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Depending on how the energy is parted among the species of the system and among their degrees of freedom, plasma is usually classified as thermonuclear, thermal equilibrium or cold non-equilibrium plasmas 2 , 3. Cold atmospheric plasma CAP indicates that the kinetic energy of the gas atoms, molecules, and ions is lower than that of the electrons, which results in a minimal temperature increase when compared to room temperature 4.

Over the past decade, owing to advanced technology that allows plasma to be sustained at atmospheric pressure and room temperature, CAP has shown remarkably selective effects on biological systems both in vitro and in vivo. Direct topical plasma treatment of xenografted tumours as well as dermal treatment of wounds and other ailments in mammalian models have been extensively reported 5 , 6. When in contact with living matter, plasma can promote inactivation of microorganisms, stimulation of cell proliferation and tissue regeneration and inactivation of cancer cells by initializing apoptosis 5.

Based on these results, 15 years ago, E. Stoffels, with her pioneering paper, created the basis for a new interdisciplinary field of research called plasma medicine: direct application of CAP, in both in vitro and in vivo models, to study its therapeutic potential 3 , 7 , 8.

CAP for plasma medicine is generally generated by two major types of devices: 1 plasma jets and 2 dielectric-barrier discharges DBDs 3 , 9.

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In jets, the plasma is generated remotely, and the plasma products are delivered to the biological target via carrier gas. DBDs generate plasma either remotely, similar to the plasma jet, or directly at the surface to be treated, implying that living tissue or the cell layer itself is used as one of the electrodes directly participating in the plasma process.

Although evidence in the literature suggests that plasma-generated chemical reactive species are responsible for inducing certain cellular behaviours, plasma is composed of multiple effectors whose interaction with cells should not be overlooked. Examples of this are observed when the plasma-associated pulsed electric field promotes cell membrane electroporation, apoptosis and necrosis; UV light emitted from plasma induces DNA damage and cell death Regardless of the configuration used when plasma sources are interfaced with a biological system, the conductivity of the system can actively influence the process.

During plasma processing, some current may flow through the living tissue electrode in the form of a small conduction current, displacement current or both 3. Active plasma species diffused in the liquid actually determine the nature and density of secondary species that, in turn, interact with cells and tissues Starting from these indications, in the last three years, a new research field within plasma medicine has emerged: plasma pharmacy, which encompasses plasma activation of liquids; these liquids can be further used in contact with cells and tissue Despite the significant amount of literature on plasma medicine, the applications of plasma-activated liquid media PALM have been less explored 9 , 13 , The complexity of the chemical composition of plasma-generated solutions together with their reactivity and stability not only presents an analytical challenge, but also establishes PALM as a unique and synergistic therapeutic approach Plasma activation of liquids can be carried out through a remote process in which plasma is ignited close to the surface of the liquid 9.

Most papers on the remote treatment of liquids deal with plasma jet sources The limits of these sources in this context are mainly the lack of homogeneity of the treatment when volumes higher than a few millilitres are to be treated, and the scant control of the chemical composition of the gas phase The presence of air surrounding the plasma jet is considered an impurity that not only influences the discharge regime and operation, but also could have a serious detrimental effect on the reproducibility and overall performance of the process When the gas phase is ignited in open air, its chemical composition cannot be finely controlled; thus, a closed chamber surrounding the plasma and liquid is necessary Few papers in the literature show the use of DBDs ignited in sealed systems; certain configurations use the liquid as part of the electrical system, with the counter electrode either submerged in the liquid or underneath the liquid separated by a barrier.

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Emerging anticancer therapies i. For these reasons, scientists are looking for alternative and more effective therapies. The success of any novel cancer treatment depends on its ability to selectively target cancer cells while minimizing cytotoxicity to healthy cells.

Indeed, over the past decade, CAP has shown promising results against cancer, and clinical trials are already being organized 21 , However, the understanding of the anticancer mechanism of plasma-assisted processes is still very limited, so the basic mechanisms need to be addressed. The advantage in working with plasma, compared to working with conventional therapies, is that plasma-based cancer treatments are less likely to cause drug resistance. A variety of combinations of PALM with other chemical agents have been highlighted in the literature in efforts to gain new insights into the mechanisms of plasma effects against cancer In 24 , Tanaka et al.

The application of PALM to cancer cells resulted in the downregulation of AKT, thus impacting the signal transduction pathway associated with survival. No impact was observed on healthy brain astrocytes used as a control, suggesting selectivity of this cancer treatment. Further studies 25 indicated complete downregulation of survival and proliferation signalling networks e. Another study considered the impact of PALM on the morphology and proliferation rate of gastric cancer cells PALM seems to also affect cell motility and colony formation 29 , while the presence of foetal bovine serum FBS in cell culture medium was found to play a protective role in cancer cells 30 , probably due to the scavenging effects of ROS, resulting in lower ROS levels in the culture medium.

The use of a plasma jet working in open air smaller gaps between the plasma source and the media, has been demonstrated to result in a stronger anticancer effect 31 that differs depending on the cell line used 5.

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Optimizing plasma parameters during direct irradiation of cancer cells with plasmas should make possible the induction of immunogenic cell death ICD , as well as promote apoptosis and triggering specific, protective immune responses systemically 6 , 32 , 33 , Briefly, when cells are stressed or are dying after exposure to various physical or chemical stimuli, they can expose or release some signals that can function as either adjuvant or danger signals for the innate immune system 35 , 36 , 37 , 38 , 39 , 40 , As shown in direct plasma treatment of cancer cells, RONS present in the liquid would be responsible for the induction of ICD in tumour cells, characterized by secretion of damage-associated molecular patterns DAMPs , which ultimately increases the visibility of the killed cells to the immune system 32 , 42 , After direct CAP exposure, as well as in response to chemotherapeutic agents such as anthracyclines, tumour cells expose complexes with the DAMP calreticulin CRT on the extracellular side of their plasma membrane at a pre-apoptotic stage This feature, which is strictly correlated with immunogenicity, allows the use of dying tumour cells with CRT exposed on the surface as a vaccine therapy against cancer.

Due to the complex phenomena present at the interface of the plasma and the biological system, it is important to note that all possible in vivo and in vitro applications of plasma medicine, including the triggering of ICD, are mediated by the presence of biological liquids e. Despite the expanse of literature on PALM-assisted treatment of cancer cells for testing proliferation, apoptosis, motility and colony formation, only a few studies have investigated the induction of cellular DAMP emission stimulated by PALM.

With this approach, depending on the gas feed used, the plasma can enrich the liquid with selected RONS derived from the cascade reactions of the plasma species diffused in the liquid phase. The chemistry that occurs in liquid media interfaced with CAP as well as the chemical composition of the gas feed depends on several factors 31 , 47 : the input power of the plasma; the composition of the substrate solutions; the temporal parameters e. Compared to jets, the DBD configuration guarantees homogeneous treatments of larger surface areas i.

Introduction

With this approach, it is possible to properly design plasma treatments and, in principle, to select the RONS to be delivered to the liquid for interfering with cell cycle progression as well as triggering DNA damage, apoptosis, and cell membrane damage Moreover, by using a sealed plasma reactor and by feeding the plasma with O 2 in principle, it should be possible to enrich the liquid with ROS instead of reactive nitrogen species RNS and study the effects of the PALM on tumour cells, which will contribute to new insights into plasma-assisted ICD.

The reason why the role of specific reactive species has been addressed in this paper is that, as shown before, the chemical composition of the PALM plays a pivotal role in its effects. H 2 O 2 has been identified as a critical player in apoptosis via a caspase-independent apoptotic pathway 51 , and nitric oxide NO and RNS species are ubiquitous molecules that play a key role in various physiological and pathological processes, including genotoxic mechanisms, antiapoptotic effects, promotion or inhibition of angiogenesis, limitation of host immune response against tumours, and promotion of metastasis.

NO is a short-lived molecule that, when in contact with a complex biological milieu such as a cell culture medium, is rapidly metabolized into nitrite and nitrate after its rapid diffusion through liquid media. This effect limits the biological half-life of NO in vitro to less than a second, whereas the concentrations of NO relevant for cellular signalling can persist in phosphate-buffered saline for an hour Thus, the role of NO-related compounds in biochemistry should not be underestimated.

Quantification of such components can indirectly give an estimation of the amount of NO produced in a DBD. By demonstrating the efficacy of PALM in stimulating DAMP emission, the applicability of plasma pharmacy for cancer treatment can be dramatically extended even to internal tumours that are difficult to reach when using topical approaches.

The source consists of aluminium housing with a ground stainless steel grid electrode. A picture of the discharge ignited between the copper electrode and the grid is shown at the bottom of Fig. In yellow, the dielectric. A properly designed plexiglass chamber flow unit provides gas connectors and sockets and allows the uniform evacuation of the plasma region and the gap between the source and the liquid. The feed gas is ported in the discharge through an orifice and pumped through a second orifice positioned at the opposite side longitudinal injection.

The discharge unit is placed on the Petri dish as shown in Fig. A silicone gasket is used to seal the flow unit and the upper rim of the Petri dish.

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Enter your email address and we'll send you our best deals Subscribe. Consensus guidelines for the detection of immunogenic cell death. A myeloid and lymphoid infiltrate in murine pancreatic tumors exposed to plasma-treated medium. Schmidt, A. Stefan Arestis Stefan is the co-founder, editor and author of the gay travel blog nomadicboys. Bari: properties found.

A dry diaphragm pump Pfeiffer is used to keep the working pressure constant, measured by an MKS Baratron. Experiments were carried out at mTorr and room temperature, with a flow rate of 0. The gas flow rates were controlled with MKS mass flow controllers. The transported charges Q in the discharge space are determined indirectly through a nF capacitor. When the voltage is high enough to cause a breakdown of the gas gap, the voltage across the measuring capacitor is proportional to the transported charges in the discharge space. Therefore, a charge—voltage Q-U plot resembling a closed parallelogram, i.

The area of the parallelogram is equal to the energy deposited in the cycle discharge The dissipated energy is calculated by multiplying the mean energy per cycle by the ton.

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The 13 kVpp value of the applied voltage was selected to achieve stable operation with the liquid film and uniformly distribute the microdischarges in the interelectrode gap. The dose energy was calculated by dividing the dissipated discharge energy by the area of the copper electrode.

All materials for cell culture were purchased from EuroClone, Italy. The cells were analysed for fluorescence intensity by flow cytometry FCM. Untreated cells not loaded with the dye were used as a negative control to examine cellular autofluorescence.

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After treatment, cells were harvested and washed in ice-cold PBS pH 7. All experiments were performed in triplicate. Typical waveforms of discharge voltage and discharge current for air and O 2 carrier gases for discharge operating with and without liquid are shown in Fig.

Microdischarge activity is indicated in Fig. Due to the high amplitude of the applied voltage, the formation of microdischarges is favoured Along with the current—voltage waveforms, Fig. These plots were used to determine the energy dissipated into the plasma after one cycle of high voltage. The area of the Lissajous figure represents the energy of the electrical discharge in one AC cycle.

A Current and voltage signals and Lissajous figures showing the discharge power in air and O 2 without liquid B and of the DBD operating with and without liquid with air as the carrier gas C. In all conditions, only the treatment time influenced the energy dissipated in the system. The chemical composition of the gas feed and the energy dose are expected to influence the chemical composition of the PALM. The graph reported in Fig.

It is evident that the H 2 O 2 concentration increases with the amount of O 2 in the feed as well as with the energy density i.

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Photos: pictures corresponding to a PALM solution obtained from the three different plasma conditions and treated with the H 2 O 2 kit. Images were acquired on an Olympus CKX41 inverted microscope. The MTT assay results reported in the histogram in Fig. When PALM treatment increased intracellular ROS production compared to that in control cells, the result was a greater cytotoxic effect. The results are reported in the histogram in Fig. The protein bands are reported, and the stain-free method was used to normalize the values. The full-length blots are presented in Supplementary Fig.

The samples were obtained from the same experiment, and the blots were processed in parallel. We also evaluated whether autophagy was involved in the observed cell death. The results, shown in Fig. The optical images of Hmel1 cells in Fig. These data show that PALM induced a reduction in cell viability through two different types of cell death, apoptosis and autophagy, which could occur simultaneously. To investigate this hypothesis, the release of ATP was evaluated, and it was revealed that in Hmel1 cells, its release into the medium markedly increased as a function of time Fig. The low survival of patients affected by these two diseases depends on several factors, such as diagnosis of cancer at advanced stages, presentation of metastatic lesions, inability to treat with surgery, and the low response to chemotherapeutic or radiotherapy treatments.

In particular, the establishment of either innate or acquired resistance, which are due to a tumour microenvironment that reduces the penetration of drugs or ionizing radiations i. When exploring new therapeutic strategies, particular attention should be paid to possible indirect activities such as the induction of ICD, along with the study of direct anticancer activity. The hypothesis of this work is to use a physical tool, cold plasma, to activate a medium e. In particular, we observed that when air was used as feed, almost no effect occurred on cell viability, most likely due to the minimal presence of H 2 O 2 found in the cell culture medium and the high concentration of nitrites, the latter of which were completely absent in PALM prepared with O 2 as the gas feed.

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Nitrites, that can almost be considered products of the reaction of NO with other components present in the PALM, were not as effective as H 2 O 2 against the cancer lines investigated. The formation of long-living species such as H 2 O 2 can be explained by the short diffusion length of OH radicals in the liquid that leads to recombination reactions. The OH radicals produced during the plasma process due to the presence of water vapour in the gas phase diffuse through the liquid, producing hydrogen peroxide with different chemical patterns, as shown below:.

It is known from radiation chemistry that in the presence of high levels of molecular oxygen, H 2 O 2 could also be formed by the recombination of hydroperoxyl radicals as follows:.