Cold Plasma against multidrug-resistant Pathogens in everyday Wound Care. A physical approach.

Antibiotic resistance across a wide range of pathogens is one of the most pressing challenges in modern wound care and hygiene. Chemical agents bind to defined molecular target structures. Microorganisms then alter precisely these points of attack through mutation or gene transfer. Cold plasma pursues a fundamentally different, namely physical, approach. This article sets out why the oxidative mechanism of action of Cold Atmospheric Plasma (CAP) and Cold Atmospheric Plasma-Aerosol (CAP-A) is scientifically topical with regard to multidrug-resistant pathogens such as MRSA, and it names the limits of the available evidence. [1] [2]

Why does antibiotic resistance arise – and what sets a physical approach apart?

Conventional antibiotics act in a targeted manner on a single molecular structure of the microorganism. If that target changes, the agent can lose its point of attack. Resistance mechanisms typically rest on a pathogen modifying the binding site, degrading the agent or pumping it out of the cell. This is precisely where interest in physical methods begins. Cold plasma – the fourth state of matter alongside solid, liquid and gaseous – does not act on a defined molecular target of choice. Instead, Reactive Oxygen Species (ROS) act on the cell envelope by means of oxidative stress. What is relevant to the question of resistance is that, in the case of Reactive Oxygen Species, no single agent molecule serves as the key. The formation of known resistance mechanisms plays no role here.

The products of cold plasma are primarily these Reactive Oxygen Species with oxidative potential, which damage the cell membrane of pathogenic microorganisms and disrupt downstream redox processes. These bring about a “short circuit” of the cell membrane, as a result of which the microorganism is inactivated. In the specialist literature this effect is described as a selective disruption of the membrane potential. A “selective short circuit” in the microbial membrane causes the membrane potential to collapse and halts transmembrane transport. The decisive point is the non-specificity: the attack takes place via oxidative damage to the envelope – a mechanism that differs physically from the targeted molecular binding of chemical agents. In contrast, human and animal cells within the tissue are protected by proteins and antioxidant enzymes.

Why is this mechanism relevant to multidrug-resistant pathogens in wound care?

A non-specific, oxidative attack on the membrane does not act on the single molecular target via which conventional antibiotic resistance typically develops. Cold plasma damages microbial structures in Gram-positive and Gram-negative bacteria, including resistant strains such as MRSA. The technology does not distinguish between resistance-forming pathogens and those of lesser relevance to healthcare.

PLASMO®HEAL PRO and PLASMO®VET already use the fusion of aerosol and cold plasma in everyday clinical practice in human and veterinary medicine. The detachment and displacement effect of the aerosol in combination with Reactive Oxygen Species is an integral part of every therapy that seeks to accelerate the course of wound healing or to find answers to impaired wound healing. [3]

Conclusion. A physical method as a complement in wound care for everyday use.

The oxidative, membrane-damaging mechanism of action of cold plasma does not act on the molecular target of conventional antibiotics – which makes it scientifically interesting in the context of wound care with regard to multidrug-resistant pathogens. The available data describe microbial reduction and mechanism under defined study conditions – they do not permit generalisation to every application in the patient or to every pathogen irrespective of its environment. Cold Atmospheric Plasma-Aerosol (CAP-A) nevertheless promises a lastingly effective inactivation of microorganisms without the development of resistance. The new adjuvant therapy in modern wound care fits seamlessly into the daily routine between cleansing and subsequent dressing of the wound.

The intended purpose and use of a specific product are determined by its approval. Human and veterinary therapies are to be decided independently of this article, in consultation with the responsible medical professionals. This article does not constitute a claim of cure or therapy. The effects described relate to studies under verified, standardised conditions. This overview page on current research with Cold Atmospheric Plasma-Aerosol (CAP-A) serves information purposes only and presents independent scientific findings.

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[1] https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
‍World Health Organization (WHO). Antimicrobial resistance. Fact Sheet.

[2] https://doi.org/10.1002/ppap.201900218
Cold atmospheric pressure plasmas in dermatology: Sources, reactive agents, and therapeutic effects. Plasma Process Polym.

[3] https://doi.org/10.1371/journal.pone.0034610
Decolonisation of MRSA, S. aureus and E. coli by Cold-Atmospheric Plasma Using a Porcine Skin Model In Vitro. PLoS ONE.