Photobiomodulation: lasers vs. light emitting diodes?

Photobiomodulation (PBM) is a treatment method based on research findings showing that irradiation with certain wavelengths of red or near-infrared light has been shown to produce a range of physiological effects in cells, tissues, animals and humans. Scientific research into PBM was initially started in the late 1960s by utilizing the newly invented (1960) lasers, and the therapy rapidly became known as "low-level laser therapy". It was mainly used for wound healing and reduction of pain and inflammation. Despite other light sources being available during the first 40 years of PBM research, lasers remained by far the most commonly employed device, and in fact, some authors insisted that lasers were essential to the therapeutic benefit. Collimated, coherent, highly monochromatic beams with the possibility of high power densities were considered preferable. However in recent years, non-coherent light sources such as light-emitting diodes (LEDs) and broad-band lamps have become common. Advantages of LEDs include no laser safety considerations, ease of home use, ability to irradiate a large area of tissue at once, possibility of wearable devices, and much lower cost per mW. LED photobiomodulation is here to stay.

A possible mechanism for visible light-induced wound healing

BACKGROUND AND OBJECTIVES

Chronic wounds resistant to conventional therapy have been treated successfully with low energy lasers and light emitting diodes (LEDs) in the visible and near IR region. It has been proposed that production of low level reactive oxygen species (ROS) following illumination is the first step of photobiomodulation. It was also shown that white light (400-800 nm) has similar stimulatory effects as lasers and LEDs. ROS at higher levels are toxic to cells and bacteria.

STUDY DESIGN/MATERIALS AND METHODS

In the present study, we examined the phototoxicity of broadband (400-800 nm, 120 J/cm(2)) visible light on the survival of several pathogenic bacteria: Staphylococcus aureus 195, Pseudomonas aeruginosa 1316, Escherichia coli 1313, and Serratia marcescens. These bacteria were chosen due to their high prevalence in infected wounds. The survival of bacterial cells following illumination was monitored by counting the number of colony forming units before and after exposure to light.

RESULTS

Illumination with white light, 120 J/cm(2), caused a reduction of 62%, 83%, and 56% in the colony count of E. coli 1313, S. aureus 195 and S. marcescens, respectively, though no reduction in the viability of P. aeruginosa 1316 was demonstrated. The phototoxic effect was found to involve induction of ROS production by the bacteria. It was also found that illumination of S. aureus 195 and E. coli 1313 in the presence of pyocyanin, known to be secreted by P. aeruginosa, had a stronger bactericidal effect compared to illumination alone.

CONCLUSION

Visible light at high intensity can kill bacteria in infected wounds. Thus, illumination of infected wounds with intense visible light, prior to low intensity illumination for stimulating wound closure, may reduce infection and promote healing.

Sensitivity of Staphylococcus aureus strains to broadband visible light

The phototoxic effect of illumination with broadband visible light on the viability of two Staphylococcus aureus strains was examined in the present study. A difference in the light sensitivity of the two strains was found. Illumination of the tested strains with a fluence rate of 180 J cm(-2) caused a reduction of up to 99.8% in the colony count of one of the strains (the "sensitive" strain). Illumination of the other strain (the "resistant" strain) resulted in a 55.5% reduction in viability. Proliferation of both strains was observed at low fluence rates of light. The phototoxic effect was found to be dependent on oxy radical production. The light-sensitive strain produced higher amounts of hydroxyl and superoxide radicals than the "resistant" strain. Adaptation to oxidative stress was exhibited only by the "resistant" strain. The "sensitive" strain produced ten times more endogenous porphyrins and secreted almost nine times more porphyrins than the resistant strain. Furthermore, the "resistant" strain produced twice as many carotenoids that protect the strain from illumination than the "sensitive" strain. These results indicate that high intensities of visible light cause bacterial photoeradication, a reaction which may assist wound healing by killing the infecting bacteria. On the other hand, low intensities of white light were found to enhance bacterial proliferation and thus prolong wound infection.