Plasmamedizin – Kaltes Plasma zur Behandlung von Hautinfektionen

Zusammenfassung

Plasma, der vierte Aggregatzustand der Materie, ist ein ionisiertes Gas und kann technisch aus Gasen wie Argon, Helium, Stickstoff, Sauerstoff oder Luft bei Normaldruck und niedrigen Temperaturen hergestellt werden. Dieses „kalte atmosphärische Plasma“ (KAP) besteht dann aus einer Mischung von reaktiven Spezies wie angeregten Molekülen, geladenen Partikeln, reaktiven Sauerstoff- und Stickstoffspezies sowie UV-Strahlung. Diese Komponenten tragen zur antimikrobiellen Wirkung des Plasmas bei, vermitteln aber auch Effekte gegen Parasiten, Phagen und Viren sowie gegen Malignomzellen. KAPs können daher zur Sterilisation von Oberflächen, zur Dekontamination von Lebensmitteln, in der Dermatologie und der Zahnheilkunde eingesetzt werden. KAPs haben darüber hinaus als alternative antiseptische Therapie zur Anwendung von lokalen Antibiotika bei nicht-systemischen Infektionen rapide an Bedeutung gewonnen. Aufgrund des vielseitigen Wirkprinzips ist die Entwicklung bakterieller Resistenzen gegen KAP unwahrscheinlich.

Abstract

Plasma, the forth state of matter, is an ionised gas and can be technically produced from argon, helium, nitrogen, oxygen or air at atmospheric pressure and low temperatures. This cold atmospheric pressure plasma (CAP) consists of a mixture of reactive species such as excited molecules, charged particles, reactive oxygen and nitrogen species as well as UV radiation. These components convey the antimicrobial activity of plasma but also contribute to effects against parasites, phages and viruses as well as cancer cells. CAPs therefore can be readily used for sterilisation of surfaces, decontamination of foods, in dermatology and in dentistry. Moreover, CAPs have found application as an alternative antiseptic therapy instead of topical antibiotic treatment in non-systemic infections. Due to the versatile mechanism of action, it is considered unlikely that bacteria will develop resistance against CAPs.

• Literatur

• 1 Lackmann JW, Bandow JE. Inactivation of microbes and macromolecules by atmospheric-pressure plasma jets. Appl Microbiol Biotechnol 2014; 98: 6205-6213
• 2 Tendero C, Tixier C, Tristant P. et al. Atmospheric pressure plasmas: A review. Spectrochimica Acta Part B: Atomic Spectroscopy 2006; 61: 2-30
• 3 Yan D, Sherman JH, Keidar M. Cold atmospheric plasma, a novel promising anti-cancer treatment modality. Oncotarget 2017; 8: 15977-15995
• 4 Park GY, Park SJ, Choi MY. et al. Atmospheric-pressure plasma sources for biomedical applications. Plasma Sources Science and Technology 2012; 21: 043001
• 5 Gay-Mimbrera J, García MC, Isla-Tejera B. et al. Clinical and biological principles of cold atmospheric plasma application in skin cancer. Adv Ther 2016; 33: 894-909
• 6 Raiser J, Zenker M. Argon plasma coagulation for open surgical and endoscopic applications: state of the art. J Phys D Appl Phys 2006; 39: 3520-3523
• 7 von Woedtke T, Reuter S, Masur K. et al. Plasmas for medicine. Phys Rep 2013; 530: 291-320
• 8 Laroussi M. Low temperature plasma-based sterilization: overview and state-of-the-art. Plasma Process Polym 2005; 2: 391-400
• 9 Perni S, Liu DW, Shama G. et al. Cold atmospheric plasma decontamination of the pericarps of fruit. J Food Prot 2008; 71: 302-308
• 10 Noriega E, Shama G, Laca A. et al. Cold atmospheric gas plasma disinfection of chicken meat and chicken skin contaminated with Listeria innocua. Food Microbiol 2011; 28: 1293-1300
• 11 Heinlin J, Morfill G, Landthaler M. et al. Plasma medicine: possible applications in dermatology. JDDG 2010; 8: 968-976
• 12 Mai-Prochnow A, Murphy AB, McLean KM. et al. Atmospheric pressure plasmas: Infection control and bacterial responses. Int J Antimicrob Agents 2014; 43: 508-517
• 13 O’Connor N, Cahill O, Daniels S. et al. Cold atmospheric pressure plasma and decontamination. Can it contribute to preventing hospital-acquired infections?. J Hosp Infect 2014; 88: 59-65
• 14 Hong YF, Kang JG, Lee HY. et al. Sterilization effect of atmospheric plasma on Escherichia coli and Bacillus subtilis endospores. Lett Appl Microbiol 2009; 48: 33-37
• 15 Hähnel M, von Woedtke T, Weltmann KD. Influence of the air humidity on the reduction of bacillus spores in a defined environment at atmospheric pressure using a dielectric barrier surface discharge. Plasma Process Polym 2010; 7: 244-249
• 16 Kim PY, Kim YS, Koo IG. et al. Bacterial inactivation of wound infection in a human skin model by liquid-phase discharge plasma. PLoS One 2011; 6: e24104
• 17 Zimmermann JL, Dumler K, Shimizu T. et al. Effects of cold atmospheric plasmas on adenoviruses in solution. J Phys D Appl Phys 2011; 44: 505201
• 18 Matthes R, Bekeschus S, Bender C. et al. Pilot-study on the influence of carrier gas and plasma application (open resp. delimited) modifications on physical plasma and its antimicrobial effect against Pseudomonas aeruginosa and Staphylococcus aureus. GMS Krankenhaushyg Interdiszipl 2012; 7: 1-7
• 19 Daeschlein G, Scholz S, Ahmed R. et al. Skin decontamination by low-temperature atmospheric pressure plasma jet and dielectric barrier discharge plasma. J Hosp Infect 2012; 81: 177-183
• 20 Li YF, Taylor D, Zimmermann JL. et al. In vivo skin treatment using two portable plasma devices: Comparison of a direct and an indirect cold atmospheric plasma treatment. Clin Plasma Med 2013; 1: 35-39
• 21 Wiegand C, Beier O, Horn K. et al. Antimicrobial impact of cold atmospheric pressure plasma on medical critical yeasts and bacteria cultures. Skin Pharmacol Physiol 2014; 27: 25-35
• 22 Maisch T, Shimizu T, Li YF. et al. Decolonisation of MRSA, S. aureus and E. coli by cold-atmospheric plasma using a porcine skin model in vitro. PLoS One 2012; 7: e34610
• 23 Daeschlein G, Napp M, von Podewils S. et al. In vitro susceptibility of multidrug resistant skin and wound pathogens against low temperature atmospheric pressure plasma jet (APPJ) and dielectric barrier discharge plasma (DBD). Plasma Process. Polym 2014; 11: 175-183
• 24 Alkawareek MY, Gorman SP, Graham WG. et al. Potential cellular targets and antibacterial efficacy of atmospheric pressure non-thermal plasma. Int J Antimicrob Agents 2014; 43: 154-160
• 25 Joshi SG, Paff M, Friedman G. et al. Control of methicillin-resistant Staphylococcus aureus in planktonic form and biofilms: A biocidal efficacy study of non-thermal dielectric-barrier discharge plasma. Am J Infect Control 2010; 38: 293-301
• 26 Alkawareek MY, Algwari QT, Laverty G. et al. Eradication of Pseudomonas aeruginosa biofilms by atmospheric pressure nonthermal plasma. PLoS One 2012; 7: e44289
• 27 Fricke K, Koban I, Tresp H. et al. Atmospheric pressure plasma: a high-performance tool for the efficient removal of biofilms. PLoS One 2012; 7: e42539
• 28 Julak J, Scholtz V. Decontamination of human skin by low-temperature plasma produced by cometary discharge. Clin Plasma Med 2013; 1: 31-34
• 29 Matthes R, Bender C, Schlüter R. et al. Antimicrobial efficacy of two surface barrier discharges with air plasma against in vitro biofilms. PLoS One 2013; 8: e70462
• 30 Yasuda H, Miura T, Kurita H. et al. Biological evaluation of DNA damage in bacteriophages inactivated by atmospheric pressure cold plasma. Plasma Process Polym 2010; 7: 301-308
• 31 Zimmermann JL, Dumler K, Shimizu T. et al. Effects of cold atmospheric plasmas on adenoviruses in solution. J Phys D Appl Phys 2011; 44: 505201
• 32 Klämpfl TG, Isbary G, Shimizu T. et al. Cold atmospheric air plasma sterilization against spores and other microorganisms of clinical interest. Appl Environ Microbiol 2012; 78: 5077-5082
• 33 Trompeter F, Neff W, Franken O. et al. Reduction of Bacillus subtilis and Aspergillus niger spores using nonthermal atmospheric gas discharges. IEEE Trans Plasma Sci 2002; 30: 1416-1423
• 34 Haertel B, von Woedtke T, Weltmann KD. et al. Non-thermal atmospheric-pressure plasma possible application in wound healing. Biomol Ther 2014; 22: 477-490
• 35 Sharma A, Collins G, Pruden A. Differential gene expression in Escherichia coli following exposure to nonthermal atmospheric pressure plasma. J Appl Microbiol 2009; 107: 1440-1449
• 36 Schneider S, Lackmann J, Narberhaus F. et al. Separation of VUV/UV photons and reactive particles in the effluent of a He/O2 atmospheric pressure plasma jet. J Phys D Appl Phys 2011; 44: 295201
• 37 Schneider S, Lackmann J, Ellerweg D. et al. The role of VUV radiation in the inactivation of bacteria with an atmospheric pressure plasma jet. Plasma Process Polym 2012; 9: 561-568
• 38 Stoffels E, Sakiyama Y, Graves DB. Cold atmospheric plasma: charged species and their interactions with cells and tissues. IEEE Trans Plasma Sci 2008; 36: 1441-1457
• 39 Arndt S, Unger P, Wacker E. et al. Cold atmospheric plasma (CAP) changes gene expression of key molecules of the wound healing machinery and improves wound healing in vitro and in vivo. PLoS ONE 2013; 8: e79325
• 40 Keidar M. Plasma for cancer treatment. Plasma Sour Sci Technol 2015; 24: 033001
• 41 Wiegand C, Hipler UC. Evaluation of biocompatibility and cytotoxicity using keratinocyte and fibroblast cultures. Skin Pharmacol Physiol 2009; 22: 74-82
• 42 Wiegand C, Fink S, Beier O. et al. Dose- and Time-Dependent Cellular Effects of Cold Atmospheric Pressure Plasma Evaluated in 3D Skin Models. Skin Pharmacol Physiol 2016; 29: 257-265
• 43 Brehmer F, Haenssle HA, Daeschlein G. et al. Alleviation of chronic venous leg ulcers with a hand-held dielectric barrier discharge plasma generator (PlasmaDerm^® VU-2010): results of a monocentric, two armed, open, prospective, randomized and controlled trial (NCT01415622). JEADV 2015; 29: 148-155
• 44 Isbary G, Heinlin J, Shimizu T. et al. Successful and safe use of 2 min cold atmospheric argon plasma in chronic wounds: results of a randomized controlled trial. Br J Dermatol 2012; 167: 404-410
• 45 Heinlin J, Zimmermann JL, Zeman F. et al. Randomized placebo-controlled human pilot study of cold atmospheric argon plasma on skin graft donor sites. Wound Rep Reg 2013; 21: 800-807
• 46 Daeschlein G, Darm K, Niggemeier M. et al. Selective antistaphylococcal activity of atmospheric pressure plasma jet (APPJ) on human skin. Second International Conference on Plasma Medicine. San Antonio, Texas, USA: 2009
• 47 Mertens N, Helmke A, Goppold A. et al. Low temperature plasma treatment of human tissue. Second International Conference on Plasma Medicine. San Antonio, Texas, USA: 2009