Research and application of gas therapy in preventing biofilm associated infections.

Conventional antibiotic therapies often fail to eradicate biofilms, which can lead to persistent infections and significant clinical challenges. Gas therapy, which utilizes the unique properties of gas molecules such as nitric oxide, carbon monoxide, hydrogen, and hydrogen sulfide, is emerging as a promising and innovative strategy to address these challenges. This review first highlights gas signaling in bacterial biofilms. It then goes on to list four types of gas therapy in detail: photothermal-enhanced gas therapy, photodynamic-activated gas therapy, micro/nanobubble-mediated gas therapy, and gas-based synergistic therapy. Their potential applications and future directions are also fully discussed. Due to its unique bioactivity, low resistance, and synergy with existing treatments, gas therapy has demonstrated significant potential in the prevention and treatment of biofilm-associated infections. However, overcoming delivery challenges, validating efficacy in large-scale trials, and developing standardized protocols are essential for its clinical translation. Future efforts should prioritize the integration of nanotechnology and mechanistic studies to unlock broader therapeutic utility.