Synergistic Effect of H2O2 and NO2 in Cell Death Induced by Cold Atmospheric He Plasma

Cold atmospheric pressure plasmas (CAPPs) have emerged over the last decade as a new promising therapy to fight cancer. CAPPs' antitumor activity is primarily due to the delivery of reactive oxygen and nitrogen species (RONS), but the precise determination of the constituents linked to this anticancer process remains to be done. In the present study, using a micro-plasma jet produced in helium (He), we demonstrate that the concentration of H2O2, NO2(-) and NO3(-) can fully account for the majority of RONS produced in plasma-activated buffer. The role of these species on the viability of normal and tumour cell lines was investigated. Although the degree of sensitivity to H2O2 is cell-type dependent, we show that H2O2 alone cannot account for the toxicity of He plasma. Indeed, NO2(-), but not NO3(-), acts in synergy with H2O2 to enhance cell death in normal and tumour cell lines to a level similar to that observed after plasma treatment. Our findings suggest that the efficiency of plasma treatment strongly depends on the combination of H2O2 and NO2(-) in determined concentrations. We also show that the interaction of the He plasma jet with the ambient air is required to generate NO2(-) and NO3(-) in solution.