Introduction
Blastocystis hominis (
B. hominis) is the most prevalent intestinal colonizing parasite that infects at least one billion people worldwide. Its prevalence rates vary between countries as well as between regions in the same country [
1]. It may vary between 30 and 76% in developing nations and reach up to 30% in industrialized countries. Recently, several reviews have indicated that higher prevalence in developing countries was due to environmental contamination, poor sanitation, and bad personal hygiene practices [
2,
3]. In addition, exposure to domestic animals and fecally contaminated food and water is common [
4].
B. hominis is an obligatory, unicellular, eukaryotic, anaerobic protozoan. It is the most common gastrointestinal parasite present in the stool samples of humans and animals [
5,
6]. Such a polymorphic parasite has four major forms found in the stools and in vitro cultures: vacuolar, granular, amoeboid, and cyst [
7]. The life cycle of
B. hominis is initiated by the cyst as an infective stage. After ingestion, it develops into a vacuolar form in the large intestine. These vacuolar forms are divided into amoeboids or granular by binary fission [
8].
The clinical manifestations of
Blastocystis infection are non-specific and consist of abdominal pain, acute/chronic diarrhea, bloating, nausea, and anorexia. Symptoms might range from mild to moderate to severe acute and chronic events, especially in children and immunocompromised patients [
9]. On the other hand, it has been considered as a commensal parasite in humans that can persist with being unable to trigger any diseases [
10].
B. hominis was assumed to have a vital effect on the intestinal microbiome and has been associated with several diseases such as functional gastrointestinal disorders known as irritable bowel syndrome (IBS), hemorrhagic proctosigmoiditis, inflammatory bowel disease (IBD), and chronic spontaneous urticaria (CSU). The exact pathophysiological mechanism is not yet settled but may be due to an alteration of the intestinal permeability by pro-inflammatory cytokines resulting in visceral inflammation and hypersensitivity [
11,
12]. Several methods have been utilized for the diagnosis of
B. hominis, such as direct microscopic examination, phase contrast microscopy, immunodiagnostics, in vitro cultivation, and molecular analysis [
11,
13]. Regarding the treatment of
B. hominis, which is questioned as all gastrointestinal symptoms are self-limited without complications in many patients, metronidazole is considered the main treatment [
13‐
15]. Since 1976, several in vitro studies have documented the failure of metronidazole to cause complete clearance of
B. hominis. Consequently, the evolution of parasite resistance to antiparasitic agents has become a serious health issue that necessitates the development of new and efficient antiparasitic agents [
16,
17].
Nanoparticles (NPs) are new promising drug carriers, demonstrated to be efficient in treating many parasitic diseases. This potency is related to the ability to overcome constraints such as poor cellular permeability, low bioavailability, nonspecific distribution, and quick drug elimination from the body [
18]. Nanomaterials are more important for the emerging fields of nanomedicine, nanobiotechnology, and nanotoxicology [
19‐
22]. Whereas, in the toxicity field, NPs are being utilized as therapeutic tools against pathogenic microorganisms. Therefore, it is essential to study the nanoparticles’ properties and their usage in different biological and medical applications to understand their effect on parasites, bacteria, fungi, etc. [
23,
24]. Moreover, the type of stabilizing and capping materials used for preparing NPs is important as it affects their antimicrobial effectiveness [
25]. In general, NPs have different features compared to the same bulk materials [
26]. Such that the surface-to-volume ratio of NPs increases by decreasing the particle size. The unique size-dependent properties of inorganic nanomaterials are essential in many areas of human activity. They are widely considered a platform for targeted drug delivery, clinical diagnostics, and medical imaging. The most common inorganic nanoparticles used for these purposes are silver, iron oxide, gold, zinc oxide, and titanium.
Metallic nanoparticles show new optical properties, which are not observed in bulk metals [
27,
28]. One of these properties is the presence of an absorption band. This band is due to the surface plasmon-oscillation modes of conduction electrons that are coupled through the surface to external electromagnetic fields. Among noble metal nanomaterials, silver nanoparticles (Ag NPs) have received considerable attention owing to their attractive physicochemical properties. In addition, the strong toxicity that silver exhibits in various chemical forms to a wide range of microorganisms is very well known. Ag NPs have recently been shown to be a promising antimicrobial as well as antiparasitic material. A few investigations have shown that different surface stabilizers have important effects on Ag NP cytotoxicity. Due to its great biocompatibility and antipathogenic properties, chitosan (Cs) is utilized as an active ingredient in topical wound materials [
29]. Furthermore, several studies have reported that chitosan is considered a good stabilizer for Ag NPs [
30,
31]. Moreover, chitosan-coated silver nanoparticles show high effectiveness in killing common gram-positive and gram-negative bacteria, and fungi [
32].
Magnetic nanoparticles are the first generation of nanomaterials approved for clinical use. The superparamagnetic properties increased the possibility of developing novel and efficient biomedical applications [
33]. These applications targeted drug and gene delivery, magnetic resonance imaging, biosensors, cancer detection and treatment, diagnosis and magnetic field-assisted radiotherapy, and tissue engineering [
34]. A common type of iron oxide nanoparticles is magnetite (Fe
3O
4), which belongs to the ferrimagnetic class of magnetic nanomaterials. Fe
3O
4 NPs are highly advantageous due to their biocompatibility, biodegradability, non-toxicity, and ability to specifically target tissue. Thus, magnetite nanoparticles could represent a novel and efficient direction in the management of infectious diseases [
35].
Generally, Ag NPs and Fe
3O
4 NPs are easy to synthesize, safe for biomedical applications, and display attractive optical absorption covering the visible and near-infrared (NIR) region. Moreover, they can stand out as functional nanomaterials for photothermal therapy (PTT) [
36,
37]. PTT is the most efficient method that has been applied for the treatment of various medical situations including cancer, inflammatory, or microbial diseases. PTT is highly dependent on the excitation of a photosensitizer with a specific band of light that generates vibrational energy. The effect of such a local hyperthermal mechanism induced irreversible damage to the targeted cells by causing protein denaturation, coagulation, cell membrane destruction, and/or bubble formation around NPs upon irradiation [
38,
39].
To sum up, silver and iron oxide nanoparticles are biocompatible and non-toxic materials with attractive properties that can manage microbial and parasitic diseases. This indicates that such NPs, as photothermal absorbers, can enhance photothermal therapy by providing a promising treatment method. To the best of our knowledge, no single study exists to explore the effect of photothermally active metal NPs on B. hominis in vitro. Therefore, the present work aims to assess the effect of Ag NPs stabilized with chitosan and Fe3O4 NPs coated with polyethylene glycol (PEG) as sole agents and in combined action with LED at the wavelength band 400–700 nm to evaluate their potential anti-blastocystis activity.
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