How effective is antimicrobial photodynamic therapy in the treatment of oral fungal infections? A systematic review of currently available evidence

This summary is based on the article published in the Photochemical and Photobiological Sciences:  Treatment of oral fungal infections using antimicrobial photodynamic therapy: a systematic review of currently available evidence (May 2014)

Context

Photodynamic therapy (PDT) is a modern therapeutic strategy that involves interactions between a light source of a particular wavelength and a photosensitizer (PS) in the presence of oxygen. (1-3) This phototoxic and chemical reaction induces the production of reactive oxygen species (ROS) that cause oxidative damage to the target cells including microbial cells and tumor cells. (4-5)  Briefly, perks of PDT encompass the following:

• High target specificity; (6)
• Biocompatibility with healthy human cells; (7)
• Unlikely risk of chemical and/or thermal side-effects;  (8) and
• Improbable chances of microbes to develop resistance against PDT. (9)

Since C. albicans, a significant contributor to the etiology of oral fungal infections (such as candidiasis and denture stomatitis), has demonstrated resistance to traditional antifungal drugs (such as azoles); (10) it is speculated that PDT is a modern and more promising therapeutic strategy for the treatment of oral fungal infections compared to traditional antifungal drug therapy.

Purpose of the Review

The aim of the present study is to systematically review the pertinent literature with reference to the susceptibility of oral candidiasis to antimicrobial PDT.

Key Findings

• Results from virtually 93% of the studies (11, 12, 13) that fulfilled the eligibility criteria demonstrated that antimicrobial PDT is an efficient therapeutic strategy in treating oral fungal infections.
• In one clinical study, (14) antimicrobial PDT and conventional azole drug therapy were reported to be equally effective in treating oral Candida infections. However, it remains unclear whether antimicrobial PDT is either as effective as conventional azole antifungal therapy or is superior in antifungal efficacy to the latter. Still, some studies (15, 16, 17) cited in the present review reported that PDT exhibits antifungal effects even against azole-resistant fungi.

References

1. T. J. Dougherty, An update on photodynamic therapy applications, J. Clin. Laser Med. Surg., 2002, 20, 3–7.
2. N. Kömerik, H. Nakanishi, A. J. MacRobert, B. Henderson, P. Speight and M. Wilson, In vivo killing of Porphyromonas gingivalis by toluidine blue-mediated photosensitization in an animal model, Antimicrob. Agents Chemother., 2003, 47, 932–940.
3. M. Bassetti, D. Schär, B. Wicki, S. Eick, C. A. Ramseier, N. B. Arweiler, A. Sculean and G. E. Salvi, Anti-infective therapy of peri-implantitis with adjunctive local drug delivery or photodynamic therapy: 12-month outcomes of a randomized controlled clinical trial, Clin. Oral Implants Res., 2014, 25, 279–287.
4. F. F. Sperandio, Y. Y. Huang and M. R. Hamblin, Antimicrobial Photodynamic Therapy To Kill Gram-Negative Bacteria, Recent Pat. Anti-Infect. Drug Discovery, 2013, 8, 108–120.
5. M. R. Hamblin and T. Hasan, Photodynamic Therapy: A New Antimicrobial Approach To Infectious Disease?, Photochem. Photobiol. Sci., 2004, 3, 436–450.
6. N. S. Soukos and J. M. Goodson, Photodynamic Therapy In The Control Of Oral Biofilms, Periodontol. 2000, 2011, 55, 143–166.
7. J. F. Tremblay, S. Dussault, G. Viau, F. Gad, M. Boushira and R. Bissonnette, Photodynamic Therapy With Toluidine Blue In Jurkat Cells: Cytotoxicity, Subcellular Localization And Apoptosis Induction, Photochem. Photobiol. Sci., 2002, 1, 852–856.
8. M. Nagayoshi, T. Nishihara, K. Nakashima, S. Iwaki, K. K. Chen, M. Terashita and C. Kitamura, Bactericidal Effects Of Diode Laser Irradiation On Enterococcus Faecalis Using Periapical Lesion Defect Model, ISRN Dent., 2011, 2011, 870364.
9. R. F. Donnelly, P. A. Mccarron and M. M. Tunney, Antifungal Photodynamic Therapy, Microbiol. Res., 2008, 163, 1–12.
10. T. C. White, S. Holleman, F. Dy, L. F. Mirels and D. A. Stevens, Resistance Mechanisms In Clinical Isolates Of Candida Albicans, Antimicrob. Agents Chemother., 2002, 46, 1704–1713.
11. L. N. Dovigo, J. C. Carmello, C. A. De Souza Costa, C. E. Vergani, I. L. Brunetti, V. S. Bagnato and A. C. Pavarina, Curcumin-Mediated Photodynamic Inactivation Of Candida Albicans In A Murine Model Of Oral Candidiasis, Med. Mycol., 2013, 51, 243–251.
12. A. R. Scwingel, A. R. Barcessat, S. C. Nunez and M. S. Ribeiro, Antimicrobial Photodynamic Therapy In The Treatment of Oral Candidiasis In HIV-Infected Patients, Photomed. Laser Surg., 2012, 30, 429–432.
13. E. G. Mima, A. C. Pavarina, D. G. Ribeiro, L. N. Dovigo, C. E. Vergani and V. S. Bagnato, Effectiveness Of Photodynamic Therapy For The Inactivation Of Candida Spp. On Dentures: In Vitro Study, Photomed. Laser Surg., 2011, 29, 827–833.
14. E. G. Mima, C. E. Vergani, A. L. Machado, E. M. Massucato, A. L. Colombo, V. S. Bagnato and A. C. Pavarina, Comparison of Photodynamic Therapy Versus Conventional Antifungal Therapy For The Treatment Of Denture Stomatitis: A Randomized Clinical Trial, Clin. Microbiol. Infect., 2012, 18, E380–E388.
15. Y. M. Pupo, G. M. Gomes, E. B. Santos, L. Chaves, M. D. Michel, V. A. Kozlowski Jr., O. M. Gomes and J. C. Gomes, Susceptibility Of Candida Albicans To Photodynamic Therapy Using Methylene Blue And Toluidine Blue As Photosensitizing Dyes, Acta Odontol. Latinoam., 2011, 24, 188–192.
16. A. C. Costa, V. M. Rasteiro, C. A. Pereira, R. D. Rossoni, J. C. Junqueira and A. O. Jorge, The Effects Of Rose Bengal-And Erythrosine-Mediated Photodynamic Therapy On Candida Albicans, Mycoses, 2012, 55, 56–63.
17. S. Martins Jda, J. C. Junqueira, R. L. Faria, N. F. Santiago, R. D. Rossoni, C. E. Colombo and A. O. Jorge, Antimicrobial Photodynamic Therapy In Rat Experimental Candidiasis: Evaluation Of Pathogenicity Factors Of Candida Albicans, Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 2011, 111, 71–77.

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