Fiegler-Rudol Jakub, Kapłon Katarzyna, Kotucha Kornela, Moś Magdalena, Skaba Dariusz, Kawczyk-Krupka Aleksandra, Wiench Rafał
Department of Periodontal Diseases and Oral Mucosa Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland.
Department of Internal Diseases, Angiology and Physical Medicine, Centre for Laser Diagnostics and Therapy, Medical University of Silesia in Katowice, Batorego 15, 41-902 Bytom, Poland.
Int J Mol Sci. 2025 Apr 24;26(9):4038. doi: 10.3390/ijms26094038.
Photodynamic therapy (PDT) is a light-activated treatment that generates reactive oxygen species (ROS) to induce microbial cell death. As resistance to traditional antibiotics intensifies globally, PDT has emerged as a promising alternative or adjunctive antimicrobial strategy. Among various photosensitizers, Hypocrellin, a perylenequinone compound, has shown high ROS yield and broad-spectrum activity against bacteria and fungi. This systematic review evaluated the efficacy, safety, and therapeutic potential of Hypocrellin-mediated antimicrobial photodynamic therapy. Following PRISMA 2020 guidelines, a comprehensive literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Library for studies published between 2015 and 2025. Eligible studies included in vitro and preclinical in vivo research using Hypocrellin as a photosensitizer. Quality and risk of bias were assessed using a structured nine-item checklist. Ten eligible studies, all conducted in China, were included. Hypocrellin-mediated aPDT significantly reduced microbial loads in both planktonic and biofilm states of resistant pathogens such as Candida albicans, Candida auris, Cutibacterium acnes, and Staphylococcus aureus. The treatment acted via ROS-mediated apoptosis, membrane disruption, and mitochondrial dysfunction, with minimal cytotoxicity to mammalian cells. Studies also reported enhanced efficacy when Hypocrellin was incorporated into nanocarriers, polymeric scaffolds, or combined with chemodynamic or photothermal therapies. However, substantial heterogeneity was observed in Hypocrellin concentrations, irradiation parameters, and outcome measures. Hypocrellin-based PDT exhibits potent antimicrobial activity and favorable safety in preclinical settings, supporting its potential as an alternative to conventional antibiotics. However, standardized treatment protocols and robust clinical trials are urgently needed to validate long-term safety and translational feasibility. These findings underscore the broader promise of PDT in addressing drug-resistant infections through a mechanism unlikely to induce resistance.
光动力疗法（PDT）是一种光激活治疗方法，可产生活性氧（ROS）以诱导微生物细胞死亡。随着全球对传统抗生素的耐药性加剧，PDT已成为一种有前景的替代或辅助抗菌策略。在各种光敏剂中，竹红菌素这种苝醌类化合物已显示出高ROS产量以及对细菌和真菌的广谱活性。本系统评价评估了竹红菌素介导的抗菌光动力疗法的疗效、安全性和治疗潜力。按照PRISMA 2020指南，在PubMed、Embase、Scopus和Cochrane图书馆中对2015年至2025年发表的研究进行了全面的文献检索。符合条件的研究包括使用竹红菌素作为光敏剂的体外和临床前体内研究。使用结构化的九项清单评估质量和偏倚风险。纳入了十项均在中国进行的符合条件的研究。竹红菌素介导的抗菌光动力疗法显著降低了耐药病原体如白色念珠菌、耳念珠菌、痤疮丙酸杆菌和金黄色葡萄球菌在浮游和生物膜状态下的微生物载量。该治疗通过ROS介导的细胞凋亡、膜破坏和线粒体功能障碍起作用，对哺乳动物细胞的细胞毒性最小。研究还报告称，当竹红菌素被纳入纳米载体、聚合物支架或与化学动力学或光热疗法联合使用时，疗效会增强。然而，在竹红菌素浓度、照射参数和结果测量方面观察到了很大的异质性。基于竹红菌素的光动力疗法在临床前环境中表现出强大的抗菌活性和良好的安全性，支持其作为传统抗生素替代品的潜力。然而，迫切需要标准化的治疗方案和有力的临床试验来验证长期安全性和转化可行性。这些发现强调了光动力疗法通过一种不太可能诱导耐药性的机制来应对耐药感染的更广泛前景。
