Objetivo: Avaliar, in vivo, o efeito do tratamento endodôntico em sessão única utilizando a Terapia Fotodinâmica Antimicrobiana (aPDT) no reparo de lesões periapicais induzidas em dentes de cães, por meio da avaliação histopatológica e imunohistoquímica da angiogênese e de marcadores de formação óssea. O tratamento endodôntico em duas sessões com curativo de demora à base de hidróxido de cálcio (CH) foi utilizado como controle. Métodos: Lesões periapicais foram induzidas em 48 pré-molares superiores e inferiores de 6 cães, com 12 meses de idade. Após instrumentação dos canais radiculares, os dentes foram divididos, aleatoriamente, em 4 grupos: CH/120dias (d) e CH/180dias (d): canais radiculares preenchidos com curativo à base de CH; aPDT/120d e aPDT/180d: canais radiculares condicionados com fotossensibilizador à base de fenotiazina (10 mg/mL), por 1 minuto e irradiados com laser de diodo em toda a extensão dos canais, conforme as recomendações do fabricante. Em seguida, todos os canais radiculares foram obturados com cimento AH Plus e, após 120 ou 180 dias, os animais foram eutanasiados e os blocos contendo dentes e tecido ósseo foram submetidos ao processamento histotécnico e à coloração de hematoxilina e eosina (HE) para a análise descritiva da região periapical e mensuração das lesões periapicais, em microscopia convencional, e contagem de vasos sanguíneos sob luz convencional e no modo fluorescente. A análise imunohistoquímica foi realizada para avaliação dos marcadores da formação óssea osteopontina (OPN) e fosfatase alcalina (ALP). Os dados obtidos foram analisados estatisticamente utilizando os testes two-way ANOVA e qui-quadrado, com nível de significância de 5%. Resultados: Aos 120 dias, os dentes do grupo CH/120d apresentaram processo de reparo avançado, com ligamento periodontal apenas ligeiramente aumentado, presença abundante de fibras colágenas e escassas células inflamatórias. Os dentes do grupo aPDT/120d apresentaram o ligamento periodontal moderadamente aumentado e o infiltrado inflamatório era moderado. Poucas fibras colágenas foram observadas. Aos 180 dias, o mesmo padrão foi observado. As lesões periapicais nos grupos tratados com curativo à base de hidróxido de cálcio foram menores que as lesões nos grupos tratados com aPDT (p<0,001), e apresentaram maior número de vasos sanguíneos (p<0,0001), independentemente dos períodos de avaliação. Além disso, os dentes dos grupos tratados com pasta à base de hidróxido de cálcio apresentaram imunomarcação significativamente mais intensa para ALP e OPN (p<0,001), em ambos os períodos. Conclusões: Embora o tratamento com a aPDT tenha estimulado a angiogênese e a expressão dos marcadores da formação óssea, o tratamento endodôntico realizado em duas sessões empregando curativo à base de hidróxido de cálcio estimulou mais intensamente esses processos e promoveu melhor reparo das lesões periapicais / Aim: The aim of this study was to evaluate the in vivo effect of one-session endodontic treatment with antimicrobial photodynamic therapy (aPDT) in the repair of apical periodontitis, in dogs\' teeth, by histopathologic evaluation and imunohistochemistry for angiogenesis and bone formation markers. Two-session treatment with a calcium hydroxide (CH) dressing was used as control. Methods: Apical periodontitis were induced in 48 upper and lower premolars of six 12-monthold dogs. After root canals instrumentation, teeth were randomly divided into 4 groups: CH/120days (d) and CH/180days (d): root canals filled with CH-based dressing; aPDT/120d and aPDT/180d: root canals conditioned with phenothiazinebased photosensitizer (10 mg/mL) for 1 minute and irradiated with diode laser throughout the canals and according to the manufacturer\'s recommendations. Root canals were filled with AH Plus cement, and after 120 or 180 days, the animals were euthanized and teeth were submitted to histotechnical processing and HE staining for description of the periapical region and measurement of apical periodontitis in conventional microscopy and for counting blood vessels under conventional and fluorescent microscopy. Immunohistochemical analysis was performed to evaluate the bone formation markers osteopontin (OPN) and alkaline phosphatase (ALP). Data were statistically analyzed using two-way ANOVA and chi-square test with a significance level of 5%. Results: At 120 days, teeth in Group CH/120d presented the periodontal ligament only slightly enlarged with advanced repair and abundant collagen fibers. Inflammatory cells were scarce. Teeth in group aPDT/120d presented the periodontal ligament moderately enlarged and the inflammatory infiltrate was moderate. Few collagen fibers were observed. At 180 days, the same pattern was observed. Apical periodontitis in CH-treated groups were smaller than the lesions in aPDT-treated groups (p<0.001) and had a greater number of blood vessels (p <0.0001), regardless of evaluation periods. The teeth treated with calcium hydroxide showed significantly more intense immunostaining for ALP and OPN (p<0.001), in both periods. Conclusions: Although aPDT has stimulated angiogenesis and the expression of bone formation markers, the two-session endodontic treatment with a calcium hydroxide-based dressing stimulates them more intensely and promoted better apical periodontitis repair

Antimicrobial peptides (AMPs) and photosensitizers (PS) have gained attention as potential alternatives to traditional antibiotics for the treatment of microbial infection due to the decreased likelihood for acquired resistance. However, many AMPs and PS suffer from insufficient activity, specificity, or a combination thereof. AMPs can require high concentrations for effective activity, leading to non-specific side effects and increased costs. PS, on the other hand, are quite active, but are typically hydrophobic and suffer from non-specific binding and damage to host tissues. To solve these problems, we report a novel PS-AMP construct of the soluble PS eosin Y conjugated to the selective AMP (KLAKLAK)_(2). Eosin Y has a high singlet oxygen quantum yield, which is suitable for photodynamic activity, although the solubility of eosin Y results in poor binding and activity toward membranes on its own. On the other hand, the specificity of (KLAKLAK)_(2) is high for an AMP, but could still benefit from enhanced activity at lower concentrations. The killing activity and binding specificity of eosin-(KLAKLAK)_(2) toward both bacteria and mammalian cells was assessed using microbiology, biochemistry, and fluorescence microscopy techniques. Additionally, the mechanism of eosin-(KLAKLAK)_(2) activity was investigated using liposome models to determine factors involved in binding and membrane disruption. Furthermore, novel applications of transmission electron microscopy (TEM) methods were employed to observe the photodynamic effects of eosin-(KLAKLAK)_(2) against bacteria. The PS-AMP conjugate eosin-(KLAKLAK)_(2) displays synergistic activity between PS and AMP in model liposome systems, and is capable of killing several clinically relevant bacteria, including the multi-drug resistant Acinetobacter baumannii AYE strain. Furthermore, bacterial killing is achieved in the presence of red blood cells (RBCs) and other mammalian cell lines without significant toxicity. Liposome models reveal that the lipid composition of bacteria is a potential factor responsible for the observed binding specificity and corresponding activity. Additionally, TEM methods show that eosin-(KLAKLAK)_(2) causes extensive membrane damage to both Gram positive Staph aureus and Gram negative Escherichia coli, indicating a primary cause of cell death. A model is proposed where the activities of the PS and AMP, respectively, facilitate the activity of one another, leading to enhanced membrane disruption, and effective antibacterial activity while maintaining cell selectivity.