Abstract
Antibacterial photodynamic therapy (APDT) has drawn increasing attention from the scientific society for its potential to effectively kill multidrug-resistant pathogenic bacteria and for its low tendency to induce drug resistance that bacteria can rapidly develop against traditional antibiotic therapy. The review summarizes the mechanism of action of APDT, the photosensitizers, the barriers to PS localization, the targets, the in vitro-, in vivo-, and clinical evidence, the current developments in terms of treating Gram-positive and Gram-negative bacteria, the limitations, as well as future perspectives. Relevance for patients: A structured overview of all important aspects of APDT is provided in the context of resistant bacterial species. The information presented is relevant and accessible for scientists as well as clinicians, whose joint effort is required to ensure that this technology benefits patients in the post-antibiotic era.
Highlights
Antibacterial photodynamic therapy (APDT) has drawn increasing attention from the scientific society for its potential to effectively kill multidrug-resistant pathogenic bacteria and for its low tendency to induce drug resistance that bacteria can rapidly develop against traditional antibiotic therapy
In light of the spread of resistant ESKAPE pathogens and the potential utility of APDT, this review summarizes the mechanism of action of APDT, the PSs used for APDT, PS pharmacokinetics and its cellular targets, the in vitro, in vivo, and clinical evidence for the utility of APDT, the status quo of APDT for both Gram-positive and Gram-negative bacteria, and potential strategies to optimize APDT
It is noteworthy that this effect was more prominent when the efflux pump inhibitors (EPIs) was administered before adding toluidine blue O than after, indicating that toluidine blue O competitively binds the pump binding site of EPI and blocks its access when the EPI inhibitor is administered after incubation with toluidine blue O
Summary
The multidrug resistance of pathogenic bacteria has become a serious threat to public health. (systemic) toxicity is largely absent outside the irradiated, PS-replete zone Another important advantage of APDT over antibiotics is that no resistance is developed against the PSs. In that respect, repeated treatment with APDT did not lead to selection of resistant strains [4]. The ROS generated by APDT target various bacterial cell structures and different metabolic pathways [5]. These reasons underlie the potential utility of APDT in combatting resistant strains in a non-tominimally invasive and patient-friendly manner. For more in-depth information on APDT, readers are referred to Hamblin et al [6]
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