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Wang L, Ren M, Chen C, Yang X, Zhang C, Gao J, Wang J, Yang C. Cold atmospheric plasma in combination with laser therapy provides a window for the treatment of hyperproliferative skin disease. Photodiagnosis Photodyn Ther 2024; 48:104243. [PMID: 38862086 DOI: 10.1016/j.pdpdt.2024.104243] [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: 01/07/2024] [Revised: 04/09/2024] [Accepted: 06/07/2024] [Indexed: 06/13/2024]
Abstract
Modern medical understanding suggests that hyperproliferative skin diseases (HSDs) are complex syndromes characterized by localized hypertrophy or hyperplasia and infiltration of inflammatory cells. Various treatments, including systemic and topical pharmacotherapy, laser interventions, photodynamic therapy, and surgery, have been proposed for managing HSDs. However, challenges such as wound healing and recurrence after laser treatment have hindered the effectiveness of laser therapy. To overcome these challenges, we conducted a study combining laser therapy with cold atmospheric plasma (CAP) for the treatment of HSDs. Seven patients with different forms of HSDs, who had not responded well to conventional treatments, were enrolled in the study. These HSDs included cases of erythroplasia of Queyrat, pyoderma gangrenosum, keloids and hypertrophic scars, cellulitis, cutaneous lichen planus, and verruca vulgaris. Laser therapy was performed to remove the hyperplastic skin lesions, followed immediately by daily CAP treatment. The results were promising, with all patients successfully treated and no recurrence observed during the follow-up periods. The combined application of CAP and laser therapy proved to be an effective and complementary strategy for managing HSDs. This innovative approach provide evidence for addressing the limitation of laser therapy by utilizing CAP to promote wound healing and mitigate inflammatory responses. Chinese Clinical Trial Registry (ChiCTR2300069993).
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Affiliation(s)
- Liyun Wang
- Department of Dermatology and Venereology, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230601, China; Joint Laboratory for Plasma Clinical Applications, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230601, China
| | - Miaomiao Ren
- Department of Dermatology and Venereology, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230601, China; Joint Laboratory for Plasma Clinical Applications, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230601, China
| | - Cheng Chen
- Department of Dermatology and Venereology, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230601, China; Joint Laboratory for Plasma Clinical Applications, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230601, China
| | - Xingyu Yang
- Department of Dermatology and Venereology, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230601, China; Joint Laboratory for Plasma Clinical Applications, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230601, China
| | - Chenchen Zhang
- Department of Dermatology and Venereology, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230601, China; Joint Laboratory for Plasma Clinical Applications, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230601, China
| | - Jing Gao
- Department of Dermatology and Venereology, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230601, China; Joint Laboratory for Plasma Clinical Applications, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230601, China
| | - Jingwen Wang
- Department of Dermatology and Venereology, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230601, China; Joint Laboratory for Plasma Clinical Applications, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230601, China
| | - Chunjun Yang
- Department of Dermatology and Venereology, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230601, China; Joint Laboratory for Plasma Clinical Applications, the Second Affiliated Hospital of Anhui Medical University, Anhui Medical University, Hefei 230601, China.
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Barjasteh A, Kaushik N, Choi EH, Kaushik NK. Cold Atmospheric Pressure Plasma Solutions for Sustainable Food Packaging. Int J Mol Sci 2024; 25:6638. [PMID: 38928343 PMCID: PMC11203612 DOI: 10.3390/ijms25126638] [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: 05/23/2024] [Revised: 06/13/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Increasing the number of resistant bacteria resistant to treatment is one of the leading causes of death worldwide. These bacteria are created in wounds and injuries and can be transferred through hospital equipment. Various attempts have been made to treat these bacteria in recent years, such as using different drugs and new sterilization methods. However, some bacteria resist drugs, and other traditional methods cannot destroy them. In the meantime, various studies have shown that cold atmospheric plasma can kill these bacteria through different mechanisms, making cold plasma a promising tool to deactivate bacteria. This new technology can be effectively used in the food industry because it has the potential to inactivate microorganisms such as spores and microbial toxins and increase the wettability and printability of polymers to pack fresh and dried food. It can also increase the shelf life of food without leaving any residue or chemical effluent. This paper investigates cold plasma's potential, advantages, and disadvantages in the food industry and sterilization.
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Affiliation(s)
- Azadeh Barjasteh
- Department of Physics, Lorestan University, Khorramabad 68151-44316, Iran;
| | - Neha Kaushik
- Department of Biotechnology, College of Engineering, The University of Suwon, Hwaseong 18323, Republic of Korea;
| | - Eun Ha Choi
- Department of Electrical and Biological Physics, Plasma Bioscience Research Center, Kwangwoon University, Seoul 01897, Republic of Korea;
| | - Nagendra Kumar Kaushik
- Department of Electrical and Biological Physics, Plasma Bioscience Research Center, Kwangwoon University, Seoul 01897, Republic of Korea;
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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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Hasse S, Sommer MC, Guenther S, Schulze C, Bekeschus S, von Woedtke T. Exploring the Influence of Cold Plasma on Epidermal Melanogenesis In Situ and In Vitro. Int J Mol Sci 2024; 25:5186. [PMID: 38791225 PMCID: PMC11120903 DOI: 10.3390/ijms25105186] [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: 03/30/2024] [Revised: 04/30/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
Epidermal melanin synthesis determines an individual's skin color. In humans, melanin is formed by melanocytes within the epidermis. The process of melanin synthesis strongly depends on a range of cellular factors, including the fine-tuned interplay with reactive oxygen species (ROS). In this context, a role of cold atmospheric plasma (CAP) on melanin synthesis was proposed due to its tunable ROS generation. Herein, the argon-driven plasma jet kINPen® MED was employed, and its impact on melanin synthesis was evaluated by comparison with known stimulants such as the phosphodiesterase inhibitor IBMX and UV radiation. Different available model systems were employed, and the melanin content of both cultured human melanocytes (in vitro) and full-thickness human skin biopsies (in situ) were analyzed. A histochemical method detected melanin in skin tissue. Cellular melanin was measured by NIR autofluorescence using flow cytometry, and a highly sensitive HPLC-MS method was applied, which enabled the differentiation of eu- and pheomelanin by their degradation products. The melanin content in full-thickness human skin biopsies increased after repeated CAP exposure, while there were only minor effects in cultured melanocytes compared to UV radiation and IBMX treatment. Based on these findings, CAP does not appear to be a useful option for treating skin pigmentation disorders. On the other hand, the risk of hyperpigmentation as an adverse effect of CAP application for wound healing or other dermatological diseases seems to be neglectable.
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Affiliation(s)
- Sybille Hasse
- Leibniz Institute for Plasma Science and Technology e.V. (INP), a Member of the Leibniz Health Technologies Research Alliance, Felix-Hausdorff-Str. 2, 17489 Greifswald, Germany; (M.-C.S.); (S.B.); (T.v.W.)
| | - Marie-Christine Sommer
- Leibniz Institute for Plasma Science and Technology e.V. (INP), a Member of the Leibniz Health Technologies Research Alliance, Felix-Hausdorff-Str. 2, 17489 Greifswald, Germany; (M.-C.S.); (S.B.); (T.v.W.)
| | - Sebastian Guenther
- Institute of Pharmacy, Department Pharmaceutical Biology, Greifswald University, Friedrich-Ludwig-Jahn-Str. 17, 17489 Greifswald, Germany; (S.G.); (C.S.)
| | - Christian Schulze
- Institute of Pharmacy, Department Pharmaceutical Biology, Greifswald University, Friedrich-Ludwig-Jahn-Str. 17, 17489 Greifswald, Germany; (S.G.); (C.S.)
| | - Sander Bekeschus
- Leibniz Institute for Plasma Science and Technology e.V. (INP), a Member of the Leibniz Health Technologies Research Alliance, Felix-Hausdorff-Str. 2, 17489 Greifswald, Germany; (M.-C.S.); (S.B.); (T.v.W.)
| | - Thomas von Woedtke
- Leibniz Institute for Plasma Science and Technology e.V. (INP), a Member of the Leibniz Health Technologies Research Alliance, Felix-Hausdorff-Str. 2, 17489 Greifswald, Germany; (M.-C.S.); (S.B.); (T.v.W.)
- Institute for Hygiene and Environmental Medicine, Greifswald University Medical Centre, Walther-Rathenau-Str. 48, 17489 Greifswald, Germany
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Barjasteh A, Kaushik N, Choi EH, Kaushik NK. Cold Atmospheric Pressure Plasma: A Growing Paradigm in Diabetic Wound Healing-Mechanism and Clinical Significance. Int J Mol Sci 2023; 24:16657. [PMID: 38068979 PMCID: PMC10706109 DOI: 10.3390/ijms242316657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
Diabetes is one of the most significant causes of death all over the world. This illness, due to abnormal blood glucose levels, leads to impaired wound healing and, as a result, foot ulcers. These ulcers cannot heal quickly in diabetic patients and may finally result in amputation. In recent years, different research has been conducted to heal diabetic foot ulcers: one of them is using cold atmospheric pressure plasma. Nowadays, cold atmospheric pressure plasma is highly regarded in medicine because of its positive effects and lack of side effects. These conditions have caused plasma to be considered a promising technology in medicine and especially diabetic wound healing because studies show that it can heal chronic wounds that are resistant to standard treatments. The positive effects of plasma are due to different reactive species, UV radiation, and electromagnetic fields. This work reviews ongoing cold atmospheric pressure plasma improvements in diabetic wound healing. It shows that plasma can be a promising tool in treating chronic wounds, including ones resulting from diabetes.
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Affiliation(s)
- Azadeh Barjasteh
- Department of Physics, Lorestan University, Khorramabad 68151-44316, Iran;
| | - Neha Kaushik
- Department of Biotechnology, College of Engineering, The University of Suwon, Hwaseong 18323, Republic of Korea;
| | - Eun Ha Choi
- Department of Electrical and Biological Physics/Plasma, Bioscience Research Center, Kwangwoon University, Seoul 01897, Republic of Korea;
| | - Nagendra Kumar Kaushik
- Department of Electrical and Biological Physics/Plasma, Bioscience Research Center, Kwangwoon University, Seoul 01897, Republic of Korea;
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Ongkasuwan P. A novel treatment approach for traumatic scalp defects with exposed calvaria denuded of pericranium by combined application of low-temperature plasma and negative pressure wound therapy: A case series. Health Sci Rep 2023; 6:e1578. [PMID: 37752976 PMCID: PMC10519155 DOI: 10.1002/hsr2.1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/11/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
Background and Aims Traumatic scalp defects with an exposed calvaria denuded of the pericranium are challenging to manage. In such cases, adjunctive therapies, such as milling the outer calvarial cortex and applying negative pressure wound therapy (NPWT), can promote granulation tissue. This case series describes the successful management of traumatic scalp defects after cortical craniectomy using a combination of low-temperature plasma (LTP) and NPWT. Methods This is a retrospective single-surgeon case series. Three patients with traumatic scalp wound defects underwent cortical calvarial bone removal after LTP combined with NPWT. LTP was applied to the diploic space of the calvaria weekly or twice weekly using BioPlasmaJet BPJ1 (BIOPlasma System: Model-BioPlasmaJet System). Subsequently, NPWT was applied with a continuous pressure of 110 mmHg until good granulation tissue formation was achieved for skin graft placement. Results Two males and one female were included, and the mean follow-up duration was 7 (range 3-12) months. In addition, the average time to achieve good granulation tissue formation was 4 (2-6) weeks; all patients achieved successful split-thickness skin grafting within 3 weeks after placement without signs of calvarial infection. Conclusions The combination of LTP and NPWT is a safe and effective treatment modality for scalp defects with exposed calvaria denuded of the pericranium resulting from trauma. Combining these two therapies may provide a synergistic effect that enhances granulation tissue formation and prevents local infections without complications.
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Affiliation(s)
- Pattana Ongkasuwan
- Department of General Surgery, Plastic and Reconstructive Surgery UnitNakornping HospitalChiang MaiThailand
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7
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Wang Y, Abazid A, Badendieck S, Mustea A, Stope MB. Impact of Non-Invasive Physical Plasma on Heat Shock Protein Functionality in Eukaryotic Cells. Biomedicines 2023; 11:biomedicines11051471. [PMID: 37239142 DOI: 10.3390/biomedicines11051471] [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: 04/04/2023] [Revised: 05/06/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Recently, biomedical research has increasingly investigated physical plasma as an innovative therapeutic approach with a number of therapeutic biomedical effects. It is known from radiation and chemotherapy that these applications can lead to the induction and activation of primarily cytoprotective heat shock proteins (HSP). HSP protect cells and tissues from physical, (bio)chemical, and physiological stress and, ultimately, along with other mechanisms, govern resistance and treatment failure. These mechanisms are well known and comparatively well studied in drug therapy. For therapies in the field of physical plasma medicine, however, extremely little data are available to date. In this review article, we provide an overview of the current studies on the interaction of physical plasma with the cellular HSP system.
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Affiliation(s)
- Yanqing Wang
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Abazid
- Department of General, Visceral and Thorax Surgery, Bundeswehr Hospital Berlin, Scharnhorststrasse 13, 10115 Berlin, Germany
| | - Steffen Badendieck
- Department of General, Visceral and Thorax Surgery, Bundeswehr Hospital Berlin, Scharnhorststrasse 13, 10115 Berlin, Germany
| | - Alexander Mustea
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Matthias B Stope
- Department of Gynecology and Gynecological Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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8
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Gesundheitsökonomische Aspekte der Kaltplasmatherapie:
exemplarische Betrachtung der Versorgung chronischer Wunden mithilfe des
Plasmajet kINPen® MED. GESUNDHEITSÖKONOMIE & QUALITÄTSMANAGEMENT 2023. [DOI: 10.1055/a-2001-1879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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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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Shaw P, Vanraes P, Kumar N, Bogaerts A. Possible Synergies of Nanomaterial-Assisted Tissue Regeneration in Plasma Medicine: Mechanisms and Safety Concerns. NANOMATERIALS (BASEL, SWITZERLAND) 2022; 12:3397. [PMID: 36234523 PMCID: PMC9565759 DOI: 10.3390/nano12193397] [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: 08/15/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
Cold atmospheric plasma and nanomedicine originally emerged as individual domains, but are increasingly applied in combination with each other. Most research is performed in the context of cancer treatment, with only little focus yet on the possible synergies. Many questions remain on the potential of this promising hybrid technology, particularly regarding regenerative medicine and tissue engineering. In this perspective article, we therefore start from the fundamental mechanisms in the individual technologies, in order to envision possible synergies for wound healing and tissue recovery, as well as research strategies to discover and optimize them. Among these strategies, we demonstrate how cold plasmas and nanomaterials can enhance each other's strengths and overcome each other's limitations. The parallels with cancer research, biotechnology and plasma surface modification further serve as inspiration for the envisioned synergies in tissue regeneration. The discovery and optimization of synergies may also be realized based on a profound understanding of the underlying redox- and field-related biological processes. Finally, we emphasize the toxicity concerns in plasma and nanomedicine, which may be partly remediated by their combination, but also partly amplified. A widespread use of standardized protocols and materials is therefore strongly recommended, to ensure both a fast and safe clinical implementation.
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Affiliation(s)
- Priyanka Shaw
- Research Group PLASMANT, Department of Chemistry, University of Antwerp, 2610 Antwerp, Belgium
| | - Patrick Vanraes
- Research Group PLASMANT, Department of Chemistry, University of Antwerp, 2610 Antwerp, Belgium
| | - Naresh Kumar
- Department of Medical Devices, National Institute of Pharmaceutical Education and Research, Guwahati 781125, Assam, India
| | - Annemie Bogaerts
- Research Group PLASMANT, Department of Chemistry, University of Antwerp, 2610 Antwerp, Belgium
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Innovative Treatment Strategies to Accelerate Wound Healing: Trajectory and Recent Advancements. Cells 2022; 11:cells11152439. [PMID: 35954282 PMCID: PMC9367945 DOI: 10.3390/cells11152439] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/26/2022] Open
Abstract
Wound healing is highly specialized dynamic multiple phase process for the repair of damaged/injured tissues through an intricate mechanism. Any failure in the normal wound healing process results in abnormal scar formation, and chronic state which is more susceptible to infections. Chronic wounds affect patients’ quality of life along with increased morbidity and mortality and are huge financial burden to healthcare systems worldwide, and thus requires specialized biomedical intensive treatment for its management. The clinical assessment and management of chronic wounds remains challenging despite the development of various therapeutic regimens owing to its painstakingly long-term treatment requirement and complex wound healing mechanism. Various conventional approaches such as cell therapy, gene therapy, growth factor delivery, wound dressings, and skin grafts etc., are being utilized for promoting wound healing in different types of wounds. However, all these abovementioned therapies are not satisfactory for all wound types, therefore, there is an urgent demand for the development of competitive therapies. Therefore, there is a pertinent requirement to develop newer and innovative treatment modalities for multipart therapeutic regimens for chronic wounds. Recent developments in advanced wound care technology includes nanotherapeutics, stem cells therapy, bioengineered skin grafts, and 3D bioprinting-based strategies for improving therapeutic outcomes with a focus on skin regeneration with minimal side effects. The main objective of this review is to provide an updated overview of progress in therapeutic options in chronic wounds healing and management over the years using next generation innovative approaches. Herein, we have discussed the skin function and anatomy, wounds and wound healing processes, followed by conventional treatment modalities for wound healing and skin regeneration. Furthermore, various emerging and innovative strategies for promoting quality wound healing such as nanotherapeutics, stem cells therapy, 3D bioprinted skin, extracellular matrix-based approaches, platelet-rich plasma-based approaches, and cold plasma treatment therapy have been discussed with their benefits and shortcomings. Finally, challenges of these innovative strategies are reviewed with a note on future prospects.
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12
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Modulating the Antioxidant Response for Better Oxidative Stress-Inducing Therapies: How to Take Advantage of Two Sides of the Same Medal? Biomedicines 2022; 10:biomedicines10040823. [PMID: 35453573 PMCID: PMC9029215 DOI: 10.3390/biomedicines10040823] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/17/2023] Open
Abstract
Oxidative stress-inducing therapies are characterized as a specific treatment that involves the production of reactive oxygen and nitrogen species (RONS) by external or internal sources. To protect cells against oxidative stress, cells have evolved a strong antioxidant defense system to either prevent RONS formation or scavenge them. The maintenance of the redox balance ensures signal transduction, development, cell proliferation, regulation of the mechanisms of cell death, among others. Oxidative stress can beneficially be used to treat several diseases such as neurodegenerative disorders, heart disease, cancer, and other diseases by regulating the antioxidant system. Understanding the mechanisms of various endogenous antioxidant systems can increase the therapeutic efficacy of oxidative stress-based therapies, leading to clinical success in medical treatment. This review deals with the recent novel findings of various cellular endogenous antioxidant responses behind oxidative stress, highlighting their implication in various human diseases, such as ulcers, skin pathologies, oncology, and viral infections such as SARS-CoV-2.
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Nitsch A, Napiletzki K, Stope MB. Non‐invasive physical plasma (NIPP) treatment of a hedgehog with head injury: A novel therapy in veterinary medicine. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Andreas Nitsch
- Department of Trauma Reconstructive Surgery and Rehabilitation Medicine University Medicine Greifswald Greifswald Germany
| | | | - Matthias B. Stope
- Physical Plasma Laboratory Department of Gynecology and Gynecological Oncology University Hospital Bonn Bonn Germany
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14
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Choi KY, Sultan MT, Ajiteru O, Hong H, Lee YJ, Lee JS, Lee H, Lee OJ, Kim SH, Lee JS, Park SJ, Eden JG, Park CH. Treatment of Fungal-Infected Diabetic Wounds with Low Temperature Plasma. Biomedicines 2021; 10:27. [PMID: 35052706 PMCID: PMC8773309 DOI: 10.3390/biomedicines10010027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/07/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Diabetes mellitus renders patients susceptible to chronic wounds and various infections. Regarding the latter, fungal infections are of particular concern since, although they are the source of significant morbidity and mortality in immunocompromised patients, they are generally resistant to conventional treatment and a definite treatment strategy has not yet been established. Herein, we report the treatment of skin wounds in a diabetic rat model, infected by Candida albicans, with low temperature helium plasma generated in a hand-held atmospheric jet device. A fungal infection was induced on two dorsal skin wounds of the diabetic rats, and one wound was treated with the plasma jet whereas the other served as a control. Histological analysis revealed accelerated skin wound healing and decreased evidence of fungal infection in the plasma-treated group, as compared to the control group. Regeneration of the epidermis and dermis, collagen deposition, and neovascularization were all observed as a result of plasma treatment, but without wound contraction, scar formation or any evidence of thermal damage to the tissue. These findings demonstrate that the He plasma jet is remarkably effective in diabetic skin wounds infected by Candida albicans, thereby providing a promising medical treatment option for diabetes mellitus patients with skin wound and fungal infections.
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Affiliation(s)
- Kyu Young Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul 07441, Korea;
| | - Md. Tipu Sultan
- Nano-Bio Regenerative Medical Institute, College of Medicine, Hallym University, 1 Hallymdaehak-gil, Chuncheon 24252, Korea; (M.T.S.); (O.A.); (H.H.); (Y.J.L.); (J.S.L.); (H.L.); (O.J.L.); (S.H.K.)
| | - Olatunji Ajiteru
- Nano-Bio Regenerative Medical Institute, College of Medicine, Hallym University, 1 Hallymdaehak-gil, Chuncheon 24252, Korea; (M.T.S.); (O.A.); (H.H.); (Y.J.L.); (J.S.L.); (H.L.); (O.J.L.); (S.H.K.)
| | - Heesun Hong
- Nano-Bio Regenerative Medical Institute, College of Medicine, Hallym University, 1 Hallymdaehak-gil, Chuncheon 24252, Korea; (M.T.S.); (O.A.); (H.H.); (Y.J.L.); (J.S.L.); (H.L.); (O.J.L.); (S.H.K.)
| | - Young Jin Lee
- Nano-Bio Regenerative Medical Institute, College of Medicine, Hallym University, 1 Hallymdaehak-gil, Chuncheon 24252, Korea; (M.T.S.); (O.A.); (H.H.); (Y.J.L.); (J.S.L.); (H.L.); (O.J.L.); (S.H.K.)
| | - Ji Seung Lee
- Nano-Bio Regenerative Medical Institute, College of Medicine, Hallym University, 1 Hallymdaehak-gil, Chuncheon 24252, Korea; (M.T.S.); (O.A.); (H.H.); (Y.J.L.); (J.S.L.); (H.L.); (O.J.L.); (S.H.K.)
| | - Hanna Lee
- Nano-Bio Regenerative Medical Institute, College of Medicine, Hallym University, 1 Hallymdaehak-gil, Chuncheon 24252, Korea; (M.T.S.); (O.A.); (H.H.); (Y.J.L.); (J.S.L.); (H.L.); (O.J.L.); (S.H.K.)
| | - Ok Joo Lee
- Nano-Bio Regenerative Medical Institute, College of Medicine, Hallym University, 1 Hallymdaehak-gil, Chuncheon 24252, Korea; (M.T.S.); (O.A.); (H.H.); (Y.J.L.); (J.S.L.); (H.L.); (O.J.L.); (S.H.K.)
| | - Soon Hee Kim
- Nano-Bio Regenerative Medical Institute, College of Medicine, Hallym University, 1 Hallymdaehak-gil, Chuncheon 24252, Korea; (M.T.S.); (O.A.); (H.H.); (Y.J.L.); (J.S.L.); (H.L.); (O.J.L.); (S.H.K.)
| | - Joong Seob Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Korea;
| | - Sung-Jin Park
- Laboratory for Optical Physics and Engineering, Department of Electrical and Computer Engineering, University of Illinois, Urbana, IL 61801, USA; (S.-J.P.); (J.G.E.)
| | - James Gary Eden
- Laboratory for Optical Physics and Engineering, Department of Electrical and Computer Engineering, University of Illinois, Urbana, IL 61801, USA; (S.-J.P.); (J.G.E.)
| | - Chan Hum Park
- Nano-Bio Regenerative Medical Institute, College of Medicine, Hallym University, 1 Hallymdaehak-gil, Chuncheon 24252, Korea; (M.T.S.); (O.A.); (H.H.); (Y.J.L.); (J.S.L.); (H.L.); (O.J.L.); (S.H.K.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon 24253, Korea
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15
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Bhartiya P, Masur K, Shome D, Kaushik N, Nguyen LN, Kaushik NK, Choi EH. Influence of Redox Stress on Crosstalk between Fibroblasts and Keratinocytes. BIOLOGY 2021; 10:biology10121338. [PMID: 34943253 PMCID: PMC8698713 DOI: 10.3390/biology10121338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/25/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022]
Abstract
Simple Summary There has been significant scientific progress in skin care and skin damage repair, but the complete understanding of skin homeostasis is still beyond our reach. With an increase in environmental stress factors, the incidence rates of skin cancer and skin disorders are on the rise. Taken together with the incidence of scar- and burn-related morbidities, there is an urgent need to understand interactions between skin cells to develop novel therapies for the regeneration of healthy skin. One of the recurrent stress factors affecting the skin are the harmful free radicals, also referred to as oxidative stress. This study aimed to address the influence of oxidative stress on the interaction between two types of skin cells, keratinocytes and fibroblasts. The study utilized cold atmospheric plasma (CAP) to induce oxidative stress in cells and to assess the interactions between the two cell types. We showed that CAP can stimulate cells to enhance their proliferation and migration. This study provides a further understanding of skin cell regulation under stress conditions. Such knowledge may help in designing treatment therapies for rapid wound healing and skin repair. Abstract Although the skin is constantly subjected to endogenous and exogenous stress, it maintains a homeostatic state through wound repair and regeneration pathways. Treatment for skin diseases and injury requires a significant understanding of the various mechanisms and interactions that occur within skin cells. Keratinocytes and fibroblasts interact with each other and act as key players in the repair process. Although fibroblasts and keratinocytes are widely studied in wound healing and skin remodeling under different conditions, the influence of redox stress on keratinocyte-fibroblast crosstalk has not been thoroughly investigated. In this study, we used cold atmospheric plasma (CAP) to generate and deliver oxidative stress to keratinocytes and fibroblasts and to assess its impact on their interactions. To this end, we used a well-established in vitro 3D co-culture model imitating a realistic scenario. Our study shows that low CAP exposure is biocompatible and does not affect the viability or energetics of fibroblasts and keratinocytes. Exposure to low doses of CAP enhanced the proliferation rate of cells and stimulated the expression of key genes (KGF, MMP2, GMCSF, IL-6, and IL-8) in fibroblasts, indicating the activation and initiation of the skin repair process. Additionally, enhanced migration was observed under co-culture conditions under the given redox stress conditions, and expression of the upstream regulator and the effectors of the Hippo pathway (YAP and CYR61, respectively), which are associated with enhanced migration, were elevated. Overall, this study reinforces the application of CAP and redox stress in skin repair physiology.
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Affiliation(s)
- Pradeep Bhartiya
- Plasma Bioscience Research Center, Applied Plasma Medicine Center, Department of Electrical and Biological Physics, Kwangwoon University, Seoul 01897, Korea; (P.B.); (L.N.N.)
| | - Kai Masur
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology, 17489 Greifswald, Germany; (K.M.); (D.S.)
| | - Debarati Shome
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology, 17489 Greifswald, Germany; (K.M.); (D.S.)
| | - Neha Kaushik
- Department of Biotechnology, College of Engineering, University of Suwon, Hwaseong 18323, Korea;
| | - Linh N. Nguyen
- Plasma Bioscience Research Center, Applied Plasma Medicine Center, Department of Electrical and Biological Physics, Kwangwoon University, Seoul 01897, Korea; (P.B.); (L.N.N.)
| | - Nagendra Kumar Kaushik
- Plasma Bioscience Research Center, Applied Plasma Medicine Center, Department of Electrical and Biological Physics, Kwangwoon University, Seoul 01897, Korea; (P.B.); (L.N.N.)
- Correspondence: (N.K.K.); (E.H.C.)
| | - Eun Ha Choi
- Plasma Bioscience Research Center, Applied Plasma Medicine Center, Department of Electrical and Biological Physics, Kwangwoon University, Seoul 01897, Korea; (P.B.); (L.N.N.)
- Correspondence: (N.K.K.); (E.H.C.)
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16
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Samsavar S, Mahmoudi H, Shakouri R, Khani MR, Molavi B, Moosavi J, Daneshpazhooh M, Etesami I, Shokri B. The evaluation of efficacy of atmospheric pressure plasma in diabetic ulcers healing: A randomized clinical trial. Dermatol Ther 2021; 34:e15169. [PMID: 34676656 DOI: 10.1111/dth.15169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 12/28/2022]
Abstract
The aim of this study is to evaluate the efficacy and safety of cold atmospheric plasma (CAP) as a novel therapy for diabetic foot ulcers. This was an investigator-blinded, randomized controlled trial of 14 weeks (6 weeks of treatment and 8 weeks of follow-up). Twenty patients with diabetic foot ulcers were divided into two groups: the control group receiving standard wound care and the plasma group, which received CAP twice a week for six consecutive weeks in addition to standard wound care. The ulcer size, amount of exudate, and wound grading were determined weekly. Cold plasma was produced by applying a high voltage (4.5 kV) and a high frequency (22 kHz) to helium gas. Exudate from wounds treated with CAP showed a significant reduction in the third week after complete treatment (p = 0.039). The wound grading of the ulcers improved by the sixth week (p = 0.019), and the sizes of ulcers significantly decreased in the plasma group at the end of the treatment period (p = 0.007). In this randomized clinical trial, CAP was an effective treatment option for diabetic foot ulcers in terms of wound surface reduction and antibacterial effects.
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Affiliation(s)
- Shirin Samsavar
- Physics Department, Shahid Beheshti University, Tehran, Iran
| | - HamidReza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shakouri
- Physics Department, Shahid Beheshti University, Tehran, Iran
| | - Mohammad Reza Khani
- Laser and Plasma Research Institute, Shahid Beheshti University, Tehran, Iran
| | - Behnam Molavi
- Vascular Surgery Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamal Moosavi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ifa Etesami
- Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Shokri
- Physics Department, Shahid Beheshti University, Tehran, Iran.,Laser and Plasma Research Institute, Shahid Beheshti University, Tehran, Iran
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17
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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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18
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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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Emmert S, Pantermehl S, Foth A, Waletzko-Hellwig J, Hellwig G, Bader R, Illner S, Grabow N, Bekeschus S, Weltmann KD, Jung O, Boeckmann L. Combining Biocompatible and Biodegradable Scaffolds and Cold Atmospheric Plasma for Chronic Wound Regeneration. Int J Mol Sci 2021; 22:9199. [PMID: 34502107 PMCID: PMC8430875 DOI: 10.3390/ijms22179199] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/04/2021] [Accepted: 08/24/2021] [Indexed: 12/21/2022] Open
Abstract
Skin regeneration is a quite complex process. Epidermal differentiation alone takes about 30 days and is highly regulated. Wounds, especially chronic wounds, affect 2% to 3% of the elderly population and comprise a heterogeneous group of diseases. The prevailing reasons to develop skin wounds include venous and/or arterial circulatory disorders, diabetes, or constant pressure to the skin (decubitus). The hallmarks of modern wound treatment include debridement of dead tissue, disinfection, wound dressings that keep the wound moist but still allow air exchange, and compression bandages. Despite all these efforts there is still a huge treatment resistance and wounds will not heal. This calls for new and more efficient treatment options in combination with novel biocompatible skin scaffolds. Cold atmospheric pressure plasma (CAP) is such an innovative addition to the treatment armamentarium. In one CAP application, antimicrobial effects, wound acidification, enhanced microcirculations and cell stimulation can be achieved. It is evident that CAP treatment, in combination with novel bioengineered, biocompatible and biodegradable electrospun scaffolds, has the potential of fostering wound healing by promoting remodeling and epithelialization along such temporarily applied skin replacement scaffolds.
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Affiliation(s)
- Steffen Emmert
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany; (S.P.); (A.F.); (O.J.)
| | - Sven Pantermehl
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany; (S.P.); (A.F.); (O.J.)
| | - Aenne Foth
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany; (S.P.); (A.F.); (O.J.)
| | - Janine Waletzko-Hellwig
- Department of Oral, Maxillofacial and Plastic Surgery, University Medical Center Rostock, 18057 Rostock, Germany;
| | - Georg Hellwig
- Clinic and Policlinic for Orthopedics, University Medical Center Rostock, 18057 Rostock, Germany; (G.H.); (R.B.)
| | - Rainer Bader
- Clinic and Policlinic for Orthopedics, University Medical Center Rostock, 18057 Rostock, Germany; (G.H.); (R.B.)
| | - Sabine Illner
- Institute for Biomedical Engineering, University Medical Center Rostock, 18119 Rostock, Germany; (S.I.); (N.G.)
| | - Niels Grabow
- Institute for Biomedical Engineering, University Medical Center Rostock, 18119 Rostock, Germany; (S.I.); (N.G.)
| | - Sander Bekeschus
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), 17489 Greifswald, Germany; (S.B.); (K.-D.W.)
| | - Klaus-Dieter Weltmann
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), 17489 Greifswald, Germany; (S.B.); (K.-D.W.)
| | - Ole Jung
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany; (S.P.); (A.F.); (O.J.)
| | - Lars Boeckmann
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany; (S.P.); (A.F.); (O.J.)
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20
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van Welzen A, Hoch M, Wahl P, Weber F, Rode S, Tietze JK, Boeckmann L, Emmert S, Thiem A. The Response and Tolerability of a Novel Cold Atmospheric Plasma Wound Dressing for the Healing of Split Skin Graft Donor Sites: A Controlled Pilot Study. Skin Pharmacol Physiol 2021; 34:328-336. [PMID: 34365456 PMCID: PMC8619757 DOI: 10.1159/000517524] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/19/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cold atmospheric plasma (CAP) has positive effects on wound healing and antimicrobial properties. However, an ongoing challenge is the development of specific modes of application for different clinical indications. OBJECTIVES We investigated in a prospective pilot study the response and tolerability of a newly developed CAP wound dressing for the acute healing of split skin graft donor sites compared to conventional therapy. METHODS We applied both treatments to each patient (n = 10) for 7 days and measured 4 parameters of wound healing every other day (i.e., 1,440 measurements) using a hyperspectral imaging camera. Additionally, we evaluated the clinical appearance and pain levels reported by the patients. RESULTS The CAP wound dressing was superior to the control (p < 0.001) in the improvement of 3 wound parameters, that is, deep tissue oxygen saturation, hemoglobin distribution, and tissue water distribution. CAP was well tolerated, and pain levels were lower in CAP-treated wound areas. CONCLUSION CAP wound dressing is a promising new tool for acute wound healing.
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Affiliation(s)
- Annika van Welzen
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Matti Hoch
- Department of Systems Biology and Bioinformatics, University of Rostock, Rostock, Germany
| | | | - Frank Weber
- Department for Biostatistics and Informatics in Medicine, University Medical Center, Rostock, Germany
| | - Susen Rode
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Julia Katharina Tietze
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock, Germany
| | - Lars Boeckmann
- 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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21
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Jensen JO, Schulz L, Schleusser S, Matzkeit N, Stang FH, Mailaender P, Kraemer R, Kleemann M, Deichmann H, Kisch T. The repetitive application of cold atmospheric plasma (CAP) improves microcirculation parameters in chronic wounds. Microvasc Res 2021; 138:104220. [PMID: 34216601 DOI: 10.1016/j.mvr.2021.104220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/13/2021] [Accepted: 06/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Chronic wounds, such as venous leg ulcers, diabetic foot ulcers, and pressure ulcers, impose a significant burden on patients and health care systems worldwide. Cold atmospheric plasma (CAP) accelerates wound healing and decreases bacterial load in chronic wounds in both in vitro and in vivo experiments. For the first time, we examined the effects of a repetitive application of CAP on the microcirculation in chronic wounds. HYPOTHESIS The repetitive application of cold atmospheric plasma application further improves microcirculation in chronic wounds. METHODS Twenty patients with chronic wounds were treated repetitively with CAP. The repetitive application consisted of three CAP sessions, each lasting 90 s and separated by a 10-minute microcirculation measuring period. Microcirculation parameters were assessed with combined Laser-Doppler-Flowmetry and spectrophotometry in a tissue depth of 2 mm. RESULTS Tissue oxygen saturation was significantly increased after the first CAP application. The effect amplitude and duration were further increased after the second and third CAP application with a maximum increase by 16,7% (percent change; p = 0,004 vs. baseline) after the third application. There was no significant increase in capillary blood flow until the third CAP application. After the third CAP application, an increase by 22,6% (p = 0,014) was observed. Postcapillary filling pressure was not significantly increased over the measuring period. The repetitive application of CAP further enhances the microcirculation in chronic wounds compared to a single application. CONCLUSION The repetitive application of CAP boosts and prolongs tissue oxygen saturation and capillary blood flow in chronic wounds compared to a single application. This insight could provide an impetus for new treatment protocols.
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Affiliation(s)
- Jan-Oluf Jensen
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany.
| | - Lysann Schulz
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Sophie Schleusser
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Nico Matzkeit
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Felix H Stang
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Peter Mailaender
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Robert Kraemer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Klinikum Westfalen, Dortmund, Germany
| | - Markus Kleemann
- Department of Surgery, Dr. Erler Kliniken, Nuernberg, Germany
| | - Henriette Deichmann
- Department of Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Tobias Kisch
- Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
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22
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Sterpione F, Mas K, Rippon M, Rogers A, Mayeux G, Rigaudier F, Chauvelot P, Robilliart L, Juhel C, Lecomte Y. The clinical impact of hydroresponsive dressings in dynamic wound healing: Part I. J Wound Care 2021; 30:15-24. [PMID: 33439084 DOI: 10.12968/jowc.2021.30.1.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Management of any wound, either acute or hard-to-heal, might involve the use of multiple and different wound dressings in its treatment. This approach is necessary to overcome the myriad of clinical challenges the wound presents, as well as any underlying comorbidities that might affect the clinical outcomes. This article describes the clinical effectiveness of a coordinated wound dressing treatment regimen. METHOD This was an open-labelled non-comparative study involving patients with a variety of hard-to-heal and acute wounds of differing levels of severity, but all of which required removal of devitalised tissue to enable wound healing to progress. The first phase used the hydroresponsive wound dressing HydroClean (PAUL HARTMANN AG, Germany). The PUSH score was used as the primary measurement parameter. RESULTS A total of 86 patients (38 male/48 female), with a mean age of 67.7±21.7 years, took part in the study. The results showed that the hydroresponsive dressing was effective in managing wound exudate production and promoting wound cleansing and debridement, supporting good wound bed preparation. Wound closure was observed in 16/86 (18.6%) wounds at the end of the study (20 weeks). This enabled clinicians to switch to alternative wound dressings to promote subsequent clinical healing outcomes. CONCLUSION In this study, the hydroresponsive wound dressing was highly effective in preparing a clean wound bed such that the next stage of wound healing could be supported.
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Affiliation(s)
| | - Karine Mas
- Infirmière, 19 rue Paul Broca, 66100 Perpignan, France
| | - Mark Rippon
- Huddersfield University, Huddersfield, UK.,Daneriver Consultancy Ltd, Holmes Chapel, UK
| | | | | | | | | | | | | | - Yann Lecomte
- CEN Biotech, Dijon, Bourgogne-Franche-Comté, France
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Management of Difficult-to-Treat Warts: Traditional and New Approaches. Am J Clin Dermatol 2021; 22:379-394. [PMID: 33432476 DOI: 10.1007/s40257-020-00582-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 10/24/2022]
Abstract
Warts are regularly treated by dermatologists, and while many respond readily to first-line treatments, others may represent a therapeutic challenge. Large, deep, numerous, and extensive warts; treatment-resistant lesions with higher risk for side effects, such as hypopigmentation; or patients unable to tolerate or comply with our treatment regimen, may need alternative treatment options. In this work we review the characteristics of select modalities that should be considered for difficult-to-treat warts. We discuss efficacy and tolerability data as well as practical features that can guide us to select the best treatment for every scenario. Novel approaches, still in an investigational phase, are also discussed to illustrate potential future directions of wart treatment.
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Abstract
Nonthermal atmospheric pressure biocompatible plasma (NBP), alternatively called bio-cold plasma, is a partially ionized gas that consists of charged particles, neutral atoms and molecules, photons, an electric field, and heat. Recently, nonthermal plasma-based technology has been applied to bioscience, medicine, agriculture, food processing, and safety. Various plasma device configurations and electrode layouts has fast-tracked plasma applications in the treatment of biological and material surfaces. The NBP action mechanism may be related to the synergy of plasma constituents, such as ultraviolet radiation or a reactive species. Recently, plasma has been used in the inactivation of viruses and resistant microbes, such as fungal cells, bacteria, spores, and biofilms made by microbes. It has also been used to heal wounds, coagulate blood, degrade pollutants, functionalize material surfaces, kill cancers, and for dental applications. This review provides an outline of NBP devices and their applications in bioscience and medicine. We also discuss the role of plasma-activated liquids in biological applications, such as cancer treatments and agriculture. The individual adaptation of plasma to meet specific medical requirements necessitates real-time monitoring of both the plasma performance and the target that is treated and will provide a new paradigm of plasma-based therapeutic clinical systems.
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Affiliation(s)
- Eun H. Choi
- Plasma Bioscience Research Center/Applied Plasma Medicine Center, Department of Electrical and Biological Physics, Kwangwoon University, Seoul, 01897 Republic of Korea
| | - Han S. Uhm
- Canode # 702, 136-11 Tojeong-ro, Mapo-gu, Seoul, 04081 Republic of Korea
| | - Nagendra K. Kaushik
- Plasma Bioscience Research Center/Applied Plasma Medicine Center, Department of Electrical and Biological Physics, Kwangwoon University, Seoul, 01897 Republic of Korea
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Boekema B, Stoop M, Vlig M, van Liempt J, Sobota A, Ulrich M, Middelkoop E. Antibacterial and safety tests of a flexible cold atmospheric plasma device for the stimulation of wound healing. Appl Microbiol Biotechnol 2021; 105:2057-2070. [PMID: 33587156 PMCID: PMC7906937 DOI: 10.1007/s00253-021-11166-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 12/14/2022]
Abstract
Cold atmospheric plasma (CAP) devices generate an ionized gas with highly reactive species and electric fields at ambient air pressure and temperature. A flexible dielectric barrier discharge (DBD) was developed as an alternative antimicrobial treatment for chronic wounds. Treatment of Staphylococcus aureus in collagen-elastin matrices with CAP for 2 min resulted in a 4 log reduction. CAP treatment was less effective on S. aureus on dermal samples. CAP did not affect cellular activity or DNA integrity of human dermal samples when used for up to 2 min. Repeated daily CAP treatments for 2 min lowered cellular activity of dermal samples to 80% after 2 to 4 days, but this was not significant. Repeated treatment of ex vivo human burn wound models with CAP for 2 min did not affect re-epithelialization. Intact skin of 25 healthy volunteers was treated with CAP for 3× 20" to determine safety. Although participants reported moderate pain scores (numerical rating scale 3.3), all volunteers considered the procedure to be acceptable. Severe adverse events did not occur. CAP treatment resulted in a temporarily increased local skin temperature (≈3.4°C) and increased erythema. Lowering the plasma power resulted in a significantly lower erythema increase. Good log reduction (2.9) of bacterial load was reached in 14/15 volunteers artificially contaminated with Pseudomonas aeruginosa. This study demonstrated the in vitro and in vivo safety and efficacy in bacterial reduction of a flexible cold plasma device. Trial registration number NCT03007264, January 2, 2017 KEY POINTS: • CAP strongly reduced bacterial numbers both in vitro and in vivo. • Re-epithelialization of burn wound models was not affected by repeated CAP. • CAP treatment of intact skin was well tolerated in volunteers.
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Affiliation(s)
- Bouke Boekema
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ, Beverwijk, The Netherlands.
| | - Matthea Stoop
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
| | - Marcel Vlig
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ, Beverwijk, The Netherlands
| | - Jos van Liempt
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Ana Sobota
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Magda Ulrich
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ, Beverwijk, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Esther Middelkoop
- Association of Dutch Burn Centres, Zeestraat 29, 1941 AJ, Beverwijk, The Netherlands.,Burn Center, Red Cross Hospital, Beverwijk, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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26
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Cold Atmospheric Pressure Plasma in Wound Healing and Cancer Treatment. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10196898] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Plasma medicine is gaining increasing attention and is moving from basic research into clinical practice. While areas of application are diverse, much research has been conducted assessing the use of cold atmospheric pressure plasma (CAP) in wound healing and cancer treatment—two applications with entirely different goals. In wound healing, a tissue-stimulating effect is intended, whereas cancer therapy aims at killing malignant cells. In this review, we provide an overview of the latest clinical and some preclinical research on the efficacy of CAP in wound healing and cancer therapy. Furthermore, we discuss the current understanding of molecular signaling mechanisms triggered by CAP that grant CAP its antiseptic and tissue regenerating or anti-proliferative and cell death-inducing properties. For the efficacy of CAP in wound healing, already substantial evidence from clinical studies is available, while evidence for therapeutic effects of CAP in oncology is mainly from in vitro and in vivo animal studies. Efforts to elucidate the mode of action of CAP suggest that different components, such as ultraviolet (UV) radiation, electromagnetic fields, and reactive species, may act synergistically, with reactive species being regarded as the major effector by modulating complex and concentration-dependent redox signaling pathways.
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Emmert S, van Welzen A, Masur K, Gerling T, Bekeschus S, Eschenburg C, Wahl P, Bernhardt T, Schäfer M, Semmler ML, Grabow N, Fischer T, Thiem A, Jung O, Boeckmann L. Kaltes Atmosphärendruckplasma zur Behandlung akuter und chronischer Wunden. Hautarzt 2020; 71:855-862. [DOI: 10.1007/s00105-020-04696-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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28
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Friedman PC. Cold atmospheric pressure (physical) plasma in dermatology: where are we today? Int J Dermatol 2020; 59:1171-1184. [PMID: 32783244 DOI: 10.1111/ijd.15110] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/08/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022]
Abstract
Cold atmospheric pressure plasma is physical plasma (essentially ionized gas) created at room temperature and atmospheric pressure, and it has complex effects on cells, tissues, and living organisms. These effects are studied extensively for medical and dermatological use. This article reviews current achievements and new trends in clinical dermatological cold plasma research, discusses the basics of plasma physics and plasma engineering, and describes the most important areas of laboratory plasma research to provide a well-rounded understanding of the nature, present applications, and future promise of this exciting, emerging technology.
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The Emerging Role of Cold Atmospheric Plasma in Implantology: A Review of the Literature. NANOMATERIALS 2020; 10:nano10081505. [PMID: 32751895 PMCID: PMC7466481 DOI: 10.3390/nano10081505] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 12/12/2022]
Abstract
In recent years, cold atmospheric plasma (CAP) technologies have received increasing attention in the field of biomedical applications. The aim of this article is to review the currently available literature to provide an overview of the scientific principles of CAP application, its features, functions, and its applications in systemic and oral diseases, with a specific focus on its potential in implantology. In this narrative review, PubMed, Medline, and Scopus databases were searched using key words like “cold atmospheric plasma”, “argon plasma”, “helium plasma”, “air plasma”, “dental implants”, “implantology”, “peri-implantitis”, “decontamination”. In vitro studies demonstrated CAP’s potential to enhance surface colonization and osteoblast activity and to accelerate mineralization, as well as to determine a clean surface with cell growth comparable to the sterile control on both titanium and zirconia surfaces. The effect of CAP on biofilm removal was revealed in comparative studies to the currently available decontamination modalities (laser, air abrasion, and chlorhexidine). The combination of mechanical treatments and CAP resulted in synergistic antimicrobial effects and surface improvement, indicating that it may play a central role in surface “rejuvenation” and offer a novel approach for the treatment of peri-implantitis. It is noteworthy that the CAP conditioning of implant surfaces leads to an improvement in osseointegration in in vivo animal studies. To the best of our knowledge, this is the first review of the literature providing a summary of the current state of the art of this emerging field in implantology and it could represent a point of reference for basic researchers and clinicians interested in approaching and testing new technologies.
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Cold atmospheric plasma as an effective method to treat diabetic foot ulcers: A randomized clinical trial. Sci Rep 2020; 10:10440. [PMID: 32591594 PMCID: PMC7319950 DOI: 10.1038/s41598-020-67232-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 06/04/2020] [Indexed: 12/01/2022] Open
Abstract
Cold atmospheric plasma (CAP) was shown to decrease bacterial load in chronic wounds. It was also presented as a novel approach to healing wounds in both in vitro and in vivo experiments. We aimed to examine the first randomized clinical trial for the use of CAP in diabetic foot ulcers. Patients (n = 44) were randomly double-blinded, and assigned to receive standard care (SC, n = 22) without or with CAP, to be applied three times a week for three consecutive weeks (SC + CAP, n = 22), using block randomization with mixing block sizes of four. The trial was conducted at the Diabetes Research Center in Tehran, Iran. CAP was generated from ionized helium gas in ambient air, and driven by a high voltage (10 kV) and high frequency (6 kHz) power supply. Primary outcomes were wound size, number of cases reaching wound size of <0.5, and a bacterial load after over three weeks of treatment. CAP treatment effectively reduced the fraction of wound size (p = 0.02). After three weeks, the wounds to reach fraction wound size of ≤0.5 was significantly greater in the SC + CAP group (77.3%) compared to the SC group (36.4%) (p = 0.006). The mean fraction of bacterial load counted in each session ‘after CAP exposure’ was significantly less than ‘before exposure’ measures. CAP can be an efficient method to accelerate wound healing in diabetic foot ulcers, with immediate antiseptic effects that do not seem to last long.
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31
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Braný D, Dvorská D, Halašová E, Škovierová H. Cold Atmospheric Plasma: A Powerful Tool for Modern Medicine. Int J Mol Sci 2020; 21:E2932. [PMID: 32331263 PMCID: PMC7215620 DOI: 10.3390/ijms21082932] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 12/15/2022] Open
Abstract
Cold atmospheric plasma use in clinical studies is mainly limited to the treatment of chronic wounds, but its application in a wide range of medical fields is now the goal of many analyses. It is therefore likely that its application spectrum will be expanded in the future. Cold atmospheric plasma has been shown to reduce microbial load without any known significant negative effects on healthy tissues, and this should enhance its possible application to any microbial infection site. It has also been shown to have anti-tumour effects. In addition, it acts proliferatively on stem cells and other cultivated cells, and the highly increased nitric oxide levels have a very important effect on this proliferation. Cold atmospheric plasma use may also have a beneficial effect on immunotherapy in cancer patients. Finally, it is possible that the use of plasma devices will not remain limited to surface structures, because current endeavours to develop sufficiently miniature microplasma devices could very likely lead to its application in subcutaneous and internal structures. This study summarises the available literature on cold plasma action mechanisms and analyses of its current in vivo and in vitro use, primarily in the fields of regenerative and dental medicine and oncology.
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Affiliation(s)
| | - Dana Dvorská
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (D.B.); (E.H.); (H.Š.)
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Boeckmann L, Bernhardt T, Schäfer M, Semmler ML, Kordt M, Waldner AC, Wendt F, Sagwal S, Bekeschus S, Berner J, Kwiatek E, Frey A, Fischer T, Emmert S. [Current indications for plasma therapy in dermatology]. Hautarzt 2020; 71:109-113. [PMID: 31965204 DOI: 10.1007/s00105-019-04530-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Plasma medicine is gaining increasing interest and provides a multitude of dermatological applications. Cold atmospheric pressure plasma (CAP) can be used in clinical applications without harming the treated tissue or in a tissue destructive manner. It consists of a complex mixture of biologically active agents, which can act synergistically on the treated material or tissue. OBJECTIVES A summary of the current research findings regarding dermatological applications of CAP is provided. METHODS Literature on CAP applications in dermatology has been screened and summarized. RESULTS CAP exerts antimicrobial, tissue-stimulating, blood-flow-stimulating but also pro-apoptotic effects. By exploiting these properties, CAP is successfully applied for disinfection and treatment of chronic ulcerations. Furthermore, positive effects of CAP have been shown for the treatment of tumors, actinic keratosis, scars, ichthyosis, atopic eczema as well as for alleviation of pain and itch. CONCLUSIONS While the use of CAP for disinfection and wound treatment has already moved into clinical practice, further applications such as cancer treatment are still exploratory.
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Affiliation(s)
- L Boeckmann
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock, Strempelstr. 13, 18057, Rostock, Deutschland
| | - T Bernhardt
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock, Strempelstr. 13, 18057, Rostock, Deutschland
| | - M Schäfer
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock, Strempelstr. 13, 18057, Rostock, Deutschland
| | - M Luise Semmler
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock, Strempelstr. 13, 18057, Rostock, Deutschland
| | - M Kordt
- Rudolf-Zenker-Institut für Experimentelle Chirurgie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - A-C Waldner
- Arbeitsbereich Zellbiologie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - F Wendt
- Institut für Pharmakologie und Toxikologie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - S Sagwal
- Leibniz-Institut für Plasmaforschung und Technologie e. V., Greifswald, Deutschland
| | - S Bekeschus
- Leibniz-Institut für Plasmaforschung und Technologie e. V., Greifswald, Deutschland
| | - J Berner
- Klinik und Poliklinik für Mund-Kiefer-Gesichtschirurgie/Plastische Operationen, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - E Kwiatek
- Klinik und Poliklinik für Mund-Kiefer-Gesichtschirurgie/Plastische Operationen, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - A Frey
- Institut für Chemie, Universität Rostock, Rostock, Deutschland
| | - T Fischer
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock, Strempelstr. 13, 18057, Rostock, Deutschland
| | - S Emmert
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin Rostock, Strempelstr. 13, 18057, Rostock, Deutschland.
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VON Woedtke T, Schmidt A, Bekeschus S, Wende K, Weltmann KD. Plasma Medicine: A Field of Applied Redox Biology. In Vivo 2019; 33:1011-1026. [PMID: 31280189 DOI: 10.21873/invivo.11570] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 12/25/2022]
Abstract
Plasma medicine comprises the application of physical plasma directly on or in the human body for therapeutic purposes. Three most important basic plasma effects are relevant for medical applications: i) inactivation of a broad spectrum of microorganisms, including multidrug-resistant pathogens, ii) stimulation of cell proliferation and angiogenesis with lower plasma treatment intensity, and iii) inactivation of cells by initialization of cell death with higher plasma treatment intensity, above all in cancer cells. Based on own published results as well as on monitoring of relevant literature the aim of this topical review is to summarize the state of the art in plasma medicine and connect it to redox biology. One of the most important results of basic research in plasma medicine is the insight that biological plasma effects are mainly mediated via reactive oxygen and nitrogen species influencing cellular redox-regulated processes. Plasma medicine can be considered a field of applied redox biology.
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Affiliation(s)
- Thomas VON Woedtke
- Leibniz Institute for Plasma Science and Technology, INP Greifswald, Greifswald, Germany .,Greifswald University Medicine, Greifswald, Germany
| | - Anke Schmidt
- Leibniz Institute for Plasma Science and Technology, INP Greifswald, Greifswald, Germany
| | | | | | - Klaus-Dieter Weltmann
- Leibniz Institute for Plasma Science and Technology, INP Greifswald, Greifswald, Germany
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Wolff CM, Steuer A, Stoffels I, von Woedtke T, Weltmann KD, Bekeschus S, Kolb JF. Combination of cold plasma and pulsed electric fields – A rationale for cancer patients in palliative care. CLINICAL PLASMA MEDICINE 2019. [DOI: 10.1016/j.cpme.2020.100096] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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ROS from Physical Plasmas: Redox Chemistry for Biomedical Therapy. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:9062098. [PMID: 31687089 PMCID: PMC6800937 DOI: 10.1155/2019/9062098] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/17/2019] [Accepted: 08/25/2019] [Indexed: 12/24/2022]
Abstract
Physical plasmas generate unique mixes of reactive oxygen and nitrogen species (RONS or ROS). Only a bit more than a decade ago, these plasmas, operating at body temperature, started to be considered for medical therapy with considerably little mechanistic redox chemistry or biomedical research existing on that topic at that time. Today, a vast body of evidence is available on physical plasma-derived ROS, from their spatiotemporal resolution in the plasma gas phase to sophisticated chemical and biochemical analysis of these species once dissolved in liquids. Data from in silico analysis dissected potential reaction pathways of plasma-derived reactive species with biological membranes, and in vitro and in vivo experiments in cell and animal disease models identified molecular mechanisms and potential therapeutic benefits of physical plasmas. In 2013, the first medical plasma systems entered the European market as class IIa devices and have proven to be a valuable resource in dermatology, especially for supporting the healing of chronic wounds. The first results in cancer patients treated with plasma are promising, too. Due to the many potentials of this blooming new field ahead, there is a need to highlight the main concepts distilled from plasma research in chemistry and biology that serve as a mechanistic link between plasma physics (how and which plasma-derived ROS are produced) and therapy (what is the medical benefit). This inevitably puts cellular membranes in focus, as these are the natural interphase between ROS produced by plasmas and translation of their chemical reactivity into distinct biological responses.
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Thana P, Wijaikhum A, Poramapijitwat P, Kuensaen C, Meerak J, Ngamjarurojana A, Sarapirom S, Boonyawan D. A compact pulse-modulation cold air plasma jet for the inactivation of chronic wound bacteria: development and characterization. Heliyon 2019; 5:e02455. [PMID: 31687557 PMCID: PMC6819795 DOI: 10.1016/j.heliyon.2019.e02455] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/03/2019] [Accepted: 09/06/2019] [Indexed: 01/22/2023] Open
Abstract
A compact low-temperature plasma jet device was developed to use ambient air as plasma gas. The device was driven by a 2.52-kV high-voltage direct-current pulse in a burst mode, with a repetition rate of 2 kHz. The maximum plasma discharge current was 3.5 A, with an approximately 10 ns full-width half-maximum. Nitric oxide, hydroxyl radical, atomic oxygen, ozone, and hydrogen peroxide—important reactive oxygen and nitrogen species (RONS)—were mainly produced. The amount of plasma-generated RONS can be controlled by varying the pulse-modulation factors. After optimization, the plasma plume length was approximately 5 mm and the treatment temperature was less than 40 °C. The preliminary bactericidal effects were tested on Staphylococcus aureus, Pseudomonas aeruginosa, and methicillin-resistant S. aureus (MRSA), and their biofilms. The results showed that the plasma can effectively inactivate S. aureus, P. aeruginosa, and MRSA in both time- and pulse-dependent manner. Thus, this produced plasma device proved to be an efficient tool for inactivating deteriorating bacteria. Further versatile utilization of this portable plasma generator is also promising.
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Affiliation(s)
- Phuthidhorn Thana
- PhD Degree Program in Applied Physics, Department of Physics and Materials Science, Faculty of Science, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Apiwat Wijaikhum
- Plasma and Beam Physics Research Facility, Faculty of Science, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Pipath Poramapijitwat
- Nanoscience and Nanotechnology, Faculty of Science, Maejo University, Chiang Mai, 50290, Thailand
| | - Chakkrapong Kuensaen
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Jomkhwan Meerak
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Athipong Ngamjarurojana
- Department of Physics and Materials Science, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sureeporn Sarapirom
- ThEP Center, 239 Huay Kaew Road, Muang District, Chiang Mai, 50200, Thailand.,Applied Physics, Faculty of Science, Maejo University, Chiang Mai, 50290, Thailand
| | - Dheerawan Boonyawan
- Plasma and Beam Physics Research Facility, Faculty of Science, Chiang Mai University, Chiang Mai, 50200, Thailand.,ThEP Center, 239 Huay Kaew Road, Muang District, Chiang Mai, 50200, Thailand
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Bernhardt T, Semmler ML, Schäfer M, Bekeschus S, Emmert S, Boeckmann L. Plasma Medicine: Applications of Cold Atmospheric Pressure Plasma in Dermatology. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:3873928. [PMID: 31565150 PMCID: PMC6745145 DOI: 10.1155/2019/3873928] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/12/2019] [Indexed: 11/17/2022]
Abstract
The ability to produce cold plasma at atmospheric pressure conditions was the basis for the rapid growth of plasma-related application areas in biomedicine. Plasma comprises a multitude of active components such as charged particles, electric current, UV radiation, and reactive gas species which can act synergistically. Anti-itch, antimicrobial, anti-inflammatory, tissue-stimulating, blood flow-enhancing, and proapoptotic effects were demonstrated in in vivo and in vitro experiments, and until now, no resistance of pathogens against plasma treatment was observed. The combination of the different active agents and their broad range of positive effects on various diseases, especially easily accessible skin diseases, renders plasma quite attractive for applications in medicine. For medical applications, two different types of cold plasma appear suitable: indirect (plasma jet) and direct (dielectric barrier discharge-DBD) plasma sources. The DBD device PlasmaDerm® VU-2010 (CINOGY Technologies GmbH), the atmospheric pressure plasma jet (APPJ) kINPen® MED (INP Greifswald/neoplas tools GmbH), and the SteriPlas (Adtec Ltd., London, United Kingdom) are CE-certified as a medical product to treat chronic wounds in humans and showed efficacy and a good tolerability. Recently, the use of plasma in cancer research and oncology is of particular interest. Plasma has been shown to induce proapoptotic effects more efficiently in tumor cells compared with the benign counterparts, leads to cellular senescence, and-as shown in vivo-reduces skin tumors. To this end, a world-wide first Leibniz professorship for plasmabiotechnology in dermatology has been introduced to establish a scientific network for the investigation of the efficacy and safety of cold atmospheric plasma in dermatooncology. Hence, plasma medicine especially in dermatology holds great promise.
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Affiliation(s)
- Thoralf Bernhardt
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock 18057, Germany
| | - Marie Luise Semmler
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock 18057, Germany
| | - Mirijam Schäfer
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock 18057, Germany
| | - Sander Bekeschus
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP Greifswald), Greifswald 17489, Germany
| | - Steffen Emmert
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock 18057, Germany
| | - Lars Boeckmann
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, Rostock 18057, Germany
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Bekeschus S, Seebauer C, Wende K, Schmidt A. Physical plasma and leukocytes - immune or reactive? Biol Chem 2019; 400:63-75. [PMID: 30030959 DOI: 10.1515/hsz-2018-0224] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/20/2018] [Indexed: 12/15/2022]
Abstract
Leukocytes are professionals in recognizing and removing pathogenic or unwanted material. They are present in virtually all tissues, and highly motile to enter or leave specific sites throughout the body. Less than a decade ago, physical plasmas entered the field of medicine to deliver their delicate mix of reactive species and other physical agents for mainly dermatological or oncological therapy. Plasma treatment thus affects leukocytes via direct or indirect means: immune cells are either present in tissues during treatment, or infiltrate or exfiltrate plasma-treated areas. The immune system is crucial for human health and resolution of many types of diseases. It is therefore vital to study the response of leukocytes after plasma treatment in vitro and in vivo. This review gathers together the major themes in the plasma treatment of innate and adaptive immune cells, and puts these into the context of wound healing and oncology, the two major topics in plasma medicine.
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Affiliation(s)
- Sander Bekeschus
- Leibniz-Institute for Plasma Science and Technology (INP Greifswald), ZIK plasmatis, Felix-Hausdorff-Str. 2, D-17489 Greifswald, Germany
| | - Christian Seebauer
- Greifswald University Medical Center, Department of Oral and Maxillofacial Surgery/Plastic Surgery, Ferdinand-Sauerbruch-Str. DZ 7, D-17475 Greifswald, Germany
| | - Kristian Wende
- Leibniz-Institute for Plasma Science and Technology (INP Greifswald), ZIK plasmatis, Felix-Hausdorff-Str. 2, D-17489 Greifswald, Germany
| | - Anke Schmidt
- Leibniz-Institute for Plasma Science and Technology (INP Greifswald), ZIK plasmatis, Felix-Hausdorff-Str. 2, D-17489 Greifswald, Germany
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39
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Comparing two different plasma devices kINPen and Adtec SteriPlas regarding their molecular and cellular effects on wound healing. CLINICAL PLASMA MEDICINE 2018. [DOI: 10.1016/j.cpme.2018.01.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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40
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Hartwig S, Preissner S, Voss JO, Hertel M, Doll C, Waluga R, Raguse JD. The feasibility of cold atmospheric plasma in the treatment of complicated wounds in cranio-maxillo-facial surgery. J Craniomaxillofac Surg 2017; 45:1724-1730. [DOI: 10.1016/j.jcms.2017.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/12/2017] [Accepted: 07/18/2017] [Indexed: 11/28/2022] Open
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