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C.S. Enwemeka, et al. Journal of Photochemistry & Photobiology, B: Biology 207 (2020) 111891 cardinal method used in early Daoism, which Lingyan Tzu-Ming in- troduced in China during the first century CE [28]. In summary, evi- dence from many parts of the world clearly show that communities worldwide used heliotherapy to treat a variety of diseases. In those days, the inimical effects of UV were unknown before UV was dis- covered in 1801 [11]. The discovery of UV transformed the practice of heliotherapy into clinical phototherapy as the antimicrobial effects of UV became evident during the second half of the 19th century. As early as 1877, studies showed that UV killed anthrax bacilli [11], and by 1890, it was de- termined that it played a role in rachitis, rickettsia and peritoneal tu- berculosis [11,16,29]. By this time, lamps generating light from quartz, mercury vapor and other sources were built and used to treat acne, psoriasis, syphilis, leprosy, and pellagra, among others [11,17,25]. Three years later, Finsen began to use filtered sunlight to treat lupus vulgaris and through careful documentation published his Nobel-win- ning work, in 1901. The use of lamps and other artificial light sources to treat skin diseases continued well into the second half of the 20th century, but was quickly overtaken by easy availability of potent an- tibiotics, which became popular for their quick results and ease of use [11,25]. The development of lasers in the late 50s and the early 60s, and the subsequent evolution of light emitting diodes transformed photo- therapy; it gave rise to laser therapy or light therapy, which in turn evolved into photobiomodulation as a variety of light emitting tech- nologies were devised. Today, photobiomodulation, which takes ad- vantage of the photochemical effects of low power lasers, LEDs and other monochromatic sources of light to treat various diseases and ailments, has evolved scientifically, allowing evidence-based practice. This development now enables clinicians and others to exploit the specific effect of each wavelength or spectrum of light for treatment purposes. Detailed below are several studies, which show that we do not need UV to eradicate bacteria, viruses and other pathogens, and that relatively safer wavelengths adjacent to UV, such as violet or blue light, are antimicrobial against microorganisms. Furthermore, evidence shows that red and near infrared light have immense therapeutic value as well, and may be effective in treating a range of ailments, including the respiratory complications of coronavirus disease. 4. Photobiomodulation Advances in light technology and steady development of photo- biomodulation through research and continual adaptation to evolving technologies have enabled science to uncover the beneficial effects of several spectra of light—in particular, violet/blue light, red light and near infrared light. We now know that light in the blue 400–470 nm range is antimicrobial against numerous bacteria [23–45] and has the potential to mitigate opportunistic bacterial infections associated with COVID-19 and other coronavirus infections. Furthermore, as detailed below, laboratory experiments show that red and near infrared light, with wavelengths approximately in the range of 600–700 nm and 700–1000 nm respectively, have the potential to reduce lung in- flammation and fibrosis, and hence acute respiratory disorder syn- drome, a major cause of death in every coronavirus pandemic, in- cluding the prevailing COVID-19 pandemic. Therefore, as a part of the ongoing effort to mobilize every clinical tool with the potential to al- leviate the disease and minimize its spread, these recent studies offer compelling reasons to explore the potential effects of various spectra of light in reducing secondary bacterial infections associated with the disease, and the possibility of suppressing COVID-19 and other viral infections. 5. Antimicrobial Blue Light Recent studies demonstrate that various wavelengths in the blue spectrum are antimicrobial against the deadly methicillin-resistant Fig. 2. A simple illustration of the light spectrum. Staphylococcus aureus (MRSA) [31,32,35,45], Escherichia coli [38,40], Helicobacter pylori [39], Listeria monocytogenes [40], Pseudomonas aer- uginosa [38], Salmonella [37], Acinetobacter baumannii [41], Ag- gregatibacter actinomycetemcomitans [46], Propionibacterium acnes [34–36,47], Neisseria gonorrhoeae [48–50], Porphyromonas gingivalis [51–53], Fusobacterium nucleatum [51], and others [42,50,54-58]. An analysis of the Nobel-winning work of Finsen, supports these blue light studies, because it shows that the Finsen Lamp, used to heal many with tuberculosis infection, did not produce UV as Finsen believed; rather, it produces light in the violet/blue range [59] (Fig. 2). Indeed, the Finsen Lamp could not have emitted UV because the type of glass used to construct its lenses does not transmit UV. Thus, when Møller et al. measured the radiation transmitted through the Finsen lens systems, and the absorption of the stain solution filters in the lamps relative to the lamp's effect on Mycobacterium tuberculosis, they found that the lens and filters absorbed UV wavelengths below 340 nm [59]. Moreover, the methylene blue solution used to absorb the heat generated by the system also blocked the transmission of wave- lengths below 340 nm, as well as light in the 550–700 nm range; thus, allowing predominant transmission of light in the UV-A and violet/blue range [59]. Furthermore, the fluorescence of M. tuberculosis shows the presence of endogenous porphyrins, known to absorb blue light and engender the production of reactive oxygen species and bacterial sup- pression, not UV absorption [39,46–48,60–79]. This clearly explains Finsen's success in treating tuberculosis, im- plying that unbeknownst to the world, the 1903 Nobel Prize was awarded to Finsen for demonstrating the antimicrobial effect of violet/ blue light. The only logical explanation of Finsen's success is that en- dogenous porphyrins in tuberculosis bacteria absorbed the violet/blue light predominantly transmitted through his lamp system; the absorp- tion triggered downstream production of reactive oxygen species, thus killing the bacteria and curing his patients of tuberculosis, not UV light absorption as the Nobel laureate assumed. Just as an analysis of Finsen's lamp makes it clear that its effect was due to violet/blue light and not UV, so a thought analysis of the ra- diation from the sun renders vivid the fact that the bactericidal effect of sunlight, often ascribed to UV, can be attributed to the immense amount of blue light reaching the earth from the sun. Atmospheric ozone substantially absorbs solar UV rays, allowing transmission of violet/blue light to the surface of the earth. Indeed, the peak trans- mission at the surface of the earth is in the blue region, and together with violet light, is 10 times more than the amount of UV reaching the surface of the earth [80]. Given the absorption of violet blue light by most microbes and the resulting bactericidal effect, it seems reasonable to attribute a good proportion of the sun's environmental sanitization power to the violet blue spectrum of radiation, and not UV as many assert. Modern technology now makes flexible printed micro-LEDs readily available, making it relatively easy to develop therapeutic tools with the potential to reduce bacterial and potentially viral infections. In 3PDF Image | Light as a potential treatment for pandemic coronavirus infections
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