Silicon(IV) phthalocyanine-loaded-nanoparticles for application in photodynamic process

The aim of this study was to evaluate the potential application of biodegradable nanoparticles containing a photosensitizer in photodynamic therapy. The poly (D,L lactic-co-glycolic acid) nanoparticles were studied by steady-state techniques, time-resolved fluorescence, and laser flash photolysis. The external morphology of the nanoparticles was established by scanning electron microscopy, and the biological activity was evaluated by in vitro cell culture by 3-(4,5 dimethylthiazol-2,5 biphenyl) tetrazolium bromide assay. The particles were spherical in shape exhibiting a 435 nm diameter with a low tendency to aggregate. The loading efficiency was 77%. The phthalocyanine-loaded-nanoparticles maintained their photophysical behavior after encapsulation. The cellular viability was determined, obtaining 70% of cellular death. All the performed physical-chemical, photophysical, and photobiological measurements indicated that the phthalocyanine-loaded-nanoparticles are a promising drug delivery system for photodynamic therapy and photoprocesses. (C) 2012 Laser Institute of America.

Photodynamic inactivation of biofilms formed by Candida spp., Trichosporon mucoides, and Kodamaea ohmeri by cationic nanoemulsion of zinc 2,9,16,23-tetrakis(phenylthio)-29H, 31H-phthalocyanine (ZnPc)

The biofilms formed by opportunistic yeasts serve as a persistent reservoir of infection and impair the treatment of fungal diseases. The aim of this study was to evaluate photodynamic inactivation (PDI) of biofilms formed by Candida spp. and the emerging pathogens Trichosporon mucoides and Kodamaea ohmeri by a cationic nanoemulsion of zinc 2,9,16,23-tetrakis(phenylthio)-29H,31H-phthalocyanine (ZnPc). Biofilms formed by yeasts after 48 h in the bottom of 96-well microtiter plates were treated with the photosensitizer (ZnPc) and a GaAlAs laser (26.3 J cm(-2)). The biofilm cells were scraped off the well wall, homogenized, and seeded onto Sabouraud dextrose agar plates that were then incubated at 37A degrees C for 48 h. Efficient PDI of biofilms was verified by counting colony-forming units (CFU/ml), and the data were submitted to analysis of variance and the Tukey test (p < 0.05). All biofilms studied were susceptible to PDI with statistically significant differences. The strains of Candida genus were more resistant to PDI than emerging pathogens T. mucoides and K. ohmeri. A mean reduction of 0.45 log was achieved for Candida spp. biofilms, and a reduction of 0.85 and 0.84, were achieved for biofilms formed by T. mucoides and K. ohmeri, respectively. Therefore, PDI by treatment with nanostructured formulations cationic zinc 2,9,16,23- tetrakis (phenylthio)- 29H, 31H- phthalocyanine (ZnPc) and a laser reduced the number of cells in the biofilms formed by strains of C. albicans and non-Candida albicans as well the emerging pathogens T. mucoides and K. ohmeri.

Antimicrobial Photodynamic Therapy for the Treatment of Teeth with Apical Periodontitis: A Histopathological Evaluation

Introduction: This study evaluated the in vivo response of apical and periapical tissues of dogs' teeth with apical periodontitis after one-session endodontic treatment with and without antimicrobial photodynamic therapy (aPDT). Methods: Sixty root canals with experimentally induced apical periodontitis were instrumented and assigned to 4 groups receiving aPDT and root canal filling (RCF) or not: group aPDT+/RCF- (n = 20): aPDT (photosensitizer phenothiazine chloride at 10 mg/mL for 3 minutes and diode laser [2 = 660 nm, 60 mW/cm(2)] for 1 minute) and RCF in the same session; group aPDT+/RCF (n = 10); group aPDT /RCF+ (n = 20), and group aPDT /RCF (n = 10). Teeth were restored, and the animals were killed after 90 days. Sections from the maxillas and mandibles were stained with hematoxylin-eosin and Mallory trichrome and examined under light microscopy. Descriptive (ie, newly formed apical mineralized tissue, periapical inflammatory infiltrate, apical periodontal ligament thickness, and mineralized tissue resorption) and quantitative (ie, periapical lesion size and number of inflammatory cells) microscopic analysis was performed. Quantitative data were analyzed by the Kruskal-Wallis and Dunn tests (alpha =.05). Results: In the aPDT-treated groups, the periapical region was moderately/severely enlarged with no inflammatory cells, moderate neoangiogenesis and fibrogenesis, and the smallest periapical lesions. Conclusions: Although apical closure by mineralized tissue deposition was not achieved, the absence of inflammatory cells, moderate neoangiogenesis, and fibrogenesis in the periapical region in the groups treated with aPDT indicate that this can be a promising adjunct therapy to cleaning and shaping procedures in teeth with apical periodontitis undergoing one-session endodontic treatment. (J Endod 2012;38:360-366)

Pain in photodynamic therapy: mechanism of action and management strategies

Photodynamic therapy involves administration of a photosensitizing drug and its subsequent activation by irradiation with a light source at wavelengths matching the absorption spectrum of the photosensitizer. In many countries around the world, topical photodynamic therapy has been approved for treatment of cutaneous oncologic conditions such as actinic keratosis, Bowen's disease, and superficial basal cell carcinoma. Multicenter, randomized, controlled studies have confirmed its efficacy and superior cosmetic outcomes compared to conventional therapies. Nevertheless, this therapeutic method presents some adverse effects, such as erythema, edema, pigmentation, pustules, and pain. There is no doubt that pain is the most severe of the adverse effects, being sometimes responsible for definitive treatment interruption. The pain mechanism has not yet been fully understood, which makes complete pain control a challenge to be conquered. In spite of that, this literature review presents some useful pain management strategies as well as the most important pain-related factors in photodynamic therapy.

In vivo study of laser irradiation of fractionated drug administration based mechanism for effective photodynamic therapy in rat liver

Up-regulation of stress-activated proteins in cancer cells plays a protective role against photodynamic induced apoptosis. Post photodynamic therapy extracted normal rat liver tissue usually shows a fraction of surviving cells, the photodynamic resistant cells, residing in the necrotic region. To treat these photo-dynamic resistant cells a technique has been proposed based on fractionated drug administration of diluted photosensitizer, keeping the net concentration (5 mg/kg) constant, and subsequently varying drug light interval (DLI). Flourescence measurements were made for the presence of photosensitizer in a tissue. For qualitative analysis both histological and morphological studies were made. Although preliminary aim of this approach was not achieved but there were some interesting observation made i.e. for higher dilution of photosensitizer there was a sharp boundary between necrotic and normal portion of tissue. An increase in the absorption coefficient (alpha) from 2.7 -> 2.9 was observed as photosensitizer was diluted while the corresponding threshold dose (D (th)) persistently decreases from (0.10 -> 0.02) J/cm(2) when irradiated with a 635 nm laser fluence of 150 J/cm(2).

Photo-activated phase separation in giant vesicles made from different lipid mixtures

Using giant unilamellar vesicles (GUVs) made from POPC. DPPC, cholesterol and a small amount of a porphyrin-based photosensitizer that we name PE-porph, we investigated the response of the lipid bilayer under visible light, focusing in the formation of domains during the lipid oxidation induced by singlet oxygen. This reactive species is generated by light excitation of PE-porf in the vicinity of the membrane, and thus promotes formation of hydroperoxides when unsaturated lipids and cholesterol are present. Using optical microscopy we determined the lipid compositions under which GUVs initially in the homogeneous phase displayed Lo-Ld phase separation following irradiation. Such an effect is attributed to the in situ formation of both hydroperoxized POPC and cholesterol. The boundary line separating homogeneous Lo phase and phase coexistence regions in the phase diagram is displaced vertically towards the higher cholesterol content in respect to ternary diagram of POPC:DPPC:cholesterol mixtures in the absence of oxidized species. Phase separated domains emerge from sub-micrometer initial sizes to evolve over hours into large Lo-Ld domains completely separated in the lipid membrane. This study provides not only a new tool to explore the kinetics of domain formation in mixtures of lipid membranes, but may also have implications in biological signaling of redox misbalance. (C) 2011 Elsevier B.V. All rights reserved.

Photodynamic therapy for the treatment of induced mammary tumor in rats

The objective of this work was to evaluate photodynamic therapy (PDT) by using a hematoporphyrin derivative as a photosensitizer and light-emitting diodes (LEDs) as light source in induced mammary tumors of Sprague–Dawley (SD) rats. Twenty SD rats with mammary tumors induced by DMBAwere used. Animals were divided into four groups: control (G1), PDT only (G2), surgical removal of tumor (G3), and submitted to PDT immediately after surgical removal of tumor (G4). Tumors were measured over 6 weeks. Lesions and surgical were LEDs lighted up (200 J/cm2 dose). The light distribution in vivo study used two additional animals without mammary tumors. In the control group, the average growth of tumor diameter was approximately 0.40 cm/week. While for PDT group, a growth of less than 0.15 cm/week was observed, suggesting significant delay in tumor growth. Therefore, only partial irradiation of the tumors occurred with a reduction in development, but without elimination. Animals in G4 had no tumor recurrence during the 12 weeks, after chemical induction, when compared with G3 animals that showed 60 % recurrence rate after 12 weeks of chemical induction. PDT used in the experimental model of mammary tumor as a single therapy was effective in reducing tumor development, so the surgery associated with PDT is a safe and efficient destruction of residual tumor, preventing recurrence of the tumor.

Safety assessment of oral photodynamic therapy in rats

Photodynamic therapy (PDT) is based on the synergism of a photosensitive drug (a photosensitizer) and visible light to destroy target cells (e.g., malignant, premalignant, or bacterial cells). The aim of this study was to investigate the response of normal rat tongue mucosa to PDT following the topical application of hematoporphyrin derivative (Photogem®), Photodithazine®, methylene blue (MB), and poly(lactic-co-glycolic acid) (PLGA) nanoparticles loaded with MB. One hundred and thirty three rats were randomly divided in various groups: the PDT groups were treated with the photosensitizers for 10 min followed by exposure to red light. Those in control groups received neither photosensitizer nor light, and they were subjected to light exposure alone or to photosensitizer alone. Fluorescent signals were obtained from tongue tissue immediately after the topical application of photosensitizers and 24 h following PDT. Histological changes were evaluated at baseline and at 1, 3, 7, and 15 days post-PDT treatment. Fluorescence was detected immediately after the application of the photosensitizers, but not 24 h following PDT. Histology revealed intact mucosa in all experimental groups at all evaluation time points. The results suggest that there is a therapeutic window where PDT with Photogem®, Photodithazine®, MB, and MB-loaded PLGA nanoparticles could safely target oral pathogenic bacteria without damaging normal oral tissue.

Effect of interaction with micelles on the excited-state optical properties of zinc porphyrins and J-aggregates formation

This work reports on the photophysical properties of zinc porphyrins meso-tetrakis methylpyridiniumyl (Zn2+TMPyP) and meso-tetrakis sulfonatophenyl (Zn2+TPPS) in homogeneous aqueous solutions and in the presence of sodium dodecyl sulfate (SDS) and cetyltrimethyl ammonium bromide (CTAB) micelles. The excited-state dynamic was investigated with the Z-scan technique, UV-Vis absorption, and fluorescence spectroscopy. Photophysical parameters were obtained by analyzing the experimental data with a conventional five-energy-level diagram. The interaction of the charged side porphyrin groups with oppositely charged surfactants can reduce the electrostatic repulsion between porphyrin molecules leading to aggregation, which affected the porphyrin characteristics such as absorption cross-sections, lifetimes and quantum yields. The interaction between anionic ZnTPPS with cationic CTAB micelles induced the formation of porphyrin J-aggregates, while this effect was not observed in the interaction of ZnTMPyP with SDS micelles. This difference is, probably, due to the difference in electrostatic repulsion between the porphyrin molecules. The insights obtained by these results are important for the understanding of the photophysical behavior of porphyrins, regarding potential applications in pharmacokinetics as encapsulation of photosensitizer for drug delivery systems and in its interaction with cellular membrane.

Necrosis response to photodynamic therapy using light pulses in the femtosecond regime

One of the clinical limitations of the photodynamic therapy (PDT) is the reduced light penetration into biological tissues. Pulsed lasers may present advantages concerning photodynamic response when compared to continuous wave (CW) lasers operating under the same average power conditions. The aim of this study was to investigate PDT-induced response when using femtosecond laser (FSL) and a first-generation photosensitizer (Photogem) to evaluate the induced depth of necrosis. The in vitro photodegradation of the sensitizer was monitored during illumination either with CWor an FSL as an indirect measurement of the PDT response. Healthy liver of Wistar rats was used to evaluate the tissue response. The photosensitizer was endovenously injected and 30 min after, an energy dose of 150 Jcm-2 was delivered to the liver surface. We observed that the photodegradation rate evaluated via fluorescence spectroscopy was higher for the FSL illumination. The FSL-PDT produced a necrosis nearly twice as deep when compared to the CW-PDT. An increase of the tissue temperature during the application was measured and was not higher than 2.5 °C for the CW laser and not higher than 4.5 °C for the pulsed laser. FSL should be considered as an alternative in PDT applications for improving the results in the treatment of bulky tumors where higher light penetration is required.

Untersuchungen zum Mechanismus der zellulären und zellfreien DNA-Schädigung durch photosensibilisierende Arzneistoffe

Einige Arzneistoffe verursachen unter dem Einfluss von Sonnenlichtstrahlung folgenschwere Hautveränderungen. In der Arbeit wurden für sechs Photosensibilisatoren erstmals „Fingerabdrücke“ des zellfreien und zellulären photoinduzierten DNA Schadens in Form von Schadensprofilen erstellt. Untersucht wurden das Phenothiazin Chlorpromazin, sowie dessen Derivate 2-Hydroxypromazin, Chlorpromazinsulfoxid und Promazin; die Fluorchinolone Ciprofloxacin und Lomefloxacin; sowie Doxycyclin und Methylenblau unter Bestrahlung mit künstlich erzeugtem Sonnenlicht. Neben Strangbrüchen in der DNA konnten durch den Einsatz von spezifischen DNA-Reparaturendonukleasen als Sonden die Mengen an oxidativen Purinmodifikationen, oxidative Pyrimidinmodifikationen und abasische Stellen bestimmt werden. Durch Verwendung von modulierenden Zusätzen wurde die Beteiligung von reaktiven Sauerstoffspezies überprüft. Besonders bei den Phenothiazinen zeigten sich Besonderheiten hinsichtlich der DNA-Schädigung. Promazin induziert unter Photoaktivierung, vermutlich über einen reduktiven Angriff an der DNA, eine hohe Anzahl sonst selten beobachteter Läsionen, nämlich abasischen Stellen und Dihydropyrimidine. Photoaktiviertes Chlorpromazin konnte in Zellen unerwarteterweise wahrscheinlich über die Reaktion von Photolyseprodukten mit einem endogenen Chromophor sonnenlichtinduzierte oxidative DNA-Modifikationen verhindern. Eine Schädigung zellfreier DNA fand nur statt, wenn der Photosensibilisator im Überschuss gegenüber den DNA-Basenpaaren vorlag, vermutlich weil ansonsten die Photolyse des Chlorpromazins durch Interkalation in die DNA verhindert wurde. Fluorchinolone zeigten eine starke Generierung von DNA-Strangbrüchen in Zellen, welche möglicherweise auf photoinduzierte Reaktionen der Arzneistoffe mit der eukaryotischen Topoisomerase zurückzuführen ist. Die Korrelation der gemessenen DNA-Schäden mit der Mikrokerninduktion führte zu der Annahme, dass besonders abasische Stellen bei der Entstehung von Mikrokernen eine Rolle spielen könnten.

Design of multifunctional magnetic nanomaterials for biomedical applications

Diese Arbeit ist ein Beitrag zu den schnell wachsenden Forschungsgebieten der Nano-Biotechnologie und Nanomedizin. Sie behandelt die spezifische Gestaltung magnetischer Nanomaterialien für verschiedene biomedizinische Anwendungsgebiete, wie beispielsweise Kontrastmittel für die magnetische Resonanztomographie (MRT) oder "theragnostische" Agenzien für simultane optische/MR Detektion und Behandlung mittels photodynamischer Therapie (PDT).rnEine Vielzahl magnetischer Nanopartikel (NP) mit unterschiedlichsten magnetischen Eigenschaften wurden im Rahmen dieser Arbeit synthetisiert und erschöpfend charakterisiert. Darüber hinaus wurde eine ganze Reihe von Oberflächenmodifizierungsstrategien entwickelt, um sowohl die kolloidale als auch die chemische Stabilität der Partikel zu verbessern, und dadurch den hohen Anforderungen der in vitro und in vivo Applikation gerecht zu werden. Diese Strategien beinhalteten nicht nur die Verwendung bi-funktionaler und multifunktioneller Polymerliganden, sondern auch die Kondensation geeigneter Silanverbindungen, um eine robuste, chemisch inerte und hydrophile Siliziumdioxid- (SiO2) Schale um die magnetischen NP auszubilden.rnGenauer gesagt, der Bildungsmechanismus und die magnetischen Eigenschaften monodisperser MnO NPs wurden ausgiebig untersucht. Aufgrund ihres einzigartigen magnetischen Verhaltens eignen sich diese NPs besonders als (positive) Kontrastmittel zur Verkürzung der longitudinalen Relaxationszeit T1, was zu einer Aufhellung im entsprechenden MRT-Bild führt. Tatsächlich wurde dieses kontrastverbessernde Potential in mehreren Studien mit unterschiedlichen Oberflächenliganden bestätigt. Au@MnO „Nanoblumen“, auf der anderen Seite, sind Vertreter einer weiteren Klasse von Nanomaterialien, die in den vergangenen Jahren erhebliches Interesse in der wissenschaftlichen Welt geweckt hat und oft „Nano-hetero-Materialien“ genannt wird. Solche Nano-hetero-partikel vereinen die individuellen physikalischen und chemischen Eigenschaften der jeweiligen Komponenten in einem nanopartikulärem System und erhöhen dadurch die Vielseitigkeit der möglichen Anwendungen. Sowohl die magnetischen Merkmale von MnO, als auch die optischen Eigenschaften von Au bieten die Möglichkeit, diese „Nanoblumen“ für die kombinierte MRT und optische Bildgebung zu verwenden. Darüber hinaus erlaubt das Vorliegen zweier chemisch unterschiedlicher Oberflächen die gleichzeitige selektive Anbindung von Katecholliganden (auf MnO) und Thiolliganden (auf Au). Außerdem wurde das therapeutische Potential von magnetischen NPs anhand von MnO NPs demonstriert, die mit dem Photosensibilisator Protoporhyrin IX (PP) funktionalisiert waren. Bei Bestrahlung mit sichtbarem Licht initiiert PP die Produktion von zytotoxisch-reaktivem Sauerstoff. Wir zeigen, dass Nierenkrebszellen, die mit PP-funktionalisierten MnO NPs inkubiert wurden nach Bestrahlung mit Laserlicht verenden, während sie ohne Bestrahlung unverändert bleiben. In einem ähnlichen Experiment untersuchten wir die Eigenschaften von SiO2 beschichteten MnO NPs. Dafür wurde eigens eine neuartige SiO2-Beschichtungsmethode entwickelt, die einer nachfolgende weitere Anbindung verschiedenster Liganden und die Einlagerung von Fluoreszenzfarbstoffen durch herkömmliche Silan- Sol-Gel Chemie erlaubt. Die Partikel zeigten eine ausgezeichnete Stabilität in einer ganzen Reihe wässriger Lösungen, darunter auch physiologische Kochsalzlösung, Pufferlösungen und humanes Blutserum, und waren weniger anfällig gegenüber Mn-Ionenauswaschung als einfache PEGylierte MnO NPs. Des Weiteren konnte bewiesen werden, dass die dünne SiO2 Schicht nur einen geringen Einfluss auf das magnetische Verhalten der NPs hatte, so dass sie weiterhin als T1-Kontrastmittel verwendet werden können. Schließlich konnten zusätzlich FePt@MnO NPs hergestellt werden, welche die individuellen magnetischen Merkmale eines ferromagnetischen (FePt) und eines antiferromagnetischen (MnO) Materials vereinen. Wir zeigen, dass wir die jeweiligen Partikelgrößen, und damit das resultierende magnetische Verhalten, durch Veränderung der experimentellen Parameter variieren können. Die magnetische Wechselwirkung zwischen beiden Materialien kann dabei auf Spinkommunikation an der Grenzfläche zwischen beiden NP-Sorten zurückgeführt werden.rn

Untersuchung der DNA-Reparatur in humanen Lymphozyten

Oxidative DNA-Schäden, wie 7,8-Dihydro-8-oxoguanin (8-oxoG), werden kontinuierlich in allen Zellen durch endogene und exogene Noxen gebildet. Ohne eine effektive Reparatur können DNA-Schäden nach erfolgter Replikation als Mutationen fixiert werden und somit die Kanzerogenese initiieren.rnUntersuchungsgegenstand dieser Arbeit war die Reparatur, vorrangig von oxidativen DNA-Schäden, in humanen Lymphozyten. Dabei sollte ebenfalls überprüft werden, inwiefern eine Aktivierung dieser Immunzellen, die u.a. zu einer Initiierung der Proliferation führt, modulierend auf die DNA-Reparatur wirkt. Für diese Untersuchungen wurden primäre Lymphozyten aus Buffy Coats isoliert. Eine Aktivierung von T Lymphozyten, welche physiologisch Antigen-vermittelt über den T-Zell-Rezeptor verläuft, wurde durch eine ex vivo Stimulation mit Phytohämagglutinin (PHA) nachgeahmt. Die Induktion oxidativer DNA-Basenmodifikationen erfolgte mit Hilfe des Photosensibilisators Acridinorange in Kombination mit sichtbarem Licht. Das Schadensausmaß sowie die Reparatur wurden mittels der Alkalischen Elution unter Nutzung der Reparaturendonuklease Fpg bestimmt.rnDie Ergebnisse zeigten, dass global keine Reparatur induzierter oxidativer DNA-Schäden in primären Lymphozyten stattfindet. Eine Aktivierung der Lymphozyten mittels PHA führte hingegen zu einer deutlichen Reduktion der induzierten DNA-Schäden innerhalb einer 24-stündigen Reparaturzeit. Diese verbesserte Reparatur konnte auf eine Steigerung der Transkription und somit eine erhöhte Proteinmenge von OGG1, welches die Reparatur von 8-oxoG DNA-Glykosylase initiiert, zurückgeführt werden. Weiterführende mechanistische Untersuchungen deuten darauf hin, dass der transkriptionellen Regulation von OGG1 eine Aktivierung der JNK-Signalkaskade zugrunde liegt. Als ein verantwortlicher Transkriptionsfaktor konnte NF-YA identifiziert werden. Dessen erhöhte Bindung am OGG1-Promotor in Folge einer PHA-Stimulation konnte durch eine JNK-Hemmung reduziert werden.rnDie Ergebnisse dieser Arbeit zeigen, dass eine Aktivierung von Lymphozyten, welche die Proliferation initiiert und dadurch mit dem Risiko für die Entstehung von Mutationen und malignen Entartungen verknüpft ist, gleichzeitig eine transkriptionelle Hochregulation von OGG1 bewirkt, die die Reparatur oxidativer DNA-Schäden sicherstellt. Die Fähigkeit zur Steigerung der DNA-Reparatur unter den gezeigten Bedingungen bietet den proliferierenden Zellen einen Schutzmechanismus zur Erhaltung ihrer genomischen Stabilität.rn

Photodynamic therapy for cholangiocarcinoma: overview and new developments

PURPOSE OF REVIEW: Photodynamic therapy (PDT) with hematoporphyrins has emerged as promising treatment for nonresectable cholangiocarcinoma in several prospective observational studies and two randomized studies. This review describes the mechanism of action of PDT, gives an overview of clinical experience in cholangiocarcinoma and summarizes the results published in 2007 and 2008. RECENT FINDINGS: The mechanism of action of PDT has been further elucidated. PDT induces an apoptotic, antiangiogenic as well as an immunomodulatory response. Interleukin-6, a bile duct epithelium growth factor correlating with tumor burden, decreases after PDT. The efficacy of PDT was confirmed in a comparative study in the United States. Patients with no visible mass on imaging studies, high serum albumin levels and treatment immediately after diagnosis seem to benefit most from PDT. Although it is recommended to perform PDT in bile ducts without stents in place, illumination through metal stents is possible if the light dose is adjusted. Meso-tetrahydroxyphenyl chlorine is a new potent photosensitizer for PDT of cholangiocarcinoma. SUMMARY: In advanced nonresectable cholangiocarcinoma, PDT is the only evidence-based treatment that improves survival when compared with stenting. Therefore, PDT should be offered to those who are unsuitable for surgery.

In vitro activity of photoactivated disinfection using a diode laser in infected root canals

OBJECTIVE To investigate the lethal activity of photoactivated disinfection (PAD) on Enterococcus faecalis (ATCC 29212) and mixed populations of aerobic or anaerobic bacteria in infected root canals using a diode laser after the application of a photosensitizer (PS). MATERIALS AND METHODS First, the bactericidal activity of a low power diode laser (200 mW) against E. faecalis ATCC 29212 pre-treated with a PS (toluidine blue) for 2 min were examined after different irradiation times (30 s, 60 s and 90 s). The bactericidal activity in the presence of human serum or human serum albumin (HSA) was also examined. Second, root canals were infected with E. faecalis or with mixed aerobic or anaerobic microbial populations for 3 days and then irrigated with 1.5% sodium hypochlorite and exposed to PAD for 60 s. RESULTS Photosensitization followed by laser irradiation for 60 s was sufficient to kill E. faecalis. Bacteria suspended in human serum (25% v/v) were totally eradicated after 30 s of irradiation. The addition of HSA (25 mg/ml or 50 mg/ml) to bacterial suspensions increased the antimicrobial efficacy of PAD after an irradiation time of 30 s, but no longer. The bactericidal effect of sodium hypochlorite was only enhanced by PAD during the early stages of treatment. PAD did not enhance the activity of sodium hypochlorite against a mixture of anaerobic bacteria. CONCLUSIONS The bactericidal activity of PAD appears to be enhanced by serum proteins in vitro, but is limited to bacteria present within the root canal.