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Studies using xenograft mouse models have shown that plasma applied to the skin overlying tumors results in tumor shrinkage. Plasma is considered a nonpenetrating treatment; however, these studies demonstrate plasma effects that occur beyond the postulated depth of physical penetration of plasma components. The present study examines the propagation of plasma effects through a tissue model using three-dimensional, cell-laden extracellular matrices (ECMs). These ECMs are used as barriers against direct plasma penetration. By placing them onto a monolayer of target cancer cells to create an in-vitro analog to in-vivo studies, we distinguished between cellular effects from direct plasma exposure and cellular effects due to cell-to-cell signaling stimulated by plasma. We show that nanosecond-pulsed dielectric barrier discharge plasma treatment applied atop an acellular barrier impedes the externalization of calreticulin (CRT) in the target cells. In contrast, when a barrier is populated with cells, CRT externalization is restored. Thus, we demonstrate that plasma components stimulate signaling among cells embedded in the barrier to transfer plasma effects to the target cells.

Nanosecond-Pulsed Dielectric Barrier Discharge–Induced Antitumor Effects Propagate through Depth of Tissue via Intracellular Signaling