Abstract
Antimicrobial photodynamic therapy (aPDT) has become a fundamental tool in modern therapeutics, notably due to the expanding versatility of photosensitizers (PSs) and the numerous possibilities to combine aPDT with other antimicrobial treatments to combat localized infections. After revisiting the basic principles of aPDT, this review first highlights the current state of the art of curative or preventive aPDT applications with relevant clinical trials. In addition, the most recent developments in photochemistry and photophysics as well as advanced carrier systems in the context of aPDT are provided, with a focus on the latest generations of efficient and versatile PSs and the progress towards hybrid-multicomponent systems. In particular, deeper insight into combinatory aPDT approaches is afforded, involving non-radiative or other light-based modalities. Selected aPDT perspectives are outlined, pointing out new strategies to target and treat microorganisms. Finally, the review works out the evolution of the conceptually simple PDT methodology towards a much more sophisticated, integrated, and innovative technology as an important element of potent antimicrobial strategies.
Highlights
Antimicrobial resistance (AMR) occurring in bacteria, viruses, fungi, and parasites is a global health and development threat, declared by the WHO as one of the top 10 global public health threats facing humanity
While excellent earlier authoritative reviews provide a detailed description of Antimicrobial photodynamic therapy (aPDT) [12,13,14,15], the present review focuses on most recent developments in the field for the last 5 years, with a focus on aPDT combinatory strategies
This review aims to give a non-exhaustive overview of the diversity and richness of synthetic, natural, or hybrid single PSs and aPDT nanosystems that were recently reported, with respect to their specific advantages, limitations, and possible evolutions
Summary
Antimicrobial resistance (AMR) occurring in bacteria, viruses, fungi, and parasites is a global health and development threat, declared by the WHO as one of the top 10 global public health threats facing humanity. The misuse and overuse of antimicrobials make almost all disease-causing microbes resistant to drugs commonly used to treat them [1]. With the decline in the discovery of new antimicrobials since 1970s, the mainstream approach for the development of new drugs to combat emerging and re-emerging resistant pathogens has focused on the modification of existing compounds. While anti-cancer PDT is a clinical reality for 25 years [9], PDT as an antimicrobial treatment was demonstrated for the first time against drug-resistant infections in the healthcare sector in the early 1990s, leading to a “photo-antimicrobial renaissance era” [7]. Major MDR bacteria have been found susceptible to antimicrobial PDT (aPDT), independently of their drug-resistance profiles [10,11]. At the current stage of development, aPDT cannot address systemic infections but it holds great promise for treating localized infections and to fight AMR
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