Abstract
Major medical advances in antibiotics for infectious diseases have dramatically improved the quality of life and greatly increased life expectancy. Nevertheless, the widespread and inappropriate exploitation of antibacterial agents has resulted in the emergence of multi-drug-resistant bacteria (MDR). Consequently, the study of new drugs for the treatment of diseases associated with multi-drug-resistant bacteria and the development of new treatments are urgently needed. Inspiringly, due to the advantages of a wide antimicrobial spectrum, fast sterilization, low resistance, and little damage to host tissues and normal flora, antibacterial photodynamic therapy (APDT), which is based on the interaction between light and a nontoxic photosensitizer (PS) concentrated at the lesion site to generate reactive oxygen species (ROS), has become one of the most promising antibacterial strategies. Recently, a burgeoning APDT based on a variety of upconversion nanoparticles (UCNPs) such as PS and near-infrared (NIR) light has been fully integrated in antibacterial applications and achieved excellent performances. Meanwhile, conjugated nanoparticles have been frequently reported in UCNP design, including surface-modified PS conjugates, antibiotic-PS conjugates, and dual or multiple antibacterial modal PS conjugates. This article provides an overview of the state-of-the-art design and bactericidal effects of UCNPs and their based APDTs. The first part discusses the design and mechanisms for UCNPs currently implemented in biomedicine. The second part focuses on the applications and antimicrobial effects of diverse APDT based on UCNPs in antibacterial-related infectious diseases.
1 Introduction
At the beginning of the 20th century, infectious diseases caused by pathogenic bacteria were among the leading causes of death and presented growing challenges to health security and human progress (; ). The emergence of antimicrobial agent was primarily responsible for the improvement in cure rate and decreases in mortality for infection diseases (). However, with the increasing abuse of antibiotics in treatment and more and more infections caused by multi-drug-resistant bacteria (MDR), resistance to antibiotics has reached a rather tedious situation (; ; ). Even now, first-line antibiotics currently used are invalidated in clinical therapy (). Therefore, discovering new drugs or inventing an efficient and nontoxic bactericidal treatment has been constantly attempted to match up to the pathogenic bacteria’s speediness and frequency variation.
Unprecedented superiority of nanomaterials and novel mechanisms of action have been introduced to establish a potent platform that is capable of eliminating pathogenic bacteria efficiently without the risk of drug resistance (; ). Antibacterial photodynamic therapy (APDT), a promising alternative approach, has been believed to meet the pressing need. Light with an appropriate wavelength and a biosafety photosensitizer (PS) with a matching absorption spectrum make up the APDT (). After the activation, usually by ultraviolet (UV) or visible range emission light, the excited PS could undergo a chemical reaction with oxygen that generates reactive oxygen species (ROS), including singlet oxygen (1O2) and a hydroxyl radical around rapidly (; ). The above oxidative burst could kill bacteria selectively and efficiently (; ). This therapy method has been investigated in abundant in vitro and in vivo studies and often reached an inactivation ratio of more than 5 log10 of CFU (colony forming units) (). In particular, a lot of evidence suggests that APDT has emerged as an effective modality for MDR infections such as S. aureus, A. baumannii, Klebsiella pneumoniae, E. coli, and so on (; ; ; ). However, the limited penetration depth in biological tissues ranged from 60 µm to several millimeters of UV or visible light and the toxicity of UV in particular weakened APDT therapeutic efficacy for deep-tissue infection to a great degree (; ; ).
Judging from the limitations highlighted above, among multiple nanomaterials, upconversion nanoparticles (UCNPs) that are usually doped with lanthanide rare earth elements have attracted wide attention in biomedical diagnosis and treatment (). The core principle of UCNPs is based on the anti-Stokes shift luminescence mechanism, which could covert near-infrared (NIR) light into UV or visible light in keeping with the activation wavelength of existing PS. Compared with UV and visible emission light, NIR light, whose wavelengths range from 650 to 1,350 nm, has better penetration depth in the soft tissue (). Along with the superb penetration depth of NIR excitation, UCNPs have represented an enormous preponderance of PS loading nanoplatforms in NIR-triggered APDT to overcome the drawbacks mentioned above. As a result, traditional and clinically effective PS could continue to be used for deep-tissue therapy. Moreover, UCNPs have high chemical stability and could be easily functionalized by linking specific peptides, antibiotics, small-molecule drugs, or metallic elements to extend biological applications with high sensitivity and selectivity (). Conjugates are a commonly used method for improving nanomaterial performance in antitumor ability, biosafety, drug delivery, and other properties in biomedical applications (; ). Conjugated UCNPs with polymeric composite, antibiotics, silica coating, PS, and other functionalized nanoparticles were also constructed to increase antibacterial activity or achieve multiple strategy sterilization.
Clearly, in the future, for the UCNPs designed for antibacterial or antitumor application, conjugation strategy will be continually used to gain more effective function or synergistic effect. In recent years, plenty of significant reviews on UCNPs and their based APDT treatment have been announced, mainly focusing on the catalysis, luminous performance, bioimaging applications (e.g., MRI, X-ray CT imaging, photoacoustic (PA) imaging, NIR thermal imaging, and upconversion luminescence imaging), and tumor treatment (e.g., chemotherapy and radiotherapy) (; ; ; ; ; ). Nevertheless, the systematic antibacterial and anti-infection effects of UCNPs and its based APDT treatment with different material designs were rarely reviewed. Therefore, this review began with a brief overview of the current state of antibacterial and anti-infective therapy, followed by a preliminary outline of the antibacterial mechanism of UCNPs and the APDT treatment based on it. In addition, this article presented a comprehensive overview of novel achievements in nanomaterial compositions and the antibacterial applications of their based APDT against infectious diseases. We hope that this article will provide guidance for developing a new anti-infection strategy in the future.
2 Information sources and search strategy
The search was conducted through the PubMed, Web of Science, and Google Scholar databases using standardized methodological filters up to September 2015 across all databases with no time restrictions. Only English version articles were selected. Search strategies were mainly constructed based on these keywords: “upconversion”, “photodynamic therapy”, and “antibacterial” as follows: (“upconversion” OR “upconversion nanoparticles”) AND (“photodynamic therapy”) AND (“antibacterial” OR “bacteria” OR “infection”). In addition, the retrieved papers were manually selected to find relevant articles.
3 Antibacterial mechanism of antibacterial photodynamic therapy
A typical APDT process is made up of three inseparable parts: PS (light-absorbing molecule), a light source with a specific spectrum, and dissolved oxygen in cells (). After administration of PS and external light irradiation, PS-absorbed photons then translate from the ground state to a temporary singlet state. After that, via “intersystem crossing” or spin–flip of the HOMO electron singlet state, PS could produce relatively steady triplet state species, which could generate a large amount of ROS in a short time (). ROS could cause bacteria to be damaged in a variety of ways and then control infection (). Benefiting from its unique antibacterial mechanism, APDT does not lead to drug resistance in bacteria, which gives it a huge advantage over conventional antibacterial drugs ().
The pathways of ROS generation could be divided into two types (Figure 1A). Type Ⅰ showed that the excited PS could interact with the cellular membrane directly and then lead to electron or hydrogen shifting between PS and substrate, which could release hydroxyl radicals (·OH), superoxide anion (O2−), and hydrogen peroxide (H2O2). Type Ⅱ demonstrated that the energy from irradiation could be transferred from molecular oxygen to highly oxidative properties. According to past research, Type II in the formation of hydroxide was extremely crucial to the therapeutic effect of APDT. Interestingly, Type Ⅰ usually prevails in the dominant position in low-oxygen environments, and both pathways could occur simultaneously (). ROS can harm bacteria in a variety of ways (Figure 1B), including DNA destruction, lipid peroxidation, enzymatic system inhibition, and protein denaturation. ROS could not only induce the destruction of normal functions of DNA in microbial cells, but also result in the peroxidation of lipid in the cell membrane and the disruption of the normal function of the lipid layer. The abovementioned changes could block the working of membrane-located receptors and proteins that lead to cell perforation, losing cytosolic contents, and a decrease in enzyme activity (). However, there are still some limitations in APDT, such as the limited tissue penetration and underlying risk of cytotoxicity due to the common use of UV or visible light as an exciting light ().
FIGURE 1
This section may be divided by subheadings. It should provide a concise and precise description of the experimental results, their interpretation, and the experimental conclusions that can be drawn.
4 Upconversion luminescence mechanisms
Recently, UCNPs have drawn extensive attention because of their higher stability, ideal signal-to-noise ratio, and ability to be easily activated by low-energy photons (
FIGURE 2

(A) (a) The basic composition of UCNPs: matrix material, activated ions, and sensitized ion; (b) schematic illustration of the mechanism of organic dye-sensitized UCNPs (
There are five types of upconversion luminescence (UCL) mechanisms (Figure 2B) of upconversion nanoparticles: 1) excited-state absorption (ESA), 2) energy looping/photon avalanche (PA), 3) energy transfer upconversion (ETU), 4) cooperative sensitization (CS), and 5) energy migration upconversion (EMU). Notably, PA is rarely found in lanthanide materials (
ESA is the continuous absorption of one or more photons from the ground state to the intermediate excited state, thus obtaining UC emission (
EMU and CS require multiple centers in the sensitization or luminescence process, which involve cooperative effects. In the case of cooperative sensitization, two excited ions (ions 1 and 2) absorb one photon to generate their excited levels and then together, transfer the energy to another ion (ion 3) to upgrade its excited-state level. In the case of cooperative luminescence, two excited interacting ions (ions 1 and 2) could absorb one photon and cooperate in producing the emission (
The transition of UV or visible light from long wavelength excitation radiation is a unilinear anti-Stokes luminescence process. UCNPs absorb two or more low-energy photons and then emit higher energy light, which is different from the common Stokes luminescence type. By virtue of the long-lived and real ladder-like intermediate levels of rare-Earth ions, UCNPs could effectively convert NIR light into a higher energy emission photon, thus NIR to UV and visible light, which enables PS to be excited by deep-tissue bioimaging light (
FIGURE 3

The dopant Yb3+ and Tm3+ ions convert 980 nm of NIR light into UV light. The ZnO in the outer layer of the core-shell structure absorbs UV light to produce ROS and achieve the antibacterial effect (
5 Upconversion nanoparticles in antibacterial photodynamic therapy
This part mainly reviewed several different designs of UCNPs in recent years for APDT. As mentioned before, to convert UV-excited PS into NIR or visible light, UCNP conjugates are a feasible measure. Furthermore, hydrophobic ligands on the surface of UCNPs impede their dispersion in an aqueous environment and in biological applications due to the common fabrication routes (
5.1 Surface silica coating
Silica (SiO2) is widely used in the surface modification of UCNPs due to its great biocompatibility, optical transparency, tunable pore size, and chemical stability. In addition, the silica layer can carry other functional groups more easily, such as −SH, −NH2, and −COOH (
A core-shell UCNP coated with mesoporous silica has been reported by Grüner and coworkers. They loaded silicon (IV)2,9,16,23-tetra-tert-butyl-29H, 31H-phthalocyanine dihydroxide (SiPc) onto the surface of a mesoporous silica shell. E. coli was eradicated, and S. aureus was significantly reduced, whereas under 978 nm irradiation, the inhibition toward Gram-positive S. aureus was not apparent. It is possible that the thickness of the mesoporous silica layer and the peptidoglycan layer of Gram-positive bacteria contribute to this phenomenon. Further studies should be carried out on that mesoporous silica coating to enhance ROS diffusion (
5.2 Polymeric coating
Liu et al. first developed a NIR-triggered APDT for extensively drug-resistant Acinetobacter baumannii (XDR-AB), which is a vital bacterium for hospital infection. Free-ligand LiYF4: Yb3+Er3+ UCNPs are coated with PVP (polyvinyl pyrrolidone) to load RB (Rose Bengal) as the PS. In this report, in vitro and in vivo antimicrobial experiments of UCNPs-PVP-RB were organized to measure the APDT efficiency for XDR-AB. The in vitro test indicated that upon 980 nm NIR 10 min, the 50 μg ml−1 UCNPs-PVP-RB induced a 4.72 log10 CFU reduction, which was almost equal to the effect of extremely overdosed polymyxin B (4.90 log10). In the in vivo test, the recovery time and the HE-stained tissue slices of the XDR-AB infected wound on the mice’s back proved the excellent antibacterial effect of these UCNPs. Furthermore, they compared 980 and 550 nm light-triggered APDT in vitro on 5-mm thick pork tissue and showed that NIR light was superior for treating deep-tissue infections (
Titanium dioxide nanoparticles have good biocompatibility and stability and could produce ROS under UV conditions. Qi and coworkers designed β-NaYF4: Yb3+/Tm3+ UCNPs@TiO2 with the coating of PVP. With the 980-nm NIR light, the viability of three main periodontal pathogens (e.g., S. sanguinis, P. gingivalis, and F. nucleatum) has been greatly reduced compared with the commercial APDT drug (
5.3 Antibiotics or antibacterial materials assembled upconversion nanoparticles in antibacterial photodynamic therapy
Although drug resistance and side effects limit the use of antibiotics in current anti-infection treatments, antibiotics are still one of the most effective drugs for treating bacterial infections. Some inorganic materials such as Ag+ and Cu2+ have excellent antibacterial activity, and they have also been maturely used in infection treatment. Some attempts to combine antibiotics or other antibacterial drugs with PS that developed UCNPs-PS-drug conjugates have achieved good results (
FIGURE 4

The PAA surface-modified UCNPs were assembled with PSeV to formulate a PTT and PDT synergistic conjugates. Photothermal and photodynamic effects combined to kill MRSA in deep tissue with NIR light (
Multiple mode-based synergistic antibacterials were also reported, which combined the APDT mode with photothermal therapy (PTT) or sonodynamic therapy (SDT). These conjugates were loaded with PS and related functional particles. Synergistic therapy strategies have also been applied in antitumor field. Xu and coworkers developed a biodegradable copper/manganese silicate nanosphere (CMSN)-coated UCNP conjugate system for CDT (chemodynamic therapy)/PDT synergistic antitumor therapy with NIR light (
6 Limitations for upconversion nanoparticle-based antibacterial photodynamic therapy
Although UCNPs have been applied in many fields and shown huge potential, there are still many limitations that need to be improved and discussed in future research. The crystal structure, dopant ions, and surface functionalization of UCNPs with different capping agents strongly influence the UCL process for their practical use. In addition, nanoparticle size also has a great effect on the material. Smaller UCNPs have higher endocytosis efficiency but also possibly reduce UCL efficiency (
Another noteworthy phenomenon is the overheating of biological tissues. Well-designed UCNP-based PTT systems could be used in the antitumor or antibacterial area. However, overheating due to the absorption of 980 nm NIR light by water may cause damage to normal soft tissues (
Species of bacteria also influence APDT efficiency. The special cell wall structure of Gram-negative bacteria makes it more difficult to be killed by ROS than Gram-positive bacteria. The membrane’s external face contains all the LPS, whereas the internal face contains most of the phospholipids. In contrast, Gram-positive bacteria have a cell wall that consists of a cytoplasmic membrane surrounded by a layer of relatively porous peptidoglycan and lipoteichoic acid that facilitates penetration of the photosensitizers into the inner membrane (
7 Conclusion
UCNPs have attracted great attention in recent years because of their UCL properties. A number of previous studies have reported its antitumor, microbiological, and bioimaging properties. In this article, APDT on the basis of UCNPs has been briefly reviewed by the components, mechanisms, utilization, and current situation. It appears that antibacterial photodynamic therapy will be more closely integrated with other antimicrobial therapies in the future to achieve higher bactericidal efficiency and lower damage to the human body. NIR light-triggered APDT damage to normal tissue is negligible, and its deep penetration guarantees a stronger therapeutic effect than ultraviolet light. Certainly, toxicity to the mammalian nervous system and other tissues should be further studied, and light conversion efficiency and tissue penetration depth should also be further improved. To date, UCNPs have a promising future in antibacterial treatment, and it may be the first option for antibacterial therapy in clinical practice.
Statements
Data availability statement
The original contributions presented in the study are included in the article/Supplementary Material; further inquiries can be directed to the corresponding author.
Author contributions
Literature review and manuscript drafting: HL and JL; manuscript revision: XL; literature collection WH, YL, and FL; verification of manuscript: XX, LG, and YW. All authors read and approved the submitted manuscript.
Funding
The work was supported by the Shandong Provincial Natural Science Foundation Youth Project (ZR2021QH251) and the Clinical Medicine + X Research Project of Affiliated Hospital of Qingdao University (QDFY + X2021055).
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors, and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Glossary
- 1PS
PS in a first excited state
- 3PS
Triplet-state PS
- APDT
Antibacterial photodynamic therapy
- CDT
Chemodynamic therapy
- CR
Cross relaxation
- CS
Cooperative sensitization
- CSU
Cooperative sensitization upconversion
- E. coli
Escherichia coli
- EMU
Energy migration upconversion
- EPS
Extracellular polymeric substance
- ESA
Excited-state absorption
- ETU
Energy-transfer upconversion
- F. nucleatum
Fusobacterium nucleatum
- HOMO
Highest occupied molecular orbital
- LPS
Lipopolysaccharides
- MB
Methylene blue
- MDR
Multi-drug-resistant bacteria
- MIC
Minimum inhibitory concentration
- MSSA
Methicillin-sensitive Staphylococcus aureus
- MSSE
Methicillin-sensitive Staphycoccus epidermidis
- NIR
Near-infrared
- O2−
Superoxide anion
- OC
N-octyl chitosan
- −OH
Hydroxyl radicals
- P. gingivalis
Porphyromonas gingivalis
- PA
Photoacoustic
- PA
Photon avalanche
- PAA
Polyacrylic acid
- PPT
Photothermal therapy
- PS
Photosensitizer
- PSeV
Poly(selenoviologen)
- PVP
Polyvinyl pyrrolidone
- ROS
Reactive oxygen species
- S. aureus
Staphylococcus aureus
- SDT
Sonodynamic therapy
- UCL
Upconversion luminescence
- UCNPs
Upconversion nanoparticles
- UV
Ultraviolet
- XRD-AB
Drug-resistant Acinetobacter baumannii
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Summary
Keywords
conjugated nanoparticle, upconversion, photodynamic therapy, antibacterial, near-infrared
Citation
Lv H, Liu J, Wang Y, Xia X, Li Y, Hou W, Li F, Guo L and Li X (2022) Upconversion nanoparticles and its based photodynamic therapy for antibacterial applications: A state-of-the-art review. Front. Chem. 10:996264. doi: 10.3389/fchem.2022.996264
Received
15 August 2022
Accepted
12 September 2022
Published
04 October 2022
Volume
10 - 2022
Edited by
Siva S. Panda, Augusta University, United States
Reviewed by
Jiating Xu, Northeast Forestry University, China
Ming-Hsien Chan, Genomics Research Center, Academia Sinica, Taiwan
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© 2022 Lv, Liu, Wang, Xia, Li, Hou, Li, Guo and Li.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Xue Li, lixue@qdu.edu.cn
This article was submitted to Organic Chemistry, a section of the journal Frontiers in Chemistry
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