Red Light and PEMF

This post reviews a pilot study investigating the combination of optical and magnetic stimulation. (COMS) to treat chronic venous leg ulcers. . The devices used in this study may be replicated with commercially available magnetic and optical stimulation devices. The etiology of venous leg ulcers is complex. Treatments are usually compression stockings and other topical applications to encourage tissue repair and prevent infections. This post covers a single exploratory study suggesting that COMS might have some benefit due to improved circulation and decreased edema. A follow up study using a skeletal muscle cell line attempted to confirm the proposed mechanism. The dual red/NIR light and extremely low frequency Piomics device is currently undergoing clinical trials for diabetic foot ulcers.

Abstract [1]

The effects of concurrent optical and magnetic stimulation (COMS) therapy on wound-healing-related parameters, such as tissue oxygenation and water index, were analyzed by hyperspectral imaging: an exploratory case series. 

Background: Oedema and inadequate perfusion have been identified as key factors in delayed wound healing and have been linked to reduced mitochondrial respiration. Targeting mitochondrial dysfunction is a promising approach in the treatment of therapy refractory wounds. This sub-study aimed to investigate the effects of concurrent optical and magnetic stimulation (COMS) on oedema and perfusion through measuring tissue oxygenation and water index, using hyperspectral imaging. 

Patients and methods: In a multi-center, prospective, comparative clinical trial, eleven patients with chronic leg and foot ulcers were treated with COMS additively to Standard of Care (SOC). Hyperspectral images were collected during patient visits before and after treatment to assess short- and long-term hemodynamic and immunomodulatory effects through changes in tissue oxygenation and water index. 

Results: The average time for wound onset in the eleven patients analyzed was 183 days, with 64% of them being considered unresponsive to SOC. At week 12, the rate of near-complete and complete wound closure was 64% and 45%, respectively. COMS therapy with SOC resulted in an increased short-term tissue oxygenation over the 8-week treatment phase, with oxygen levels decreasing in-between patient visits. The study further found a decrease in tissue water content after the therapy, with a general accumulation of water levels in-between patient visits. This study’s long-term analysis was hindered by the lack of absolute values in hyperspectral imaging and the dynamic nature of patient parameters during visits, resulting in high interpatient and intervisit variability. 

Conclusions: This study showed that COMS therapy as an adjunct to SOC had a positive short-term effect on inflammation and tissue oxygenation in chronic wounds of various etiologies. These results further supported the body of evidence for safety and effectiveness of COMS therapy as a treatment option, especially for stagnant wounds that tended to stay in the inflammatory phase and required efficient phase transition towards healing.

The objective of this study was to use eth QuantumTx flavor of PEMF in conjunction with two wavelengths of photobiomodulation: 660 nm and 830 nm to treat venous leg ulcers (VLU) that the Cleveland Clinic defines as long lasting ulcers arising from veins that might involve faulty valves and decreased circulation. Two of the 11 participants had mixed leg ulcers (MLU). There were five females and six males in this study. Ulcers were treated with Standard of Care (SOC) for four weeks ending on day 29. COMS treatment lased eight weeks ending on day 113.

Proposed mechanism

Fig 1 is a cartoon that illustrates the intersection between the two. The Pionics website has a slightly different version of this cartoon. The company has a device that combines red/NIR light and PEMF and is currently conducting clinical trials in the United States.

PEMF	Photobiomodulation
the unpaired electron in the FAD cofactor in cryptochrome results in the generation of superoxide	not in the cartoon, red light generates singlet 1O2 and higher order ROS when absorbed by chromophores.
ROS activate TRP Ca2+ channels that increase intracellular ca2+	not in the cartoon, photomodulation may heat lipid membranes that activate the TRPV1 Ca2+ channel
Ca2+ binds to calmodulin which regulates calcineurin and eNOS
calcineurin is a phosphatase which activates the transcription factor NFAT, which results in mitochondrial gene transcription	not in the cartoon, red light ROS activate hypoxia inducible factor alpha (HIFα) that leads to growth factor TGFβ that leads to collagen synthesis
eNOS, endothelial nitric oxide synthase produces nitric oxide which can relax blood vessels and bind to the heme group of cytochrome c oxidase	PBM releases NO from CCO increasing blood flow.
NO bound to CCO inhibits electron transport and ATP production	CCO also absorbs in the NIR region. red light increases ATP production by multiple means. Addressed in the red light and mitochondria post.

Methods

Sessions lasted 16 minutes. All participants had long standing ulcers that had failed to heal. A baseline of standard of care was conducted to assess how fast these ulcers were healing on their own. Fig 2 describes the study design.

the PEMF device

The PEMF pulse had a asymmetrical trapezoidal shape with a 20 Hz frequency, with an increasing peak field strength up to 1.6 mT (16 Gauss) Customized COMS One devices were provided by Piomic Medical AG (Zürich, Switzerland). The COMS One is a Class IIa medical device, CE-certified for the stimulation of chronic leg and foot ulcers, which incorporates the technology for concurrent optical and magnetic stimulation. Piomics is currently conducting clinical trials for diabetic foot ulcers.

Micro-Pulse. com sells affordable PEMF devices capable of delivering about this frequency can be obtained with the M1 model from The “brainwave entrainment” mode has the following:

beta 2 wave — MED: 16.5 Hz to 20 Hz (4 minute cycle)–

beta3 wave — HIGH: 20 Hz to 28 Hz (4 minute cycle)

Micro-Pulse ICES pulses are the same shape: very narrow very rapid rise/fall pulses. Micro-Pulse is pretty silent about magnetic fields for multiple reasons having to to do with the dependence on distance and slew rate that was addressed in a different post. Some numbers in development work covered in this post are 0.025 T and 10 Gauss for bone healing.

the red light device

Two types of LEDs, 660 nm (red) and 830 nm near-infrared (NIR). These lights were pulsed at 1 kHz with a maximum pulse width of 0.3 ms. A pulse peak power of 25 mW/cm² was emitted at an average power output of 5 mW/cm² at the treatment area.

Red Light Therapy Home RLTH allows uses to program both the 660 nm and 830 nm channels to pulse at defined frequencies up to 5000 Hz. Keep in mind that the frequency of pulsing is totally different from the frequency associated with the wavelength λ of the light. The wavelength of 20 Hz PEMF is measured in kilometers!

hyperspectral imaging

The transcranial red light post deep dived into many absorption spectra of compounds in our brains in the red and NIR region of the electromagnetic spectrum. If an object before our field of view appears blue when lit by broad spectrum white light it is because there are compounds in the object absorb or scatter green and red light. When a scan is done in the NIR-red region and remission recorded, it is like putting whole tissue into a spectrophotometer.

Remission spectra were recorded in the spectral range from 500 to 1000 nm with a resolution of 5 nm, a measurement area of approximately 20–30 cm², and standard image size of 640 × 480 pixels. The camera system allowed for quick and uncomplicated measurements without the need for special measurement conditions, except for the avoidance of external light illumination. The transcranial red light post touched on the absorption of water, a measurement of edema of a wound. Transcranial red light also touched on absorption of oxy- and deoxy-hemoglobin, a measurement of perfusion of blood. What Traber 2023 did not address was the absorption of light of the reduced and oxidized cytochrome C oxidase.

results

Fig 3 is a heat map of a non healing wound before and after COMS treatment. Note that the water channel does not appear to change that much but that the hemoglobin channel is much more intense. The edema is visible in the water channel too.  oxygenation levels in-between therapy sessions generally decreased. Water accumulated in the days between treatments for all patients.

Fig 4 is a success story for patient 001 who had the ulcer for over a year that did not respond to standard of care. While changes in oxyhemoglobin were not that great, this patient achieved near complete wound reduction.

Fig 5 are bar graphs depicting changes in oxygenation for each patient. The values were estimated and put in the table below so as to view everything at once.

Fig 6 looks at the water channel in patient 001. Changes were noted. It’s important to pay attention to the color scale on the heat map to see the reduction

Fig 7 the bar graphs from which the changes were estimated.

Fig 8 shows only visible light photographs from one of the few COMS non-responders

Patient ID	Indication	Wound Onset (Days)	Wound Size at Baseline (cm²)	Area Reduction Day 29	Area Reduction Day 113	% change HbO before vs after	% change HbO between treatments	% change water before vs after	% change water between treatments	notes
001	VLU	428	8.7	0%	99%	+1	-1	-13	21	COMS made big difference
002	VLU	43	2.4	79%	100%	40	-45	+2	10	⇧water content after the treatment.
003	VLU	94	5.5	22%	53%	20	-17	-17	26	medium responder
004	VLU	821	12.1	−12%	43%	17	-8	-6	8	cardiovascular comorbiditis
005	VLU	33	3.7	49%	100%	8	-10	-13	28	healed w/out HbO & H2O
006	MLU	60	29.6	6%	100%	2	-5	-5	3	no SOC response, COMS healed
007	VLU	33	2.1	19%	−19%	-8	+12	-5	8	wound ⇧ HbO⇩
008	MLU	214	11.2	19%	100%	17	-17	-1	2	healed w/out H2O
009	MLU	67	21.6	17%	72%	-5	+6	-9	12	HbO⇩
010	VLU	128	26.8	68%	93%	1	-10	-5	2	healed w/out HbO & H2O
011	VLU	92	5.4	91%	100%	4	-2	-0.5	2	already healed w/SOC

Some patients had exceptional recoveries that coincided with their use of PEMF in combination with red/NIR photobiomodulation, With a sample size this small we cannot conclude that the improvement was the result of COMS. It seems unlikely that they made other changes in their life or if the improvement, for some, was simply a change in the weather. The results are encouraging.

The authors started out with the hypotheses that red/NIR improves lymph drainage such that edema is reduced. PEMF increases NO synthesis and hence better blood flow and that leads to more ATP production for healing. The results of these 11 patients are very encouraging but make it clear that things are way more complicated. One of the complications is the use of the antibiotic streptomycin that block PEMF activated TRPC1 Ca²⁺ channels in a skeletal muscle myoblast cell culture study of [2].

1. Fig 1 red/NIR and PEMF synergize o increase cell proliferation. [2]
2. Fig 2 Streptomycin during COMS blunted the cell proliferation while Streptomycin after did not. [2]
3. Fig 3 In the absence of Streptomycin, ie when TRPC1 Ca²⁺ channels are operational, CyclinD1 and ERK kinase are part of the signaling that leads to more TRPC1 Ca²⁺ channel protein expression. Extracellular regulated kinase is a kinase that is turned on by extracellular growth factors that, through some very complicated processes, also activate Cyclin D1 that binds to another protein kinase that controls the progression of the cell cycle. [2]
4. Fig 4 Some small changes were observed in reactive oxygen species as well as a small but significant increase in ATP were observed. [2]

It might be best to wait until the Pionics COMS clinical trials have been completed. This post is under no circumstances meant to suggest that either of these publications will treat venous leg ulcers once they have formed. Once they have healed, there is always the chance of them returning. Perhaps Pionics or DIY combinations of devices may discourage these ulcers from returning. Consult with your helthcare provider before going down this route.

Buying your own devices

You may buy your own new MicroPulse devices on their website or certified refurbished on their Ebay store.

If you would like to order your own red light therapy device from Red Light Therapy Home, use this promo code for a 6% discount

Friend6-ZQDGW49R

References

1. Traber J, Wild T, Marotz J, Berli MC, Franco-Obregón A. Concurrent Optical- and Magnetic-Stimulation-Induced Changes on Wound Healing Parameters, Analyzed by Hyperspectral Imaging: An Exploratory Case Series. Bioengineering (Basel). 2023 Jun 23;10(7):750. PMC free paper
2. Iversen JN, Fröhlich J, Tai YK, Franco-Obregón A. Synergistic Cellular Responses Conferred by Concurrent Optical and Magnetic Stimulation Are Attenuated by Simultaneous Exposure to Streptomycin: An Antibiotic Dilemma. Bioengineering (Basel). 2024 Jun 21;11(7):637. PMC free paper