The inhibitory activity of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) on Candida albicans biofilms

Background: Biofilm-associated Candida albicans (C. albicans) infections are hard to cure due to their high levels of resistance to antifungal agents. Photodynamic therapy (PDT) is a promising approach for controlling infections caused by C. albicans. This study was designed to explore the inhibitory activity of PDT using 5-aminolevulinic acid (ALA) as photosensitizer against C. albicans biofilms. Methods: C. albicans cell suspensions were incubated for 48 h to form mature biofilms. ALA solution was diluted to 15 mM and incubated with C. albicans biofilms for 5 h before irradiated by red light semiconductor laser under the light intensity of 300 J/cm2 and fluence rate of 100 mW/cm2 for 50 min. The inhibitory activity was evaluated from subcellular level, molecular level and transcriptional level using transmission electron microscopy (TEM) observation, flow cytometry analysis and quantitative Real-Time Polymerase Chain Reaction (qRTPCR) assays, respectively. Results: From subcellular level, the degraded content of the cytoplasm, nuclear condensation and mitochondrial swelling were observed after ALA-PDT. From molecular level, ALA-PDT resulted in 19.4 % cell apoptosis. From transcriptional level, ALA-PDT significantly reduced the mRNA expressions of hyphae-specific genes (HWP1 and ALS3) and long-term biofilm maintenance genes (UME6 and HGC1), whereas ALA or red light alone had no significant effect. Conclusions: The inhibitory activity indicated that ALA-PDT may have the potential to serve as an antifungal strategy in eliminatingC. albicans biofilms.