Antibody-targeted lethal photosensitization of Porphyromonas gingivalis

Photodynamic Therapy with Tolonium Chloride and a Diode Laser (635 nm) in the Non-Surgical Management of Periodontitis: A Clinical Study

This study aimed to evaluate the efficacy of photodynamic therapy (PDT) using tolonium chloride and a 635 nm diode laser as an adjunct to non-surgical periodontitis treatment, specifically scaling and root planing (SRP) alone. A total of 32 patients with a pocket probing depth > 5 mm were included in the study. Among them, 16 patients underwent SRP alone (control group), and the remaining 16 patients received SRP along with PDT (study group). The PDT procedure utilized a 635 nm diode laser (Smart M, Lasotronix, Poland) and tolonium chloride. Clinical periodontal parameters, such as the plaque index (PI), bleeding on probing (BOP), gingival recession (GR), probing pocket depth (PPD), and clinical attachment loss (CAL), were assessed before treatment (T0) and at 3 months after treatment (T3). At T3, both groups demonstrated a significant reduction in the PI, BOP, PD, and CAL compared to T0. The SRP + PDT group displayed a significant reduction in PPD (3.79 mm ± 0.35) compared to the SRP alone group (4.85 mm ± 0.42) at T3. Furthermore, the SRP + PDT group exhibited a significant reduction in CAL (5.01 ± 0.81) compared to the SRP group (5.99 ± 1.08) at T3. Within the study's limitations, it was concluded that PDT, with tolonium chloride and a 635 nm diode laser, significantly contributed to the non-surgical treatment of periodontitis.

Farnesol potentiates photodynamic inactivation of Staphylococcus aureus with the use of red light-activated porphyrin TMPyP

Photodynamic inactivation (PDI) or antibacterial photodynamic therapy (aPDT) is a method based on the use of a photosensitizer, light of a proper wavelength and oxygen, which combined together leads to an oxidative stress and killing of target cells. PDI can be applied towards various pathogenic bacteria independently on their antibiotic resistance profile. Optimization of photodynamic treatment to eradicate the widest range of human pathogens remains challenging despite the availability of numerous photosensitizing compounds. Therefore, a search for molecules that could act as adjuvants potentiating antibacterial photoinactivation is of high scientific and clinical importance. Here we propose farnesol (FRN), a well described sesquiterpene, as a potent adjuvant of PDI, which specifically sensitizes Staphylococcus aureus to 5,10,15,20-tetrakis(1-methylpyridinium-4-yl)porphyrin tetratosylate (TMPyP) upon red light irradiation. Interestingly, the observed potentiation strongly depends on the presence of light. Analysis of this combined action of FRN and TMPyP, however, showed no influence of farnesol on TMPyP photochemical properties, i.e. the amount of reactive oxygen species that were produced by TMPyP in the presence of FRN. The accumulation rate of TMPyP in Staphylococcus aureus cells did not change, as well as the influence of staphyloxanthin inhibition. The precise mechanism of observed sensitization is unclear and probably involves specific molecular targets.

Towards microbe-targeted photosensitizers: Synthesis, characterization and in vitro photodynamic inactivation of the tuberculosis model pathogen M. smegmatis by porphyrin-peptide conjugates

Porphyrin-peptide conjugates have a breadth of potential applications, including use in photodynamic therapy, boron neutron capture therapy, as fluorescence imaging tags for tracking subcellular localization, as magnetic resonance imaging (MRI) positive-contrast reagents and as biomimetic catalysts. Here, we have explored three general routes to porphyrin-peptide conjugates using the Cu(I)-catalyzed Huisgen-Medal-Sharpless 1,3-dipolar cycloaddition of peptide-containing azides with a terminal alkyne-containing porphyrin, thereby generating porphyrin-peptide conjugates (PPCs) comprised of a cationic porphyrin coupled to short antimicrobial peptides. In addition to characterizing the PPCs using a variety of spectroscopic (UV-vis, [Formula: see text]H- and [Formula: see text]C-NMR) and mass spectrometric methods, we evaluated their efficacy as photosensitizers for the in vitro photodynamic inactivation of Mycobacterium smegmatis as a model for the pathogen Mycobacterium tuberculosis. Difficulties that needed to be overcome for the efficient synthesis of PPCs were the limited solubility of the quaternized pyridyl porphyrin in common solvents, undesired (de)metallation and transmetallation, and chromatographic purification. Photodynamic inactivation studies of a small library of PPCs against Mycobacterium smegmatis confirmed our hypothesis that the porphyrin-based photosensitizer maintains its ability to efficiently inactivate bacteria when conjugated to a small peptide by upwards of 5–6 log units (99.999[Formula: see text]%) using white light illumination (400–700 nm, 60 mW/cm[Formula: see text], 30 min). Further, hemolysis assays revealed the lack of toxicity of the PPCs against sheep blood at concentrations employed for in vitro photodynamic inactivation. Taken together, the results demonstrated the ability of PPCs to maintain their antimicrobial photodynamic inactivation efficacy when possessing a short cationic peptides for enabling the potential targeting of pathogens in vivo.

Signed, Sealed, Delivered: Conjugate and Prodrug Strategies as Targeted Delivery Vectors for Antibiotics

Innate and developed resistance mechanisms of bacteria to antibiotics are obstacles in the design of novel drugs. However, antibacterial prodrugs and conjugates have shown promise in circumventing resistance and tolerance mechanisms via directed delivery of antibiotics to the site of infection or to specific species or strains of bacteria. The selective targeting and increased permeability and accumulation of these prodrugs not only improves efficacy over unmodified drugs but also reduces off-target effects, toxicity, and development of resistance. Herein, we discuss some of these methods, including sideromycins, antibody-directed prodrugs, cell penetrating peptide conjugates, and codrugs.

The Effect of Different Implant Surfaces and Photodynamic Therapy on Periodontopathic Bacteria Using TaqMan PCR Assay following Peri-Implantitis Treatment in Dog Model

Introduction

Peri-implantitis is one of the late complications that leads to implant failure and is associated with specific microorganisms identified as periodontopathic bacteria. The objective of this study was to evaluate the relationship between the different implant surfaces and number of Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola using TaqMan PCR assay after peri-implantitis treatment using photodynamic therapy.

Method

Forty-eight dental implants with four different surface treatments (M: machined; SA: sandblasted acid-etched; S: 1 µm sputter HA-coated; and P: plasma spraying HA-coated) were inserted in six beagle dogs. After nine months of peri-implantitis induction, a split mouth design was used; on control side decontamination was performed using open flap mechanical debridement OFD with plastic curette, while photodynamic therapy PDT using diode laser (Ga Al As 830-nm) was used in the test side. For the following 2 weeks low-level laser therapy LLLT (10mW) was applied for the test side on alternative days for 6 sec on each implant side. Peri-implant microbial samples were collected using paper points and analyzed using TaqMan PCR before peri-implantitis treatment, immediately after treatment and 5 months posttreatment.

Results

Both treatment modalities showed significant decrease in all bacterial count from baseline to immediately after treatment (P< 0.0001). The count increased between immediately after treatment to 5 months after treatment (P< 0.0001); however, the count after 5 months was significantly lower than at baseline. PDT had a stronger effect on reducing P. gingivalis count than T. denticola and T. forsythia compared to OFD. For T. forsythia, implant surface treatment had the greatest effect which was also statistically significant (P= 0.02) with considerably lower effect of PDT or their interaction.

Conclusion

The results suggest that PDT and OFD have significant benefits in peri-implantitis treatment by reducing bacterial count. The presence of bacterial complex with different response to therapeutic modality suggests the use of combined decontamination methods for peri-implantitis treatment.

Selective Photocatalytic Disinfection by Coupling StrepMiniSog to the Antibody Catalyzed Water Oxidation Pathway

For several decades reactive oxygen species have been applied to water quality engineering and efficient disinfection strategies; however, these methods are limited by disinfection byproduct and catalyst-derived toxicity concerns which could be improved by selectively targeting contaminants of interest. Here we present a targeted photocatalytic system based on the fusion protein StrepMiniSOG that uses light within the visible spectrum to produce reactive oxygen species at a greater efficiency than current photosensitizers, allowing for shorter irradiation times from a fully biodegradable photocatalyst. The StrepMiniSOG photodisinfection system is unable to cross cell membranes and like other consumed proteins, can be degraded by endogenous digestive enzymes in the human gut, thereby reducing the consumption risks typically associated with other disinfection agents. We demonstrate specific, multi-log removal of Listeria monocytogenes from a mixed population of bacteria, establishing the StrepMiniSOG disinfection system as a valuable tool for targeted pathogen removal, while maintaining existing microbial biodiversity.

Preclinical studies and prospective clinical applications for bacteria-targeted imaging: the future is bright

Bacterial infections are a frequently occurring and major complication in human healthcare, in particular due to the rapid increase of antimicrobial resistance and the emergence of pan-drug-resistant microbes. Current anatomical and functional imaging modalities are insufficiently capable of distinguishing sites of bacterial infection from sterile inflammation. Therefore, definitive diagnosis of an infection can often only be obtained by tissue biopsy and subsequent culture and, occasionally, a definite diagnosis even appears to be impossible. To accurately diagnose bacterial infections early, novel imaging modalities are urgently needed. In this regard, bacteria-targeted imaging is an attractive option due to its specificity. Here, different bacteria-targeted imaging approaches are reviewed, and their promising future perspectives are discussed.

Combined effects of photodynamic therapy and irrigants in disinfection of root canals

In this study, the combined effects of photodynamic therapy and irrigants in eradicating common endodontic pathogens are evaluated. Roots of 80 extracted single rooted teeth are divided into 2 groups (1) mechanical flushing; (2) antibacterial irrigation. After cleaning and shaping, they are inoculated with either (A) Streptococcus mutans or (B) Enterococcus faecalis and incubated. They are again subdivided and either only irrigated or irrigated and lased. Dentin shavings are taken from root canal walls and cultured. Statistical analysis using One-Way ANOVA and Post-hoc tests are done. The combination eradicated both bacteria. Antibacterial irrigants controlled S. mutans better than PDT (p = 0.041). The combination of PDT and antibacterial irrigation proposed in this study can be used in all primary cases for thorough and reliable disinfection of root canals but may be highly effective in resistant cases like endodontic failures, as E. faecalis is prevalent in such cases.

Bacterial imaging and photodynamic inactivation using zinc(II)-dipicolylamine BODIPY conjugates

Targeted imaging and antimicrobial photodynamic inactivation (PDI) are emerging methods for detecting and eradicating pathogenic microorganisms. This study describes two structurally related optical probes that are conjugates of a zinc(II)-dipicolylamine targeting unit and a BODIPY chromophore. One probe is a microbial targeted fluorescent imaging agent, mSeek, and the other is an oxygen photosensitizing analogue, mDestroy. The conjugates exhibited high fluorescence quantum yield and singlet oxygen production, respectively. Fluorescence imaging and detection studies examined four bacterial strains: E. coli, S. aureus, K. pneumonia, and B. thuringiensis vegetative cells and purified spores. The fluorescent probe, mSeek, is not phototoxic and enabled detection of all tested bacteria at concentrations of ∼100 CFU mL(-1) for B. thuringiensis spores, ∼1000 CFU mL(-1) for S. aureus and ∼10,000 CFU mL(-1) for E. coli. The photosensitizer analogue, mDestroy, inactivated 99-99.99% of bacterial samples and selectively killed bacterial cells in the presence of mammalian cells. However, mDestroy was ineffective against B. thuringiensis spores. Together, the results demonstrate a new two-probe strategy to optimize PDI of bacterial infection/contamination.

Antibodies armed with photosensitizers: from chemical synthesis to photobiological applications

Targeting photosensitizers to cancer cells by conjugating them with specific antibodies, able to recognize and bind to tumor-associated antigens, is today one of the most attractive strategies in photodynamic therapy (PDT). This comprehensive review updates on chemical routes available for the preparation of photo-immunoconjugates (PICs), which show dual chemical and biological functionalities: photo-properties of the photosensitizer and the immunoreactivity of the antibody. Moreover, photobiological results obtained with such photo-immunoconjugates using in vitro and in vivo cancer models are also discussed.

Targeted imaging of bacterial infections: advances, hurdles and hopes

Bacterial infections represent an increasing problem in modern health care, in particular due to ageing populations and accumulating bacterial resistance to antibiotics. Diagnosis is rarely straightforward and consequently treatment is often delayed or indefinite. Therefore, novel tools that can be clinically implemented are urgently needed to accurately and swiftly diagnose infections. Especially, the direct imaging of infections is an attractive option. The challenge of specifically imaging bacterial infections in vivo can be met by targeting bacteria with an imaging agent. Here we review the current status of targeted imaging of bacterial infections, and we discuss advantages and disadvantages of the different approaches. Indeed, significant progress has been made in this field and the clinical implementation of targeted imaging of bacterial infections seems highly feasible. This was recently highlighted by the use of so-called smart activatable probes and a fluorescently labelled derivative of the antibiotic vancomycin. A major challenge remains the selection of the best imaging probes, and we therefore present a set of target selection criteria for clinical implementation of targeted bacterial imaging. Altogether, we conclude that the spectrum of potential applications for targeted bacterial imaging is enormous, ranging from fundamental research on infectious diseases to diagnostic and therapeutic applications.

Laser in dentistry: An innovative tool in modern dental practice

The term LASER is an acronym for ‘Light Amplification by the Stimulated Emission of Radiation’. As its first application in dentistry by Miaman, in 1960, the laser has seen various hard and soft tissue applications. In the last two decades, there has been an explosion of research studies in laser application. In hard tissue application, the laser is used for caries prevention, bleaching, restorative removal and curing, cavity preparation, dentinal hypersensitivity, growth modulation and for diagnostic purposes, whereas soft tissue application includes wound healing, removal of hyperplastic tissue to uncovering of impacted or partially erupted tooth, photodynamic therapy for malignancies, photostimulation of herpetic lesion. Use of the laser proved to be an effective tool to increase efficiency, specificity, ease, and cost and comfort of the dental treatment.

Identification of methicillin-resistant Staphylococcus aureus-specific peptides for targeted photoantimicrobial chemotherapy

The increasing prevalence of multi-drug resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), necessitates development of alternative modes of bacterial targeting which are not hindered by antibiotic resistance and minimise collateral damage. To achieve this, the FliTrx™ bacterially-displayed peptide library was panned against MRSA and randomly selected clones (n = 20) were DNA sequenced. One selected peptide was synthesised as both cyclic and linear constructs. Binding of the cyclic construct was observed by flow cytometry against isolates of MRSA whilst the linear construct showed low affinity. Low reactivity was observed with other Staphylococcal sp., gram-negative bacteria and human keratinocytes. The selected peptide was also cloned in-frame, within the thioredoxin gene into the pPROTet.E 6xHN vector for protein expression. A porphyrin photosensitiser (5-(4-isothiocyanatophenyl)-10,15,20-tris(4-N-methylpyridiniumyl)porphyrin trichloride) was conjugated to the recombinant protein and the in vitro cytotoxic effect of the resulting bioconjugate was determined against MRSA and other non-specific bacterial and mammalian cell lines. Photoantimicrobial chemotherapy (PACT) using the bioconjugate showed a 66% reduction in MRSA growth in comparison with non-irradiated cells. This work demonstrates the potential to isolate peptides with binding specificity against MRSA that can be used for targeted PACT, providing an effective alternative to antibody targeting.

Photodynamic antimicrobial therapy

Photodynamic antimicrobial therapy (PACT) involves the utilisation of photosensitizers activated by exposure to visible light in order to eradicate microbes (this method has already been applied in photodynamic therapy of tumours). Photodynamic effect of the particular photosensitive substance (PS) is attributed to its ability to penetrate susceptible microorganisms, to absorb the light of certain wavelength, and to generate reactive cytotoxic oxygen products. The target microorganisms for photoinactivation are bacteria, fungi, viruses and protozoa. Photodynamic antimicrobial therapy is proposed as a potentially topical, non-invasive approach suitable for treatment of locally occurring infection. The fact that bacteria are becoming increasingly resistant to antibiotics and antiseptics has lead to an increased interest in the development of new alternative eradication methods, such as PACT. Research and development of photosensitive substances are aimed at finding effective antimicrobial substances, which would have a broad-spectrum potency.

Photodynamic therapy: a targeted therapy in periodontics

The oral cavity is colonized by a large number and highly diversified communities of micro-organisms. Bacterial biofilm present on tooth or root surface is a major cause of gingivitis and periodontitis. Chemical antimicrobial agents are widely used in prophylactic and therapeutic regimens for dental plaque related diseases, which are among the most common human infections. As these agents are difficult to maintain at therapeutic concentrations in the oral cavity and can be rendered ineffective by resistance development in target organisms, there is a need for an alternative antimicrobial approach. A novel approach, photodynamic therapy (PDT), could be a solution to these problems. Lethal photosensitization of many bacteria, both Gram positive and Gram negative was found in many studies. The advantage of this new approach includes rapid bacterial elimination, minimal chance of resistance development and safety of adjacent host tissue and normal microflora. Thus, the available knowledge of photodynamic therapy should encourage a more clinically oriented application of this technique.

Endodontic antimicrobial photodynamic therapy: safety assessment in mammalian cell cultures

OBJECTIVES

The purpose of this study was to assess the in vitro synergistic effect of methylene blue (MB) and red light on human gingival fibroblasts and osteoblasts with parameters similar to those that may be applied in a clinical setting for endodontic disinfection.

MATERIALS AND METHODS

Both cell types were sensitized with 50 microg/mL MB followed by exposure to red light at 665 nm for 5 minutes with an irradiance of 10, 20, and 40 mW/cm(2). After photodynamic therapy (PDT), cell viability and mitochondrial activity were evaluated by the neutral red and MTT assay, respectively. The assessment of PDT-induced apoptosis was investigated by western blot analysis using cleaved poly(ADP-ribose) polymerase-specific antibodies.

RESULTS

Light at 20 and 40 mW/cm(2) with MB had modest effects at 24 hours on osteoblasts in both assays, whereas sodium hypochlorite completely eliminated cells. Western blot analysis revealed no signs of apoptosis in either cell type.

CONCLUSION

The data suggest that there is a safe therapeutic window whereby PDT can inactivate endodontic pathogens without affecting host cell viability.

Pulp temperature increase during photo-activated disinfection (PAD) of periodontal pockets: an in vitro study

The capacity of photo-sensitizers, used in combination with laser light to kill micro-organisms has been demonstrated in different studies. Photo-activated disinfection (PAD) has been introduced in periodontology as an aid for disinfection of periodontal pockets. The aim of this study is to verify the harm for dental vitality of the use of PAD in periodontal pockets. Root canals of 24 freshly extracted human teeth where prepared using profiles up to a size of ISO #50 and filled with thermo-conductor paste. A silicon-based false gum was made in which a periodontal pocket was created and filled with photo-sensitizer phenothiazine chloride (phenothiazine-5-ium, 3.7-bis (dimethylamino)-, chloride). The external root surface was irradiated during 60 s with a 660-nm diode laser (output power: 20 mW; power density: 0.090 W/cm(2); Energy density: 5.46 J/cm(2)) using a periodontal tip with a diameter of 1 mm and a length of 7 mm. Temperatures were recorded inside the root canal using a thermocouple. Measurements were recorded every second, starting at 10 s before lasering, during the irradiation and were continued for 150 s after the end of irradiation, and six measurements were done per tooth. An average temperature increase of 0.48 +/- 0.11 degrees C was recorded. Our results demonstrated that pulp temperature increase was lower than 3 degrees C, which is considered to be harmless for pulp injury. Regarding pulp temperature increase, the use of PAD for disinfection of periodontal pockets can be considered as a safe procedure for dental vitality.

Design of a Peptibody Consisting of the Antimicrobial Peptide dhvar5 and a llama Variable Heavy-chain Antibody Fragment

Immunoconjugates have been widely studied as potential therapeutics for infectious diseases to direct unspecific antimicrobials to pathogens. In this study, the recombinant approach was used for expression of the immunoconjugate composed of the variable domain of a llama heavy-chain antibody (VHH) against Streptococcus mutans and dhvar5, a synthetic antimicrobial peptide. Before cloning, the impact of the elongation of the peptide termini on its biological activity was evaluated by chemical synthesis of the N- or C-termini extended dhvar5 peptides. As the elongation of the C-terminus had a greater influence on decline of the antimicrobial activity, the N-terminal fusion was designed. To promote in vivo release of the active peptide, a factor Xa cleavage site was inserted between VHH and dhvar5. Propagation of transformed Escherichia coli with the constructed plasmid was only possible in the absence of isopropyl beta-D-thiogalactoside (IPTG). Although these data demonstrate that the diminished antimicrobial activity of dhvar5 by the N-terminal fusion to VHH was not sufficient for the protection of the bacterial host cells against the peptide lethal effect, an insight into propeptides biological activities may be beneficial not only for new and more successful rearrangement of the VHH-dhvar5 immunoconjugate construct, but also design of the other recombinant molecules composed of peptides toxic to host cells.

Lethal photosensitization and guided bone regeneration in treatment of peri-implantitis: an experimental study in dogs

The purpose of this study was to evaluate the effect of lethal photosensitization and guided bone regeneration (GBR) on the treatment of ligature-induced peri-implantitis in different implant surfaces. The treatment outcome was evaluated by clinical and histometric methods. A total of 40 dental implants with four different surface coatings (10 commercially pure titanium surface (cpTi); 10 titanium plasma-sprayed (TPS); 10 acid-etched surface; 10 surface-oxide sandblasted) were inserted into five mongrel dogs. After 3 months, the animals with ligature-induced peri-implantitis were subjected to surgical treatment using a split-mouth design. The controls were treated by debridment and GBR, while the test side received an additional therapy with photosensitization, using a GaAlAs diode laser, with a wavelength of 830 nm and a power output of 50 mW for 80 s (4 J/cm2), and sensitized toluidine blue O (100 microg/ml). The animals were sacrificed 5 months after therapy. The control sites presented an earlier exposition of the membranes on all coating surfaces, while the test group presented a higher bone height gain. Re-osseointegration ranged between 41.9% for the cpTi surface and 31.19% for the TPS surface in the test sites; however differences were not achieved between the surfaces. The lethal photosensitization associated with GBR allowed for better re-osseointegration at the area adjacent to the peri-implant defect regardless of the implant surface.

Development of a novel targeting system for lethal photosensitization of antibiotic-resistant strains of Staphylococcus aureus

Light-activated antimicrobial agents (photosensitizers) are promising alternatives to antibiotics for the treatment of topical infections. To improve efficacy and avoid possible damage to host tissues, targeting of the photosensitizer to the infecting organism is desirable, and this has previously been achieved using antibodies and chemical modification of the agent. In this study we investigated the possibility of using a bacteriophage to deliver the photosensitizer tin(IV) chlorin e6 (SnCe6) to Staphylococcus aureus. SnCe6 was covalently linked to S. aureus bacteriophage 75, and the ability of the conjugate to kill various strains of S. aureus when exposed to red light was determined. Substantial kills of methicillin- and vancomycin-intermediate strains of S. aureus were achieved using low concentrations of the conjugate (containing 1.5 microg/ml SnCe6) and low light doses (21 J/cm2). Under these conditions, the viability of human epithelial cells (in the absence of bacteria) was largely unaffected. On a molar equivalent basis, the conjugate was a more effective bactericide than the unconjugated SnCe6, and killing was not growth phase dependent. The conjugate was effective against vancomycin-intermediate strains of S. aureus even after growth in vancomycin. The results of this study have demonstrated that a bacteriophage can be used to deliver a photosensitizer to a target organism, resulting in enhanced and selective killing of the organism. Such attributes are desirable in an agent to be used in the photodynamic therapy of infectious diseases.

Photodynamic inactivation of fibroblasts by a cationic porphyrin

An important determinant of the clinical applicability and value of antimicrobial photodynamic inactivation (PDI) is the cytotoxicity of the treatment to human cells. We evaluated the in vitro cytotoxicity of PDI to human dermal fibroblasts using 5-phenyl-10,15,20-tris(N-methyl-4-pyridyl)porphyrin chloride (TriP[4]) as the photosensitiser. The fibroblasts were exposed to a PDI regime that is known to be sufficient for the inactivation of Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans. The PDI experiments were carried out in phosphate-buffered saline (PBS) and in 6.25%, 12.5%, 25% and 50% fetal calf serum (FCS)/PBS suspensions. Cell viability subsequent to exposure was evaluated after 0 h, 6 h and 18 h using the methylthiazoletetrazolium (MTT) assay and compared to pretreatment values. At a TriP[4] concentration previously demonstrated to induce a 5 log(10)-unit reduction in a viable count for S. aureus, 79% of the fibroblasts were photo-inactivated. Increasing the FCS concentration in the medium protected the fibroblasts against PDI. Based on our in vitro results, we propose that in vivo PDI of S. aureus holds potential; however, PDI of P. aeruginosa and C. albicans will probably require such a strong PDI regime that it will induce substantial damage to fibroblasts.

Photodynamic therapy for periodontal diseases: State of the art

BACKGROUND

Photodynamic killing of periodontopathogenic bacteria may be an alternative to the systemic application of antibacterial drugs used in the treatment of periodontal diseases. Even though the method is still in the experimental stage, increasing bacterial resistance problems may promote the introduction of photodynamic therapy (PDT) into periodontal practice.

AIM

In this review a literature survey is given of PDT as seen from a periodontal perspective.

METHODS

In this review, the present knowledge and experience of PDT is summarized. Literature data are presented on drawbacks of conventional antibiotics, the mechanism of PDT, bactericidal effects of PDT as well as results of clinical efforts. The future prospects of the method are discussed.

RESULTS

The application of photosensitizing dyes and their excitation by visible light enables effective killing of periodontopathogens. Encouraging studies using PDT in periodontitis and in peri-implantitis are known.

CONCLUSION

Even though PDT is still in experimental stages of development and testing, the method may be an adjunct to conventional antibacterial measures in periodontology. Clinical follow-up studies are needed to confirm the efficacy of the procedure.

Photodynamic therapy targeted to pathogens

Photodynamic therapy (PDT) employs a non-toxic dye termed a photosensitizer (PS) together with low intensity visible light, which, in the presence of oxygen, produce cytotoxic species. PS can be targeted to its destination cell or tissue and, in addition, the irradiation can be spatially confined to the lesion giving PDT the advantage of dual selectivity. This promising approach can be used for various applications including microbial inactivation and the treatment of infections. Resistance to PDT has not been shown and multiantibiotic-resistant strains are as easily killed as naive strains. It is known that Gram (+) bacteria are more sensitive to PDT as compared to Gram (-) species. However, the use of cationic PS or agents that increase the permeability of the outer membrane allows for the effective killing of Gram (-) organisms. Some PS have an innate positive charge, but our approach is to link PS to a cationic molecular vehicle such as poly-L-lysine. This modification dramatically increases PS binding to and penetrating through the negatively charged bacterial permeability barrier. Due to focused light delivery the use of PDT is possible only for localized infections. Nonetheless numerous diseases can be treated. Selectivity of the PS for microbes over host cells, accurate delivery of the PS into the infected area, and PDT dose adjustment help minimize side effects and give PDT an advantage over conventional therapy. There are only a few reports about the use of antimicrobial PDT in animal models and clinical trials. We have used genetically modified bioluminescent bacteria to follow the effect of PDT in infected wounds, burns, and soft tissue infections in mice. Not only were bacteria infecting wounds, burns, and abscesses killed, but mice were saved from death due to sepsis and wound healing was improved.

Antibody-Directed Photodynamic Therapy of MethicillinResistant Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) is a world-wide public health problem, causing nosocomial and community-acquired infections. Furthermore, MRSA is increasingly resistant to many conventional antimicrobials, so there is a real need to develop alternative approaches for MRSA decolonization and treatment. Previously, we have demonstrated that MRSA can be killed with an immunoglobulin G (IgG)-SnCe6 conjugate and red light, but effectiveness was dependent on the particular strain and the growth phase. In this investigation, we used an antibody raised against MRSA to make an Ab-SnCe6 conjugate capable of targeting many MRSA strains in all growth phases. To suspensions of important epidemic MRSA, each grown to stationary, lag, or exponential phase, the Ab-SnCe6 conjugate was added and samples exposed to red light. Survivors were then enumerated. This treatment was very effective at killing all the different MRSA strains tested, in all growth phases. The Ab-SnCe6 conjugate was able to kill EMRSA-16 selectively in a mixed suspension of EMRSA-16 and Escherichia coli, and was much better at killing EMRSA-16 than a coagulase-negative staphylococcus, S. epidermidis. These results demonstrate that photodynamic therapy of MRSA is very effective when the photosensitizer is targeted to the pathogen using a suitable antibody and may be a good candidate for a novel treatment of MRSA infections.

The current status of laser applications in dentistry

A range of lasers is now available for use in dentistry. This paper summarizes key current and emerging applications for lasers in clinical practice. A major diagnostic application of low power lasers is the detection of caries, using fluorescence elicited from hydroxyapatite or from bacterial by-products. Laser fluorescence is an effective method for detecting and quantifying incipient occlusal and cervical carious lesions, and with further refinement could be used in the same manner for proximal lesions. Photoactivated dye techniques have been developed which use low power lasers to elicit a photochemical reaction. Photoactivated dye techniques can be used to disinfect root canals, periodontal pockets, cavity preparations and sites of peri-implantitis. Using similar principles, more powerful lasers can be used for photodynamic therapy in the treatment of malignancies of the oral mucosa. Laser-driven photochemical reactions can also be used for tooth whitening. In combination with fluoride, laser irradiation can improve the resistance of tooth structure to demineralization, and this application is of particular benefit for susceptible sites in high caries risk patients. Laser technology for caries removal, cavity preparation and soft tissue surgery is at a high state of refinement, having had several decades of development up to the present time. Used in conjunction with or as a replacement for traditional methods, it is expected that specific laser technologies will become an essential component of contemporary dental practice over the next decade.

Lethal photosensitization of periodontal pathogens by a red-filtered Xenon lamp in vitro

BACKGROUND

The ability of Helium-Neon (He-Ne) laser irradiation of a photosensitizer to induce localized phototoxic effects that kill periodontal pathogens is well documented and is termed photodynamic therapy (PDT).

OBJECTIVES

We investigated the potential of a conventional light source (red-filtered Xenon lamp) to activate toluidine blue O (TBO) in vitro and determined in vitro model parameters that may be used in future in vivo trials.

MATERIALS AND METHODS

Porphyromonas gingivalis 381 was used as the primary test bacterium.

RESULTS

Treatment with a 2.2 J/cm2 light dose and 50 micro g/ml TBO concentration resulted in a bacterial kill of 2.43 +/- 0.39 logs with the He-Ne laser control and 3.34 +/- 0.24 logs with the lamp, a near 10-fold increase (p = 0.028). Increases in light intensity produced significantly higher killing (p = 0.012) that plateaued at 25 mW/cm2. There was a linear relationship between light dose and bacterial killing (r2 = 0.916); as light dose was increased bacterial survival decreased. No such relationship was found for the drug concentrations tested. Addition of serum or blood at 50% v/v to the P. gingivalis suspension prior to irradiation diminished killing from approximately 5 logs to 3 logs at 10 J/cm2. When serum was washed off, killing returned to 5 logs for all species tested except Bacteroides forsythus (3.92 +/- 0.68 logs kill).

CONCLUSIONS

The data indicate that PDT utilizing a conventional light source is at least as effective as laser-induced treatment in vitro. Furthermore, PDT achieves significant bactericidal activity in the presence of serum and blood when used with the set parameters of 10 J/cm2, 100 mW/cm2 and 12.5 micro g/ml TBO.

Treatment of ligature-induced peri-implantitis by lethal photosensitization and guided bone regeneration: a preliminary histologic study in dogs

BACKGROUND

The purpose of this pilot study was to evaluate the healing potential and reosseointegration in ligature-induced peri-implantitis defects adjacent to various dental implant surfaces following lethal photosensitization.

METHODS

A total of 36 dental implants with 4 different surface coatings (9 commercially pure titanium surface [CPTi]; 9 titanium plasma-sprayed [TPS]; 9 hydroxyapatite [HA]; and 9 acid-etched [AE]) were inserted in 6 male mongrel dogs 3 months after extraction of mandibular premolars. After a 2-month period of ligature-induced peri-implantitis and 12 months of natural peri-implantitis progression, only 19 dental implants remained. The dogs underwent surgical debridement of the remaining dental implant sites and lethal photosensitization by combination of toluidine blue O (100 microg/ml) and irradiation with diode laser. All exposed dental implant surfaces and bone craters were meticulously cleaned by mechanical means, submitted to photodynamic therapy, and guided bone regeneration (GBR) using expanded polytetrafluoroethylene (ePTFE) membranes. Five months later, biopsies of the implant sites were dissected and prepared for ground sectioning and analysis.

RESULTS

The percentage of bone fill was HA: 48.28 +/- 15.00; TPS: 39.54 +/- 12.34; AE: 26.88 +/- 22.16; and CPTi: 26.70 +/- 16.50. The percentage of reosseointegration was TPS: 25.25 +/- 11.96; CPTi: 24.91 +/- 17.78; AE: 17.30 +/- 15.41; and HA: 15.83 +/- 9.64.

CONCLUSION

These data suggest that lethal photosensitization may have potential in the treatment of peri-implantitis.