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Sabrin S, Hong SH, Karmokar DK, Habibullah H, Fitridge R, Short RD, Szili EJ. Healing wounds with plasma-activated hydrogel therapy. Trends Biotechnol 2024:S0167-7799(24)00190-2. [PMID: 39209604 DOI: 10.1016/j.tibtech.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/16/2024] [Accepted: 07/20/2024] [Indexed: 09/04/2024]
Abstract
Chronic wound infections are a silent pandemic in danger of becoming a global healthcare crisis. Innovations to control infections and improve healing are required. In the context of this challenge, researchers are exploiting plasma-activated hydrogel therapy (PAHT) for use either alone or in combination with other antimicrobial strategies. PAHT involves the cold atmospheric pressure plasma activation of hydrogels with reactive oxygen and nitrogen species to decontaminate infections and promote healing. This opinion article describes PAHT for wound treatment and provides an overview of current research and outstanding challenges in translating the technology for medical use. A 'blueprint' of an autonomous PAHT is presented in the final section that can move the management and treatment of wounds from the clinical setting to the community.
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Affiliation(s)
- Sumyea Sabrin
- Future Industries Institute, University of South Australia, Mawson Lakes Campus, Mawson Lakes, SA 5095, Australia.
| | - Sung-Ha Hong
- Future Industries Institute, University of South Australia, Mawson Lakes Campus, Mawson Lakes, SA 5095, Australia
| | - Debabrata K Karmokar
- UniSA STEM, University of South Australia, Mawson Lakes Campus, Mawson Lakes, SA 5095, Australia
| | - Habibullah Habibullah
- UniSA STEM, University of South Australia, Mawson Lakes Campus, Mawson Lakes, SA 5095, Australia
| | - Robert Fitridge
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5005, Australia; Vascular and Endovascular Service, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Robert D Short
- Department of Chemistry, The University of Sheffield, Dainton Building, Brook Hill, Sheffield S3 7HF, UK.
| | - Endre J Szili
- UniSA STEM, University of South Australia, Mawson Lakes Campus, Mawson Lakes, SA 5095, Australia.
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Klenivskyi M, Khun J, Thonová L, Vaňková E, Scholtz V. Portable and affordable cold air plasma source with optimized bactericidal effect. Sci Rep 2024; 14:15930. [PMID: 38987305 PMCID: PMC11237098 DOI: 10.1038/s41598-024-66017-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/26/2024] [Indexed: 07/12/2024] Open
Abstract
The paper reports a low-cost handheld source of a cold air plasma intended for biomedical applications that can be made by anyone (detailed technical information and a step-by-step guide for creating the NTP source are provided). The plasma source employs a 1.4 W corona discharge in the needle-to-cone electrode configuration and is an extremely simple device, consisting basically of two electrodes and a cheap power supply. To achieve the best bactericidal effect, the plasma source has been optimized on Escherichia coli. The bactericidal ability of the plasma source was further tested on a wide range of microorganisms: Staphylococcus aureus as a representative of gram-positive bacteria, Pseudomonas aeruginosa as gram-negative bacteria, Candida albicans as yeasts, Trichophyton interdigitale as microfungi, and Deinococcus radiodurans as a representative of extremophilic bacteria resistant to many DNA-damaging agents, including ultraviolet and ionizing radiation. The testing showed that the plasma source inactivates all the microorganisms tested in several minutes (up to 105-107 CFU depending on a microorganism), proving its effectiveness against a wide spectrum of pathogens, in particular microfungi, yeasts, gram-positive and gram-negative bacteria. Studies of long-lived reactive species such as ozone, nitrogen oxides, hydrogen peroxide, nitrite, and nitrate revealed a strong correlation between ozone and the bactericidal effect, indicating that the bactericidal effect should generally be attributed to reactive oxygen species. This is the first comprehensive study of the bactericidal effect of a corona discharge in air and the formation of long-lived reactive species by the discharge, depending on both the interelectrode distance and the discharge current.
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Affiliation(s)
- Myron Klenivskyi
- Department of Physics and Measurements, University of Chemistry and Technology, Prague, Czech Republic
| | - Josef Khun
- Department of Physics and Measurements, University of Chemistry and Technology, Prague, Czech Republic
| | - Laura Thonová
- Department of Physics and Measurements, University of Chemistry and Technology, Prague, Czech Republic
- Department of Physics, Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Eva Vaňková
- Department of Physics and Measurements, University of Chemistry and Technology, Prague, Czech Republic
| | - Vladimír Scholtz
- Department of Physics and Measurements, University of Chemistry and Technology, Prague, Czech Republic.
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Zhang X, Liew KJ, Cao L, Wang J, Chang Z, Tan MCY, Chong KL, Chong CS. Transcriptome analysis of Candida albicans planktonic cells in response to plasma medicine. J Med Microbiol 2024; 73. [PMID: 38967406 DOI: 10.1099/jmm.0.001841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Abstract
Introduction. Cold plasma is frequently utilized for the purpose of eliminating microbial contaminants. Under optimal conditions, it can function as plasma medicine for treating various diseases, including infections caused by Candida albicans, an opportunistic pathogen that can overgrow in individuals with weakened immune system.Gap Statement. To date, there has been less molecular study on cold plasma-treated C. albicans.Research Aim. The study aims to fill the gap in understanding the molecular response of C. albicans to cold plasma treatment.Methodology. This project involved testing a cold plasma generator to determine its antimicrobial effectiveness on C. albicans' planktonic cells. Additionally, the cells' transcriptomics responses were investigated using RNA sequencing at various treatment durations (1, 3 and 5 min).Results. The results show that our cold plasma effectively eliminates C. albicans. Cold plasma treatment resulted in substantial downregulation of important pathways, such as 'nucleotide metabolism', 'DNA replication and repair', 'cell growth', 'carbohydrate metabolism' and 'amino acid metabolism'. This was an indication of cell cycle arrest of C. albicans to preserve energy consumption under unfavourable conditions. Nevertheless, C. albicans adapted its GSH antioxidant system to cope with the oxidative stress induced by reactive oxygen species, reactive nitrogen species and other free radicals. The treatment likely led to a decrease in cell pathogenicity as many virulence factors were downregulated.Conclusion. The study demonstrated the major affected pathways in cold plasma-treated C. albicans, providing valuable insights into the molecular response of C. albicans to cold plasma treatment. The findings contribute to the understanding of the antimicrobial efficiency of cold plasma and its potential applications in the field of microbiology.
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Affiliation(s)
- Xinhua Zhang
- School of Photoelectric Engineering, Changzhou Institute of Technology, Changzhou 213028, PR China
- Suzhou Amazing Grace Medical Equipment Co., Ltd, Suzhou 215101, PR China
- Jiangsu Huayu Printing & Coating Equipment Co. Ltd, Nantong 226300, PR China
| | - Kok Jun Liew
- Department of Biosciences, Faculty of Science, Universiti Teknologi Malaysia, Skudai 81310, Johor, Malaysia
| | - Li Cao
- Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou 215153, PR China
| | - Jie Wang
- Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou 215153, PR China
| | - Zhidong Chang
- Suzhou Amazing Grace Medical Equipment Co., Ltd, Suzhou 215101, PR China
| | - Melvin Chun Yun Tan
- Department of Biosciences, Faculty of Science, Universiti Teknologi Malaysia, Skudai 81310, Johor, Malaysia
| | - Kheng Loong Chong
- Department of Biosciences, Faculty of Science, Universiti Teknologi Malaysia, Skudai 81310, Johor, Malaysia
| | - Chun Shiong Chong
- Department of Biosciences, Faculty of Science, Universiti Teknologi Malaysia, Skudai 81310, Johor, Malaysia
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Yousefian F, Smythe C, Han H, Elewski BE, Nestor M. Treatment Options for Onychomycosis: Efficacy, Side Effects, Adherence, Financial Considerations, and Ethics. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2024; 17:24-33. [PMID: 38495549 PMCID: PMC10941855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Background Onychomycosis is a fungal infection of the nail unit that affects a large patient population globally. Onychomycosis, or tinea unguium, has a benign chronic clinical course; however, it can cause complications in certain patient populations suffering from diabetes and peripheral vascular disease. As nails grow slowly, onychomycosis requires a lengthy treatment plan, and choosing appropriate treatments can be challenging. There are a variety of treatment modalities available for patients including topical, oral, laser, light therapy, procedures such as avulsion and matrixectomy, supplements, over-the-counter medication, and plasma therapy that can be used as monotherapy or in combination for patient satisfaction. Objective We sought to review treatment options for onychomycosis, taking into consideration the efficacy, side effect profiles, practicality of treatment (adherence), and costs to help healthcare providers offer ethically appropriate treatment regimens to their patients. Methods A literature search was conducted using electronic databases (PubMed, Embase, Medline, CINAHL, EBSCO) and textbooks, in addition to the clinical experiences of the authors and other practitioners in treating onychomycosis, and a summary of the findings are presented here. Results Although topical (efinaconazole, tavaborole, ciclopirox), oral (terbinafine, itraconazole), and laser (1064nm Nd:YAG lasers, both short-pulsed and Q-switched lasers, carbon dioxide lasers, and the diode 870, 930nm) are the current Food and Drug Administration (FDA)-approved treatments for onychomycosis, they are just a fraction of available treatment options. New and emerging therapies including new topical and oral medications, combination therapy, photodynamic light therapy, procedural, supplements, over-the-counter medication, and plasma therapy are discussed in our review. Discussion Onychomycosis has high reinfection and recurrence rates, and the treatment remains challenging as treatment selection involves ethical, evidence-based decision-making and consideration of each individual patient's needs, adherence, budget, the extent of quality of life discomfort, and aesthetic goals, independent of potential financial benefits to the clinicians.
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Affiliation(s)
- Faraz Yousefian
- Drs. Yousefian, Smythe, Han and Nestor are with the Center for Clinical and Cosmetic Research in Aventura, Florida
| | - Ciaran Smythe
- Drs. Yousefian, Smythe, Han and Nestor are with the Center for Clinical and Cosmetic Research in Aventura, Florida
| | - Haowei Han
- Drs. Yousefian, Smythe, Han and Nestor are with the Center for Clinical and Cosmetic Research in Aventura, Florida
| | - Boni E. Elewski
- Dr. Elewski is with the Department of Dermatology at the University of Alabama at Birmingham School of Medicine in Birmingham, Alabama
| | - Mark Nestor
- Drs. Yousefian, Smythe, Han and Nestor are with the Center for Clinical and Cosmetic Research in Aventura, Florida
- Additionally, Dr. Nestor is with the University of Miami's Miller School of Medicine in Miami, Florida
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Poddar S, Das A, Hay RJ, Wollina U. Newer Therapies in Dermatophytosis. Indian J Dermatol 2023; 68:515-519. [PMID: 38099134 PMCID: PMC10718254 DOI: 10.4103/ijd.ijd_829_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
With the advent of newer drugs and formulations, the armamentarium to combat dermatophytosis is ever-expanding. However, we must be rational and scientific when choosing the drugs. This review is an attempt to summarise the recently approved and upcoming therapeutic options for dermatophytosis.
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Affiliation(s)
- Shreya Poddar
- From the Department of Dermatology, IPGMER and SSKM, Kolkata, West Bengal, India
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | | | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
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Nonthermal Plasma Effects on Fungi: Applications, Fungal Responses, and Future Perspectives. Int J Mol Sci 2022; 23:ijms231911592. [PMID: 36232892 PMCID: PMC9569944 DOI: 10.3390/ijms231911592] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/18/2022] Open
Abstract
The kingdom of Fungi is rich in species that live in various environments and exhibit different lifestyles. Many are beneficial and indispensable for the environment and industries, but some can threaten plants, animals, and humans as pathogens. Various strategies have been applied to eliminate fungal pathogens by relying on chemical and nonchemical antifungal agents and tools. Nonthermal plasma (NTP) is a potential tool to inactivate pathogenic and food-contaminating fungi and genetically improve fungal strains used in industry as enzyme and metabolite producers. The NTP mode of action is due to many highly reactive species and their interactions with biological molecules. The interaction of the NTP with living cells is believed to be synergistic yet not well understood. This review aims to summarize the current NTP designs, applications, and challenges that involve fungi, as well as provide brief descriptions of underlying mechanisms employed by fungi in interactions with the NTP components.
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Falotico JM, Lipner SR. Updated Perspectives on the Diagnosis and Management of Onychomycosis. Clin Cosmet Investig Dermatol 2022; 15:1933-1957. [PMID: 36133401 PMCID: PMC9484770 DOI: 10.2147/ccid.s362635] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/08/2022] [Indexed: 12/02/2022]
Abstract
Onychomycosis is the most common nail disease encountered in clinical practice and can cause pain, difficulty with ambulation, and psycho-social problems. A thorough history and physical examination, including dermoscopy, should be performed for each patient presenting with nail findings suggestive of onychomycosis. Several approaches are available for definitive diagnostic testing, including potassium hydroxide and microscopy, fungal culture, histopathology, polymerase chain reaction, or a combination of techniques. Confirmatory testing should be performed for each patient prior to initiating any antifungal therapies. There are several different therapeutic options available, including oral and topical medications as well as device-based treatments. Oral antifungals are generally recommended for moderate to severe onychomycosis and have higher cure rates, while topical antifungals are recommended for mild to moderate disease and have more favorable safety profiles. Oral terbinafine, itraconazole, and griseofulvin and topical ciclopirox 8% nail lacquer, efinaconazole 10% solution, and tavaborole 5% solution are approved by the Food and Drug Administration for treatment of onychomycosis in the United States and amorolfine 5% nail lacquer is approved in Europe. Laser treatment is approved in the United States for temporary increases in clear nail, but clinical results are suboptimal. Oral fluconazole is not approved in the United States for onychomycosis treatment, but is frequently used off-label with good efficacy. Several novel oral, topical, and over-the-counter therapies are currently under investigation. Physicians should consider the disease severity, infecting pathogen, medication safety, efficacy and cost, and patient age, comorbidities, medication history, and likelihood of compliance when determining management plans. Onychomycosis is a chronic disease with high recurrence rates and patients should be counseled on an appropriate plan to minimize recurrence risk following effective antifungal therapy.
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Affiliation(s)
- Julianne M Falotico
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Shari R Lipner
- Weill Cornell Medicine, Department of Dermatology, New York, NY, USA
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Tan F, Wang Y, Zhang S, Shui R, Chen J. Plasma Dermatology: Skin Therapy Using Cold Atmospheric Plasma. Front Oncol 2022; 12:918484. [PMID: 35903680 PMCID: PMC9314643 DOI: 10.3389/fonc.2022.918484] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
Cold atmospheric plasma-based plasma medicine has been expanding the diversity of its specialties. As an emerging branch, plasma dermatology takes advantage of the beneficial complexity of plasma constituents (e.g., reactive oxygen and nitrogen species, UV photons, and electromagnetic emission), technical versatility (e.g., direct irradiation and indirect aqueous treatment), and practical feasibility (e.g., hand-held compact device and clinician-friendly operation). The objective of this comprehensive review is to summarize recent advances in the CAP-dominated skin therapy by broadly covering three aspects. We start with plasma optimisation of intact skin, detailing the effect of CAP on skin lipids, cells, histology, and blood circulation. We then conduct a clinically oriented and thorough dissection of CAP treatment of various skin diseases, focusing on the wound healing, inflammatory disorders, infectious conditions, parasitic infestations, cutaneous malignancies, and alopecia. Finally, we conclude with a brief analysis on the safety aspect of CAP treatment and a proposal on how to mitigate the potential risks. This comprehensive review endeavors to serve as a mini textbook for clinical dermatologists and a practical manual for plasma biotechnologists. Our collective goal is to consolidate plasma dermatology’s lead in modern personalized medicine.
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Affiliation(s)
- Fei Tan
- Department of Otorhinolaryngology and Head & Neck Surgery (ORL-HNS), Shanghai Fourth People’s Hospital, and School of Medicine, Tongji University, Shanghai, China
- The Royal College of Surgeons in Ireland, Dublin, Ireland
- The Royal College of Surgeons of England, London, United Kingdom
- *Correspondence: Fei Tan,
| | - Yang Wang
- Department of Pathology, Shanghai Fourth People’s Hospital, and School of Medicine, Tongji University, Shanghai, China
| | - Shiqun Zhang
- Department of Pharmacology, Shanghai Tenth People’s Hospital, and School of Medicine, Tongji University, Shanghai, China
| | - Runying Shui
- Department of Surgery, Department of Dermatology, Huadong Hospital, Fudan University, Shanghai, China
| | - Jianghan Chen
- Department of Surgery, Department of Dermatology, Shanghai Fourth People’s Hospital, and School of Medicine, Tongji University, Shanghai, China
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Veerana M, Yu N, Ketya W, Park G. Application of Non-Thermal Plasma to Fungal Resources. J Fungi (Basel) 2022; 8:jof8020102. [PMID: 35205857 PMCID: PMC8879654 DOI: 10.3390/jof8020102] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/15/2022] [Accepted: 01/20/2022] [Indexed: 12/21/2022] Open
Abstract
In addition to being key pathogens in plants, animals, and humans, fungi are also valuable resources in agriculture, food, medicine, industry, and the environment. The elimination of pathogenic fungi and the functional enhancement of beneficial fungi have been the major topics investigated by researchers. Non-thermal plasma (NTP) is a potential tool to inactivate pathogenic and food-spoiling fungi and functionally enhance beneficial fungi. In this review, we summarize and discuss research performed over the last decade on the use of NTP to treat both harmful and beneficial yeast- and filamentous-type fungi. NTP can efficiently inactivate fungal spores and eliminate fungal contaminants from seeds, fresh agricultural produce, food, and human skin. Studies have also demonstrated that NTP can improve the production of valuable enzymes and metabolites in fungi. Further studies are still needed to establish NTP as a method that can be used as an alternative to the conventional methods of fungal inactivation and activation.
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Affiliation(s)
- Mayura Veerana
- Plasma Bioscience Research Center, Department of Plasma-Bio Display, Kwangwoon University, Seoul 01897, Korea; (M.V.); (N.Y.); (W.K.)
| | - Nannan Yu
- Plasma Bioscience Research Center, Department of Plasma-Bio Display, Kwangwoon University, Seoul 01897, Korea; (M.V.); (N.Y.); (W.K.)
| | - Wirinthip Ketya
- Plasma Bioscience Research Center, Department of Plasma-Bio Display, Kwangwoon University, Seoul 01897, Korea; (M.V.); (N.Y.); (W.K.)
| | - Gyungsoon Park
- Plasma Bioscience Research Center, Department of Plasma-Bio Display, Kwangwoon University, Seoul 01897, Korea; (M.V.); (N.Y.); (W.K.)
- Department of Electrical and Biological Physics, Kwangwoon University, Seoul 01897, Korea
- Correspondence: ; Tel.: +82-2-940-8324
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Inactivation of Dermatophytes Causing Onychomycosis Using Non-Thermal Plasma as a Prerequisite for Therapy. J Fungi (Basel) 2021; 7:jof7090715. [PMID: 34575753 PMCID: PMC8467917 DOI: 10.3390/jof7090715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 12/18/2022] Open
Abstract
Following our previous study of the therapy of onychomycosis by non-thermal plasma (NTP) and nail hygiene and to obtain some prerequisite data of dermatophytes sensitivity, the dynamics of those inactivation by NTP plasma was monitored for various strains of Trichophyton iterdigitale, Trichophyton benhamiae, Trichophyton rubrum, and Microsporum canis. Three strains of each species on agar plates were exposed with plasma produced by a DC corona discharge in the point-to-ring arrangement in various time intervals. Although all strains were sufficiently sensitive to plasma action, significant differences were observed in their sensitivity and inactivation dynamics. These differences did not correlate with the species classification of individual strains, but could be assigned to four arbitrarily created types of strain response to NTP according to their sensitivity. These results indicate that the sensitivity to plasma is not an inherent property of the fungal species, but varies from strain to strain.
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Shemer A, Daniel R, Kassem R, Geffen Y, Galili E. Cold sub-atmospheric and atmospheric pressure plasma for the treatment of Trichophyton rubrum onychomycosis: An in-vitro study. Dermatol Ther 2020; 33:e14084. [PMID: 32729232 DOI: 10.1111/dth.14084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
Previous studies have suggested the applicability of cold atmospheric pressure plasma for the treatment of onychomycosis. Whether delivering cold plasma in sub-atmospheric pressure would be beneficial for this purpose is yet to be established. The current study aimed to evaluate efficacy of cold sub-atmospheric and atmospheric pressure plasma in Trichophyton rubrum growth inhibition. Bovine nails infected with T. rubrum were treated by a cold air plasma device, which enables utilizing plasma in sub-atmospheric pressures (Low = 100 millibar; High = 300 millibar) or atmospheric pressure. The infected foci were exposed to the plasma source directly or indirectly. Treatment with high sub-atmospheric pressure setting achieved T. rubrum growth reduction of 94.0% and 73.0%, for direct and indirect exposure to the plasma source, respectively (P < .001). Low sub-atmospheric pressure setting achieved similar T. rubrum growth reduction of 86.2% for direct exposure to the plasma source (P < .001), but only marginally significant 58.8% reduction rate for indirect exposure to the plasma source (P = .056). None statistically significant fungal growth reduction was attained with the use of atmospheric pressure setting. Cold plasma was shown to effectively inhibit T. rubrum nail growth, with sub-atmospheric pressure setting achieving better outcome than atmospheric pressure.
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Affiliation(s)
- Avner Shemer
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ralph Daniel
- University of Mississippi Medical Center, Jackson, Mississippi, USA.,University of Alabama, Birmingham, Alabama, USA
| | - Riad Kassem
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Geffen
- Department of Clinical Microbiology, Rambam Medical Center, Haifa, Israel
| | - Eran Galili
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bulson JM, Liveris D, Derkatch I, Friedman G, Geliebter J, Park S, Singh S, Zemel M, Tiwari RK. Non-thermal atmospheric plasma treatment of onychomycosis in an in vitro human nail model. Mycoses 2019; 63:225-232. [PMID: 31677288 PMCID: PMC7003814 DOI: 10.1111/myc.13030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Onychomycosis affects almost 6% of the world population. Topical azoles and systemic antifungal agents are of low efficacy and can have undesirable side effects. An effective, non-invasive therapy for onychomycosis is an unmet clinical need. OBJECTIVE Determine the efficacy threshold of non-thermal atmospheric plasma (NTAP) to treat onychomycosis in an in vitro model. METHODS A novel toe/nail-plate model using cadaver nails and agarose media inoculated with Candida albicans was exposed to a range of NTAP doses. RESULTS Direct exposure of C albicans and Trichophyton mentagrophytes to 12 minutes of NTAP results in complete killing at doses of 39 and 15 kPulses, respectively. Onset of reduced viability of C albicans to NTAP treatment through the nail plate occurs at 64 kPulses with 10× and 100× reduction at 212 and 550 kPulses, respectively. CONCLUSIONS NTAP is an effective, non-invasive therapeutic approach to onychomycosis that should be evaluated in a clinical setting.
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Affiliation(s)
| | - Dionysios Liveris
- Department of Microbiology and Immunology, New York Medical College, Valhalla, NY, USA
| | | | - Gary Friedman
- MOE Medical Devices LLC, Valhalla, NY, USA.,Electrical and Computer Engineering Department, Drexel University, Philadelphia, PA, USA
| | | | - Sin Park
- MOE Medical Devices LLC, Valhalla, NY, USA
| | - Sarnath Singh
- Department of Microbiology and Immunology, New York Medical College, Valhalla, NY, USA
| | - Marc Zemel
- MOE Medical Devices LLC, Valhalla, NY, USA
| | - Raj K Tiwari
- Department of Microbiology and Immunology, New York Medical College, Valhalla, NY, USA
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