Synergistic Effects of Photobiomodulation Therapy with Combined Wavelength on Diabetic Wound Healing In Vitro and In Vivo

Photobiomodulation and Vascularization in Conduit-Based Peripheral Nerve Repair: A Narrative Review

Background: Peripheral nerve injuries pose a significant clinical issue for patients, especially in the most severe cases wherein complete transection (neurotmesis) results in total loss of sensory/motor function. Nerve guidance conduits (NGCs) are a common treatment option that protects and guides regenerating axons during recovery. However, treatment outcomes remain limited and often fail to achieve full reinnervation, especially in critically sized defects (>3 cm) where a lack of vascularization leads to neural necrosis. Conclusions: A multitreatment approach is, therefore, necessary to improve the efficacy of NGCs. Stimulating angiogenesis within NGCs can help alleviate oxygen deficiency through rapid inosculation with the host vasculature, whereas photobiomodulation therapy (PBMT) has demonstrated beneficial therapeutic effects on regenerating nerve cells and neovascularization. In this review, we discuss the current trends of NGCs, vascularization, and PBMT as treatments for peripheral nerve neurotmesis and highlight the need for a combinatorial approach to improve functional and clinical outcomes.

Photobiomodulation at molecular, cellular, and systemic levels

Since the reporting of Endre Mester's results, researchers have investigated the biological effects induced by non-ionizing radiation emitted from low-power lasers. Recently, owing to the use of light-emitting diodes (LEDs), the term photobiomodulation (PBM) has been used. However, the molecular, cellular, and systemic effects involved in PBM are still under investigation, and a better understanding of these effects could improve clinical safety and efficacy. Our aim was to review the molecular, cellular, and systemic effects involved in PBM to elucidate the levels of biological complexity. PBM occurs as a consequence of photon-photoacceptor interactions, which lead to the production of trigger molecules capable of inducing signaling, effector molecules, and transcription factors, which feature it at the molecular level. These molecules and factors are responsible for cellular effects, such as cell proliferation, migration, differentiation, and apoptosis, which feature PBM at the cellular level. Finally, molecular and cellular effects are responsible for systemic effects, such as modulation of the inflammatory process, promotion of tissue repair and wound healing, reduction of edema and pain, and improvement of muscle performance, which features PBM at the systemic level.

Synergistic effects of integrin binding peptide (RGD) and photobiomodulation therapies on bone-like microtissues to enhance osteogenic differentiation

Bone tissue engineering aims to diversify and enhance the strategies for bone regeneration to overcome bone-related health problems. Bone mimetic peptides such as Gly-Arg-Gly-Asp-Ser (RGD) are useful tools for osteogenic differentiation. Similarly, photobiomodulation (PBM) at 600-800 nm of wavelength range improves bone tissue healing via the production of intracellular reactive oxygen species (ROS), ATP synthesis, and nitric oxide (NO) release. Besides, traditional monolayer cell culture models have limited conditions to exhibit the details of a mechanism such as a peptide or PBM therapy. However, scaffold-free microtissues (SFMs) can mimic a tissue more properly and be an efficient way to understand the mechanism of therapy via cell-cell interaction. Thus, the synergistic effects of RGD peptide (1 mM) and PBM applications (1 J/cm² energy density at 655 nm of wavelength and 5 J/cm² energy density at 808 nm of wavelength) were evaluated on SFMs formed with the co-culture of Human Bone Marrow Stem Cells (hBMSC) and Human Umbilical Vein Endothelial Cells (HUVEC) for osteogenic differentiation. Cell viability assays, mechanistic analysis, and the evaluation of osteogenic differentiation markers were performed. Combined therapies of RGD and PBM were more successful to induce osteogenic differentiation than single therapies. Especially, RGD + PBM at 655 nm group exhibited a higher capability of osteogenic differentiation via ROS production, ATP synthesis, and NO release. It can be concluded that the concomitant use of RGD and PBM may enhance bone regeneration and become a promising therapeutic tool to heal bone-related problems in clinics.

Effects of multiwavelength photobiomodulation for the treatment of traumatic soft tissue injuries associated with bone fractures: A double-blind, randomized controlled clinical trial

This study evaluated the efficacy and safety of multiwavelength photobiomodulation (MPBM) in healing soft tissue injuries associated with tibial and/or ankle fractures. Participants were randomized into the MPBM or control group. Primary outcome was wound healing, measured by the Bates-Jensen scale. Assessments were performed daily. Twenty-seven hospitalized adults were included. MPBM showed an improvement in the daily mean Bates-Jensen scale (MPBM 32.1 vs. control 34.2; p = 0.029), daily mean pain score change (MPBM 0.5 vs. control 0.2; p = 0.04) and occurrence of infection at the site of the external fixator pins (MPBM 15.3% vs. control 57.1%; p = 0.02). MPBM group also showed faster-wound resolution (MPBM 13.1 vs. control 23.1 days). Subgroup analysis showed improvement in the MPBM group among less severe patients on the Bates-Jensen scale (MPBM 27.4 vs. control 34.7; p = 0.0081) and mean time for wound resolution (MPBM 7.0 vs. control 14.6 days; p = 0.03). MPBM appears safe and effective in reducing wound resolution time, infection in the surgical pin sites, reported pain and time before definitive surgery.

Photobiomodulation with Blue Light on Wound Healing: A Scoping Review

BACKGROUND

Photobiomodulation consists of inducing healing by irradiating light. This scoping review investigates the effect of blue light on the healing process.

METHODS

The MEDLINE, Web of Science, Scopus, and CINAHL databases were searched. Two reviewers independently examined the search results and extracted data from the included studies. A descriptive analysis was performed.

RESULTS

Twenty-two articles were included. Studies were categorized as in vitro/mixed, preclinical, and clinical. The power density used was 10-680 mW/cm2 in most of the in vitro/preclinical studies, the irradiation time ranged from 5 s to 10 min, and different wavelengths and energy densities were used. In clinical studies, the wavelength ranged from 405 to 470 nm, and the energy density varied from 1.5 to 30 J/cm2.

CONCLUSIONS

A low energy density (<20 J/cm2) was able to stimulate the different cell types and proteins involved in healing, while a high energy density, 20.6-50 J/cm2, significantly reduced cell proliferation, migration, and metabolism. There is a great variety of device parameters among studies, and this makes it difficult to conclude what the best technical specifications are. Thus, further studies should be performed in order to define the appropriate parameters of light to be used.