Combined photothermal and photodynamic therapy
Photodynamic/photothermal combination therapy involves the usage of a chemical compound or nanomaterial that, when irradiated at a certain wavelength, converts light energy into reactive oxygen species (ROS) and heat. This has shown to be highly effective in the treatment of skin infections, showing increased wound healing rates and a lower impact on human cell viability than photodynamic (PD) or photothermal (PT) therapies. The compounds involved often employ additional mechanisms of action or side effect reduction mechanisms, further increasing their efficacy. Phototherapies are minimally invasive, with the primary toxicity issues surrounding phototoxicity and the nonspecific ROS and heat mechanisms of action affecting healthy human cells (albeit in lower amounts than the target cells). In skin wound infections, multiple phototherapeutic approaches have observed increased rates of wound closure over nontreated controls. This is typically due to an upregulation of vascular endothelial growth factor (VEGF) and hypoxia-inducible factor (HIF). Phototherapies are also active against both gram-positive and gram-negative bacteria, with photodynamic therapy having some exceptions. To apply this technique, a photosensitizer is localized to the wound or tumor site, either topically or intravenously. Once localized, the target area is exposed to a laser of a selected wavelength and intensity for a predetermined irradiation time. The wavelength, localization technique, laser intensity, and irradiation period are determined based on the individual phototherapeutic agent, as these factors can vary greatly from compound to compound. Topical applications may be through the incorporation of the phototherapeutic agent with a hydrogel that will slowly leech the compound into the wound, allowing for a more controlled production of ROS and/or heat. Phototherapy Types Photodynamic Therapy Photosensitizers and approved treatments A photosensitizer is a chemical compound or nanomaterial capable of capturing light energy and using this energy to generate ROS. Currently, there are 6 photosensitizers that are clinically-approved or undergoing clinical trials for the treatment of cancers and 1 approved for the treatment of eye disorders and diseases. Photodynamic therapy (PDT) is also often used for acne treatment as well as various dermatological conditions such as psoriasis, atopic dermatitis, and vitiligo. It is highly unlikely that bacteria would gain resistance to a photosensitizer or PDT treatment, as the photosensitizers can generate ROS within or outside of the target cell, both of which damage the membrane Mechanism of action A photosensitizer generates ROS through one of two processes. Type I involves a redox reaction that results in the creation of superoxides (O2•−), hydroxyl radicals (OH•), and radical peroxides, whereas Type II generates singlet oxygen directly through an electron transfer from the photosensitizer. These ROS go on to nonspecifically damage a variety of cellular components, including proteins, DNA, and lipids as they seek to remove the radical. Limitations Due to the necessity of oxygen for PDT, these treatments do not work as well in hypoxic environments, including in developed tumors and some deep wounds. Dental infections tend to also respond better to photothermal therapy than photodynamic therapy, though both have a strong effect. The efficacy of PDT for antimicrobial usage is limited by