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Review
. 2023 Jun 13;15(6):1721.
doi: 10.3390/pharmaceutics15061721.

Photodynamic Therapy, Probiotics, Acetic Acid, and Essential Oil in the Treatment of Chronic Wounds Infected with Pseudomonas aeruginosa

Jaeson D Chin  1 , Lei Zhao  2 , Trenton G Mayberry  3 , Braydon C Cowan  3 , Mark R Wakefield  3   4 , Yujiang Fang  1
Affiliations
Review

Photodynamic Therapy, Probiotics, Acetic Acid, and Essential Oil in the Treatment of Chronic Wounds Infected with Pseudomonas aeruginosa

Jaeson D Chin et al. Pharmaceutics. .

Abstract

As a prevalent medical problem that burdens millions of patients across the world, chronic wounds pose a challenge to the healthcare system. These wounds, often existing as a comorbidity, are vulnerable to infections. Consequently, infections hinder the healing process and complicate clinical management and treatment. While antibiotic drugs remain a popular treatment for infected chronic wounds, the recent rise of antibiotic-resistant strains has hastened the need for alternative treatments. Future impacts of chronic wounds are likely to increase with aging populations and growing obesity rates. With the need for more effective novel treatments, promising research into various wound therapies has seen an increased demand. This review summarizes photodynamic therapy, probiotics, acetic acid, and essential oil studies as developing antibiotic-free treatments for chronic wounds infected with Pseudomonas aeruginosa. Clinicians may find this review informative by gaining a better understanding of the state of current research into various antibiotic-free treatments. Furthermore. this review provides clinical significance, as clinicians may seek to implement photodynamic therapy, probiotics, acetic acid, or essential oils into their own practice.

Keywords: Pseudomonas aeruginosa; acetic acid; chronic wounds; photodynamic therapy; probiotics.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Types of PA antibiotic resistance, including intrinsic, adaptive, and acquired. Increased expression of efflux pumps is one mechanism of intrinsic resistance. These pumps work to get rid of harmful substances such as antibiotics from the cell’s internal environment. PA also synthesizes enzymes that perform chemical alterations on the antibiotic, leading to its inactivation. Other enzymes hydrolyze antibiotics leading to their destruction. The cell may also induce alteration of porin membrane proteins leading to decreased membrane permeability. This decreased permeability prevents antibiotics from entering the cell. Adaptive resistance occurs through rapid alterations of the cell due to environmental changes and the presence of antibiotics. Biofilm formation, which prevents diffusion of antibiotics into the cell, can also trigger adaptive resistance. Acquired resistance is when the bacterium develops resistance through genetic modification either through horizontal gene transfer or chromosomal gene mutations.
Figure 2
Figure 2
A schematic displaying the mechanism behind photodynamic therapy (PDT), and photothermal therapy (PTT). A light source at a specific wavelength irradiates a photosensitizer (PS) from its ground state (PSG) to an excited singlet state (PSEs). The PSEs is then transformed into an excited triplet state (PSEt) through intersystem crossing. Returning to PSG results in fluorescence and photothermal conversion. Heat produced from this reaction is used in PTT. From PSEt, a reactive oxygen species (ROS) is created through either type 1 or type 2 chemical reactions. A type 1 mechanism, known as electron transfer, includes the creation of free radicals and radical ions through electron transfer reactions. A type 2 mechanism, called energy transfer, involves a molecule of oxygen which is used to generate a singlet oxygen. ROS created from either reaction then act on targets such as bacteria, viruses, protozoa, and cancerous cells, causing damage and death. Bacteria cells are destroyed through apoptosis, autophagy, or necrosis pathways.
Figure 3
Figure 3
Schematic showing relevant meta-analyses and review papers dealing with probiotics in wound healing. Shown in blue are positive conclusions drawn from the studies while pink displays negative conclusions [4,155,156,157].
Figure 4
Figure 4
Illustration of the 4 stages of wound healing and some characteristics of each stage.
See this image and copyright information in PMC

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References

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Grants and funding

Yujiang Fang was supported by a grant from Des Moines University (IOER 112-3749).