping review

BACKGROUND

Pseudomonas aeruginosa is a Gram-negative bacillus that causes superficial and deep infections, which can be minor to life-threatening. Recently, P. aeruginosa has gained significant relevance due to the increased incidence of multidrug-resistant (MDR) strains that complicate antibiotic treatment. Due to MDR strains, alternative therapies, such as antimicrobial photodynamic therapy (PDT), are presented as a good option to treat nonsystemic infections. PDT combines a photosensitizer agent (PS), light, and oxygen to generate free radicals that destroy bacterial structures such as the envelope, matrix, and genetic material. This work aimed to identify the development stage of the PDT applied to P. aeruginosa to conclude which research stage should be emphasized more.

METHODS

Systematic bibliographic search in various public databases was performed. Related articles were identified using keywords, and relevant ones were selected using inclusion and exclusion criteria according to the PRISMA protocol.

RESULTS

We found 29 articles that meet the criteria, constituting a good body of evidence associated with using PDT against P. aeruginosa in vitro and less developed for in vivo research.

CONCLUSIONS

We conclude that PDT could become an effective adjunct to antimicrobial therapy against P. aeruginosa. This effectiveness depends on the PS used and the location of the infection. Many PS already demonstrated efficacy in PDT, but the evidence is supported significantly by in vitro and very few in vivo studies. Therefore, we conclude that further research efforts should focus on demonstrating the safety and efficacy of these PSs in vivo in animal infection models.

Antimicrobial photodynamic therapy for the treatment of oral infections: A systematic review

Oral infection is a common clinical symptom. While antibiotics are widely employed as the primary treatment for oral diseases, the emergence of drug-resistant bacteria has necessitated the exploration of alternative therapeutic approaches. One such modality is antimicrobial photodynamic therapy (aPDT), which utilizes light and photosensitizers. Indeed, aPDT has been used alone or in combination with other treatment options dealing with periodontal disease for the elimination of biofilms from bacterial community to achieve bone formation and/or tissue regeneration. In this review article, in addition to factors affecting the efficacy of aPDT, various photosensitizers, the latest technology and perspectives on aPDT are discussed in detail. More importantly, the article emphasizes the novel design and clinical applications of photosensitizers, as well as the synergistic effects of chemical and biomolecules with aPDT to achieve the complete eradication of biofilms and even enhance the biological performance of tissues surrounding the treated oral area.

Management of oral mucositis: a systematic review

INTRODUCTION

Oral mucositis is one of the most common complications following chemotherapy and/or head and neck radiotherapy. Various treatments for oral mucositis have been proposed. However, there has still been no review of the most frequent and most effective type of therapy to treat oral mucositis. This systematic review aims to determine the most frequent and effective types of therapy to treat and reduce the severity of oral mucositis.

EVIDENCE ACQUISITION

The literature search was carried out using PRISMA guidelines. Publications included from 2010 to June 2021 with a clinical trial, prospective, and retrospective observational research design. The following databases were used: PubMed, Cochrane Library, and Wiley Online Library. The search was for limited articles published in English, which were screened and analyzed by three authors. The risk of bias of each study was also assessed by three authors simultaneously, using different types of instruments depending on its study design.

EVIDENCE SYNTHESIS

Forty-seven of 1274 journals were included. From 3577 subjects, oral mucositis was more common in males than females (2.12: 1), with a mean age of 56.39 (18-90 years). The most commonly used types of therapy are low-level laser therapy (396 subjects) and lysozyme-based compounds (314 subjects). Meanwhile, the most effective type of therapy is low-level laser therapy.

CONCLUSIONS

Low-level laser therapy is the most commonly used oral mucositis therapy and is also the most effective in reducing the degree of oral mucositis and associated pain.

Sonophotodynamic inactivation of Pseudomonas aeruginosa biofilm mediated by curcumin

The inactivation of Pseudomonas aeruginosa biofilm is a major challenge, as biofilms are less responsive to conventional treatments and responsible for persistent infections. This has led to the investigation of alternative approaches for biofilm control such as photodynamic (PDI) and sonodynamic (SDI) inactivation. The combination of them, known as Sonophotodynamic Inactivation (SPDI), has improved the effectiveness of the process. Curcumin, a well-established photosensitizer, has been identified as a potential sonosensitizer. This study evaluated the most effective combination for SPDI against P. aeruginosa biofilms in vitro, varying curcumin concentrations and ultrasound intensities. The results indicated that the inactivation was directly proportional to the curcumin concentration. Using curcumin 120 µM and 3.0 W.cm-2 of ultrasound intensity, SPDI demonstrated the highest and the best synergistic results, equivalent to 6.9 ± 2.1 logs of reduction. PDI reduced 0.7 ± 0.9 log and SDI had no effect. In conclusion, SPDI with curcumin is a promising approach for biofilm inactivation.

The role of the light source in antimicrobial photodynamic therapy

Antimicrobial photodynamic therapy (APDT) is a promising approach to fight the growing problem of antimicrobial resistance that threatens health care, food security and agriculture. APDT uses light to excite a light-activated chemical (photosensitiser), leading to the generation of reactive oxygen species (ROS). Many APDT studies confirm its efficacy in vitro and in vivo against bacteria, fungi, viruses and parasites. However, the development of the field is focused on exploring potential targets and developing new photosensitisers. The role of light, a crucial element for ROS production, has been neglected. What are the main parameters essential for effective photosensitiser activation? Does an optimal light radiant exposure exist? And finally, which light source is best? Many reports have described the promising antibacterial effects of APDT in vitro, however, its application in vivo, especially in clinical settings remains very limited. The restricted availability may partially be due to a lack of standard conditions or protocols, arising from the diversity of selected photosensitising agents (PS), variable testing conditions including light sources used for PS activation and methods of measuring anti-bacterial activity and their effectiveness in treating bacterial infections. We thus sought to systematically review and examine the evidence from existing studies on APDT associated with the light source used. We show how the reduction of pathogens depends on the light source applied, radiant exposure and irradiance of light used, and type of pathogen, and so critically appraise the current state of development of APDT and areas to be addressed in future studies. We anticipate that further standardisation of the experimental conditions will help the field advance, and suggest key optical and biological parameters that should be reported in all APDT studies. More in vivo and clinical studies are needed and are expected to be facilitated by advances in light sources, leading to APDT becoming a sustainable, alternative therapeutic option for bacterial and other microbial infections in the future.

DNase enhances photodynamic therapy against fluconazole-resistant Candida albicans biofilms

OBJECTIVE

This study evaluated the effectiveness of DNase I combined with antimicrobial photodynamic therapy, mediated by Photodithazine^® and light-emitting diode light, against biofilms formed by a fluconazole-resistant Candida albicans strain (ATCC 96901) and two clinical isolates (R14 and R70).

MATERIALS AND METHODS

Biofilms were grown for 48 h and exposed to DNase for 5 min, followed by application of a photosensitizer (P) and light (L), either singly or combined (P+L+, P-L+, P+L-, P-L-, P-L-DNase, P+L+DNase, P+L-DNase, and P-L+DNase; n = 12). Biofilm analysis included quantification of extracellular matrix components (water-soluble and insoluble proteins and polysaccharides, and extracellular DNA), and biomass (total and insoluble), as well as enumeration of colony-forming units. The data were analyzed using three-way analysis of variance with Bonferroni's post-hoc test.

RESULTS

The DNase treatment combined with aPDT showed a reduction of 1.92, 1.65, and 1.29 log₁₀ of cell viability compared with untreated controls for ATCC 96901, R14, and R70 strains, respectively. It also reduced extracellular matrix contents of water-soluble polysaccharides (36.3%) and extracellular DNA (72.3%), as well as insoluble biomass content (43.3%).

CONCLUSION

The three strains showed similar behavior when treated with DNase, and the extracellular matrix components were affected, improving the effectiveness of antimicrobial photodynamic therapy.

A Novel In Vitro Method to Assess the Microbial Barrier Function of Tissue Adhesives Using Bioluminescence Imaging Technique

Background. Tissue glues can minimize treatment invasiveness, mitigate the risk of infection, and reduce surgery time; ergo, they have been developed and used in surgical procedures as wound closure devices beside sutures, staples, and metallic grafts. Regardless of their structure or function, tissue glues should show an acceptable microbial barrier function before being used in humans. This study proposes a novel in vitro method using Escherichia coli Lux and bioluminescence imaging technique to assess the microbial barrier function of tissue glues. Different volumes and concentrations of E. coli Lux were applied to precured or cured polyurethane-based tissue glue placed on agar plates. Plates were cultured for 1 h, 24 h, 48 h, and 72 h with bioluminescence signal measurement subsequently. Herein, protocol established a volume of 5 μL of a 1 : 100 dilution of E. coli Lux containing around 2 × 10⁷ CFU/mL as optimal for testing polyurethane-based tissue glue. Measurement of OD_600nm, determination of CFU/mL, and correlation with the bioluminescence measurement in p/s unit resulted in a good correlation between CFU/mL and p/s and demonstrated good reproducibility of our method. In addition, this in vitro method could show that the tested polyurethane-based tissue glue can provide a reasonable barrier against the microbial penetration and act as a bacterial barrier for up to 48 h with no penetration and up to 72 h with a low level of penetration through the material. Overall, we have established a novel, sensitive, and reproducible in vitro method using the bioluminescence imaging technique for testing the microbial barrier function of new tissue glues.

Antimicrobial Photodynamic Therapy: Latest Developments with a Focus on Combinatory Strategies

Antimicrobial photodynamic therapy (aPDT) has become a fundamental tool in modern therapeutics, notably due to the expanding versatility of photosensitizers (PSs) and the numerous possibilities to combine aPDT with other antimicrobial treatments to combat localized infections. After revisiting the basic principles of aPDT, this review first highlights the current state of the art of curative or preventive aPDT applications with relevant clinical trials. In addition, the most recent developments in photochemistry and photophysics as well as advanced carrier systems in the context of aPDT are provided, with a focus on the latest generations of efficient and versatile PSs and the progress towards hybrid-multicomponent systems. In particular, deeper insight into combinatory aPDT approaches is afforded, involving non-radiative or other light-based modalities. Selected aPDT perspectives are outlined, pointing out new strategies to target and treat microorganisms. Finally, the review works out the evolution of the conceptually simple PDT methodology towards a much more sophisticated, integrated, and innovative technology as an important element of potent antimicrobial strategies.

Photodynamic Inactivation Using Natural Bioactive Compound Prevents and Disrupts the Biofilm Produced by Staphylococcus saprophyticus

Staphylococcus saprophyticus, the food-borne bacteria present in dairy products, ready-to-eat food and environmental sources, has been reported with antibiotic resistance, raising concerns about food microbial safety. The antimicrobial resistance of S. saprophyticus requires the development of new strategies. Light- and photosensitizer-based antimicrobial photodynamic inactivation (PDI) is a promising approach to control microbial contamination, whereas there is limited information regarding the effectiveness of PDI on S. saprophyticus biofilm control. In this study, PDI mediated by natural bioactive compound (curcumin) associated with LED was evaluated for its potential to prevent and disrupt S. saprophyticus biofilms. Biofilms were treated with curcumin (50, 100, 200 µM) and LED fluence (4.32 J/cm², 8.64 J/cm², 17.28 J/cm²). Control groups included samples treated only with curcumin or light, and samples received neither curcumin nor light. The action was examined on biofilm mass, viability, cellular metabolic activity and cytoplasmic membrane integrity. PDI using curcumin associated with LED exhibited significant antibiofilm activities, inducing biofilm prevention and removal, metabolic inactivation, intracellular membrane damage and cell death. Likewise, scanning electronic microscopy observations demonstrated obvious structural injury and morphological alteration of S. saprophyticus biofilm after PDI application. In conclusion, curcumin is an effective photosensitizer for the photodynamic control of S. saprophyticus biofilm.

Photodynamic Inactivation of an Endodontic Bacteria Using Diode Laser and Indocyanine Green-Loaded Nanosphere

Apical periodontitis, an inflammatory lesion causing bone resorption around the apex of teeth, is treated by eradicating infectious bacteria from the root canal. However, it has a high recurrence rate and often requires retreatment. We investigated the bactericidal effect of antimicrobial photodynamic therapy (aPDT)/photodynamic antimicrobial chemotherapy (PACT) using indocyanine green (ICG)-loaded nanospheres coated with chitosan and a diode laser on a biofilm of Enterococcus faecalis, a pathogen of refractory apical periodontitis. Biofilm of E. faecalis was cultured in a porcine infected root canal model. ICG solution was injected into the root canal, which was then irradiated with a laser (810 nm wavelength) from outside the root canal. The bactericidal effect was evaluated by colony counts and scanning electron microscopy. The result of the colony counts showed a maximum 1.89 log reduction after irradiation at 2.1 W for 5 min. The temperature rise during aPDT/PACT was confirmed to be within a safe range. Furthermore, the light energy transmittance through the root was at a peak approximately 1 min after the start of irradiation, indicating that most of the ICG in the root canal was consumed. This study shows that aPDT/PACT can suppress E. faecalis in infected root canals with high efficiency.

Photodynamic Therapy and Photobiomodulation on Oral Lesion in Patient with Coronavirus Disease 2019: A Case Report

Objective: This article reports the case of a patient with oral manifestation of coronavirus disease 2019 (COVID-19) treated with photobiomodulation (PBM) and photodynamic therapy (PDT). Background: Some dermatological and oral mucosal lesions have recently been linked to severe acute respiratory syndrome coronavirus 2 infection. Methods: A 65-year-old female patient with a confirmed real-time reverse transcriptase-polymerase chain reaction diagnosis of COVID-19 presented with dry edematous lips, edema with mucosal desquamation, ulceration and blood crust on the inner aspect of the lips, gingival petechiae and erythematous and pseudomembranous lesions on the dorsum of the tongue. The treatment protocol was three sessions of antimicrobial PDT (aPDT) (660 nm diode laser + methylene blue) to the lips and tongue, every 24 h to control contamination, followed by PBM (low-power laser, 100 mW, 2 J/point) to the lips, tongue, and oral mucosa for additional four sessions every 24 h. Results: Therapy association promoted pain control and healing of oral mucosal lesions in 7 days of treatment. Conclusions: PBM and aPDT could be an interesting approach to manage COVID-19 patients.

Antimicrobial Effectiveness of Photodynamic Therapy, 5% Sodium Hypochlorite and 2% Chlorhexidine Gluconate in Root Canal Treated Teeth: A Clinical Study

Objective:

To evaluate the effectiveness of photodynamic therapy (PDT), sodium hypochlorite (NaOCl) and chlorhexidine gluconate (CHO) in the endodontic re-treatment in the removing of microorganisms from previously filled infected root canals.

Materials and Methods:

The study samples consist of 54 root canal treated anterior teeth with apical periodontitis were randomly divided into three groups according to the disinfection protocol. Microbiological samples from the root canals were collected after removing the gutta-percha (S1) and following the endodontic re-treatment (S2) with either 5% NaOCl, 2% CHO or PDT procedure for 1 minute. Microbiological samples were cultivated on selective plates to assess the presence or absence of microbial growth and determine the average reduction of viable microorganisms.

Results:

Significant reduction in the total bacterial count in all the groups at post treatment ( P < .001). PDT provided statistically higher (99.74%) elimination of Enterococcus faecalis in comparison to NaOCl (95%) and CHO (88%).

Conclusions:

The use of PDT in endodontic re-treatment led to the significant reduction of the remaining bacterial species. So, PDT can be used for routine endodontic disinfection in failed root canal cases.

Antimicrobial Photodynamic Inactivation Affects the Antibiotic Susceptibility of Enterococcus spp. Clinical Isolates in Biofilm and Planktonic Cultures

Enterococcus faecium and Enterococcus faecalis are opportunistic pathogens that can cause a vast variety of nosocomial infections. Moreover, E. faecium belongs to the group of ESKAPE microbes, which are the main cause of hospital-acquired infections and are especially difficult to treat because of their resistance to many antibiotics. Antimicrobial photodynamic inactivation (aPDI) represents an alternative to overcome multidrug resistance problems. This process requires the simultaneous presence of oxygen, visible light, and photosensitizing compounds. In this work, aPDI was used to resensitize Enterococcus spp. isolates to antibiotics. Antibiotic susceptibility testing according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) recommendations was combined with synergy testing methods recommended by the American Society for Microbiology. Two clinical isolates, E. faecalis and E. faecium, were treated with a combination of aPDI utilizing rose bengal (RB) or fullerene (FL) derivative as photosensitizers, antimicrobial blue light (aBL), and 10 recommended antibiotics. aPDI appeared to significantly impact the survival rate of both isolates, while aBL had no significant effect. The synergy testing results differed between strains and utilized methods. Synergy was observed for RB aPDI in combination with gentamycin, ciprofloxacin and daptomycin against E. faecalis. For E. faecium, synergy was observed between RB aPDI and gentamycin or ciprofloxacin, while for RB aPDI with vancomycin or daptomycin, antagonism was observed. A combination of FL aPDI gives a synergistic effect against E. faecalis only with imipenem. Postantibiotic effect tests for E. faecium demonstrated that this isolate exposed to aPDI in combination with gentamycin, streptomycin, tigecycline, doxycycline, or daptomycin exhibits delayed growth in comparison to untreated bacteria. The results of synergy testing confirmed the effectiveness of aPDI in resensitization of the bacteria to antibiotics, which presents great potential in the treatment of infections caused by multidrug-resistant strains.

Microscopy Methods for Biofilm Imaging: Focus on SEM and VP-SEM Pros and Cons

Simple Summary

Bacterial biofilms cause infections that are often resistant to antibiotic treatments. Research about the formation and elimination of biofilms cannot be undertaken without detailed imaging techniques. In this review, traditional and cutting-edge microscopy methods to study biofilm structure, ultrastructure, and 3-D architecture, with particular emphasis on conventional scanning electron microscopy and variable pressure scanning electron microscopy, are addressed, with the respective advantages and disadvantages. When ultrastructural characterization of biofilm matrix and its embedded bacterial cells is needed, as in studies on the effects of drug treatments on biofilm, scanning electron microscopy with customized protocols such as the osmium tetroxide (OsO₄), ruthenium red (RR), tannic acid (TA), and ionic liquid (IL) must be preferred over other methods for the following: unparalleled image quality, magnification and resolution, minimal sample loss, and actual sample structure preservation. The first step to make a morphological assessment of the effect of the various pharmacological treatments on clinical biofilms is the production of images that faithfully reflect the structure of the sample. The extraction of quantitative parameters from images, possible using specific software, will allow for the scanning electron microscopy morphological evaluation to no longer be considered as an accessory technique, but a quantitative method to all effects.

Abstract

Several imaging methodologies have been used in biofilm studies, contributing to deepening the knowledge on their structure. This review illustrates the most widely used microscopy techniques in biofilm investigations, focusing on traditional and innovative scanning electron microscopy techniques such as scanning electron microscopy (SEM), variable pressure SEM (VP-SEM), environmental SEM (ESEM), and the more recent ambiental SEM (ASEM), ending with the cutting edge Cryo-SEM and focused ion beam SEM (FIB SEM), highlighting the pros and cons of several methods with particular emphasis on conventional SEM and VP-SEM. As each technique has its own advantages and disadvantages, the choice of the most appropriate method must be done carefully, based on the specific aim of the study. The evaluation of the drug effects on biofilm requires imaging methods that show the most detailed ultrastructural features of the biofilm. In this kind of research, the use of scanning electron microscopy with customized protocols such as osmium tetroxide (OsO₄), ruthenium red (RR), tannic acid (TA) staining, and ionic liquid (IL) treatment is unrivalled for its image quality, magnification, resolution, minimal sample loss, and actual sample structure preservation. The combined use of innovative SEM protocols and 3-D image analysis software will allow for quantitative data from SEM images to be extracted; in this way, data from images of samples that have undergone different antibiofilm treatments can be compared.

Photodynamic Therapy With Propolis: Antibacterial Effects on Staphylococcus aureus, Streptococcus mutans and Escherichia coli Analysed by Atomic Force Microscopy

Introduction: Photodynamic therapy (PDT) is a process that uses a light source (e.g. laser), oxygen molecules and a photosensitizing agent. PDT aims to act against pathogens, including those resistant to antimicrobials. The association of PDT with natural drugs, such as Propolis, has not been widely studied. Methods: Therefore, this study aimed to evaluate the antimicrobial effect of PDT in vitro by using Propolis as a photosensitizing agent. For this purpose, the dry Propolis extract was used as a photosensitizer and a low-power laser (Photon Laser III model) was irradiated onto the microwells for 90 seconds. Gram-positive and Gram-negative bacterial strains were used in the tests at a concentration of 5 × 10⁵ CFU/mL. Initially, the antibacterial activity of the photosensitizers without laser action was determined by using a serial microdilution method before the experiment with a laser. After the incubation of the plates in a bacteriological oven, resazurin (0.1%) was added and the minimum inhibitory concentration (MIC) was determined. Alterations in the morphology of the bacteria were analysed by using atomic force microscopy (AFM). Results: Bacteria were sensitive to Propolis with MICs ranging from 13.75 to 0.85 mg/mL, but no susceptibility was observed for methylene blue without laser application. A change was observed for MIC values of Propolis against Staphylococcus aureus after irradiation, which decreased from 1.71 mg/mL to 0.85 mg/mL. However, this behaviour was not observed in Escherichia coli, the only gram-negative strain used. In addition, AFM images revealed alterations in the size of one of the bacteria tested. Conclusion: The Propolis is more active against gram-positive bacteria and PDT improved its activity against one of the strains tested.

Photodynamic Therapy as a New Treatment for Chronic Rhinosinusitis - A Systematic Review

This review examines the latest evidence for photodynamic therapy (PDT) in treating chronic rhinosinusitis. MedLine, EMBASE and TRIP Database searches were conducted using the terms: "photodynamic" or "phototherapy" or "photo" and "sinusitis" or "rhinosinusitis," date range January 2000 to May 2020. A total of 192 records were initially identified, after duplicates and exclusions, 9 full papers and 3 abstracts were included. All study types including in-vitro, animal and human studies were evaluated. Whilst there is in-vitro evidence for the efficacy of PDT's bactericidal effect on drug resistant bacteria and biofilm viability, there are few clinical studies. PDT is a promising area of research, but larger, focused studies looking at the safety, delivery, efficacy, and patient selection are required before it can be considered a viable treatment for CRS.

Antimicrobial photodynamic therapy against Propionibacterium acnes biofilms using hypericin (Hypericum perforatum) photosensitizer: in vitro study

Acne vulgaris is the most recurring skin condition in the world, causing great harm to the physical and psychological well-being of many patients. Antimicrobial photodynamic therapy (aPDT) has broad therapeutic applicability. The purpose was to evaluate in vitro the photodynamic inactivation against Propionibacterium acnes (P. acnes) biofilms by using different concentrations of hypericin (Hypericum perforatum) photosensitizer associated with different energies of low-level laser. The biofilms were placed in 96-well microplates with a 6.4-mm diameter surface, by using standard suspensions (2 × 10⁷ CFU/mL) and grown in brain heart infusion broth (BHI) for 48 h in anaerobic chamber. Subsequently, the control group received application of 0.9% sterile saline solution for 3 min; the photosensitising groups received hypericin at concentrations of 5 and 15 μg/mL for 3 min; the laser groups received irradiation of energies of 3 and 5 J (660 nm, continuous output, 100 mW, 30 and 50 s and 100 J/cm² and 166 J/cm², respectively); the aPDT groups received 5 and 15 μg/mL concentrations of hypericin associated with energies of 3 and 5 J of low-level laser irradiation. After the biofilms were broken up and seeded for CFU counting. The results showed a reduction in P. acnes biofilms after aPDT emphasising that 15 μg/mL hypericin associated with 3 and 5 J laser irradiation reduced biofilms by 14.1 and 27.9%, respectively. In addition, all groups of aPDT demostrated statistically significant reductions. In vitro photodynamic inactivation against P. acnes biofilms using different concentration of hypericin photosensitizer associated with different energies of low-level laser promoted effective antimicrobial action.

Effects of antimicrobial photodynamic therapy on antibiotic-resistant Escherichia coli

This study used Electron Cryo-tomography (ECT) and fluorescent images to evaluate antimicrobial photodynamic therapy (aPDT) on the envelope architecture of a Gram-negative bacteria and the effects of combined therapy of aPDT and antibiotics. Standard and clinical suspension of Escherichia coli were submitted to photodynamic treatment with methylene blue solution (100μM) and a 100 mW LED emitting at 660 nm with 3 and 18 J of energy. As a control group, a suspension of E. coli was submitted to penicillin V for 60 min at 30 °C, to compare the damage in cell wall structure. After treatment, ECT images were collected and E. coli biofilms were grown in glass-cover slides and stained with live/dead staining for fluorescence analysis before and after treatments. Bacteria were also submitted to disc diffusion and MIC₅₀ tests with Ampicillin, Amoxicillin + Clavulanic acid, Clindamycin and Erythromycin. For in vivo experiment Galleria mellonella larvae were infected with E. coli and treated with antibiotics, aPDT or combined therapy. ECT images presented damage to cell walls and vesicles structures inside and outside the bacteria and fluorescent images showed dose dependent effect of aPDT. Antibiotic or aPDT alone did not improve the survival of caterpillars, but the combined therapy significantly increased survival curve. ECT and fluorescent images shows that aPDT seems to promote micro-damages to cell envelope and causes the production of membrane vesicles permeabilizing cell membranes. The results showed that pre-treating bacterial cells with a photosensitizer and light make them more susceptible to antibiotics and could be an alternative to local infection treatment by resistant bacteria.

Biofilm Inactivation using Photodynamic Therapy in Dentistry: a review of literature

Introduction: Photodynamic therapy (PDT) is a therapy involving light and a photosensitising chemical substance, used in conjunction with molecular oxygen in order to elicit cell death (photo-toxicity) and thus ability to kill microbial cells, including bacteria, fungi and viruses. Photodynamic therapy is an alternative method of biofilm disruption and it is considered a new way of microorganism inactivation. It is also an additional procedure to reduce the infection rate in patients, caused by the increasing antimicrobials resistance of bacteria. The aim of this literature review was to evaluate the specific effects and the antibacterial effectiveness of photodynamic therapy using different types of photosensitizers (Erythrosine, Rose Bengal, Toluidine blue, Methylene blue, Ozone, Riboflavin, Curcumin, Chlorhexidine, SAPYR) and a visible light of a specific wavelength for each photosensitizer and to reveal the applications of PDT in periodontics, endodontics, prosthodontics and dental caries. Methods: A research of literature was performed in an attempt to find all the articles published on this topic in the last 10 years. The articles was searched by using a certain combination of different keywords (photodynamic therapy ) and (diode laser ) and (teeth) in PubMed database. Results: A total number of 83 articles were found. After applying inclusion and exclusion criteria, 35 articles were taken into consideration for our study and among them 4 were a manuscript, 3 was a review of literature, 1 was an in vivo evaluation and 27 were in vitro studies. Conclusion: Considering that none of the disinfection methods can completely remove the biofilm, PDT is a therapeutic tool complementary to conventional disinfection, with great applicability in dentistry. PDT showed significantly efficacy in reduction of biofilms. Exposure to light in the presence of a photosensitizing chemical substance helps in the reduction of microbes and the protocols could be recommended for clinical usage, but only together with ‘classic ‘ disinfection.

Tannic acid-modified silver nanoparticles for enhancing anti-biofilm activities and modulating biofilm formation

The formation of bacterial biofilms is a key factor in the emergence of chronic infections due to the strong resistance of biofilms to conventional antibiotics. There is an urgent need to develop an effective strategy to control the formation of biofilms. In this study, a nanocomposite of tannic acid and silver (Tannin-AgNPs) was designed and successfully prepared based on the quorum sensing (QS) inhibitory activity of tannic acid and the anti-bacterial activity of silver. The dynamic light scattering and SEM observations indicated that the obtained Tannin-AgNPs were spherical with a mean particle size of 42.37 nm. Tannic acid was successfully modified on the surface of silver nanoparticles and characterized via Fourier transform infrared (FTIR) spectroscopy. The prepared Tannin-AgNPs demonstrated a more effective anti-bacterial and anti-biofilm activity against E. coli than the unmodified AgNPs or tannic acid. In addition, the Tannin-AgNPs can modulate the formation process of E. coli biofilms, shorten the growth period of biofilms and extend the dispersion period of biofilms. Tannin-AgNPs also showed the function of decreasing the production of the QS signal molecule. The proposed strategy of constructing a nanocomposite using AgNPs and natural components with QS inhibitory activity is effective and promising for inhibiting the formation of biofilms.

Contamination of wounds with fecal bacteria in immuno-suppressed mice

Immunocompromised patients are predisposed to chronically infected wounds. Especially ulcers in the dorsal region often experience secondary polymicrobial infections. However, current wound infection models mostly use single-strain bacteria. To mimic clinically occurring infections caused by fecal contamination in immunocompromised/immobile patients, which differ significantly from single-strain infections, the present study aimed at the establishment of a new mouse model using infection by fecal bacteria. Dorsal circular excision wounds in immunosuppressed mice were infected with fecal slurry solution in several dilutions up to 1:8,000. Impact of immunosuppressor, bacterial load and timing on development of wound infections was investigated. Wounds were analyzed by scoring, 3D imaging and swab analyses. Autofluorescence imaging was not successful. Dose-finding of cyclophosphamide-induced immunosuppression was necessary for establishment of bacterial wound infections. Infection with fecal slurry diluted 1:166 to 1:400 induced significantly delayed wound healing (p < 0.05) without systemic reactions. Swab analyses post-infection matched the initial polymicrobial suspension. The customized wound score confirmed significant differences between the groups (p < 0.05). Here we report the establishment of a simple, new mouse model for clinically occurring wound infections by fecal bacteria and the evaluation of appropriate wound analysis methods. In the future, this model will provide a suitable tool for the investigation of complex microbiological interactions and evaluation of new therapeutic approaches.

The efficacy of photodynamic inactivation with laser diode on Staphylococcus aureus biofilm with various ages of biofilm

Biofilms are able to cause microorganisms to be 80% more resistant to antibiotics. The extracelullar polymeric substance (EPS) in biofilm functions to protect bacteria, making it difficult for antibiotics to penetrate the biofilm layer. This study aims to determine the effectiveness of photodynamic inactivation with blue diode laser to reduce Staphylococcus aureus biofilm at various ages of biofilms. The light source is a 403 nm blue diode laser with an energy power of about 27.65±0.01 mW. The study was designed with two groups: Group C was the untreated control group with variations in age of biofilms (0; 6; 11; 17; 24; 32; 40 and 48) hours; Group T was a laser treatment group with variations in age of biofilm and energy density (4.23; 8.46; 12.70; 16.93 and 21.16) J/cm². Biofilm reduction measurement method using ELISA test was performed to calculate OD⁵⁹⁵ value. The statistical analysis results of variance showed that there was an influence of biofilm age and irradiation energy density of laser on biofilm reduction. Optical density analysis showed the most optimum biofilm reduction happened when biofilm age is perfectly constructed (about 17 hours) and with 91% reduction. The longer biofilm age lived among those biofilms, the greater the reduction. The results of the Scanning Microscope Electron and fluorescent microscope measurement showed destruction site of the EPS biofilm and bacterial cell death. So, the activated photodynamic with 403 nm laser diode is effective to reduce the Staphylococcus aureus biofilm in the maturation phase.

Photodynamic Activity on Biofilm in Endotracheal Tubes of Patients Admitted to an Intensive Care Unit

Ventilator-associated pneumonia (VAP) is an infection that arises after endotracheal intubation affecting patients under intensive care. The presence of the endotracheal tube (ETT) is a risk factor since it is colonized by multispecies biofilm. Antimicrobial photodynamic therapy (aPDT) could be a strategy to decontaminate ETTs. We verify if methylene blue (MB) associated with external illumination of the ETT could be an alternative to destroy biofilm. We performed an in vitro and ex vivo study. In vitro study was performed with P. aeruginosa biofilm grew over ETT for 7 days. After treatment, the surviving cells were cultured for 3 days and the biofilm was analyzed by crystal violet absorbance. Ex vivo study employed ETT obtained from extubated patients. aPDT was performed with MB (100 µm) and red LED (λ = 640±20 nm). We quantified the biofilm thickness and used scanning electron microscopy and fluorescence technique to verify morphological and functional changes after aPDT. Our results showed that bacteria remain susceptible to aPDT after sequential treatments. We also attested that aPDT can reduce biofilm thickness, disrupt biofilm attachment from ETT surface and kill microbial cells. These data suggest that aPDT should be investigated to decrease VAP incidence via ETT decontamination.

Conjugate of chitosan nanoparticles with chloroaluminium phthalocyanine: Synthesis, characterization and photoinactivation of Streptococcus mutans biofilm

BACKGROUND

Antimicrobial photodynamic therapy (aPDT) using chloroaluminium phthalocyanine (ClAlPc) has high oxidative power allowing for the control of biofilms, especially when the photosensitizer is administered in an appropriate release vehicle. This study aimed to develop/characterize the ClAlPc encapsulated in chitosan nanoparticles (CSNPs), and evaluate its antimicrobial properties against S. mutans biofilms.

METHODS

CSNPs were prepared by ion gelation, and characterization studies included particle size, polydispersion index (IPd), zeta potential, accelerated stability, absorption spectrum and ClAlPc quantification. The S. mutans biofilms were formed in bovine dentin blocks at 37 °C for 48 h under microaerophilic conditions. 8 μM ClAlPc was combined with a diode laser (InGaAlP) at 660 nm and 100 J/cm². The aPDT toxicity was verified by dark phototoxicity. The antimicrobial activity was verified by CFU/mL and biofilm was analyzed by scanning electron microscopy (SEM). The number of viable bacteria was analyzed by ANOVA and Tukey HSD tests (α = 0.05).

RESULTS

The characterization revealed that the ClAlPc nanoparticles were found in nanometer-scale with adequate photophysical and photochemical properties. The aPDT mediated by ClAlPc + CSNPs nanoconjugate showed a significant reduction in the viability of S. mutans (1log10 CFU/mL) compared to the negative control (PBS, p < 0.05). The aPDT mediated by ClAlPc was similar to PBS (p > 0.05). SEM revealed change in biofilm morphology following the treatment of bacteria with aPDT ClAlPc + CSNPs. Cells were arranged as single or in shorted chains. Irregular shapes of S. mutans were found.

CONCLUSION

ClAlPc nanoparticles are considered stable and aPDT mediated by ClAlPc + CSNPs nanoconjugate was effective against S. mutans biofilm.

The ineffectiveness of antimicrobial photodynamic therapy in the absence of preincubation of the microorganisms in the photosensitizer

Abstract Introduction: Considering its potential as an alternative therapy to combat multiresistant bacteria, photodynamic therapy has been improved and better studied in recent years, and determining its optimized application patterns is important. Objective: This study aimed to evaluate the action of antimicrobial photodynamic therapy mediated by methylene blue in the absence of preincubation of infectious agents in the photosensitizer. Method: Standard strains of Staphylococcus aureus and Pseudomonas aeruginosa were used, which was or was not submitted to two methylene blue concentrations (0.1 μg/mL and 500 mg/mL) applied alone or in combination with a variety of red laser emission parameters (660 nm); in both cases, the streak was performed immediately after mixing between the photosensitizer and the solution containing the bacteria. Results: In the dishes with only methylene blue application neither antibacterial was produced, nor inhibition at the application points of the photodynamic therapy in the case of the bacterium Pseudomonas aeruginosa. However, in the cultures of Staphylococcus aureus in which laser emission was associated with the concentration of 500 mg/mL of the photosensitizer, inhibition was present at the laser application points. Conclusion: The time of exposure to the photosensitizer prior to the application of phototherapy seems to be an essential factor for the optimized action of photodynamic therapy, especially in the case of Gram-negative bacteria.

Potassium iodide enhances the photobactericidal effect of methylene blue on Enterococcus faecalis as planktonic cells and as biofilm infection in teeth

OBJECTIVE

To explore the effectiveness, biosafety, photobleaching and mechanism of antimicrobial photodynamic therapy (aPDT) using methylene blue (MB) plus potassium iodide (KI), for root canal infections.

METHODS

Different combinations and concentrations of MB, KI and 660 nm LED light were used against E. faecalis in planktonic and in biofilm states by colony-forming unit (CFU), confocal laser scanning microscopy (CLSM), scanning electron microscopy (SEM). Human gingival fibroblasts (HGF) were used for safety testing by Cell Counting Kit-8 (CCK8) and fluorescence microscopy (FLM). The photobleaching effect and mechanisms were analyzed.

RESULTS

KI could not only enhance MB aPDT on E. faecalis in both planktonic and biofilm states even in a hypoxic environment, but also produced a long-lasting bactericidal effect after end of the illumination. KI could accelerate photobleaching to reduce tooth staining by MB, and the mixture was harmless for HGFs. Mechanistic studies showed the generation of hydrogen peroxide and free iodine, and iodine radicals may be formed in hypoxia.

CONCLUSION

aPDT with MB plus KI could be used for root canal disinfection and clinical studies are worth pursuing.

Photobiomodulation and photodynamic therapy for the treatment of oral mucositis in patients with cancer

BACKGROUND

Photobiomodulation therapy (PBM-T) can penetrate soft tissues and exert analgesic and healing effects, and is thus a promising alternative for prevention and treatment of oral mucositis (OM). The aim of this study was to evaluate the efficacy of PBM-T, alone or combined with photodynamic therapy (PDT), for treatment of OM in cancer patients.

METHODS

Fifty-six patients were recruited from the Oncology Department of a teaching hospital. Patients underwent grading of OM and were divided into two groups (n = 28 each): PBM-T and PBM-T + PDT. In the PBM-T group, low-level laser was applied to 61 points in the oral cavity, once weekly for 4 weeks (wavelength 660 nm, power 100 mW, energy density 142 J/cm², spot energy 4 J, irradiation time 40 s). In the PBM-T + PDT group, in addition to PBM-T as described above, patients rinsed with 20 ml of photosensitizing mouthwash (curcumin 1.5 g/L) and the oral cavity was irradiated with a blue (468 nm) LED for 5 min.

RESULTS

Significant reductions in OM grade were observed after application of PBM-T or PBM-T + PDT (p < 0.0001). PBM-T + PDT resulted in a shorter time to resolution of lesions compared to PBM-T alone (p = 0.0005).

CONCLUSIONS

PBM-T, alone or combined with PDT, can be used for the treatment of OM. PDT + PBM-T in particular accelerated the OM healing process, reducing time to lesion remission from 15 to 11 days.

An Insight into Advanced Approaches for Photosensitizer Optimization in Endodontics-A Critical Review

Apical periodontitis is a biofilm-mediated disease; therefore, an antimicrobial approach is essential to cure or prevent its development. In the quest for efficient strategies to achieve this objective, antimicrobial photodynamic therapy (aPDT) has emerged as an alternative to classical endodontic irrigation solutions and antibiotics. The aim of the present critical review is to summarize the available evidence on photosensitizers (PSs) which has been confirmed in numerous studies from diverse areas combined with several antimicrobial strategies, as well as emerging options in order to optimize their properties and effects that might be translational and useful in the near future in basic endodontic research. Published data notably support the need for continuing the search for an ideal endodontic photosensitizer, that is, one which acts as an excellent antimicrobial agent without causing toxicity to the human host cells or presenting the risk of tooth discoloration. The current literature on experimental studies mainly relies on assessment of mixed disinfection protocols, combining approaches which are already available with aPDT as an adjunct therapy. In this review, several approaches concerning aPDT efficiency are appraised, such as the use of bacteriophages, biopolymers, drug and light delivery systems, efflux pump inhibitors, negative pressure systems, and peptides. The authors also analyzed their combination with other approaches for aPDT improvement, such as sonodynamic therapy. All of the aforementioned techniques have already been tested, and we highlight the biological challenges of each formulation, predicting that the collected information may encourage the development of other effective photoactive materials, in addition to being useful in endodontic basic research. Moreover, special attention is dedicated to studies on detailed conditions, aPDT features with a focus on PS enhancer strategies, and the respective final antimicrobial outcomes. From all the mentioned approaches, the two which are most widely discussed and which show the most promising outcomes for endodontic purposes are drug delivery systems (with strong development in nanoparticles) and PS solubilizers.

Effect of photodynamic therapy potentiated by ultrasonic chamber on decontamination of acrylic and titanium surfaces

Photodynamic Therapy (PDT) is an alternative to surface decontamination that is based on the interaction between a non-toxic photosensitizer (PS) and a light source to allow for the formation of reactive oxygen species. The objective of this study was to test a new patented device - the "Ultrasonic Photodynamic Inactivation Device" (UPID) under the patent deposit MU-BR 20.2018.00.9356-3 - for the photodynamic inactivation on contaminated acrylic plates and titanium disk. This new low cost device contains light emitting diodes (LEDs) and was built in a stainless-steel container for better light distribution. In addition, 28 waterproof red LEDs plates, with a wavelength of 660 nm were used, containing three irradiators in each plate, for which the irradiation distribution and the spectral irradiance on all 6 internal faces of this device were calculated. The effect of red LED irradiation (660 nm) methylene blue (MB) (100 μmol/L) diluted in water or 70% alcohol on three types of microorganisms: Candida albicans ATCC 10231, Staphylococcus aureus ATCC 25923 and Escherichia coli ATCC 25922. In order to estimate the effects of PDI, acrylic plates and Titanium disks were contaminated by bacterial suspensions (3 × 10⁸ CFU/mL), then treated with a solution of MB for 30 min, followed by irradiation for 30 min (0.45 J/cm²). Microbial inhibition was evaluated by counting the number of colony forming units (CFU), compared to the control group. The results showed that the UPID promoted significant reduction (p < 0.001) of the microorganism when compared with the positive control. The new device promoted an effective microbial inhibition on the surfaces tested and, thus, makes possible new studies. The perspective is that this new device may be a low-cost and non-toxic alternative to the disinfection of biomedical devices, non-critical instruments and also for use in the food industry.

The potential of commercially available phytotherapeutic compounds as new photosensitizers for dental antimicrobial PDT: A photochemical and photobiological in vitro study

The present study evaluated the effectiveness of extracts of commercially available Curcuma longa, Citrus lemon, Hamamelis virginiana and Hypericum perforatum as photosensitizers in Antimicrobial Photodynamic Therapy (aPDT). Each photosensitizer (PS) was analyzed in a spectrophotometer between 350 and 750 nm to determine the ideal light source. Once the absorption bands were determined, three light sources were selected. To determine the concentration of use, the compounds were tested at different concentrations on bovine dentin samples to evaluate the risk of staining. Once the concentration was determined, the PSs were evaluated for dark toxicity and phototoxicity on fibroblast and bacteria culture. Each compound was then irradiated with each light source and evaluated for the production of reactive oxygen species (ROS). The bacterial reduction was tested on E. faecalis culture in planktonic form and on biofilm using an energy of 10 J and an Energy Density of 26 J/cm². The tested compounds exhibited light absorption in three bands of the visible spectrum: violet (405 nm), blue (460 nm) and red (660 nm). At a 1:6 concentration, none of the compounds caused tooth staining as they did not exhibit significant toxicity in the cells or bacterial suspension. Additionally, significant ROS production was observed when the compounds were irradiated at each wavelength. When aPDT was performed on the plactonic and biofilm bacteria, significant microbial reduction was observed in both cases, reaching a reduction of up to 5Logs. In conclusion, extracts of Curcuma longa, Citrus lemon, Hamamelis virginiana and Hypericum perforatum exhibited potential for use as photosensitizing agents in aPDT.

Inflammatory potential of monospecies biofilm matrix components

AIM

To assess the inflammatory potential of biofilm matrix constituents of Enterococcus faecalis and Pseudomonas aeruginosa monospecies biofilms on macrophages.

METHODOLOGY

In vitro biofilms of E. faecalis and P. aeruginosa were grown (7 days) in aerobic and anaerobic conditions. The biofilm matrix components: exopolysaccharides (EPS) and extracellular DNA (eDNA) were extracted and quantified. The inflammatory potential of EPS and eDNA was assessed on macrophage cell lines (RAW 267.4) using nitric oxide (NO), and enzyme-linked immunosorbent assay for tumour necrosis factor (TNF-α) and interleukin-6 (IL-6) expressions. LPS from P. aeruginosa and planktonic bacteria were positive controls. One-way analysis of variance and the Tukey post hoc test were used for statistical analysis.

RESULTS

Extracted EPS from both biofilm strains was associated with higher levels than eDNA in both growth conditions (P < 0.05). The biofilm components had less inflammatory potential compared to planktonic bacteria and LPS. EPS produced higher levels of inflammatory response compared to eDNA for both strains (P < 0.05). IL-6 and TNF-α, and NO expression showed no difference for E. faecalis EPS (P ≥ 0.05). In contrast, P. aeruginosa EPS and eDNA had significant levels of IL-6 compared to TNF-α and NO (P < 0.05).

CONCLUSIONS

Monospecies biofilm matrix EPS and eDNA from the bacterial strains tested had the ability to induce a low-grade inflammatory response when compared to planktonic bacteria and LPS. This study highlights the potential of biofilm matrix/components, devoid of bacteria to induce low-grade chronic inflammation.

Effect of photodynamic therapy on surface decontamination in clinical orthodontic instruments

The objective was to develop, characterize and test a box containing light emission diode (LED), Patent Deposit MU-BR20.2017.002297-3, which was named "Photodynamic Inactivation Device" (PID) and verify if it's suitable in microbial reduction or disinfection action of solid surfaces using PID. The equipment was made in a container of polypropylene with a lid of the same material and, for a better use of irradiation the internal part was covered with a layer of reflective aluminum. In addition, sixty boards of red LED 660 nm wavelength, containing three radiators each, for which the distribution of irradiation and spectral irradiance in all of the six internal faces were calculated in this device. That way, a low cost alternative was tested over three types of microorganisms present on the human microbiota: two strains Gram-positive (Gram +), Staphylococcus aureus and Streptococcus mutans and one strain Gram-negative (Gram -), Escherichia coli, inoculated in orthodontic instruments previously autoclaved. To assess the Photodynamic Inactivation (PDI) over these bacteria, instruments were contaminated by bacterial suspensions (3 × 10⁸ CFU/mL) and ulterior treatment with a solution of 100 μmol/L of MB for 20 min, and irradiated for another 20 min (energy density of 026 J/cm²). Microbial reduction was assessed by number counting of Colony Forming Units (CFU). At the end, microbial reduction of the surface of orthodontic metal instruments was compared with the positive group of each group. Results showed that PID caused a significant reduction (p < 0.05) of the microbial charge stuck in the orthodontic instruments. Thus, the photo prototype of the drawing is appropriate for phototherapy studies, granting it´s advantageous to the low level light therapy as well as for the antimicrobial photodynamic therapy. The perspective is that PID may potentialize the dissemination of phototherapy studies for determining its proper use in health science. And, thus, propose a low cost and atoxic alternative for disinfection of biomedical appliances as non-critical instruments, allowing also for use in the food industry.

Light Activated Disinfection in Root Canal Treatment-A Focused Review

Light activated disinfection (LAD) is a strategy for optimizing root canal disinfection by using a highly-selective, targeted killing of bacteria using a combination of photosensitizers and light. Over the past decade, numerous in vitro and clinical studies have been performed to demonstrate the effectiveness of this mode of root canal disinfection. While most studies offer an important understanding of the effectiveness of LAD on monospecies biofilms, few have offered credence to the fact that infections of the root canal system are mediated by polymicrobial biofilms. Hence, it is imperative to understand the effect of LAD on polymicrobial biofilms both in terms of microbial killing and the changes in the biofilm architecture. The aim of this review was to systematically review the literature to evaluate the effect of LAD on dual and multispecies biofilms and demonstrate the antibiofilm effect of LAD. Two databases (PubMed and Scopus) were searched to identify eligible studies using a combination of key words. These studies were reviewed to draw conclusions on the effect of LAD on dual and multi species biofilm and the antibiofilm effect of LAD. It was found that LAD alone may be unable to eradicate dual and multispecies biofilms, but it may enhance the effect of conventional canal debridement strategies. Novel formulations of photosensitizers with nanoparticles showed the potential to inhibit biofilm formation and/or disrupt the biofilm architecture.

Antimicrobial Photodynamic Therapy to Control Clinically Relevant Biofilm Infections

Biofilm describes a microbially-derived sessile community in which microbial cells are firmly attached to the substratum and embedded in extracellular polymeric matrix. Microbial biofilms account for up to 80% of all bacterial and fungal infections in humans. Biofilm-associated pathogens are particularly resistant to antibiotic treatment, and thus novel antibiofilm approaches needed to be developed. Antimicrobial Photodynamic therapy (aPDT) had been recently proposed to combat clinically relevant biofilms such as dental biofilms, ventilator associated pneumonia, chronic wound infections, oral candidiasis, and chronic rhinosinusitis. aPDT uses non-toxic dyes called photosensitizers (PS), which can be excited by harmless visible light to produce reactive oxygen species (ROS). aPDT is a multi-stage process including topical PS administration, light irradiation, and interaction of the excited state with ambient oxygen. Numerous in vitro and in vivo aPDT studies have demonstrated biofilm-eradication or substantial reduction. ROS are produced upon photo-activation and attack adjacent targets, including proteins, lipids, and nucleic acids present within the biofilm matrix, on the cell surface and inside the microbial cells. Damage to non-specific targets leads to the destruction of both planktonic cells and biofilms. The review aims to summarize the progress of aPDT in destroying biofilms and the mechanisms mediated by ROS. Finally, a brief section provides suggestions for future research.

Effect of S. Mutans and S. Sanguinis on Growth and Adhesion of P. Gingivalis and Their Ability to Adhere to Different Dental Materials

Background

Caries and periodontal diseases are caused by the biofilm formed by caries- and periodontal disease-related bacteria. Specific biofilms could be formed on different filling materials in oral cavity. Thus, to explore the inhibition effect of restorative filling materials on biofilm formation is of great significance in the treatment of caries and periodontal disease.

Material/Methods

The supernatants of S. mutans, S. sanguinis, and P. gingivalis suspension were combined with BHI broth. After 24 h, the live P. gingivalis number was calculated by colony counting and the biofilm was monitored by fluorescence microscopy. To test the adhesive ability of S. mutans and S. sanguinis on different dental materials, the biofilm was formed on different dental materials and then the bacterial number was calculated by using a Spectramax 250 microplate reader at OD 550, and the adhesive ability of S. mutans and S. sanguinis on different dental materials was analyzed by scanning electron microscopy.

Results

The growth and biofilm formation of P. gingivalis was significantly inhibited by S. mutans and S. sanguinis supernatants (P<0.05). All groups except the zinc phosphate cement group (B) exerted a strong inhibitory effect on the biofilm formation of S. mutans and S. sanguinis (P<0.05).

Conclusions

The supernatants of S. mutans and S. sanguinis significantly inhibited the growth and biofilm formation of P. gingivalis, and the adhesive ability of S. mutans and S. sanguinis are different on different dental materials. These results provide useful information on dental caries, periodontal disease, and dental materials.

Immunomodulatory effect of photodynamic therapy in Galleria mellonella infected with Porphyromonas gingivalis

Porphyromonas gingivalis is an important pathogen in the development of periodontal disease. Our study investigated if the treatment with antimicrobial photodynamic therapy (aPDT) that employs a nontoxic dye, followed by irradiation with harmless visible light can attenuate the experimental infection of P. gingivalis in Galleria mellonella. Firstly, different concentrations of P. gingivalis ranging from 10² to 10⁶ cells/larva were injected into the animal to obtain a lethal concentration. Next, the following groups of G. mellonella infected with P. gingivalis were evaluated: inoculation of the photosensitizer and application of laser (P + L+), inoculation of physiologic solution and application of laser (P-L+), inoculation the photosensitizer without laser (P + L-) and inoculation of physiologic solution without Laser (P-L-). The effects of aPDT on infection by P. gingivalis were evaluated by survival curve analysis and hemocytes count. A lethal concentration of 10⁶ cells/larva was adopted for evaluating the effects of aPDT on experimental infection with P. gingivalis. We found that after 120 s of PDT application, the death of G. mellonella was significantly lower compared to the control groups (p = 0.0010). Moreover, the hemocyte density in the P+L+ group was increased by 9.6 × 10⁶ cells/mL (2.62-fold increase) compared to the infected larvae with no treatment (L-P- group) (p = 0.0175). Finally, we verified that the aPDT led to a significant reduction of the number of P. gingivalis cells in G. mellonella hemolymph. In conclusion, PDT application was effective against P. gingivalis infection by increasing the survival of G. mellonella and was able to increase the circulating hemocytes indicating that PDT activates the G. mellonella immune system.

Antimicrobial Photodynamic Therapy against Endodontic Enterococcus faecalis and Candida albicans Mono and Mixed Biofilms in the Presence of Photosensitizers: A Comparative Study with Classical Endodontic Irrigants

Endodontic biofilms eradication from the infected root canal system remains as the primary focus in endodontic field. In this study, it was assessed the efficacy of antimicrobial Photodynamic Therapy (aPDT) with the Zn(II)chlorin e6 methyl ester (Zn(II)e₆Me) activated by red light against monospecies and mixed biofilms of Enterococcus faecalis and Candida albicans. The results were compared with the ones obtained with Rose Bengal (RB), Toluidine Blue-O (TBO), the synthetic tetracationic porphyrin (TMPyP) as well as classical endodontic irrigants (3% NaOCl, 17% EDTA and 2% CHX). The antimicrobial efficacy of aPDT toward monospecies and mixed biofilms was quantified resorting to safranin red method. The changes of biofilm organization and of cellular ultrastructure were evaluated through several microscopy techniques (light, laser confocal and transmission electron microscopy). Zn(II)e₆Me once activated with light for 60 or 90 s was able to remove around 60% of the biofilm’s biomass. It was more efficient than TBO and RB and showed similar efficiency to TMPyP and classical irrigants, CHX and EDTA. As desirable in a PS, Zn(II)e₆Me in the dark showed smaller activity than TMPyP. Only NaOCl revealed higher efficiency, with 70–90% of the biofilm’s biomass removal. The organization of biofilms and the normal microbial cell ultrastructure were extensively damaged by the presence of Zn(II)e₆Me. aPDT with Zn(II)e₆Me showed to be an efficient antimicrobial strategy deserving further studies leading to a future clinical usage in endodontic disinfection.

Methylene blue-containing liposomes as new photodynamic anti-bacterial agents

Novel cationic liposomes containing the photo-activatable drug methylene blue (MB) strongly enhance the antibacterial activity of MB towards Gram-negative bacteria and improve biofilm penetration.