Hygiene & Medizin 5/2013
- Plasma Medicine – medical application of physical plasma
Thomas von Woedtke, Klaus-Dieter Weltmann
HygMed 2013; 38 : 180–185
Plasma medicine is a new research field at the interface between physics, life sciences and medicine with a present huge international upward movement. In the centre of attention is the application of cold atmospheric plasmas for medical therapy. Basic research in plasma medicine is concentrated on mechanisms of plasma effects on living cells and tissue in which reactive oxygen and nitrogen species generated in or transferred into the liquid cell environment play a key role. Clinical research is focused on plasma applications to support wound healing processes as well as to treat infective and inflammative skin diseases. Further applications in dentistry or oncology are to be expected.
- Physical cold atmospheric pressure plasma as promising option for treatment of chronic wounds
Axel Kramer, Claudia Bender, Ojan Assadian, Axel Ekkernkamp, Bernd Hartmann, Claus-Dieter Heidecke, Peter Hinz, Ina Koban, Kai Masur, Rutger Matthes, Hans-Robert Metelmann, Lars I. Partecke, Stephan Reuter, Axel Sckell et al.
HygMed 2013; 38 : 186–191
Cold atmospheric pressure plasma was investigated by means of a graded test hierarchy regarding its suitability for the treatment of chronic wounds. The working hypothesis is underlined by the following reasons. I. Every healing process involves energy. II. A wound cannot heal as long as it is infected. III. Necrotic tissue must be removed for healing. IV. The chronic wound should be transferred from its stagnation to an acute healing state by inflammatory and proliferation-supporting stimuli. Initially, the effectiveness against bacterial biofilms in vitro and the antiseptic efficacy on the skin were established. In parallel, the compatibility of the monolayer and the 3-D cell culture were determined. Using bioassays like the chorioallantois membrane of the hen’s egg, porcine eye tissue and also on the human skin the wound tolerance of the plasma treatment could be confirmed. Thereby, the analysis of a mild activity of inflammation processes in the chorioallantois membrane of the hen’s egg presented an important finding regarding the assessment of the prospects of success in the treatment of chronic wounds. The first successful treatment by atmospheric pressure plasma of ineffective conventionally treated chronic wounds in domestic animals and, for the first time, in patients, allows the conclusion that physical cold plasma – also termed as “tissue tolerable plasma” – presents an innovative option in the treatment of chronic wounds.
- Physical plasma processes for surface functionalization of implants in orthopedic surgery
Barbara Nebe, Birgit Finke, Rainer Hippler, Jürgen Meichsner, Andreas Podbielski, Michael Schlosser, Rainer Bader
HygMed 2013; 38 : 192–197
Implants serve in orthopedic surgery first and foremost in the care of fractures, bone defects and degenerative changes in joints. Depending upon their purpose, the implants remain in the body either temporarily or permanently. In the case of permanent implants like an artificial joint replacement, permanent integration in the bone is necessary. For this, the adhesion and ingrowth of bone cells on the appropriately constructed implant surface is required. This can be supported by an appropriate functionalization of the surface. Bacteria brought in from the outside or protracted endogenous bacteria can colonize bone implants. This can lead to the formation of a bacterial film on the implant and infection of the surrounding tissues. This usually results in the implant having to be removed due to functional limitations or simply because it is a seat of infection; for the person affected this is a considerable burden. In order to avoid a bacterial colonization of the implant, coating the implant with antibacterial agents such as antibiotics, silver or copper is currently being investigated. In the joint project PlasmaImp of Campus PlasmaMed success has been achieved in applying positively charged, nanometer-thin polymer coatings (plasma polymerized allylamine or ethylenediamine) to the implant surface, therewith accelerating the ingrowth of bone cells. In addition, plasma coating processes have been achieved in which copper in varying quantities can be applied to the implant surface in an organized, uniform and temporary fashion. These coatings can prevent the colonization of the surface by dangerous bacterial infectious agents.
- Biological effects of non-thermal atmospheric-pressure plasma on human HaCaT-keratinocytes
Beate Haertel, Susanne Straßenburg, Manuela Harms, Kristian Wende, Ulrike Lindequist, Thomas von Woedtke
HygMed 2013; 38 : 198–205
The generation of non-thermal atmospheric-pressure plasmas was the basis for treating sensitive materials as tissues and living cells. They are of great importance for medicine, since plasmas are able to inactivate microorganisms and to stimulate cellular processes. Plasma treatment of chronic infected wounds could be one of possible applications; however, basics of plasma-cell interaction are needed prior to medical application. This article describes biological effects of physical plasma on human HaCaT-keratinocytes, which were treated with Surface Dielectric Barrier Discharge plasma (DBE) either directly, indirectly (addition of plasma-treated culture medium) or directly with exchange of medium subsequently after treatment. Viability, apoptosis, intra-cellular reactive oxygen species (ROS), DNA and expression of cell surface molecules were investigated. Vitality depends on exposure time to plasma, working gas, treatment regimen and condition of cells treated (cells in suspension, adherent cells). Cell dead after short exposure time was mainly caused by induction of apoptosis, while necrotic cells increased with prolongation of plasma treatment time. Besides induction of intracellular ROS, DNA damage was observed. DNA changes were reversible after shorter plasma treatment cycles. Plasma treatment led to an accumulation of cells in G2/M phase of cell cycle to allow repair mechanisms. Expression of cell surface molecules was particularly decreased after treatment of HaCaT-keratinocytes in suspension. In conclusion, all changes observed depend on exposure time, working gas, treatment regimen and condition of cells treated. Reactive oxygen species are of significant importance. Since alterations detected after shorter plasma treatment cycles are rever-sible, keratinocytes can be treated without lethal effects by plasma.
- Plasma Medicine in Dentistry
Lukasz Jablonowski, Ina Koban, Thomas Kocher
HygMed 2013; 38 : 206–211
Cold atmospheric pressure plasma is still comparatively unknown in dentistry. Plasma medicine is a young and interdisciplinary field that examines the possibilities of cold atmospheric pressure plasmas for medical applications. Plasma provides a broad range of properties that could offer new treatment alternatives in numerous diseases. Many diseases in medicine and dentistry are associated with bacteria, which are organized in biofilms, where they are protected from external influences, such as drugs or treatments. The good antimicrobial activity of plasma on biofims was already demonstrated. Plasma opens up new possibilities in the treatment of dental caries, periodontal disease or peri-implantitis which is still untreatable. Furthermore plasma has the ability to modify surfaces, which could be interesting for new filling techniques or implant materials. On the basis of current knowledge about the application of cold atmospheric pressure plasmas we discuss the possibilities and prospects of plasma medicine in the field of dentistry.
- Plasma sources for biomedical applications
René Bussiahn, Norbert Lembke, Roland Gesche, Thomas von Woedtke, Klaus-Dieter Weltmann
HygMed 2013; 38 : 212–216
Physical plasmas applied to biological materials give cause for interdisciplinary research and open up new therapeutic options in medicine. Basic research aims for clarifying the interaction between plasma and living tissue or organisms. Direct therapeutic application in dentistry and dermatology like wound healing or treatment of skin diseases are of highest interest. This requires cold and tissue-tolerable plasma. In recent years, very different plasma source concepts had been developed and tested for their practicability. Their basic characterization in terms of electrical and thermal properties as well as spectral emission and production of chemical reactive species is a precondition for risk assessment and evaluation of possible fields of application. In the following, two examples of such plasma sources are introduced.