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Plasma-activated saline (PAS) is an experimental therapeutic agent produced by exposing a sterile saline solution to cold atmospheric plasma (CAP). This process generates a variety of long-lived reactive oxygen species (ROS) and reactive nitrogen species (RNS), such as hydrogen peroxide, nitrites, and nitrates, within the liquid. PAS exerts its anti-cancer effects primarily by inducing oxidative stress, which triggers apoptosis through the ROS-mediated Fas/CD95 signaling pathway and may also induce ferroptosis. It is being investigated as a novel treatment for intracavity tumors, particularly muscle-invasive bladder cancer (MIBC), where it can be administered via intravesical perfusion to selectively kill cancer cells while sparing healthy tissue.
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