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Evaluation of the anticancer effects induced by cold atmospheric plasma on leukemia stem cells

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Published 29 May 2020 © 2020 IOP Publishing Ltd
, , Special Issue on Nanosecond-Pulsed Atmospheric-Pressure Plasmas Citation Rui Feng et al 2020 Plasma Res. Express 2 024001 DOI 10.1088/2516-1067/ab9154

2516-1067/2/2/024001

Abstract

The application of cold atmospheric plasma (CAP) in cancer treatment has received extensive attention. However, little research was observed on the anticancer effects of CAP to tumor stem cells. Here, we analyzed the discharge characteristics of a CAP jet and plasma-induced effects on acute myeloid leukemia (AML) stem cells. Our results showed that the most active particles can be produced when helium is doped with 0.5% oxygen and the jet device is driven by a pulsed power supply. And when using this plasma jet device to treat acute myeloid leukemia (AML) stem cells, it is found that CAP jet can effectively inhibit the cell activity of AML stem cells, which provides new ideas for the treatment of AML.

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1. Introduction

Plasma is the fourth state of matter [1]. For gaseous substances, when the temperature is slowly and continuously increased, the ionization process repeatedly occurs. When the concentration of negatively charged free electrons and positively charged cations reaches a certain value, the state represented by the nature of molecular atoms at the microscopic level will also change the nature of the material, and the properties will become completely different from the gas, which is called the plasma state. According to the principle of temperature stratification, plasma can be classified into high temperature plasma and cold plasma [2].

At present, cold atmospheric plasma (CAP) has opened up a new field of plasma biomedicine [3]. Since living organisms are very sensitive to temperature, the CAP used in biomedicine must also be a 'cold plasma' with a temperature close to room temperature. Therefore, plasma biomedicine generally refers to the collective name for the theory, technology, and applications of CAP applied to biomedicine, which is a new world for the development of plasma science. Plasma biomedicine mainly includes two aspects: (1) The application of CAP to non-clinical applications such as biological mutation breeding [4], disinfection, sterilization [5], and biomaterial surface compatibility treatment. (2) The application of CAP directly to clinical treatment, including anti-infection, trauma treatment [6], hemostasis, dermatological treatment, tooth cleaning, skin beauty and so on. Among these applications of CAP, the most concerned are: biological mutation breeding, disinfection and sterilization, wound treatment, beauty and dermatological treatment, tooth whitening and root canal disinfection [7], cancer treatment [8], and so on. Studies have shown that CAP can be efficiently used as sterilization with acceptable harm on body cells in the appropriate dose range, which makes it promising as a new effective method to treat diseases [9]. Plasma can also change the growth and reproduction characteristics of cells. Related research shows that proper plasma treatment can promote cancer cell apoptosis [10] without causing significant damage to surrounding normal cells. As we know, cell necrosis is usually accompanied by the rapid release of intracellular enzymes and the products of cell rupture, which will lead to the occurrence of inflammation and is not conducive to clinical application. However, during the process of apoptosis, the cell membrane remains intact, so it will not leak the intracellular materials that cause inflammation of the cells, and it will not cause damage to the surrounding normal cell tissues [11]. Therefore, plasma technology has great potential in the treatment of malignant tumors [12].

Cancer is difficult to cure because most patients relapse and become resistant to drugs after the symptoms have resolved, and the presence of tumor stem cells is considered to be the key factor cause of this problem [13]. Tumor stem cells are different from ordinary tumor cells. They are a small group of special cells in tumor cells. They have self-renewal ability, unlimited proliferation ability and differentiation potential. The differentiation potential means that the tumor cells can proliferate and differentiate into ordinary tumor cells. However they are often in a non-proliferative state and have a wide spectrum resistance [14]. Generally, conventional chemotherapy and other methods are only effective for ordinary cancer cells in the proliferative stage. After the treatment, the latent drug-resistant stem cells will recover and proliferate, forming a new drug-resistant tumor cell population and causing relapse. Therefore, some new methods are needed to effectively inactivate and suppress tumor stem cells in order to solve the problems of cancer recurrence and drug resistance.

Acute myeloid leukemia (AML) is a type of malignant proliferative disease that originates from hematopoietic stem cells and can grow rapidly in bone marrow and blood [15]. It has the characteristics of fierce disease, easy recurrence, and high mortality rate [16, 17]. In recent years, its incidence has gradually increased, which is extremely harmful to society and the public. At present, the treatment of AML is mainly induced by chemotherapy [18]. Common drugs include cytarabine, homoharringtonine and daunorubicin [19, 20]. In severe cases, allogeneic hematopoietic stem cell transplantation is required [21]. However, for AML other than acute promyelocytic leukemia (M3 type), the curative effect is not optimistic, and the prognosis is mostly poor. 60%−80% of AML patients with complete remission will eventually relapse. AML was the first cancer to be clearly confirmed to have tumor stem cells [22]. Lapidot et al [23] firstly confirmed the CD34+/CD38−leukemia stem cell subset, which has similar infinite proliferation and self-renewal capabilities as normal hematopoietic stem cells. Most of them are at rest. They have broad-spectrum drug resistance [24, 25] and can escape the killing of conventional chemotherapy drugs. The persistence of leukemia stem cells is considered to be the source of leukemia occurrence, recurrence and drug resistance [26]. Therefore, effective killing and removal of leukemia stem cells has become an important target for leukemia treatment. CD123 is an interleukin-3 a-chain receptor. Its activated signaling pathway can promote cell proliferation and is related to leukemia [27]. CD123 is expressed in primary leukocytes in most patients with AML and LSCs overexpress CD123, while normal hematopoietic stem cells do not. Functional studies of the CD123+ cell population reveals that the CD34+/CD123+ cell population implanted in non-obese diabetic(NOD) and severe combined immunodeficiency (SCID) mice can trigger the development of AML in mice [28, 29]. Based on the above studies, it is generally believed that leukemia stem cells can be isolated in combination with surface-specific antigen phenotypes (CD34+/CD38−/CD123+) for related research on leukemia stem cells. At the same time, other surface antigen phenotypes (CD90−, CD47+, TIM-3+, etc) can be used for further subdividing the leukemia stem cell subgroup to study the various cell biological functions of leukemia stem cells [23, 3032].

Therefore, in this paper, the AML with relatively clear phenotype of tumor stem cells was taken as the research object, and the effect of CAP on tumor stem cells is studied by detecting the cell activity [33] of leukemia stem cells after plasma treatment.

2. Experiment details

2.1. Experiment setup

Figure 1 illustrates the plasma jet device used in this experiment. We use two different power sources in the device. For example, we take the pulsed power as an example to introduce the plasma generating device. The device is divided into three parts [34]: power supply, oscilloscope and plasma jet device. The plasma jet device adopts a laboratory-made standardized module. Inside the device, we use a quartz glass tube with an outer diameter of 6 mm and an inner diameter of 4 mm as an insulating medium. A copper foil is wound around the glass tube exit as a ground electrode, and the glass tube has a built-in needle electrode as a high voltage electrode. The high voltage electrode and the ground electrode are respectively connected to a power source, and the power source parameters are adjusted to an appropriate value to generate plasma.

Figure 1.

Figure 1. Plasma jet device driven by pulse or sinusoidal power supply.

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The pulse power supply is capable of adjusting the output voltage amplitude, pulse width, and time delay, and the sinusoidal power supply is capable of adjusting the output voltage amplitude and fine-tuning the frequency. In the circuit, we connect the CH1 channel of the oscilloscope to the high-voltage pole through the high-voltage probe, and connect the CH2 channel to the ground electrode via the current probe. It is convenient to read the voltage and power values of the device in real-time through the oscilloscope.

2.2. Characterization techniques

2.2.1. Liquid phase active particle detection

Hydrogen peroxide detection kit [35] and total nitric oxide detection kit produced by Beyotime Biotechnology Co., Ltd were used to detect the liquid-phase active particles of the cell culture solution treated by the jet. The number of the hydrogen peroxide detection kit is S0038, and the number of the nitric oxide detection kit is S0023. In the experiment, the type of power supply and the gas passed in the jet device were used as variables, and the discharge power and processing time of the jet device were controlled to be the same. The hydrogen peroxide and nitric oxide contents in the cell culture fluid after the treatment were measured. According to different control conditions, the experiment is divided into four groups: sinusoidal power source + He and 0.5% ${{\rm{N}}}_{2},$ sinusoidal power source + He and 0.5% ${{\rm{O}}}_{2},$ pulse power source + He and 0.5% ${{\rm{N}}}_{2},$ pulse power source + He and 0.5% ${{\rm{O}}}_{2}.$

During the experiment, the jet generating device was fixed on an iron stand, and the cell culture solution was placed directly under the jet device. Then we connect the power supply and the oscilloscope and control the oscilloscope power display to 1 watt. It's necessary to adjust the height of the iron stand so that the plasma plume could just touch the culture solution page. The discharge processing time is 30 s. The processed culture medium sample is added to the kit reagent and tested in a microplate reader to obtain a measurement result.

2.2.2. Spectral measurement

Since each atom has its own characteristic spectral line, it is possible to identify the substance and determine its chemical composition based on the spectrum. This method is called spectral analysis [36] For spectral analysis, either emission spectrum or absorption spectrum can be used. The advantages of this method are very sensitive and fast. If the content of a certain element in the substance reaches ${10}^{-10}$ grams, and its characteristic spectral line can be found from the spectrum, so it can be checked out.

The measurement of the absorption spectrum is based on the characteristic spectrum of the element to be measured. The content is calculated from the intensity of the measured element's spectrum after being absorbed by the ground state atoms in the sample vapor. It complies with Beer–Lambert Law [37]:

K is the absorbance and T is the transmittance. I represents the intensity of the outgoing light and ${I}_{0}$ represents the intensity of the incident light. K is the molar absorption coefficient, c is the concentration of the light absorbing substance, and b is the thickness of the absorption layer.

Therefore, during the discharge of the device, we used an optical lens-assisted spectrometer to measure the absorption spectrum of the plasma plume in the discharge part, so as to explore the material composition and relative content of the discharge area during the discharge process.

2.3. Effect of plasma jet on AML stem cells and the sorting process

In order to investigate the effect of low temperature plasma jet on the growth process of leukemia stem cells, we select AML stem cells as the treatment object for cell experiments.

According to the literature [23, 3032], we select CD34-FITC, CD38-PE and CD123-APC for trichromatic labeling and sorting. Firstly, we select the cell group P1. Then we select the non adherent single cell subgroup P2 through the parameters of FSC-H and FSC-W. Thirdly P4 of CD38 −/CD123+ cell subgroup is selected by CD123-APC and CD38-PE. Finally, we select the positive subgroup P5 in P4 subgroup by CD34-FITC. The subpopulation P5 with phenotype of CD38 −/CD123+/CD34+ cells were considered as the leukemia stem cells.

AML stem cells with good cell morphology were selected before the experiment, and a blank control group was set. In the experiment, first connect the oscilloscope, pulse power and jet device in order. The mixed gas containing helium and 0.5% nitrogen with a flow rate of 3 l min−1 is inserted into the jet device, while the culture dish containing the cells is placed directly under the setting device. The iron stand is adjusted to a suitable position so that the plasma plume is just at the liquid level of the culture solution. Then we turn on the power and set the pulse power parameters as: voltage 6000 volts, pulse width 1 us, delay 15. During the experiment, the voltage was fine-tuned according to the power of the oscilloscope to make the power stable at 1 watt and start timing. After 30 s of processing time, the power was turned off and stopped. After that, we replace the gas in the jet device with the mixed gas containing helium and 0.5% nitrogen with a flow rate of 3 l min−1, and repeat the above steps.

After the above experiments are completed, we replace the pulse power supply with a sinusoidal power supply, then connect the oscilloscope, the sinusoidal power supply, and the jet device in order. The above experimental process is repeated to obtain treated cells with two mixed gases respectively. After culturing the four experimental groups and the control group for 24 h, the cell activity is measured by cell-titer-glo assay.

3. Results

3.1. Plasma parameters in pulsed arc discharge and jet discharge

3.1.1. Voltage and current waveform

When the output voltage of the power supply is adjusted so that the discharge power of the jet device is 1 watt, the voltage and current waveforms are shown in figure 2. Figure 2(a) is a voltage and current waveform diagram of a pulse power supply under constant discharge power, and figure 2(b) is a voltage and current waveform diagram of a sinusoidal power supply under constant discharge power.

Figure 2.

Figure 2. Oscilloscope waveform diagram of sinusoidal power supply at 1 watt.

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When the output voltage of the power supply is adjusted so that the output voltage is 8 kV, the voltage and current waveforms are shown in figure 3. Figure 3(a) is a voltage and current waveform diagram of a pulse power supply at a constant output voltage, and figure 3(b) is a voltage and current waveform diagram of a pulse power supply at a constant output voltage.

Figure 3.

Figure 3. Oscilloscope waveform diagram sinusoidal power supply at 8 kV.

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3.1.2. Liquid phase active particle concentration

The power and processing time are consistent during the control of the discharge process, and the discharge power and background gas components are used as variables. The contents of hydrogen peroxide and nitrite ions in the cell culture fluid of the four groups were measured respectively: pulsed power + Helium and 0.5% nitrogen, pulsed power + Helium and 0.5% oxygen, sinusoidal power + Helium and 0.5% nitrogen, sinusoidal power + Helium and 0.5% oxygen. The content of hydrogen peroxide in the four groups of the cell culture fluids is shown in figure 4(a), and the content of nitrite ions is shown in figure 4(b).

Figure 4.

Figure 4. Liquid phase active particle concentration under gas conditions of pulse-He + 0.5%N2, pulse-He + 0.5%O2, sine-He + 0.5%N2 and sine-He + 0.5%O2.

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Considering only the driving power and the same background gas, we found that under the same gas composition, the amount of hydrogen peroxide produced by the pulse power driving device was slightly higher than that of the sinusoidal power. When the background gas is only taken into consideration, the amount of hydrogen peroxide generated when helium is doped with oxygen is higher than when helium is doped with nitrogen. Overall, when the device is driven by a pulsed power source and the background gas is Helium and 0.5% nitrogen, the hydrogen peroxide content in the cell culture fluid is the highest, which is about 4–6 times that of the other three groups.

Considering only the driving power and the same background gas, we found that under the same gas composition, the amount of nitrite ion produced by the pulse power driving device was slightly higher than that of the sinusoidal power. When the background gas is only taken into consideration, the amount of nitrite ion generated when helium is doped with oxygen is higher than when helium is doped with nitrogen. Overall, when the device is driven by a pulsed power source and the background gas is Helium and 0.5% nitrogen, the hydrogen peroxide content in the cell culture fluid is the highest, which is about 8–9 times that of the other three groups.

For the above experimental results, we think that the reason why the pulsed power supply generates more active particles is that during the pulse discharge, the peak voltage is higher and the sustaining time is longer, which results in more energy concentration and more active particles. For the phenomenon that oxygen-doped helium produces more active particles than nitrogen-doped helium, we think that the main reason is that the main long-life active particles such as hydrogen peroxide and nitrite ions contain oxygen element. Therefore, doping an appropriate amount of oxygen in the easily ionized background gas helium helps the production of these oxygen-containing active particles. Aiming at the problem that the nitrogen doping in helium has little effect on the content of nitrate ions, we suspect that the nitrogen content in the air at the jet exit is enough to combine with the reactive oxygen generated. So doping nitrogen in the background gas has little effect on the content of nitrate ions.

3.1.3. Absorption spectrum measurement

Using the discharge power source and the background gas components as variables, the power during the discharge process is controlled, and the absorption spectra of the plasma plumes of the four groups of jet devices are detected respectively: pulsed power + Helium and 0.5% nitrogen, pulsed power + Helium and 0.5% oxygen, sinusoidal power + Helium and 0.5% nitrogen, sinusoidal power + Helium and 0.5% oxygen.

In the case of 1 watt power, figure 5 compares the relative intensity of the plasma absorption spectrum under different conditions. Comparing figures 5(a) and (c), when the same gas is inserted in, the absorption line spectrum of the pulse power source and the sinusoidal power source is about the same. It indicates that different power sources do not change the material composition of the plasma plume. Comparing figure 5(b) with figure 5(d), as well as combining the spectral line identification in figure 6, it is found that when the gas is helium and 0.5% oxygen, the relative intensity of O (3p−3s) with a line length around 780 nm is obviously different. When driven by pulse power, the relative intensity of O (3p−3s) is 1350 a.u. When driven by sinusoidal power, the relative intensity of O (3p−3s) is 1200 au. Under the same conditions, the intensity of the pulse power is greater than that of sinusoidal power 11%. It also confirms that in the example of liquid-phase active particles, the amount of active particles generated by the pulse power source is more than that of the sinusoidal power source under the same conditions.

Figure 5.

Figure 5. Comparison of plasma spectral emission intensity under conditions gas conditions of pulse-He + 0.5%N2, pulse-He + 0.5%O2, sine-He + 0.5%N2 and sine-He + 0.5%O2.

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Figure 6.

Figure 6. Identification of main spectral lines of plasma jet device driven by pulsed power supply.

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Then, under the same power supply and gas conditions, when the discharge power is 0.5 watt and 2.5 watt, we measure the absorption spectrum of the plasma plume. The measurement results are shown in figure 7. Figure 7 shows that in the same background gas and power source, changing the discharge power only affects the intensity of the absorption spectrum without changing the spectral line distribution and shape of the absorption spectrum. The larger the discharge power, the stronger the relative intensity of the absorption spectrum.

Figure 7.

Figure 7. Comparison of emission spectrum intensity at different powers.

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It is easy to find the characteristic spectral lines representing the oxygen and nitrogen atoms in figure 6. We set the spectral line near the wavelength of 337 nm as the characteristic line of the nitrogen atom, and set the spectral line near the wavelength of 777 nm as the characteristic line of the oxygen atom. Five discharge power gradients of 0.5 watt, 1 watt, 1.5 watt, 2 watt, and 2.5 watt are set to compare the relative intensities of the spectral lines. They are all driven by pulse power. Figure 8(a) shows that when the background gas is different, N-337 nm is more sensitive to power changes. With the increase of power, the absorption spectrum intensity of N-337 nm in the experimental group using helium + 0.5% nitrogen increased much faster than the experimental group using helium +0.5% oxygen. Figure 8(b) shows that O-777 nm is not sensitive to power changes when the background gas is different. When the power is low, the difference between different background gases is greater than that of high power. Accordingly, we conclude that different atoms have different sensitivities to power growth. Based on this characteristic, the proportion of each component in the discharge product can be affected by controlling the discharge power.

Figure 8.

Figure 8. Comparison of N-337 nm and O-777 nm line intensity under gas conditions of pulse-He + 0.5%N2, pulse-He + 0.5%O2, sine-He + 0.5%N2 and sine-He + 0.5%O2.

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3.2. Comparison of stem cells and ordinary cells

We treat AML stem cells with plasma jet in the experiment and observe the effect of CAP on the activity of leukemia stem cells. The first step is to sort CD34+/CD38−/CD123+ leukemia stem cells by high-speed flow cytometry (figure 9).

Figure 9.

Figure 9. Schematic diagram of flow sorting steps of leukemia stem cells. (a) AML cell population; (b) Non adherent single cell subsets P2 screened by FSC-H and FSC-W; (c) CD38−/CD123+ cell subpopulation P4 screened by CD123-APC and CD38-PE; (d) The positive subgroup P5 selected from P4 subgroup by CD34-FITC).

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Leukemia stem cell purity test is performed on the AML stem cells after flow sorting. Figure 10 shows that the purity of the stem cells after sorting is 98.3%, which meets the experimental requirements.

Figure 10.

Figure 10. Leukemia stem cell purity test.

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The cell viability test was performed in the control group and the experimental group after jet treatment. Figure 11 illustrates that compared with the control group of AML stem cells, the cell activity of the experimental group treated with jet was significantly reduced. It shows that jet plasma can partly reduce the cell activity of AML stem cells and provide new possibilities for the treatment of AML.

Figure 11.

Figure 11. Cell Viability of treated AML stem cells.

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4. Conclusions

4.1. Liquid active particles

We think that the reason why the pulsed power supply generates more active particles is that during the pulse discharge, the peak voltage is higher and the sustaining time is longer, which results in more energy concentration and more active particles. For the phenomenon that oxygen-doped helium produces more active particles than nitrogen-doped helium, we think that the main reason is that the main long-life active particles such as hydrogen peroxide and nitrite ions contain oxygen element. Therefore, doping an appropriate amount of oxygen in the easily ionized background gas helium helps the production of these oxygen-containing active particles. Aiming at the problem that the nitrogen doping in helium has little effect on the content of nitrate ions, we suspect that the nitrogen content in the air at the jet exit is enough to combine with the reactive oxygen generated. So doping nitrogen in the background gas has little effect on the content of nitrate ions.

4.2. Absorption spectrum

It is found that when the gas is helium and 0.5% oxygen, the relative intensity of O (3p−3s) with a line length around 780 nm is obviously different. When driven by pulse power, the relative intensity of O (3p−3s) is 1350 a.u. When driven by sinusoidal power, the relative intensity of O (3p−3s) is 1200 au. Under the same conditions, the intensity of the pulse power is greater than that of sinusoidal power 11%. It also confirms that in the example of liquid-phase active particles, the amount of active particles generated by the pulse power source is more than that of the sinusoidal power source under the same conditions.

In the same background gas and power source, changing the discharge power only affects the intensity of the absorption spectrum without changing the spectral line distribution and shape of the absorption spectrum. The larger the discharge power, the stronger the relative intensity of the absorption spectrum.

When the background gas is different, N-337 nm is more sensitive to power changes. With the increase of power, the absorption spectrum intensity of N-337 nm in the experimental group using helium +0.5% nitrogen increased much faster than the experimental group using helium +0.5% oxygen. O-777 nm is not sensitive to power changes when the background gas is different. When the power is low, the difference between different background gases is greater than that of high power. Accordingly, we conclude that different atoms have different sensitivities to power growth. Based on this characteristic, the proportion of each component in the discharge product can be affected by controlling the discharge power.

4.3. Acute myeloid leukemia stem cell experiment

It is illustrated that compared with the control group of AML stem cells, the cell activity of the CAP jet-treated AML stem cells was reduced.

Our preliminary study shows that plasma can inhibit AML stem cells. It can inhibit the cell activity of AML stem cells treated under different air components and power stimulation. The specific mechanism needs further study. At the same time, previous experimental results show that the plasma dose used in this paper has little damage to normal cells. Therefore, CAP can be used as an effective means to kill tumor stem cells.

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10.1088/2516-1067/ab9154