Photodynamic inactivation of biofilm: taking a lightly colored approach to stubborn infection

Evaluation of visible light and natural photosensitizers against Staphylococcus epidermidis and Staphylococcus saprophyticus planktonic cells and biofilm

Antimicrobial photoinactivation (API) has shown some promise in potentially treating different nosocomial bacterial infections, however, its application on staphylococci, especially other than Staphylococcus aureus or methicillin-resistant S. aureus (MRSA) species is still limited. Although S. aureus is a well-known and important nosocomial pathogen, several other species of the genus, particularly coagulase-negative Staphylococcus (CNS) species such as Staphylococcus epidermidis and Staphylococcus saprophyticus, can also cause healthcare-associated infections and foodborne intoxications. CNS are often involved in resilient biofilm formation on medical devices and can cause infections in patients with compromised immune systems or those undergoing invasive procedures. In this study, the effects of chlorophyllin and riboflavin-mediated API on S. epidermidis and S. saprophyticus planktonic cells and biofilm are demonstrated for the first time. Based on the residual growth determination and metabolic reduction ability changes, higher inactivating efficiency of chlorophyllin-mediated API was determined against the planktonic cells of both tested species of bacteria and against S. saprophyticus biofilm. Some insights on whether aqueous solutions of riboflavin and chlorophyllin, when illuminated with optimal exciting wavelength (440 nm and 402 nm, respectively) generate O2-•, are also provided in this work.

Biofilm inhibition/eradication: exploring strategies and confronting challenges in combatting biofilm

Biofilms are complex communities of microorganisms enclosed in a self-produced extracellular matrix, posing a significant threat to different sectors, including healthcare and industry. This review provides an overview of the challenges faced due to biofilm formation and different novel strategies that can combat biofilm formation. Bacteria inside the biofilm exhibit increased resistance against different antimicrobial agents, including conventional antibiotics, which can lead to severe problems in livestock and animals, including humans. In addition, biofilm formation also imposes heavy economic pressure on industries. Hence it becomes necessary to explore newer alternatives to eradicate biofilms effectively without applying selection pressure on the bacteria. Excessive usage of antibiotics may also lead to an increase in the number of resistant strains as bacteria employ an advanced antimicrobial resistance mechanism. This review provides insight into multifaceted technologies like quorum sensing inhibition, enzymes, antimicrobial peptides, bacteriophage, phytocompounds, and nanotechnology to neutralize biofilms without developing antimicrobial resistance (AMR). Furthermore, it will pave the way for developing newer therapeutic agents to deal with biofilms more efficiently.

Refining antimicrobial photodynamic therapy: effect of charge distribution and central metal ion in fluorinated porphyrins on effective control of planktonic and biofilm bacterial forms

Antibiotic resistance represents a pressing global health challenge, now acknowledged as a critical concern within the framework of One Health. Photodynamic inactivation of microorganisms (PDI) offers an attractive, non-invasive approach known for its flexibility, independence from microbial resistance patterns, broad-spectrum efficacy, and minimal risk of inducing resistance. Various photosensitizers, including porphyrin derivatives have been explored for pathogen eradication. In this context, we present the synthesis, spectroscopic and photophysical characteristics as well as antimicrobial properties of a palladium(II)-porphyrin derivative (PdF2POH), along with its zinc(II)- and free-base counterparts (ZnF2POH and F2POH, respectively). Our findings reveal that the palladium(II)-porphyrin complex can be classified as an excellent generator of reactive oxygen species (ROS), encompassing both singlet oxygen (Φ△ = 0.93) and oxygen-centered radicals. The ability of photosensitizers to generate ROS was assessed using a variety of direct (luminescence measurements) and indirect techniques, including specific fluorescent probes both in solution and in microorganisms during the PDI procedure. We investigated the PDI efficacy of F2POH, ZnF2POH, and PdF2POH against both Gram-negative and Gram-positive bacteria. All tested compounds proved high activity against Gram-positive species, with PdF2POH exhibiting superior efficacy, leading to up to a 6-log reduction in S. aureus viability. Notably, PdF2POH-mediated PDI displayed remarkable effectiveness against S. aureus biofilm, a challenging target due to its complex structure and increased resistance to conventional treatments. Furthermore, our results show that PDI with PdF2POH is more selective for bacterial than for mammalian cells, particularly at lower light doses (up to 5 J/cm2 of blue light illumination). This enhanced efficacy of PdF2POH-mediated PDI as compared to ZnF2POH and F2POH can be attributed to more pronounced ROS generation by palladium derivative via both types of photochemical mechanisms (high yields of singlet oxygen generation as well as oxygen-centered radicals). Additionally, PDI proved effective in eliminating bacteria within S. aureus-infected human keratinocytes, inhibiting infection progression while preserving the viability and integrity of infected HaCaT cells. These findings underscore the potential of metalloporphyrins, particularly the Pd(II)-porphyrin complex, as promising photosensitizers for PDI in various bacterial infections, warranting further investigation in advanced infection models.

Medium-term antifungal effects of methylene blue versus flavin mononucleotide in the treatment of moderate toenail onychomycosis

BACKGROUND

Methylene blue (MB) and flavin mononucleotide (FMN)-mediated photodynamic therapy (PDT) have demonstrated local antimicrobial effect, but no direct comparative study has been published so far for the treatment of toenail onychomycosis.

OBJECTIVES

To directly compare the short and medium-term efficacy of MB versus FMN as photosensitizers in PDT for toenail onychomycosis by applying them in a 40% w/w urea cream in two different dye concentrations.

METHODS

Forty toenails with distal and lateral subungual moderate onychomycosis due to dermatophyte fungi were randomised to receive 10 weekly sessions of PDT mediated by four topical formulations including MB or FMN at two different concentrations: Group I: 0.1% w/w MB; Group II: 2% w/w MB; Group III: 0.1% w/w FMN; and Group IV: 2% w/w FMN. Photographs were used for onychomycosis severity index (OSI) estimation allowing clinical assessment at any point of the study. Microscopic and microbiological evaluations were carried out at baseline, 27- and 35-week follow-ups. Side effects were recorded along with patient satisfaction.

RESULTS

At week 27, mycological cure rates were 60%, 30%, 50% and 40% and complete cure rates were 0%, 20%, 10% and 20%, for Groups I, II, III and IV respectively. At week 35, mycological cure rates were 70%, 70%, 70% and 60% and complete cure rates were 30%, 50%, 70% and 30%, for Groups I, II, III and IV respectively. All cream formulations were safe and patients were fairly satisfied.

CONCLUSIONS

Results of the present work confirm PDT as a therapeutic alternative for onychomycosis. Although all cream formulations were safe and effective, with a good degree of satisfaction, higher cure rates were obtained with 2% w/w MB cream and 0.1% w/w FMN cream.

Bactericidal effect of Iberin combined with photodynamic antimicrobial chemotherapy against Pseudomonas aeruginosa biofilm cultured on ex vivo wound model

Wounds infected by Pseudomonas aeruginosa (P. aeruginosa) biofilms are characterized by poor healing and by being long lasting. Pyocyanin and pyoverdine are exotoxins that contribute to P. aeruginosa pathogenicity in wound infections and are known as virulence factors. Despite the usefulness of antimicrobial photodynamic therapy (PDT) in the management of wound infections, biofilms are hurdle for microbial photoinactivation. Quorum sensing (QS) is a cell density-dependent chemical signaling system P. aeruginosa uses to regulate biofilm formation and virulence factors production. In the current study, QS attenuation was used in combination with PDT against P. aeruginosa biofilm cultured on skin explant. Iberin is a QS inhibitor that attenuates P. aeruginosa virulence and affects biofilm integrity. The antibiofilm and QS inhibitory activities of iberin in combination with either riboflavin or 5,10,15,20-Tetrakis(1-methyl-4-pyridinio) porphyrin tetra p-toluenesulfonate (TMP) mediated PDT were investigated using viable count method and pyocyanin and pyoverdine assays, respectively. No bactericidal activity was reported when iberin was added to a mature biofilm (24 h) followed by PDT. When added to a growing biofilm at multiple time points (0 h, 24 h and 48 h), iberin inhibited P. aeruginosa biofilm QS signaling system. This inhibitory effect resulted in an observable decrease in the levels of the QS-regulated virulence factors, pyocyanin and pyoverdine, without any effect on the growth of the biofilm cultures. These changes in biofilm virulence were associated with a decrease in biofilm resistance to PDT and caused bactericidal effect upon photosensitizers treatment and irradiation. Iberin-treated-riboflavin-mediated PDT resulted in a significant 1.3 log reduction in biofilm population. Similarly, iberin-treated-TMP-mediated PDT caused a significant 1.8 log reduction in biofilm population. The combination of QS inhibitor with PDT is a promising alternative antimicrobial therapy for the management of biofilms.

The effect of photodynamic therapy in controlling the oral biofilm: A comprehensive overview

Several resistance mechanisms are involved in dental caries, including oral biofilms. An accumulation of bacteria on the surface of teeth is called plaque. Periodontitis and gingivitis are caused by dental plaque. In this review article, we aimed to review the studies associated with the application of photodynamic therapy (PDT) to prevent and treat various microbial biofilm-caused oral diseases in recent decades. There are several studies published in PubMed that have described antimicrobial photodynamic therapy (APDT) effects on microorganisms. Several in vitro and in vivo studies have demonstrated the potential of APDT for treating endodontic, periodontal, and mucosal infections caused by bacteria as biofilms. Reactive oxygen species (ROS) are activated in the presence of oxygen by integrating a nontoxic photosensitizer (PS) with appropriate wavelength visible light. By causing irreversible damage to microorganisms, ROS induces some biological and photochemical events. Testing several wavelengths has been conducted to identify potential PS for APDT. A standard protocol is not yet available, and the current review summarizes findings from dental studies on APDT.

A Systematic Evaluation of Curcumin Concentrations and Blue Light Parameters towards Antimicrobial Photodynamic Therapy against Cariogenic Microorganisms

Dental caries is a highly preventable and costly disease. Unfortunately, the current management strategies are inadequate at reducing the incidence and new minimally invasive strategies are needed. In this study, a systematic evaluation of specific light parameters and aqueous curcumin concentrations for antimicrobial photodynamic therapy (aPDT) was conducted. Aqueous solutions of curcumin were first prepared and evaluated for their light absorbance after applying different ~56 mW/cm2 blue light treatments in a continuous application mode. Next, these same light treatments as well as different application modes were applied to the curcumin solutions and the molar absorptivity coefficient, reactive oxygen species (ROS) release, minimum inhibitory concentration (MIC), and minimum bactericidal concentration (MBC) for Streptococcus mutans and the MIC and minimum fungicidal concentration (MFC) for Candida albicans were measured. After up to 1 min of light treatment, the molar absorptivity of curcumin when added to culture media was lower than that for water only; however, at higher energy levels, this difference was not apparent. There was a noted dependence on both ROS type and cariogenic microorganism species on the sensitivity to both blue light treatment and application mode. In conclusion, this study provides new information towards improving the agonistic potential of aPDT associated with curcumin against cariogenic microorganisms.

In Vitro Comparative Evaluation of the Efficacy of Antimicrobial Photodynamic Therapy, Chlorhexidine, Sodium Fluoride, and Hydrogen Peroxide for Acrylic Resin Disinfection

Introduction: Plaque accumulation on the surface of removable orthodontic appliances could lead to dental caries, periodontitis, and fungal infections. This study evaluated the effectiveness of antimicrobial photodynamic therapy (aPDT), chlorhexidine (CHX), sodium fluoride (NaF), and hydrogen peroxide (H2O2) for the disinfection of acrylic resin. Methods: In this in vitro experimental study, 100 acrylic resin specimens were randomly divided into five groups (n=20 each): Enterococcus faecalis, Streptococcus mutans, Streptococcus salivarius, Streptococcus sanguinis, and Lactobacillus acidophilus. Each group was immersed separately in 5 mL of microbial suspension. They were then incubated until biofilm formation on their surface. Of each microorganism, one biofilm sample in phosphate-buffered saline was considered as negative control, and other biofilm samples (n=80) were subjected to aPDT with curcumin, 0.12% CHX (positive control), 1% H2O2, and 0.2% NaF. Finally, the number of colonies was counted. Data were analyzed by the Kruskal-Wallis and Mann-Whitney tests, two-way ANOVA, and Bonferroni adjustment at a significance level of 0.05. Results: The interaction effect of the treatment modality and type of microorganism was significant on the microbial count (effect size: 0.91, P<0.05). Maximum bacterial proliferation was noted in the following combinations: NaF/E. faecalis, H2O2/E. faecalis, and H2O2/S. salivarius. Microorganisms had no or insignificant growth and proliferation in the aPDT and CHX groups. Conclusion: The results supported the optimal antimicrobial efficacy of PDT which was comparable to that of CHX. aPDT showed superior antimicrobial efficacy to NaF and H2O2 for the disinfection of acrylic resin.

Treatments for Dissecting Cellulitis of the Scalp: A Systematic Review and Treatment Algorithm

BACKGROUND

Dissecting cellulitis of the scalp (DCS) is a chronic inflammatory skin condition characterized by abscesses, nodules, fistulas, and scarring alopecia. Management of this oftentimes debilitating dermatosis can be challenging due to its recalcitrant nature. There is limited data regarding the efficacy of treatment options for DCS.

OBJECTIVE

The aim of this study was to conduct a systematic review of the literature to explore the efficacy and safety of reported DCS treatments.

METHODS

In October 2022, MEDLINE and EMBASE databases were searched for articles on treatments for DCS. Studies that contained outcome efficacy data for DCS treatments were included. Reviews, conference abstracts, meta-analyses, commentaries, non-relevant articles, and articles with no full-text available were excluded. Data extraction was performed by two independent reviewers.

RESULTS

A total of 110 relevant articles with 417 patients were identified. A majority of studies (86.4%) were case reports or series. Treatment options included systemic antibiotics, oral retinoids, biologics, procedural treatments, combination agents, and topical treatments. Oral retinoids and photodynamic therapy were the most extensively studied medical and procedural interventions, respectively.

CONCLUSION

Overall, randomized controlled trials are needed to evaluate various treatment regimens for DCS and provide patients with a robust, evidence-based approach to therapy.

Polyphenolic natural products as photosensitizers for antimicrobial photodynamic therapy: recent advances and future prospects

Antimicrobial photodynamic therapy (aPDT) has become a potent contender in the fight against microbial infections, especially in the context of the rising antibiotic resistance crisis. Recently, there has been significant interest in polyphenolic natural products as potential photosensitizers (PSs) in aPDT, given their unique chemical structures and inherent antimicrobial properties. Polyphenolic natural products, abundant and readily obtainable from natural sources, are generally regarded as safe and highly compatible with the human body. This comprehensive review focuses on the latest developments and future implications of using natural polyphenols as PSs in aPDT. Paramount polyphenolic compounds, including curcumin, hypericin, quercetin, hypocrellin, celastrol, riboflavin, resveratrol, gallic acid, and aloe emodin, are elaborated upon with respect to their structural characteristics, absorption properties, and antimicrobial effects. Furthermore, the aPDT mechanism, specifically its targeted action on microbial cells and biofilms, is also discussed. Polyphenolic natural products demonstrate immense potential as PSs in aPDT, representing a promising alternate approach to counteract antibiotic-resistant bacteria and biofilm-related infections.

Disinfection of influenza a viruses by Hypocrellin a-mediated photodynamic inactivation

BACKGROUND

Influenza A viruses can be transmitted indirectly by surviving on the surface of an object. Photodynamic inactivation (PDI) is a promising approach for disinfection of pathogens.

METHODS

PDI was generated using Hypocrellin A (HA) and red light emitting diode (625-635 nm, 280 W/m2). Effects of the HA-mediated PDI on influenza viruses H1N1 and H3N2 were evaluated by the reduction of viral titers compared to virus control. After selection of the HA concentrations and illumination times, the applicability of PDI was assessed on surgical masks. Reactive oxygen species (ROS) were determined using a 2'-7'-dichlorodihydrofluorescein diacetate fluorescence probe.

RESULTS

In solution, 10 μM HA inactivated up to 5.11 ± 0.19 log10 TCID50 of H1N1 and 4.89 ± 0.38 log10 TCID50 of H3N2 by illumination for 5 and 30 min, respectively. When surgical masks were contaminated by virus before HA addition, PDI inactivated 99.99% (4.33 ± 0.34 log reduction) of H1N1 and 99.40% (2.22 ± 0.39 log reduction) of H3N2 under the selected condition. When the masks were pretreated with HA before virus addition, PDI decontaminated 99.92% (3.11 ± 0.19 log reduction) of H1N1 and 98.71% (1.89 ± 0.20 log reduction) of H3N2 virus. The fluorescence intensity of 2',7'-dichlorofluorescein in photoactivated HA was significantly higher than the cell control (P > 0.05), indicating that HA efficiently generated ROS.

CONCLUSIONS

HA-mediated PDI is effective for the disinfection of influenza viruses H1N1 and H3N2. The approach could be an alternative to decontaminating influenza A viruses on the surfaces of objects.

Photodynamic Therapy and Its Synergism with Melittin Against Drug-Resistant Acinetobacter baumannii Isolates with High Biofilm Formation Ability

Drug-resistant biofilm producer A. baumannii isolates are a global concern that warns researchers about the development of new treatments. This study was designed to analyze the effect of photodynamic therapy (PDT) as monotherapy and associated with melittin on multidrug-resistant A. baumannii isolates. Sub-lethal doses of photosensitizer, LED, and PDT were determined. The PDT effect on the biofilm and expression of biofilm-associated genes was evaluated by scanning electron microscopy and quantitative real-time PCR (qRT-PCR) methods, respectively. The synergistic effect of PDT and melittin on the survival of MDR/XDR strong biofilm producer isolates was evaluated by checkerboard assay. Survival rates were significantly decreased at the lowest concentration of 12.5-50 μg/ml in 4 min at an energy density of 93.75 J/cm2 (P < 0.05). The optimized PDT method had a bactericidal effect against all tested groups, and the mean expression levels of csu, abaI, bap, and ompA genes in the strong biofilm producers were decreased significantly compared to the control group. The combined effect of LED and melittin successfully reduced the MDR/XDR A. baumannii strong biofilm producers' growth from 3.1 logs. MB-mediated aPDT and combined treatment of PDT with melittin, which has been investigated for the first time in this study, can be an efficient strategy against MDR/XDR A. baumannii isolates with strong biofilm production capacity.

Photoantimicrobial activity of Schiff-base Morpholino phthalocyanines against drug resistant micro-organisms in their planktonic and biofilm forms

Antimicrobial photodynamic inactivation (aPDI) is an alternative treatment for the eradication of drug-resistant micro-organisms. One of the advantages of this technique, it that there is no possibility of microbial resistance. Hence, herein, the preparation and characterization of novel neutral and cationic morpholine containing Schiff base phthalocyanines are reported. The cationic complexes (4 and 5) gave moderate singlet oxygen quantum yields (Φ_Δ) of ∼0.2 in aqueous media. Conversely, the neutral complexes generated very low Φ_Δ values making them very poor candidates for antimicrobial studies. The cationic phthalocyanines showed excellent photodynamic activity against planktonic cells of all micro-organisms (Candida albicans, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Salmonella enterica subspecies enterica serovar Choleraesuis, vancomycin-resistant E. faecium, and methicillin-resistant Staphylococcus aureus). The efficiency of aPDI was shown to be both concentration and light-dose-dependent. Mono biofilms were susceptible when treated with 200 µM of cationic Pcs at 108 J/cm². However, ∼10% of the mixed biofilm survived after treatment.

Hydrogen peroxide enhances the efficacy of photodynamic therapy against Candida albicans biofilms

The present study aimed to evaluate the effectiveness of hydrogen peroxide (H₂O₂) combined with antimicrobial photodynamic therapy (aPDT) on biofilms formed by Candida albicans strains which are either susceptible to or resistant to fluconazole. Biofilms were grown and treated with H₂O₂, followed by the application of Photodithazine® (P) and red light-emitting diode (LED) (L) either separately or combined (n = 12). After the treatment, biofilms were evaluated by estimating colony-forming unit ml^-1, extracellular matrix components [water -soluble and -insoluble polysaccharides, proteins, extracellular DNA (eDNA)], biomass (total and insoluble dry-weight), and protein concentration. Biofilms formed by both strains presented a significant reduction in cell viability, biomass, extracellular matrix components (both types of polysaccharides, eDNA), and proteins (in the soluble and insoluble portion of biofilms) compared to the control. Microscopy images of the biofilms after treatments showed disarticulation of the matrix and scattered fungal cells. The application of H₂O₂ can disturb the organization of the extracellular matrix, and its association with aPDT potentiated the effect of the treatment.

The first evidence of antibiofilm action of Proteus mirabilis with tetra-cationic porphyrins containing cisplatin by antimicrobial photodynamic therapy

Biofilms are responsible for up to 80% of antimicrobial-resistant nosocomial infections. Most of these infections are associated with medical devices such as urinary catheters, and in this context, it is estimated that 90-100% of patients who undergo long-term catheterization develop infections. Proteus mirabilis, the most prevalent microorganism, is responsible for 20-45% of these infections. Thus, this study aimed to evaluate, for the first time, the antimicrobial and antibiofilm effects of cationic porphyrins on P. mirabilis. Neutral porphyrins 3-H₂TPyP and 4-H₂TpyP and tetra-cationic derivatives 3-cis-PtTPyP and 4-cis-PtTPyP were evaluated in broth microdilution tests to determine the minimum inhibitory and bactericidal concentrations. Time-kill curves, checkerboard test, reactive oxygen species (ROS) scavenger assays, conventional biofilm formation, and biofilm assay with catheters were also performed. The microdilution tests showed greater efficacy against P. mirabilis when 3-cis-PtTPyP was exposed to white-light conditions; this also occurred when the microbial time-kill curve was performed at 0, 2, 6, and 12 h. The radical superoxide species was possibly responsible for photoinactivation in the ROS scavenger assays. In biofilm assays (conventional and catheter), 3-cis-PtTPyP obtained better results when irradiated with a white-light source. In the checkerboard assay, the same compound showed no differences when tested in association with ciprofloxacin hydrochloride. Our findings lead us to conclude that antimicrobial photodynamic therapy and cationic porphyrins obtained positive results and are promising alternatives to treat P. mirabilis biofilms.

Sweet light o' mine: Photothermal and photodynamic inactivation of tenacious pathogens using conjugated polymers

Each year a rising number of infections can not be successfully treated owing to the increasing pandemic of antibiotic resistant pathogens. The global shortage of innovative antibiotics fuels the emergence and spread of drug resistant microbes. Basic research, development, and applications of alternative therapies are urgently needed. Since the 90´s, light-mediated therapies have promised to be the next frontier combating multidrug-resistance microbes. These platforms have demonstrated to be a reliable, rapid, and efficient alternative to eliminate tenacious pathogens while avoiding the emergence of resistance mechanisms. Among the materials showing antimicrobial activity triggered by light, conjugated polymers (CPs) have risen as the most promising option to tackle this complex situation. These materials present outstanding characteristics such as high absorption coefficients, great photostability, easy processability, low cytotoxicity, among others, turning them into a powerful class of photosensitizer (PS)/photothermal agent (PTA) materials. Herein, we summarize and discuss the advances in the field of CPs with applications in photodynamic inactivation and photothermal therapy towards bacteria elimination. Additionally, a section of current challenges and needs in terms of well-defined benchmark experiments and conditions to evaluate the efficiency of phototherapies is presented.

Enzyme-Photocatalyst Tandem Microrobot Powered by Urea for Escherichia coli Biofilm Eradication

Urinary-based infections affect millions of people worldwide. Such bacterial infections are mainly caused by Escherichia coli (E. coli) biofilm formation in the bladder and/or urinary catheters. Herein, the authors present a hybrid enzyme/photocatalytic microrobot, based on urease-immobilized TiO₂ /CdS nanotube bundles, that can swim in urea as a biocompatible fuel and respond to visible light. Upon illumination for 2 h, these microrobots are able to remove almost 90% of bacterial biofilm, due to the generation of reactive radicals, while bare TiO₂ /CdS photocatalysts (non-motile) or urease-coated microrobots in the dark do not show any toxic effect. These results indicate a synergistic effect between the self-propulsion provided by the enzyme and the photocatalytic activity induced under light stimuli. This work provides a photo-biocatalytic approach for the design of efficient light-driven microrobots with promising applications in microbiology and biomedicine.

Microbiome-derived antimicrobial peptides offer therapeutic solutions for the treatment of Pseudomonas aeruginosa infections

Microbiomes are rife for biotechnological exploitation, particularly the rumen microbiome, due to their complexicity and diversity. In this study, antimicrobial peptides (AMPs) from the rumen microbiome (Lynronne 1, 2, 3 and P15s) were assessed for their therapeutic potential against seven clinical strains of Pseudomonas aeruginosa. All AMPs exhibited antimicrobial activity against all strains, with minimum inhibitory concentrations (MICs) ranging from 4–512 µg/mL. Time-kill kinetics of all AMPs at 3× MIC values against strains PAO1 and LES431 showed complete kill within 10 min to 4 h, although P15s was not bactericidal against PAO1. All AMPs significantly inhibited biofilm formation by strains PAO1 and LES431, and induction of resistance assays showed no decrease in activity against these strains. AMP cytotoxicity against human lung cells was also minimal. In terms of mechanism of action, the AMPs showed affinity towards PAO1 and LES431 bacterial membrane lipids, efficiently permeabilising the P. aeruginosa membrane. Transcriptome and metabolome analysis revealed increased catalytic activity at the cell membrane and promotion of β-oxidation of fatty acids. Finally, tests performed with the Galleria mellonella infection model showed that Lynronne 1 and 2 were efficacious in vivo, with a 100% survival rate following treatment at 32 mg/kg and 128 mg/kg, respectively. This study illustrates the therapeutic potential of microbiome-derived AMPs against P. aeruginosa infections.

Photodynamic therapy-a promising treatment of oral mucosal infections

The treatment of oral mucosal infections is increasingly challenging owing to antibiotic resistance. Therefore, alternative antimicrobial strategies are urgently required. Photodynamic therapy (PDT) has attracted attention for the treatment of oral mucosal infections because of its ability to effectively inactivate drug-resistant bacteria, completely heal clinical infectious lesions and usually offers only mild adverse reactions. This review briefly summarizes relevant scientific data and published papers and discusses the potential mechanism and application of PDT in the treatment of oral mucosal infections.

Inactivation of Bacillus subtilis by Curcumin-Mediated Photodynamic Technology through Inducing Oxidative Stress Response

Photodynamic sterilization technology (PDT) is widely used in disease therapy, but its application in the food industry is still at the research stage because of the limitations of food-grade photosensitizers. Curcumin exhibits photosensitivity and is widely used as a food additive for its natural color. This study aimed to determine the effect of curcumin-mediated photodynamic technology (Cur-PDT) on Bacillus subtilis and to elucidate the anti-bacterial mechanism involved. First, the effects of curcumin concentration, duration of light irradiation, light intensity, and incubation time on the inactivation of B. subtilis were analyzed. It was found that Cur-PDT inactivated 100% planktonic cells with 50 μmol/L curcumin in 15 min (120 W). Then, the cell morphology, oxidation state and the expression of membrane structure- and DNA damage-related genes of B. subtilis vegetative cells were investigated under different treatment conditions. The membrane permeability of cells was enhanced and the cell membrane structure was damaged upon treatment with Cur-PDT, which were exacerbated with increases of treatment time and curcumin concentration. Meanwhile, the production of reactive oxygen species increased and the activities of the antioxidant enzymes SOD, GPX, and CAT decreased inside the cells. Furthermore, the Cur-PDT treatment significantly downregulated the mRNA of the membrane protein TasA and upregulated the DNA damage recognition protein UvrA and repair protein RecA of B. subtilis. These results suggested that curcumin-mediated PDT could effectively inactivate B. subtilis by inducing cell redox state imbalance, damaging DNA, and disrupting membrane structures.

Recent advances in nanoparticle-based targeting tactics for antibacterial photodynamic therapy

Abstract

The rise of antibacterial drug resistance means treatment options are becoming increasingly limited. We must find ways to tackle these hard-to-treat drug-resistant and biofilm infections. With the lack of new antibacterial drugs (such as antibiotics) reaching the clinics, research has switched focus to exploring alternative strategies. One such strategy is antibacterial photodynamic therapy (aPDT), a system that relies on light, oxygen, and a non-toxic dye (photosensitiser) to generate cytotoxic reactive oxygen species. This technique has already been shown capable of handling both drug-resistant and biofilm infections but has limited clinical approval to date, which is in part due to the low bioavailability and selectivity of hydrophobic photosensitisers. Nanotechnology-based techniques have the potential to address the limitations of current aPDT, as already well-documented in anti-cancer PDT. Here, we review recent advances in nanoparticle-based targeting tactics for aPDT.

Graphical Abstract

Enhanced antimicrobial activity through the combination of antimicrobial photodynamic therapy and low-frequency ultrasonic irradiation

The rapid increase of antibiotic resistance in pathogenic microorganisms has become one of the most severe threats to human health. Antimicrobial photodynamic therapy (aPDT), a light-based regimen, has offered a compelling nonpharmacological alternative to conventional antibiotics. The activity of aPDT is based on cytotoxic effect of reactive oxygen species (ROS), which are generated through the photosensitized reaction between photon, oxygen and photosensitizer. However, limited by the penetration of light and photosensitizers in human tissues and/or the infiltration of oxygen and photosensitizers in biofilms, the eradication of deeply located or biofilm-associated infections by aPDT remains challenging. Ultrasound irradiation bears a deeper penetration in human tissues than light and, sequentially, can promote drug delivery through cavitation effect. As such, the combination of ultrasound and aPDT represents a potent antimicrobial strategy. In this review, we summarized the recent progresses in the area of the combination therapy using ultrasound and aPDT, and discussed the potential mechanisms underlying enhanced antimicrobial effect by this combination therapy. The future research directions are also highlighted.

Magnetic-Responsive Photosensitizer Nanoplatform for Optimized Inactivation of Dental Caries-Related Biofilms: Technology Development and Proof of Principle

Conventional antibiotic therapies for biofilm-trigged oral diseases are becoming less efficient due to the emergence of antibiotic-resistant bacterial strains. Antimicrobial photodynamic therapy (aPDT) is hampered by restricted access to bacterial communities embedded within the dense extracellular matrix of mature biofilms. Herein, a versatile photosensitizer nanoplatform (named MagTBO) was designed to overcome this obstacle by integrating toluidine-blue ortho (TBO) photosensitizer and superparamagnetic iron oxide nanoparticles (SPIONs) via a microemulsion method. In this study, we reported the preparation, characterization, and application of MagTBO for aPDT. In the presence of an external magnetic field, the MagTBO microemulsion can be driven and penetrate deep sites inside the biofilms, resulting in an improved photodynamic disinfection effect compared to using TBO alone. Besides, the obtained MagTBO microemulsions revealed excellent water solubility and stability over time, enhanced the aPDT performance against S. mutans and saliva-derived multispecies biofilms, and improved the TBO's biocompatibility. Such results demonstrate a proof-of-principle for using microemulsion as a delivery vehicle and magnetic field as a navigation approach to intensify the antibacterial action of currently available photosensitizers, leading to efficient modulation of pathogenic oral biofilms.

pH-Responsive Oxygen and Hydrogen Peroxide Self-Supplying Nanosystem for Photodynamic and Chemodynamic Therapy of Wound Infection

The combination of photodynamic therapy (PDT) and chemodynamic therapy (CDT) has been continuously explored in the antibacterial aspect and has achieved more effective antibacterial effect than a single therapy. We design a pH-responsive O₂ and H₂O₂ self-supplying zeolitic imidazolate framework-67 (ZIF-67) nanosystem for PDT/CDT of wound infection. Under the acidic inflammatory conditions, ZIF-67 can degrade to produce Co²⁺ and release CaO₂ and graphene quantum dots (GQDs). The exposed CaO₂ reacted with water to generate H₂O₂ and O₂. The self-supplied O₂ alleviates hypoxia at the site of inflammation and enhances external light-initiated GQD-mediated PDT, while H₂O₂ was catalyzed by endogenous Co²⁺ to produce hydroxyl radicals for Co²⁺-triggered CDT. In vitro and in vivo experiments confirm that CaO₂/GQDs@ZIF-67 has a combined PDT/CDT effect. The antibacterial mechanism indicates that bacteria post-treated with CaO₂/GQDs@ZIF-67 may be sterilized by reactive oxygen species-mediated oxidative stress and the leakage of bacterial contents. The experiments also find that CaO₂/GQDs@ZIF-67 may activate the immune response and enhance the therapeutic effect by activating the cyclic GMP-AMP synthase-stimulator of interferon genes signaling pathway.

Recent Advances in Photodynamic Therapy against Fungal Keratitis

Fungal keratitis is a serious clinical infection on the cornea caused by fungi and is one of the leading causes of blindness in Asian countries. The treatment options are currently limited to a few antifungal agents. With the increasing incidence of drug-resistant infections, many patients fail to respond to antibiotics. Riboflavin-mediated corneal crosslinking (similar to photodynamic therapy (PDT)) for corneal ectasia was approved in the US in the early 2000s. Current evidence suggests that PDT could have the potential to inhibit fungal biofilm formation and overcome drug resistance by using riboflavin and rose bengal as photosensitizers. However, only a few clinical trials have been initiated in anti-fungal keratitis PDT treatment. Moreover, the removal of the corneal epithelium and repeated application of riboflavin and rose bengal are required to improve drug penetration before and during PDT. Thus, an improvement in trans-corneal drug delivery is mandatory for a successful and efficient treatment. In this article, we review the studies published to date using PDT against fungal keratitis and aim to enhance the understanding and awareness of this research area. The potential of modifying photosensitizers using nanotechnology to improve the efficacy of PDT on fungal keratitis is also briefly reviewed.

Antimicrobial photodynamic therapy (aPDT) for biofilm treatments. Possible synergy between aPDT and pulsed electric fields

Currently, microbial biofilms have been the cause of a wide variety of infections in the human body, reaching 80% of all bacterial and fungal infections. The biofilms present specific properties that increase the resistance to antimicrobial treatments. Thus, the development of new approaches is urgent, and antimicrobial photodynamic therapy (aPDT) has been shown as a promising candidate. aPDT involves a synergic association of a photosensitizer (PS), molecular oxygen and visible light, producing highly reactive oxygen species (ROS) that cause the oxidation of several cellular components. This therapy attacks many components of the biofilm, including proteins, lipids, and nucleic acids present within the biofilm matrix; causing inhibition even in the cells that are inside the extracellular polymeric substance (EPS). Recent advances in designing new PSs to increase the production of ROS and the combination of aPDT with other therapies, especially pulsed electric fields (PEF), have contributed to enhanced biofilm inhibition. The PEF has proven to have antimicrobial effect once it is known that extensive chemical reactions occur when electric fields are applied. This type of treatment kills microorganisms not only due to membrane rupture but also due to the formation of reactive compounds including free oxygen, hydrogen, hydroxyl and hydroperoxyl radicals. So, this review aims to show the progress of aPDT and PEF against the biofilms, suggesting that the association of both methods can potentiate their effects and overcome biofilm infections.

Boosting the inactivation of bacterial biofilms by photodynamic targeting of matrix structures with Thioflavin T

We report that Thioflavin T (ThT), the reference fluorogenic probe for amyloid detection, displays photodynamic activity against bacterial biofilms. ThT recognizes key structures of the biofilm matrix, disrupting the complex architecture and efficiently inactivating bacterial cells. We also show that ThT phototherapy synergistically boosts the activity of conventional antimicrobials.

Biofilms in Diabetic Foot Ulcers: Impact, Risk Factors and Control Strategies

Diabetic foot ulcers (DFUs) are a serious complication from diabetes mellitus, with a huge economic, social and psychological impact on the patients' life. One of the main reasons why DFUs are so difficult to heal is related to the presence of biofilms. Biofilms promote wound inflammation and a remarkable lack of response to host defences/treatment options, which can lead to disease progression and chronicity. In fact, appropriate treatment for the elimination of these microbial communities can prevent the disease evolution and, in some cases, even avoid more serious outcomes, such as amputation or death. However, the detection of biofilm-associated DFUs is difficult due to the lack of methods for diagnostics in clinical settings. In this review, the current knowledge on the involvement of biofilms in DFUs is discussed, as well as how the surrounding environment influences biofilm formation and regulation, along with its clinical implications. A special focus is also given to biofilm-associated DFU diagnosis and therapeutic strategies. An overview on promising alternative therapeutics is provided and an algorithm considering biofilm detection and treatment is proposed.

Effect of Topology on Photodynamic Sterilization of Porphyrinic Metal-Organic Frameworks

Porphyrinic metal-organic frameworks (MOFs) are promising photosensitizers due to the lack of self-aggregation of porphyrin in aqueous solution. However, how the topology of porphyrinic MOFs affects the generation of singlet oxygen (¹ O₂ ) is unclear. Here, the effect of the topology of porphyrinic MOFs on their photodynamic performance is reported. Four porphyrinic zirconium MOFs (MOF-525, MOF-545, PCN-223 and PCN-224 with different topologies: ftw, csq, shp and she, respectively) were selected to study the influence of topology on the photodynamic antibacterial performance. The ¹ O₂ generation and the photodynamic antibacterial performance followed an decreasing order of MOF-545>MOF-525>PCN-224>PCN-223. The results reveal that the pore size, the distance between porphyrin, and the number of porphyrin per Zr₆ O₈ cluster in MOFs greatly affected ¹ O₂ generation. This work provides guidance for designing new MOFs for efficient photodynamic sterilization.

Radiographic and antimicrobial evaluation of enterococcus Faecalis and Actinomyces Israelii micro-organisms after photodynamic therapy (aPDT)

This study evaluated the action of Antimicrobial Photodynamic Therapy (aPDT) on Enterococcus faecalis and Actinomyces israelii. Samples were taken from the root canal system, at different stages of treatment and bacteria were identified through qPCR. Fifty teeth (incisors, canines, and premolars) with pulp necrosis and periapical lesion diagnosis were randomly selected and divided into 2 groups: Group 1 (G1) - Endodontic Therapy with Mechanical Chemical Preparation (MPQ) and intracanal medication; Group 2 (G2) - Endodontic therapy with MPQ, intracanal medication, and 2 applications of aPDT. APDT was performed with application of 0.005% methylene blue, wavelength of 660 nm, and 90 seconds. Follow-up was performed with an initial x-ray and an x-ray 60 days after the end of treatment. The radiographs were scored evaluated by two examiners to classify periapical repair: total repair, partial repair, doubtful repair, or no repair. Enterococcus faecalis was found more frequently in G1 than G2. Actinomyces israelii was found equally in G1 and G2. Evaluation of the two bacteria between collections 1, 2 and 3, showed that there was no difference, both in G1 and in G2. There was association between the variables group and repair classification in radiographs evaluation. APDT did not promote better results in endodontic treatment, being similar to conventional treatment. However, this study pointed out that molecular methods may not be efficient in detecting bacteria after treatment, and colony-forming units may complement, being an effective quantifying method. Therefore, new studies must be carried out to show the possible effectiveness of aPDT.

Comparison of Antibacterial Activity and Wound Healing in a Superficial Abrasion Mouse Model of Staphylococcus aureus Skin Infection Using Photodynamic Therapy Based on Methylene Blue or Mupirocin or Both

Background: Antibiotic resistance and impaired wound healing are major concerns in S. aureus superficial skin infections, and new therapies are needed. Antimicrobial photodynamic therapy (aPDT) is a new therapeutic approach for infections, but it also improves healing in many wound models. Objective: To compare the antimicrobial activity and the effects on wound healing of aPDT based on Methylene Blue (MB-aPDT) with mupirocin treatment, either alone or in combination, in superficial skin wounds of S. aureus-infected mice. Additionally, to evaluate the clinical, microbiological, and cosmetic effects on wound healing. Materials and Methods: A superficial skin infection model of S. aureus was established in SKH-1 mice. Infected wounds were treated with MB-aPDT, MB-aPDT with a daily topical mupirocin or only with mupirocin. No treatment was carried out in control animals. Daily clinical and microbiological examinations were performed until complete clinical wound healing. Histopathological studies and statistical analysis were performed at the end of the study. Results: MB-aPDT treatment induced the best wound healing compared to mupirocin alone or to mupirocin plus MB-aPDT. Superficial contraction at 24 h and a greater reduction in size at 48 h, quicker detachment of the crust, less scaling, and absence of scars were observed. Histopathological studies correlated with clinical and gross findings. By contrast, mupirocin showed the highest logaritmic reduction of S. aureus. Conclusions: MB-aPDT and mupirocin treatments are effective in a murine superficial skin infection model of S. aureus. One session of MB-aPDT was the best option for clinical wound healing and cosmetic results. The addition of mupirocin to MB-aPDT treatment improved antimicrobial activity; however, it did not enhance wound healing. No synergistic antibacterial effects were detected.

Bactericidal efficiency of porphyrin systems

Photodynamic Inactivation is an innovative technique used to combat bacterial and viral infections which involves the use of photosensitizing agents along with light to generate cytotoxic reactive oxygen species able to kill bacteria and viruses. In the first section of this minireview, porphyrin-based fluorophores are shown to be remarkable dye candidates for PDI (photodynamic inactivation) applications. The second section is dedicated to the description of porphyrin-based antimicrobial materials and their potentialities for industrial applications such as in food packaging or antimicrobial medical devices and hygiene. Finally, the failings and perspectives of PDI are analyzed to demonstrate how the PDI technique could be an efficient and ecologically friendly antimicrobial technique.

Cationic zinc (II) phthalocyanine nanoemulsions for photodynamic inactivation of resistant bacterial strains

BACKGROUND

The growing emergence of microbial resistance to antibiotics represents a worldwide challenge. Antimicrobial photodynamic inactivation (aPDI) has been introduced as an alternative technique, especially when combined with nanotechnology. Therefore, this study was designed to investigate the therapeutic merits of combined aPDI and nanoemulsion in infections caused by resistant bacterial strains.

METHODS

Cationic zinc (II) phthalocyanine nanoemulsions (ZnPc-NE) were prepared using isopropyl myristate (IPM) as oil phase, egg phosphatidylcholine (egg PC) as emulsifier, and N-cetyl-N,N,N-trimethyl ammonium bromide (CTAB). Nanoemulsions were characterized for particle size, polydispersity, zeta potential, viscosity, and skin deposition. The in-vitro aPDI was investigated on human resistant pathogens; gram-positive methicillin-resistant Staphylococcus aureus (MRSA) and gram-negative Multidrug-resistant strain of Escherichia coli (MDR E. coli), under different experimental conditions. In addition, in-vivo model of abrasion wound infected by MDR E. coli was induced in rats to investigate the therapeutic potential of the selected formulation.

RESULTS

It was evident that the selected ZnPc formulation (20 % IPM, 2 % egg PC and 0.5 % CTAB) displayed a particle size of 209.9 nm, zeta potential +73.1 mV, and 23.66 % deposition of ZnPc in skin layers. Furthermore, the selected formulation combined with light achieved almost 100 % eradication of the two bacterial strains, with superior bacterial load reduction and wound healing propertiesin-vivo, compared to either the nanoemulsion formulation or laser alone.

CONCLUSION

ZnPc nanoemulsion improved antimicrobial photodynamic therapy in inactivating resistant bacterial infections and provided a promising therapeutic means of treating serious infections, and hence could be applied in diseases caused by other bacterial strains.

An orthodontic acrylic resin containing seaweed Ulva lactuca as a photoactive phytocompound in antimicrobial photodynamic therapy: Assessment of anti-biofilm activities and mechanical properties

BACKGROUND

Uncontrolled accumulation of microbial plaque and formation of biofilm on the surface orthodontic acrylic removable appliances increases the risk of enamel decalcification and periodontal diseases. The purpose of the present study was to evaluate antimicrobial activities, anti-virulence potencies, and mechanical properties of orthodontic acrylic resin containing different concentrations of Ulva lactuca (a green marine macroalga) following photo-activation against Streptococcus mutans.

MATERIALS AND METHODS

Minimum inhibitory concentration (MIC) of U. lactuca was determined against S. mutans. Acrylic resin specimens with different concentrations of U. lactuca (0.2 %, 0.5 %, 1%, 2.5 %, 5%, and 10 % weight/weight) were fabricated. Flexural strength values, antimicrobial effects, and anti-biofilm activities of samples were assessed in comparison with original acrylic resin as the control group. Also, the expression of the virulence-associated genes was assessed by quantitative real-time polymerase chain reaction.

RESULTS

U. lactuca at concentrations of 1-10% significantly reduced the S. mutans growth rate by 20.3%-63.3% in comparison to the control group (P < 0.05). Therefore, the concentration of 1% of U. lactuca was considered as a MIC. The highest and lowest flexural strength values were observed in the control group (43.5 ± 2.4 MPa) and the group with a 10 % concentration of U. lactuca (19.2 ± 1.8 MPa), respectively. Flexural strength values decreased in samples containing 2.5 %, 5%, and 10 % concentrations of U. lactuca in comparison to the control group significantly (P > 0.05). In the disc agar diffusion test, the growth inhabitation zones around samples containing different concentrations of photo-activated U. lactuca ranged from 13 mm to 25 mm in diameter. Interestingly, the anti-biofilm activity of U. lactuca-mediated aPDT against S. mutans was dose-dependent. Additionally, the sub-MIC dose of U. lactuca (0.5 %) following photo-activation could significantly decrease the expression levels of gtfB, gtfC, and gtfD to 4.1-, 5.3-, and 7.4-fold, respectively.

CONCLUSIONS

Adding photo-activated U. lactuca to the orthodontic acrylic resin at a concentration of 1% increases its antibacterial and anti-biofilm activities besides not detrimentally affects its flexural strength.

The Antibacterial Effects of Supermolecular Nano-Carriers by Combination of Silver and Photodynamic Therapy

The over-use of antibiotics has promoted multidrug resistance and decreased the efficacy of antibiotic therapy. Thus, it is still in great need to develop efficient treatment strategies to combat the bacteria infection. The antimicrobial photodynamic therapy (aPDT) and silver nanoparticles have been emerged as effective antibacterial methods. However, the silver therapy may induce serious damages to human cells at high concentrations and, the bare silver nanoparticles may rapidly aggregate, which would reduce the antibacterial efficacy. The encapsulation of sliver by nano-carrier is a promising way to avoid its aggregation and facilitates the co-delivery of drugs for combination therapy, which does not require high concentration of sliver to exert antibacterial efficacy. This work constructed a self-assembled supermolecular nano-carrier consisting of the photosensitizers (PSs), the anti-inflammatory agent and silver. The synthesized supermolecular nano-carrier produced reactive oxygen species (ROS) under the exposure of 620-nm laser. It exhibited satisfying biocompatibility in L02 cells. And, this nano-carrier showed excellent antibacterial efficacy in Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) as indicated by bacterial growth and colony formation. Its antibacterial performance is further validated by the bacteria morphology through the scanning electron microscope (SEM), showing severely damaged structures of bacteria. To summary, the supermolecular nano-carrier TCPP-MTX-Ag-NP combining the therapeutic effects of ROS and silver may serve as a novel strategy of treatment for bacterial infection.

Antibacterial and Antibiofilm Photodynamic Activities of Lysozyme-Au Nanoclusters/Rose Bengal Conjugates

Antibacterial photodynamic therapy (aPDT) utilizes reactive oxygen species such as singlet oxygen (1O2) and free radicals via photosensitizers, which are light and light-sensitive agents, to reduce bacterial infections. It has been utilized as a treatment for dental diseases in place of antibiotic therapies. However, aPDT does not always cause the desired therapeutic effect due to the instability of organic photosensitizers and the formation of bacterial biofilms. To promote the antibacterial and antibiofilm effects of aPDT, we have proposed a lysozyme (Lys)-gold nanoclusters (Au NCs)/rose bengal (Lys-Au NCs/RB) conjugate as a novel photosensitizer. This conjugate was found to effectively impede the growth of both gram-positive and gram-negative bacteria when exposed to white light-emitting diode (LED) irradiation. The photoexcited Lys-Au NCs/RB showed significantly higher antibacterial activity than photoexcited Lys-Au NCs or RB alone. The synergistic effect is a result of the combination of Lys (an antibacterial protein) and enhanced 1O2 generation related to resonance energy transfer (RET) in the Au NCs/RB conjugate. Photoexcited Lys-Au NCs/RB increased the effects of aPDT in a dose- and time-dependent manner. Furthermore, the photoexcited Lys-Au NCs/RB successfully decreased Streptococcus mutans biofilm formation. However, in contrast, it did not have a negative effect on the proliferation, adhesion, or spread of mammalian cells, indicating low cytotoxicity. Lys-Au NCs/RB is a novel photosensitizer with low cytotoxicity that is capable of bacterial inactivation and the suppression of biofilm formation, and could help to improve dental treatments in the future.

Akim A, Chong PP. Approaches for Mitigating Microbial Biofilm-Related Drug Resistance: A Focus on Micro- and Nanotechnologies

Biofilms play an essential role in chronic and healthcare-associated infections and are more resistant to antimicrobials compared to their planktonic counterparts due to their (1) physiological state, (2) cell density, (3) quorum sensing abilities, (4) presence of extracellular matrix, (5) upregulation of drug efflux pumps, (6) point mutation and overexpression of resistance genes, and (7) presence of persister cells. The genes involved and their implications in antimicrobial resistance are well defined for bacterial biofilms but are understudied in fungal biofilms. Potential therapeutics for biofilm mitigation that have been reported include (1) antimicrobial photodynamic therapy, (2) antimicrobial lock therapy, (3) antimicrobial peptides, (4) electrical methods, and (5) antimicrobial coatings. These approaches exhibit promising characteristics for addressing the impending crisis of antimicrobial resistance (AMR). Recently, advances in the micro- and nanotechnology field have propelled the development of novel biomaterials and approaches to combat biofilms either independently, in combination or as antimicrobial delivery systems. In this review, we will summarize the general principles of clinically important microbial biofilm formation with a focus on fungal biofilms. We will delve into the details of some novel micro- and nanotechnology approaches that have been developed to combat biofilms and the possibility of utilizing them in a clinical setting.

Eradication of Acinetobacter baumannii Planktonic and Biofilm Cells Through Erythrosine-Mediated Photodynamic Inactivation Augmented by Acetic Acid and Chitosan

Photodynamic inactivation (PDI) is an attractive treatment modality for multidrug-resistant bacterial infections. The effectiveness of photosensitization by anionic photosensitizers such as erythrosine B can be further enhanced by the addition of biological or chemical molecules. This study aimed to investigate of the enhancement effect of acetic acid and chitosan on erythrosine-mediated PDI of Acinetobacter baumannii in planktonic and biofilm forms. The planktonic cell growth of three A. baumannii strains was subjected to PDI by using erythrosine B (50 µM) in 0.01% acetic acid and green laser light (530 nm) at fluence of 40 J/cm². The phototoxic effect of erythrosine B (100 µM) in combination with chitosan (12.5 mg/ml) (in a solution of acetic acid) at fluence of 80 J/cm2 on biofilms was also evaluated. Finally, the cytotoxicity and phototoxicity of the mentioned mixture were assessed on human fibroblasts. Planktonic cells of all three studied A. baumannii strains were almost eradicated by erythrosine B-mediated PDI in the presence of acetic acid. Also, PDI combined with chitosan resulted in a marked decrease in the number of viable biofilm cells (> 3 log₁₀ CFU). At the same experimental conditions, only 15% of the fibroblasts were photoinactivated. The results showed that PDI by using erythrosine B in acetic acid is very effective against A. baumannii planktonic cells and could eliminate them significantly. Also, chitosan enhanced the anti-biofilm efficacy of erythrosine B-mediated PDI against A. baumannii, suggesting that combination therapy may be useful in targeting biofilms.

Photoactive antimicrobial coating based on a PEDOT-fullerene C60 polymeric dyad

A photostable and photodynamic antimicrobial surface was successfully obtained and applied to photoinactivate microorganisms. This approach was based on the synthesis of a fullerene C₆₀ derivative (EDOT-C₆₀) where fullerene C₆₀ is covalently linked to 3,4-ethylenedioxythiophene (EDOT) through a 1,3-dipolar cycloaddition reaction. This dual-functional monomer bears an EDOT center connected via an alkyl chain to a fullerene C₆₀ moiety. In this structure, EDOT acts as an electropolymerizable unit that allows the film formation over conducting substrates, while fullerene C₆₀ performs the photodynamic antimicrobial activity. Electrochemical polymerization of EDOT was used to obtain stable and photodynamic polymeric films (PEDOT-C₆₀) in a controllable procedure. Cyclic voltammetry and UV-visible spectroscopy studies showed that the fullerene C₆₀ units were not altered during the electropolymerization process, obtaining surfaces with high fullerene content. Photobleaching measurements demonstrated that the electropolymerized films were highly photostable. Moreover, photodynamic properties of PEDOT-C₆₀ were compared with fullerene C₆₀ and showed that electrodeposited films were able to generate reactive oxygen species (ROS) through the two photomechanisms, producing singlet molecular oxygen (type II) and superoxide radical anion (type I). All studies demonstrated that fullerene C₆₀ moieties covalently attached to the polymeric matrix mainly conserve the photodynamic characteristics. Hence, photodynamic action sensitized by PEDOT-C₆₀ was assessed in vitro against Staphylococcus aureus. The photosensitized inactivation by the electropolymerized films on bacteria suspensions produced >99.9% reduction in S. aureus survival. Fluorescence microscopy experiments with S. aureus adhered to the PEDOT-C₆₀ surface showed a complete microbe annihilation. Also, the eradication of biofilms formed on PEDOT-C₆₀ surfaces resulted in a photokilling >99.9% after visible light irradiation. Our results demonstrated that these antimicrobial photodynamic polymeric films are a promising and versatile platform to photoinactivate microorganisms and to obtain photostable self-sterilizing surfaces.

A photostable and photodynamic antimicrobial surface was developed. The antimicrobial activity of the material reached outstanding levels of inactivation under different conditions: planktonic suspensions, adhered cells to the surface, and biofilms.

'Secondary biofilms' could cause failure of peracetic acid high-level disinfection of endoscopes

INTRODUCTION

The reduced susceptibility of biofilms to disinfectants presents a challenge to the successful reprocessing of medical equipment. This study examined the effect of residual biomass remaining after previous disinfection with peracetic acid (PAA) on the tolerance of subsequent mature Pseudomonas aeruginosa biofilms to PAA. The effect of enzymatic degradation of specific components of the extracellular polymeric substance (EPS) of P. aeruginosa biofilm on the effectiveness of PAA disinfection was also evaluated.

METHODS

The susceptibility of biofilm grown on the biomass of PAA-killed biofilm to PAA was compared with the PAA susceptibility of biofilm grown in wells of a 24-well plate by evaluating their viability using the plate count assay. The effect of PAA on biofilm biomass was measured using crystal violet quantification of total biofilm biomass, while its effect on the polysaccharide and protein components of biofilm EPS was quantified using the phenol-sulphuric acid assay or Bradford assay, respectively. A confocal microscope was used to visualize the distribution of living and dead cells in biofilms grown on residual biofilm biomass.

FINDINGS

The presence of residual biomass from previously disinfected biofilms significantly enhanced the tolerance of subsequent biofilms. A 96-h-old 'secondary biofilm' formed on disinfected biomass survived PAA concentrations of 4000 ppm, which exceeds the concentrations used in practice for high-level disinfection.

CONCLUSION

These observations indicate that, under certain circumstances, recolonization of residual EPS can cause failure of disinfection of medical equipment such as endoscopes, and emphasizes the importance of cleaning endoscopes prior to disinfection.

Treatment of halitosis with photodynamic therapy in older adults with complete dentures: A randomized, controlled, clinical trial

BACKGROUND

Halitosis of oral origin is mainly caused by the release of H₂S (hydrogen sulfide) by bacteria lodged on the tongue. Antimicrobial photodynamic therapy (aPDT) has been evaluated for the treatment of halitosis, but there are no previous reports of the use of this treatment modality in older people with dentures. The aim of the present study was to compare the effect of aPDT and tongue scraping (standard treatment) in older people with complete dentures diagnosed with halitosis (H2S gas concentration>112 ppb).

METHODS

The participants were divided into two groups: G1- treatment with a tongue scraper (n = 20); G2- treatment with aPDT (n = 20). Halimeter testing was performed before and after treatments using gas chromatography and was repeated after seven days.

RESULTS

After treatment, the group treated with aPDT had a lower mean concentration of H2S gas (18.5 ppb) than the tongue scraping group (185.3 ppb). After one week, the mean concentration of H2S increased to 218.2 ppb in the tongue scraping group and 39 ppb in the PDT group.

CONCLUSIONS

Both treatments were able to reduce the concentration of H2S but only treatment with aPDT was able to decrease halitosis to socially unnoticeable levels. Moreover, this normal breath condition remained for seven days only in the aPDT group.

Photodynamic Therapy as a New Treatment for Chronic Rhinosinusitis - A Systematic Review

This review examines the latest evidence for photodynamic therapy (PDT) in treating chronic rhinosinusitis. MedLine, EMBASE and TRIP Database searches were conducted using the terms: "photodynamic" or "phototherapy" or "photo" and "sinusitis" or "rhinosinusitis," date range January 2000 to May 2020. A total of 192 records were initially identified, after duplicates and exclusions, 9 full papers and 3 abstracts were included. All study types including in-vitro, animal and human studies were evaluated. Whilst there is in-vitro evidence for the efficacy of PDT's bactericidal effect on drug resistant bacteria and biofilm viability, there are few clinical studies. PDT is a promising area of research, but larger, focused studies looking at the safety, delivery, efficacy, and patient selection are required before it can be considered a viable treatment for CRS.

Effect of rutin as flavonoid compound on photodynamic inactivation against P. aeruginosa and S. aureus

Antimicrobial photodynamic therapy (aPDT) has drawn increasing attention for its potential to effectively kill multidrug-resistant pathogenic bacteria and also for its low tendency to induce drug resistance. Antimicrobial photodynamic therapy (aPDT) is the application of photoactive dye followed by light irradiation that leads to the death of microbial cells mainly by reactive oxygen species (ROS) production in the presence of oxygen molecules. Methylene Blue (MB) as a photosensitizer is a hydrophobic drug molecule and prone to aggregation and dimer formation which lead to its low phototoxicity. Rutin, a flavonoid compound which is derived from plants such as wheat, apple, and tea has many properties such as antibacterial activity. In this study, we investigated the effect of rutin as a flavonoid compound on photodynamic inactivation by MB on Pseudomonas aeruginosa and Staphylococcus aureus. After performing the Minimum Inhibitory Concentration (MIC) assay (to measure minimum inhibitory concentration) and the MTT assay (to evaluate methylene blue toxicity), the effect of aPDT at 660 nm and pretreatment or post treatment with rutin on bacteria in the forms of planktonic and biofilm were investigated. The results showed that by a combination of rutin (800 μg/mL) with methylene blue (MB 8 μg/mL) as a photosensitizer and aPDT (660 nm, 5 min), there is a more reduction in the number of bacteria in the planktonic condition and bacterial biofilm production in comparison to MB alone. MB-aPDT showed no toxic effect against human dermal fibroblast with the proposed strategy which could suggest its application with rutin as a novel approach in the treatment of bacteria in wound infection.

The penetration effect of HMME-mediated low-frequency and low-intensity ultrasound against the Staphylococcus aureus bacterial biofilm

Background

The purpose of this study was to observe the effect of hematoporphyrin monomethyl ether (HMME)-mediated low-frequency and low-intensity ultrasound on mature and stable Staphylococcus aureus (S. aureus) biofilms under different ultrasound parameters.

Methods

The biofilm was formed after 48-h culture with stable concentration of bacterial solution. Different types of ultrasound and time were applied to the biofilm, and the ultrasonic type and time of our experiments were determined when the biofilm was not damaged. The penetration effects of low-frequency and low-intensity ultrasound were decided by the amount of HMME that penetrated into the biofilm which was determined by fluorescence spectrometry.

Results

The destruction of biofilms by pulse waveform was the strongest. Sinusoidal low-frequency and low-intensity ultrasound can enhance the biofilm permeability. For a period of time after the ultrasound was applied, the biofilm permeability increased, however, changes faded away over time.

Conclusions

Low-frequency and low-intensity sinusoidal ultrasound significantly increased the permeability of the biofilms, which was positively correlated with the time and the intensity of ultrasound. Simultaneous action of ultrasound and HMME was the most effective way to increase the permeability of the biofilms.