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Abdo AI, Kopecki Z. Comparing Redox and Intracellular Signalling Responses to Cold Plasma in Wound Healing and Cancer. Curr Issues Mol Biol 2024; 46:4885-4923. [PMID: 38785562 PMCID: PMC11120013 DOI: 10.3390/cimb46050294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
Cold plasma (CP) is an ionised gas containing excited molecules and ions, radicals, and free electrons, and which emits electric fields and UV radiation. CP is potently antimicrobial, and can be applied safely to biological tissue, birthing the field of plasma medicine. Reactive oxygen and nitrogen species (RONS) produced by CP affect biological processes directly or indirectly via the modification of cellular lipids, proteins, DNA, and intracellular signalling pathways. CP can be applied at lower levels for oxidative eustress to activate cell proliferation, motility, migration, and antioxidant production in normal cells, mainly potentiated by the unfolded protein response, the nuclear factor-erythroid factor 2-related factor 2 (Nrf2)-activated antioxidant response element, and the phosphoinositide 3-kinase/protein kinase B (PI3K/Akt) pathway, which also activates nuclear factor-kappa B (NFκB). At higher CP exposures, inactivation, apoptosis, and autophagy of malignant cells can occur via the degradation of the PI3K/Akt and mitogen-activated protein kinase (MAPK)-dependent and -independent activation of the master tumour suppressor p53, leading to caspase-mediated cell death. These opposing responses validate a hormesis approach to plasma medicine. Clinical applications of CP are becoming increasingly realised in wound healing, while clinical effectiveness in tumours is currently coming to light. This review will outline advances in plasma medicine and compare the main redox and intracellular signalling responses to CP in wound healing and cancer.
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Affiliation(s)
- Adrian I. Abdo
- Richter Lab, Surgical Specialties, Adelaide Medical School, University of Adelaide, Adelaide, SA 5000, Australia
- Department of Surgery, The Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia
| | - Zlatko Kopecki
- Future Industries Institute, STEM Academic Unit, University of South Australia, Mawson Lakes, SA 5095, Australia
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Schmidt A, Singer D, Aden H, von Woedtke T, Bekeschus S. Gas Plasma Exposure Alters Microcirculation and Inflammation during Wound Healing in a Diabetic Mouse Model. Antioxidants (Basel) 2024; 13:68. [PMID: 38247492 PMCID: PMC10812527 DOI: 10.3390/antiox13010068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/21/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024] Open
Abstract
Diabetes can disrupt physiological wound healing, caused by decreased levels or impaired activity of angiogenic factors. This can contribute to chronic inflammation, poor formation of new blood vessels, and delayed re-epithelialization. The present study describes the preclinical application of medical gas plasma to treat a dermal, full-thickness ear wound in streptozotocin (STZ)-induced diabetic mice. Gas plasma-mediated effects occurred in both sexes but with gender-specific differences. Hyperspectral imaging demonstrated gas plasma therapy changing microcirculatory parameters, particularly oxygen saturation levels during wound healing, presumably due to the gas plasma's tissue delivery of reactive species and other bioactive components. In addition, gas plasma treatment significantly affected cell adhesion by regulating focal adhesion kinase and vinculin, which is important in maintaining skin barrier function by regulating syndecan expression and increasing re-epithelialization. An anticipated stimulation of blood vessel formation was detected via transcriptional and translational increase of angiogenic factors in gas plasma-exposed wound tissue. Moreover, gas plasma treatment significantly affected inflammation by modulating systemic growth factors and cytokine levels. The presented findings may help explain the mode of action of successful clinical plasma therapy of wounds of diabetic patients.
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Affiliation(s)
- Anke Schmidt
- ZIK plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Felix-Hausdorff-Str. 2, 17489 Greifswald, Germany
| | - Debora Singer
- ZIK plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Felix-Hausdorff-Str. 2, 17489 Greifswald, Germany
- Clinic and Policlinic for Dermatology and Venerology, Rostock University Medical Center, Strempelstr. 13, 18057 Rostock, Germany
| | - Henrike Aden
- ZIK plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Felix-Hausdorff-Str. 2, 17489 Greifswald, Germany
| | - Thomas von Woedtke
- ZIK plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Felix-Hausdorff-Str. 2, 17489 Greifswald, Germany
- Institute of Hygiene and Environmental Medicine, Greifswald University Medical Center, Sauerbruchstr., 17475 Greifswald, Germany
| | - Sander Bekeschus
- ZIK plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Felix-Hausdorff-Str. 2, 17489 Greifswald, Germany
- Clinic and Policlinic for Dermatology and Venerology, Rostock University Medical Center, Strempelstr. 13, 18057 Rostock, Germany
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Baz A, Bakri A, Butcher M, Short B, Ghimire B, Gaur N, Jenkins T, Short RD, Riggio M, Williams C, Ramage G, Brown JL. Staphylococcus aureus strains exhibit heterogenous tolerance to direct cold atmospheric plasma therapy. Biofilm 2023; 5:100123. [PMID: 37138646 PMCID: PMC10149328 DOI: 10.1016/j.bioflm.2023.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 05/05/2023] Open
Abstract
The global clinical and socioeconomic impact of chronic wounds is substantial. The main difficulty that clinicians face during the treatment of chronic wounds is the risk of infection at the wound site. Infected wounds arise from an accumulation of microbial aggregates in the wound bed, leading to the formation of polymicrobial biofilms that can be largely resistant to antibiotic therapy. Therefore, it is essential for studies to identify novel therapeutics to alleviate biofilm infections. One innovative technique is the use of cold atmospheric plasma (CAP) which has been shown to possess promising antimicrobial and immunomodulatory properties. Here, different clinically relevant biofilm models will be treated with cold atmospheric plasma to assess its efficacy and killing effects. Biofilm viability was assessed using live dead qPCR, and morphological changes associated with CAP evaluated using scanning electron microscopy (SEM). Results indicated that CAP was effective against Candida albicans and Pseudomonas aeruginosa, both as mono-species biofilms and when grown in a triadic model system. CAP also significantly reduced viability in the nosocomial pathogen, Candida auris. Staphylococcus aureus Newman exhibited a level of tolerance to CAP therapy, both when grown alone or in the triadic model when grown alongside C. albicans and P. aeruginosa. However, this degree of tolerance exhibited by S. aureus was strain dependent. At a microscopic level, biofilm treatment led to subtle changes in morphology in the susceptible biofilms, with evidence of cellular deflation and shrinkage. Taken together, these results indicate a promising application of direct CAP therapy in combatting wound and skin-related biofilm infections, although biofilm composition may affect the treatment efficacy.
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Affiliation(s)
- Abdullah Baz
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - Ahmed Bakri
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - Mark Butcher
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - Bryn Short
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - Bhagirath Ghimire
- Department of Chemistry and Material Science Institute, University of Lancaster, Lancaster, LA1 4YB, United Kingdom
| | - Nishtha Gaur
- Department of Chemistry and Material Science Institute, University of Lancaster, Lancaster, LA1 4YB, United Kingdom
| | - Toby Jenkins
- Department of Chemistry, University of Bath, Bath, BA2 7AY, United Kingdom
| | - Robert D. Short
- Department of Chemistry and Material Science Institute, University of Lancaster, Lancaster, LA1 4YB, United Kingdom
| | - Marcello Riggio
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - Craig Williams
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
- Microbiology Department, Lancaster Royal Infirmary, University of Lancaster, Lancaster, LA1 4YW, United Kingdom
| | - Gordon Ramage
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
| | - Jason L. Brown
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- Glasgow Biofilm Research Network, 378 Sauchiehall Street, Glasgow, G2 3JZ, United Kingdom
- Corresponding author. Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.
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Bekeschus S. Medical gas plasma technology: Roadmap on cancer treatment and immunotherapy. Redox Biol 2023; 65:102798. [PMID: 37556976 PMCID: PMC10433236 DOI: 10.1016/j.redox.2023.102798] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 08/11/2023] Open
Abstract
Despite continuous therapeutic progress, cancer remains an often fatal disease. In the early 2010s, first evidence in rodent models suggested promising antitumor action of gas plasma technology. Medical gas plasma is a partially ionized gas depositing multiple physico-chemical effectors onto tissues, especially reactive oxygen and nitrogen species (ROS/RNS). Today, an evergrowing body of experimental evidence suggests multifaceted roles of medical gas plasma-derived therapeutic ROS/RNS in targeting cancer alone or in combination with oncological treatment schemes such as ionizing radiation, chemotherapy, and immunotherapy. Intriguingly, gas plasma technology was recently unraveled to have an immunological dimension by inducing immunogenic cell death, which could ultimately promote existing cancer immunotherapies via in situ or autologous tumor vaccine schemes. Together with first clinical evidence reporting beneficial effects in cancer patients following gas plasma therapy, it is time to summarize the main concepts along with the chances and limitations of medical gas plasma onco-therapy from a biological, immunological, clinical, and technological point of view.
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Affiliation(s)
- Sander Bekeschus
- ZIK plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Felix-Hausdorff-Str. 2, 17489, Greifswald, Germany; Clinic and Policlinic for Dermatology and Venerology, Rostock University Medical Center, Strempelstr. 13, 18057, Rostock, Germany.
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Hofmeyer S, Weber F, Gerds S, Emmert S, Thiem A. A Prospective Randomized Controlled Pilot Study to Assess the Response and Tolerability of Cold Atmospheric Plasma for Rosacea. Skin Pharmacol Physiol 2023; 36:205-213. [PMID: 37490882 PMCID: PMC10652650 DOI: 10.1159/000533190] [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] [Received: 03/29/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Rosacea is a common, facial, chronic inflammatory skin disease. Due to its complex pathogenesis, adequate therapy of rosacea can be challenging. An innovative recent therapeutic tool is cold atmospheric plasma (CAP), which is already established in the treatment of chronic wounds and promising in different other skin diseases. METHODS In a split-face pilot study we investigated dielectric-barrier-discharged CAP in erythemato-telangiectatic (ETR) and/or papulopustular rosacea (PPR). CAP treatment was applied on lesional skin of a randomized side once daily (90 s/area) for 6 weeks. The other untreated side served as control. Co-primary endpoints were ≥1 improvement of the Investigator Global Assessment (IGA) score on the treated side compared to control and a decline of the Dermatology Life Quality Index (DLQI) after 6 weeks. Secondary endpoints included inflammatory lesion count (papules and pustules), skin redness intensity and erythema size. Adverse events (AEs) were recorded constantly. Additionally, participants were weekly assessed for symptoms, skin condition, trigger factors, skin care, treatment success, and local tolerance parameters. All p values were calculated using the Wilcoxon signed-rank test. RESULTS Twelve subjects (ETR, n = 3; ETR and PPR, n = 9) completed the study. DLQI was significantly improved after 6 weeks (p = 0.007). On the CAP-treated side, lesions (p = 0.007) and erythema size (p = 0.041) were significantly reduced compared to the control. IGA (p = 0.2) and skin redness intensity (p = 0.5) did not differ significantly between control and CAP-treated side. No serious AEs occurred and treatment was well tolerated. CONCLUSION CAP is a promising new treatment of rosacea, especially for PPR.
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Affiliation(s)
- Stella Hofmeyer
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Frank Weber
- Institute for Biostatistics and Informatics in Medicine and Ageing Research, University Medical Center Rostock, Rostock, Germany
| | - Sandra Gerds
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Steffen Emmert
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Alexander Thiem
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
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Suwanchinda A, Nararatwanchai T. The efficacy and safety of the innovative cold atmospheric-pressure plasma technology in the treatment of striae distensae: A randomized controlled trial. J Cosmet Dermatol 2022; 21:6805-6814. [PMID: 36217555 DOI: 10.1111/jocd.15458] [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: 07/26/2022] [Revised: 08/25/2022] [Accepted: 10/03/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Available current therapeutics modalities for striae distensae (SD) provide inconsistently effective outcomes. There is ongoing research on innovative treatment modalities to find better treatment solutions. OBJECTIVES To evaluate the efficacy and safety of innovative cold atmospheric plasma (CAP) technology in the treatment of striae distensae. METHODS This study includes twenty-three patients with striae distensae. The body was divided into two halves. One side was randomly treated with CAP biweekly on the same treated side for five sessions with 30 days follow-up after the last session. Another half was left untreated. Efficacy assessment was done using patient and observer scar assessment scale (POSAS), patient satisfaction scales, and Antera 3D® skin imaging system. Safety assessment was evaluated using the visual analog scale (VAS) and adverse effects monitoring. RESULTS Patient and observer scar assessment scale, patient and observer overall opinion score, and patient and observer total score in a summary of all rated characteristics, comparing treated and untreated areas, showed a statistically significant reduction in all parameters after one treatment (*p-value <0.05). Patients rated satisfaction as a great improvement in 52.3%, moderate improvement in 39.1%, extreme improvement in 4.3%, and slight improvement in 4.3%. Adverse effects included small scabs, shallow wounds, and rash. CONCLUSION Cold atmospheric plasma is a safe and effective, innovative treatment modality for striae distensae with minimal side effects.
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Affiliation(s)
- Atchima Suwanchinda
- Department of Dermatology, School of Anti-aging and Regenerative Medicine, Mae Fah Luang University, Bangkok, Thailand
| | - Thamthiwat Nararatwanchai
- Department of Dermatology, School of Anti-aging and Regenerative Medicine, Mae Fah Luang University, Bangkok, Thailand
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Borchardt T, Helmke A, Ernst J, Emmert S, Schilling AF, Felmerer G, Viöl W. Topically Confined Enhancement of Cutaneous Microcirculation by Cold Plasma. Skin Pharmacol Physiol 2022; 35:343-353. [PMID: 36353780 PMCID: PMC9811424 DOI: 10.1159/000527700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION We aim to explore potentials and modalities of cold atmospheric pressure plasma (CAP) for the subsequent development of therapies targeting an increased perfusion of the lower leg skin tissue. In this study, we addressed the question whether the microcirculation enhancement is restricted to the tissue in direct contact with plasma or if adjacent tissue might also benefit. METHODS A dielectric barrier discharge (DBD)-generated CAP device exhibiting an electrode area of 27.5 cm2 was used to treat the anterior lower leg of ten healthy subjects for 4.5 min. Subsequently, hyperspectral imaging was performed to measure the tempospatially resolved characteristics of microcirculation parameters in superficial (up to 1 mm) and deeper (up to 5 mm) skin layers. RESULTS In the tissue area covered by the plasma electrode, DBD-CAP treatment enhances most of the perfusion parameters. The maximum oxygen saturation increase reached 8%, the near-infrared perfusion index (NIR) increased by a maximum of 4%, and the maximum tissue hemoglobin increase equaled 14%. Tissue water index (TWI) was lower in both the control and the plasma groups, thus not affected by the DBD-CAP treatment. Yet, our study reveals that adjacent tissue is hardly affected by the enhancements in the electrode area, and the effects are locally confined. CONCLUSION Application of DBD-CAP to the lower leg resulted in enhancement of cutaneous microcirculation that extended 1 h beyond the treatment period with localization to the tissue area in direct contact with the cold plasma. This suggests the possibility of tailoring application schemes for topically confined enhancement of skin microcirculation, e.g., in the treatment of chronic wounds.
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Affiliation(s)
- Thomas Borchardt
- Faculty of Engineering and Health, HAWK University of Applied Sciences and Arts, Goettingen, Germany,*Thomas Borchardt,
| | - Andreas Helmke
- Faculty of Engineering and Health, HAWK University of Applied Sciences and Arts, Goettingen, Germany
| | - Jennifer Ernst
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen. Georg-August-University, Goettingen, Germany
| | - Steffen Emmert
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Arndt F. Schilling
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen. Georg-August-University, Goettingen, Germany
| | - Gunther Felmerer
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen. Georg-August-University, Goettingen, Germany
| | - Wolfgang Viöl
- Faculty of Engineering and Health, HAWK University of Applied Sciences and Arts, Goettingen, Germany
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Suwanchinda A, Nararatwanchai T. Efficacy and safety of the innovative cold atmospheric-pressure plasma technology in the treatment of keloid: A randomized controlled trial. J Cosmet Dermatol 2022; 21:6788-6797. [PMID: 36120805 DOI: 10.1111/jocd.15397] [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: 07/26/2022] [Revised: 09/10/2022] [Accepted: 09/16/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Keloid (KD) treatment is challenging for both physicians and patients. It can be functional debilitating and psychologically distressing. Available current therapeutics modalities give inconsistently effective results. OBJECTIVES To evaluate the efficacy and safety of innovative cold atmospheric plasma (CAP) technology in the treatment of keloid. METHODS This prospective, randomized control trial, the assessor-blinded trial, includes 18 patients with keloids. The keloid lesion was divided into two halves. One side was randomly treated with CAP technology biweekly on the same treated side for five sessions with a follow-up 30 days after finishing the final treatment. Another half was left untreated as a control. Efficacy assessment using POSAS, VSS, Patients' satisfaction scale, Antera 3D® skin imaging system. The safety assessment using VAS and adverse effects monitoring was completed. RESULTS Objective assessment using Antera 3D® skin imaging system (Miravex, Dublin, Ireland) showed statistically significant improvement (p-value <0.05) on the treated side compared with the untreated side in all parameters, color, melanin, hemoglobin, texture, except for volume. POSAS, patient, and observer overall opinion score, and patient and observer total score in the summary of all rated characteristics, comparing the treated and untreated areas, showed a statistically significant reduction in all parameters after two treatments (*p-value <0.05). VSS showed statistically significant improvement after the second treatment and continued to the last follow-up. Most patients rated satisfaction scales up to 72.2% as moderate improvement, 11.1% as great improvement, 11.1% as slight improvement, and 5.6% as no change. The adverse effect was only a small scab in one patient. CONCLUSION CAP technology could be considered an alternative treatment for keloid offering mild-to-moderate improvement with minimal side effects.
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Affiliation(s)
- Atchima Suwanchinda
- Department of Dermatology, School of Anti-aging and Regenerative Medicine, Mae Fah Luang University, Bangkok, Thailand
| | - Thamthiwat Nararatwanchai
- Department of Dermatology, School of Anti-aging and Regenerative Medicine, Mae Fah Luang University, Bangkok, Thailand
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Lin SP, Khumsupan D, Chou YJ, Hsieh KC, Hsu HY, Ting Y, Cheng KC. Applications of atmospheric cold plasma in agricultural, medical, and bioprocessing industries. Appl Microbiol Biotechnol 2022; 106:7737-7750. [PMID: 36329134 PMCID: PMC9638309 DOI: 10.1007/s00253-022-12252-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
Abstract
Abstract
Atmospheric cold plasma (ACP) is a nonthermal technology that is extensively used in several industries. Within the scopes of engineering and biotechnology, some notable applications of ACP include waste management, material modification, medicine, and agriculture. Notwithstanding numerous applications, ACP still encounters a number of challenges such as diverse types of plasma generators and sizes, causing standardization challenges. This review focuses on the uses of ACP in engineering and biotechnology sectors in which the innovation can positively impact the operation process, enhance safety, and reduce cost. Additionally, its limitations are examined. Since ACP is still in its nascent stage, the review will also propose potential research opportunities that can help scientists gain more insights on the technology. Key points • ACP technology has been used in agriculture, medical, and bioprocessing industries. • Chemical study on the reactive species is crucial to produce function-specific ACP. • Different ACP devices and conditions still pose standardization problems.
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Affiliation(s)
- Shin-Ping Lin
- School of Food Safety, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, Taiwan
| | - Darin Khumsupan
- Institute of Biotechnology, College of Bioresources and Agriculture, National Taiwan University, Taipei, Taiwan
| | - Yu-Jou Chou
- Institute of Food Science and Technology, College of Bioresources and Agriculture, National Taiwan University, Taipei, Taiwan
| | - Kuan-Chen Hsieh
- Institute of Food Science and Technology, College of Bioresources and Agriculture, National Taiwan University, Taipei, Taiwan
| | - Hsien-Yi Hsu
- School of Energy and Environment & Department of Materials Science and Engineering, City University of Hong Kong, Kowloon Tong, Hong Kong, China
- Shenzhen Research Institute of City University of Hong Kong, Shenzhen, 518057, China
| | - Yuwen Ting
- Institute of Food Science and Technology, College of Bioresources and Agriculture, National Taiwan University, Taipei, Taiwan.
| | - Kuan-Chen Cheng
- Institute of Biotechnology, College of Bioresources and Agriculture, National Taiwan University, Taipei, Taiwan.
- Institute of Food Science and Technology, College of Bioresources and Agriculture, National Taiwan University, Taipei, Taiwan.
- Department of Optometry, Asia University, 500, Lioufeng Rd., Wufeng, Taichung, 41354, Taiwan.
- Department of Medical Research, China Medical University Hospital, China Medical University, 91, Hsueh-Shih Road, Taichung, 40402, Taiwan.
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Efficacy of Cold Atmospheric Plasma Therapy on Chronic Wounds: An Updated Systematic Review and Meta-Analysis of RCTs. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5798857. [PMID: 36262869 PMCID: PMC9576403 DOI: 10.1155/2022/5798857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/26/2022] [Indexed: 11/22/2022]
Abstract
Objective A previous meta-analysis has revealed that cold atmospheric plasma (CAP) might not be clinically beneficial to chronic wounds. However, several new randomized controlled trials (RCTs) reported that CAP was an effective treatment option for accelerating wound healing in chronic wounds. The purpose of this review is to incorporate these new results and evaluate the efficacy of CAP in chronic wounds. Methods The major databases, including PubMed, Embase, Cochrane Library, and Web of Science, were searched for articles related to CAP treatment in chronic wounds until March 21, 2022. The literature retrieval and evaluation were carried out by two independent researchers. Result A total of 13 randomized clinical trials published between 2010 and 2022 were finally included. CAP therapy showed to be more effective in reducing the area of wounds (mean difference (MD): -1.74, 95%; confidence interval (CI): [-3.14, -0.33], p = 0.02), compared with non-CAP treatments. The immediate reduction of the bacterial load was higher in the CAP group than in the control group. (MD: -0.37, 95%; CI: [-0.7, -0.05], p = 0.02). Conclusion No significant changes were found in long-term antibacterial efficacy and pain perception between the two groups. However, more RCTs of excellent methodological quality are required to confirm technical details of the source of AP and the appropriate duration of the treatment with plasma.
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Roy A, Banerjee A, Das SC, Vaid A, Katiyal S, Majumdar A. Tolerance effect of a shock-free atmospheric plasma on human skin. APPLIED PHYSICS. A, MATERIALS SCIENCE & PROCESSING 2022; 128:866. [PMID: 36101661 PMCID: PMC9454411 DOI: 10.1007/s00339-022-06022-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED In this work, a shock-free argon-fed plasma plume was generated by a variable-frequency power supply and the discharge characteristics were investigated from the voltage and current waveforms between 72 and 92 kHz frequencies. The higher electron temperature dominates the plasma chemical process and the average plasma temperature is about 30 ℃ under these conditions. The influence of non-thermal atmospheric plasma plume length and plume temperature on Ar gas flow is optimized at 7 sL/min. The average charge accumulation on the plume tip area and the dependence of flow rate on the plasma irradiation area were also explored. This atmospheric pressure plasma jet (APPJ) has been proposed for human-skin irradiation on different areas (even on the tongue) owing to its less painful, tingling and burning effect. Optical emission spectroscopy (OES) confirmed the presence of excited argon with reactive nitrogen (RNS) and oxygen species (ROS). This study contributes to a better understanding of non-thermal plasma effects on the human body which may find prospects for disinfection and prevention of different diseases during the current pandemic time. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s00339-022-06022-w.
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Affiliation(s)
- Avishek Roy
- Department of Electronics, Vidyasagar College, 39 Sankar Ghosh Lane, Kolkata, 700006 India
| | - Arindam Banerjee
- Department of Physics, Indian Institute of Engineering Science and Technology, Shibpur, 711103 India
| | | | - Akshay Vaid
- FCIPT Division, Institute for Plasma Research, A10-B, GIDC, Gandhinagar, 382044 India
| | - Sumant Katiyal
- School of Electronics, Devi Ahilya Vishwavidyalaya, Indore, 452001 India
| | - Abhijit Majumdar
- Department of Physics, Indian Institute of Engineering Science and Technology, Shibpur, 711103 India
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Zhang Z, Chen H, Shen W, Deng J, Bai C, Xiao Y, Lyu L. Localized delivery of curcumin by thermosensitive hydrogels for promoting wound healing. J Cosmet Dermatol 2022; 21:5081-5091. [PMID: 35384267 DOI: 10.1111/jocd.14967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Curcumin can promote wound healing, but its drug delivery medium needs to be improved further. OBJECTIVES A curcumin-loaded thermosensitive hydrogel was prepared, its characterization was evaluated, and its promoting effect on wound healing was observed. METHODS Curcumin-loaded thermosensitive hydrogels were prepared with different percentages of poloxamer 188 and poloxamer 407. A small tube inversion assay was used to observe the sol-gel transition temperature, and a rotational rheometer was used to detect the sol viscosity, sol-gel phase transition temperature and phase transition time. The microstructure of the gel was observed by scanning electron microscopy, and Fourier infrared spectroscopy was used to evaluate whether curcumin was successfully loaded. Finally, its promoting effect on wound healing was observed in vivo and in vitro. RESULTS Poloxamer 407 24% and poloxamer 188 1% were selected to prepare curcumin-loaded thermosensitive hydrogels. After 60 ± 15 s at 32 °C, the sol-gel transition process was completed, with certain elastic behavior and solid-like rheological properties. Scanning electron microscopy showed that the pores of the curcumin-P407/P188 thermosensitive hydrogel were interconnected, with an average pore size ranging from 5 to 10 μm. Hydrogels showed a higher swelling ratio. Fourier transform infrared spectroscopy showed that curcumin had been incorporated into the hydrogel. Live/dead cell assays suggested that the hydrogel was not toxic to fibroblasts. Curcumin-loaded thermosensitive hydrogels can promote an increase in S-phase fibroblasts and improve wound healing. CONCLUSIONS Curcumin-loaded P407/P188 thermosensitive hydrogel improves wound healing. More in-depth research is needed in the future.
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Affiliation(s)
- Zhigang Zhang
- Science and Technology Achievement Incubation Center, Kunming Medical University, Kunming, Yunnan, China
| | - Huiya Chen
- Department of Dermatology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Wanlu Shen
- Science and Technology Achievement Incubation Center, Kunming Medical University, Kunming, Yunnan, China
| | - Juqing Deng
- Science and Technology Achievement Incubation Center, Kunming Medical University, Kunming, Yunnan, China
| | - Chunling Bai
- Science and Technology Achievement Incubation Center, Kunming Medical University, Kunming, Yunnan, China
| | - Yun Xiao
- Department of Dermatology, The Third Affiliated Hospital, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Lechun Lyu
- Science and Technology Achievement Incubation Center, Kunming Medical University, Kunming, Yunnan, China
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Atmospheric pressure plasma jet-mouse skin interaction: Mitigation of damages by liquid interface and gas flow control. Biointerphases 2022; 17:021004. [PMID: 35360909 DOI: 10.1116/6.0001596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The possible benefits of an atmospheric pressure plasma jet skin treatment have been tested in vivo on mouse skin. Many studies have been conducted in vitro on mouse skin cells, but only a few in vivo where, due to the complexity of the biological system, plasma can cause severe damages. For this reason, we investigated how kHz plasma generated in a jet that is known to inflict skin damage interacts with mouse skin and explored how we can reduce the skin damage. First, the focus was on exploring plasma effects on skin damage formation with different plasma gases and jet inclinations. The results pointed to the perpendicular orientation of a He plasma jet as the most promising condition with the least skin damage. Then, the skin damage caused by a He plasma jet was explored, focusing on damage mitigation with different liquid interfaces applied to the treatment site, adding N2 to the gas mixture, or alternating the gas flow dynamics by elongating the jet's glass orifice with a funnel. All these mitigations proved highly efficient, but the utmost benefits for skin damage reduction were connected to skin temperature reduction, the reduction in reactive oxygen species (ROS), and the increase in reactive nitrogen species (RNS).
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Bekeschus S, von Woedtke T, Emmert S, Schmidt A. Medical gas plasma-stimulated wound healing: Evidence and mechanisms. Redox Biol 2021; 46:102116. [PMID: 34474394 PMCID: PMC8408623 DOI: 10.1016/j.redox.2021.102116] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022] Open
Abstract
Defective wound healing poses a significant burden on patients and healthcare systems. In recent years, a novel reactive oxygen and nitrogen species (ROS/RNS) based therapy has received considerable attention among dermatologists for targeting chronic wounds. The multifaceted ROS/RNS are generated using gas plasma technology, a partially ionized gas operated at body temperature. This review integrates preclinical and clinical evidence into a set of working hypotheses mainly based on redox processes aiding in elucidating the mechanisms of action and optimizing gas plasmas for therapeutic purposes. These hypotheses include increased wound tissue oxygenation and vascularization, amplified apoptosis of senescent cells, redox signaling, and augmented microbial inactivation. Instead of a dominant role of a single effector, it is proposed that all mechanisms act in concert in gas plasma-stimulated healing, rationalizing the use of this technology in therapy-resistant wounds. Finally, addressable current challenges and future concepts are outlined, which may further promote the clinical utilization, efficacy, and safety of gas plasma technology in wound care in the future.
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Affiliation(s)
- Sander Bekeschus
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), A Member of the Leibniz Research Alliance Leibniz Health Technology, Felix-Hausdorff-Str. 2, 17489, Greifswald, Germany.
| | - Thomas von Woedtke
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), A Member of the Leibniz Research Alliance Leibniz Health Technology, Felix-Hausdorff-Str. 2, 17489, Greifswald, Germany; Institute for Hygiene and Environmental Medicine, Greifswald University Medical Center, Sauerbruchstr., 17475, Greifswald, Germany
| | - Steffen Emmert
- Clinic for Dermatology and Venereology, Rostock University Medical Center, Strempelstr. 13, 18057, Rostock, Germany
| | - Anke Schmidt
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), A Member of the Leibniz Research Alliance Leibniz Health Technology, Felix-Hausdorff-Str. 2, 17489, Greifswald, Germany
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Bekeschus S, Kramer A, Schmidt A. Gas Plasma-Augmented Wound Healing in Animal Models and Veterinary Medicine. Molecules 2021; 26:molecules26185682. [PMID: 34577153 PMCID: PMC8469854 DOI: 10.3390/molecules26185682] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 12/26/2022] Open
Abstract
The loss of skin integrity is inevitable in life. Wound healing is a necessary sequence of events to reconstitute the body’s integrity against potentially harmful environmental agents and restore homeostasis. Attempts to improve cutaneous wound healing are therefore as old as humanity itself. Furthermore, nowadays, targeting defective wound healing is of utmost importance in an aging society with underlying diseases such as diabetes and vascular insufficiencies being on the rise. Because chronic wounds’ etiology and specific traits differ, there is widespread polypragmasia in targeting non-healing conditions. Reactive oxygen and nitrogen species (ROS/RNS) are an overarching theme accompanying wound healing and its biological stages. ROS are signaling agents generated by phagocytes to inactivate pathogens. Although ROS/RNS’s central role in the biology of wound healing has long been appreciated, it was only until the recent decade that these agents were explicitly used to target defective wound healing using gas plasma technology. Gas plasma is a physical state of matter and is a partially ionized gas operated at body temperature which generates a plethora of ROS/RNS simultaneously in a spatiotemporally controlled manner. Animal models of wound healing have been vital in driving the development of these wound healing-promoting technologies, and this review summarizes the current knowledge and identifies open ends derived from in vivo wound models under gas plasma therapy. While gas plasma-assisted wound healing in humans has become well established in Europe, veterinary medicine is an emerging field with great potential to improve the lives of suffering animals.
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Affiliation(s)
- Sander Bekeschus
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Felix-Hausdorff-Str. 2, 17489 Greifswald, Germany;
- Correspondence:
| | - Axel Kramer
- Institute for Hygiene and Environmental Medicine, Greifswald University Medical Center, Sauerbruchstr., 17475 Greifswald, Germany;
| | - Anke Schmidt
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), Felix-Hausdorff-Str. 2, 17489 Greifswald, Germany;
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Thiem A, Has C, Diem A, Klausegger A, Hamm H, Emmert S. [Wound therapy with cold atmospheric plasma in severe recessive dystrophic epidermolysis bullosa : A pilot study]. Hautarzt 2021; 73:384-390. [PMID: 34519836 DOI: 10.1007/s00105-021-04883-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cold atmospheric pressure plasma (CAP) has antimicrobial and wound-healing properties. Patients affected by severe autosomal recessive dystrophic epidermolysis bullosa (RDEB) suffer from widespread, difficult-to-treat wounds, which require complex wound management. OBJECTIVE In a pilot project, we investigated over a period of 5 months the response and tolerability of a CAP wound therapy in a 21-year-old and a 28-year-old female patient with severe generalized RDEB and following cutaneous squamous cell cancer (cSSC) in the older patient. MATERIALS AND METHODS In both patients, diagnosis of RDEB was confirmed by molecular genetics. Individual- and patient-specific wound therapy was continued during the study period, and additionally CAP therapy with a dielectric barrier discharge (DBE) device was initiated. CAP treatment was performed for 90 s per wound and could be applied every day or every other day. Clinical evaluation included photographic documentation and regular interviews of patients and parents. RESULTS CAP-treated wounds largely demonstrated improved wound healing and signs of a reduced bacterial contamination. Furthermore, CAP proved to prevent wound chronification. When applied on a polyester mesh, it was well-tolerated on most body sites. CONCLUSION The introduction of CAP could improve the wound management of EB patients and should be evaluated in clinical studies. The effect of CAP on cSSC development should be particularly studied.
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Affiliation(s)
- Alexander Thiem
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock, Strempelstr. 13, 18057, Rostock, Deutschland.
| | - Cristina Has
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Anja Diem
- EB-Ambulanz, Universitätsklinik für Dermatologie und Allergologie, Universitätsklinikum Salzburg, Salzburg, Österreich
| | - Alfred Klausegger
- EB-Ambulanz, Universitätsklinik für Dermatologie und Allergologie, Universitätsklinikum Salzburg, Salzburg, Österreich
| | - Henning Hamm
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Steffen Emmert
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock, Strempelstr. 13, 18057, Rostock, Deutschland
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