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Plasma medicine—current state of research and medical application

K-D Weltmann, Th von Woedtke2017年Plasma Physics and Controlled FusionIF 2.2出版社

Plasma medicine means the direct application of cold atmospheric plasma (CAP) on or in the human body for therapeutic purposes. Further, the field interacts strongly with results gained for biological decontamination. Experimental research as well as first practical application is realized using two basic principles of CAP sources: dielectric barrier discharges (DBD) and atmospheric pressure plasma jets (APPJ). Originating from the fundamental insights that the biological effects of CAP are most probably caused by changes of the liquid environment of cells, and are dominated by reactive oxygen and nitrogen species (ROS, RNS), basic mechanisms of biological plasma activity are identified. It was demonstrated that there is no increased risk of cold plasma application and, above all, there are no indications for genotoxic effects. The most important biological effects of cold atmospheric pressure plasma were identified: (1) inactivation of a broad spectrum of microorganisms including multidrug resistant ones; (2) stimulation of cell proliferation and tissue regeneration with lower plasma treatment intensity (treatment time); (3) inactivation of cells by initialization of programmed cell death (apoptosis) with higher plasma treatment intensity (treatment time). In recent years, the main focus of clinical applications was in the field of wound healing and treatment of infective skin diseases. First CAP sources are CE-certified as medical devices now which is the main precondition to start the introduction of plasma medicine into clinical reality. Plasma application in dentistry and, above all, CAP use for cancer treatment are becoming more and more important research fields in plasma medicine. A further in-depth knowledge of control and adaptation of plasma parameters and plasma geometries is needed to obtain suitable and reliable plasma sources for the different therapeutic indications and to open up new fields of medical application.

日本語訳

プラズマ医学とは、低温大気圧プラズマ(CAP)を治療目的で人体に直接、または体内に適用することを意味する。さらに、この分野は生物学的除染において得られた成果と強く相互作用する。実験的研究ならびに最初の実用化は、CAP源の2つの基本原理、すなわち誘電体バリア放電(DBD)と大気圧プラズマジェット(APPJ)を用いて実現される。CAPの生物学的効果は、おそらく細胞の液体環境の変化によって引き起こされ、活性酸素種および活性窒素種(ROS、RNS)が支配的であるという基本的な知見に基づき、プラズマの生物学的活性の基本メカニズムが特定された。低温プラズマの適用によるリスクの増大はないことが実証され、とりわけ遺伝毒性効果の兆候は認められなかった。低温大気圧プラズマの最も重要な生物学的効果として、以下が特定された:(1)多剤耐性菌を含む広範囲の微生物の不活化;(2)低いプラズマ強度(処理時間)での細胞増殖の促進および組織再生;(3)高いプラズマ強度(処理時間)でのプログラム細胞死(アポトーシス)の誘導による細胞の不活化。近年、臨床応用の主な焦点は創傷治癒および感染性皮膚疾患の治療に置かれている。最初のCAP源は現在、医療機器としてCE認証を取得しており、これはプラズマ医学の臨床実践への導入を開始するための主要な前提条件である。歯科におけるプラズマ応用、とりわけ癌治療のためのCAP使用は、プラズマ医学においてますます重要な研究分野になりつつある。異なる治療適応症に対して適切かつ信頼性の高いプラズマ源を獲得し、新たな医療応用分野を開拓するためには、プラズマパラメータの制御および適応に関するさらなる深い知識が必要である。

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