Abstract
Health problems and reduced treatment effectiveness due to antimicrobial resistance have become important global problems and are important factors that negatively affect life expectancy. Antimicrobial photodynamic therapy (APDT) is constantly evolving and can minimize this antimicrobial resistance problem. Reactive oxygen species produced when nontoxic photosensitizers are exposed to light are the main functional components of APDT responsible for microbial destruction; therefore, APDT has a broad spectrum of target pathogens, such as bacteria, fungi, and viruses. Various photosensitizers, including natural extracts, compounds, and their synthetic derivatives, are being investigated. The main limitations, such as weak antimicrobial activity against Gram-negative bacteria, solubility, specificity, and cost, encourage the exploration of new photosensitizer candidates. Many additional methods, such as cell surface engineering, cotreatment with membrane-damaging agents, nanotechnology, computational simulation, and sonodynamic therapy, are also being investigated to develop novel APDT methods with improved properties. In this review, we summarize APDT research, focusing on natural photosensitizers used in in vitro and in vivo experimental models. In addition, we describe the limitations observed for natural photosensitizers and the methods developed to counter those limitations with emerging technologies.
Highlights
After penicillin was identified as a product of Penicillium notatum by Alexander Fleming in 1928, its widespread consumption was noted in the early 1940s
PSs and light irradiation are the main mechanisms of photodynamic therapy (PDT), and the reactive oxygen species (ROS) generated and the singlet oxygen (1 O2 ) converted from molecular oxygen by PSs are responsible for bacterial damage [17]
Many isolates of E. faecalis are known to be resistant to ampicillin and result in a high incidence of vancomycin-resistant Enterococcus faecium infections, but Antimicrobial photodynamic therapy (APDT) might be an effective treatment against such drug-resistant strains of E. faecium [32,33]
Summary
After penicillin was identified as a product of Penicillium notatum by Alexander Fleming in 1928, its widespread consumption was noted in the early 1940s. Antimicrobial photodynamic therapy (APDT) is a challenging method to overcome excess antibiotic consumption and limit antibiotic resistance gene transfer. By the time PDT focused on cancer cell treatment, APDT was focused on overcoming antibiotic resistance by targeting bacteria, algae, yeasts, and viruses [8]. Viera et al [9] studied APDT efficiency against a broad range of organisms, including bacteria, fungi, and viruses, and reported that APDT is effective against a wide range of organisms. Tissue specificity is another advantage of APDT. Oxygen, and PSs in precise cooperation are the key factors determining APDT efficiency and are responsible for ROS production and the inactivation of the targeted cells [11]
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