Perfusable Plasma-Activated Saline for Oxidative Stress Delivery to Induce Tumor Cell Apoptosis in Nonmuscle-Invasive Bladder Cancer

Nonmuscle-invasive bladder cancer (NMIBC) is a common urologic malignancy. Currently, conventional postoperative perfusion therapy for NMIBC still has high side effects and recurrence rates. Cold atmospheric plasma is a fledgling reactive oxygen species (ROS)-based therapeutic technique for cancer treatment. In this study, we examined the feasibility of plasma-activated saline (PAS) perfusion for treating NMIBC. The results show that underwater bubble plasma can generate abundant ROS in PAS. In vitro studies revealed that PAS could trigger apoptosis in bladder cancer T24 cells by activating the ROS-mediated caspase-3 cascade reaction. In vivo tests revealed that intravesical PAS perfusion effectively inhibited nonmuscle-invasive T24 tumor growth without significant side effects. Therefore, our results suggest that intravesical PAS perfusion may be a novel treatment option for NMIBC. The anticancer effect of plasma-activated saline on nonmuscle-invasive bladder cancer was investigated. Excessive reactive oxygen species in plasma-activated saline induced oxidative stress in tumor cells and further activated the downstream cysteine asparaginase 3 cascade reaction, triggering apoptosis of tumor cells. The excellent anticancer effect and no toxic side effects were confirmed in a mouse xenograft model of orthotopic bladder cancer. image