Photodynamic therapy (PDT) as a non-radiative treatment has been applied successfully in various cancers. PDT may be a useful adjunct in the treatment of vertebral metastases. PDT efficacy requires the administration of a photosensitiser drug followed by subsequent drug activation by wavelength specific light. The study purpose was to establish the pharmacokinetic profiles for 2 photosensitisers, BPD-MA and 5-ALA induced PpIX, to determine the optimal drug-light interval for vertebral PDT.
Photodynamic therapy (PDT) using verteporfin is widely used for treatment of age related macular degeneration (AMD).
Due to non-perfect selectivity of the drug accumulation in the neovasculature some collateral damage to healthy tissue
arises during the treatment. Damage to healthy structures in the eye is always a concern because of a high probability of
reducing visual acuity. Two-photon (2-&ggr;) photodynamic therapy potentially offers much higher treatment selectivity than
its one-photon (1-&ggr;) counterpart. By utilizing focused light for 2-&ggr; excitation, treatment volumes on the order of
microliters can be achieved thus maximizing localized insult to abnormal blood vessels and sparing healthy tissue. We
propose that 2-&ggr; photodynamic therapy will be valuable in the treatment of choroidal neovascularization secondary to
age related macular degeneration as well as other conditions. To ascertain feasibility of 2-&ggr; photodynamic therapy we
measured 2-&ggr; spectrum and cross sections of verteporfin (80 GM at 940 nm, 1 GM = 10-50 cm4s/photon), chlorin e6 (14
GM at 800 nm) and tetrasulfonated aluminum phthalocyanine (140 GM at 900 nm) and investigated their in vitro
efficiency under 2-&ggr; excitation. Only verteporfin demonstrated cell kill under the used irradiation parameters (average
light intensity 9.1 mW, wavelength 850 nm, total light dose 6900 J/cm2). Dorsal skinfold window chamber model in
mouse was used to test efficiency of 2-&ggr; PDT with verteporfin in vivo. Although we were able to induce photodynamic
damage to a blood vessel using 1-&ggr; excitation, 2-&ggr; excitation resulted in no visible damage to irradiated blood vessel. The most probable reason is low efficiency of verteporfin as a 2-&ggr; photosensitizer. We also report 2-&ggr; spectrum of new
photosensitizer, HCC4 (4300 GM at 830 nm), specifically designed for efficient 2-&ggr; excitation.
Photodynamic therapy (PDT) entails the combination of photosensitizer and light to generate cytotoxic
molecules that derive from molecular oxygen (O2). The presence of sufficient O2 within the target tissues is
critical to the efficiency of PDT. This study investigates the use of hyperbaric oxygen therapy in
combination with PDT (HOTPDT) to augment the photodynamic action of methylene blue (MB) or 5-aminolevulinic acid (ALA) against gram positive and gram negative bacterial strains in vitro.
Staphylococcus aureus or Pseudomonas aeruginosa were grown in trypticase soy broth as planktonic
cultures (~108/mL) or as established biofilms in 48 well plates (3 days old) at 32°C. Dark toxicity and PDT
response in the presence or absence of HOT (2 atmospheres, 100% O2 for 30, 60 or 120 min) was
established for both MB (0-0.1 mM) and ALA (0- 1 mM) for a range of incubation times. The number of
surviving colonies (CFU/mL) was plotted for each treatment groups. Light treatments (5, 10, 20 or 30
J/cm2) were conducted using an array of halogen bulbs with a red filter providing 90% transmittance over
600-800 nm at 21 mW/cm2. HOT increased the dark toxicity of MB (30 min, 0.1 mM) from < 0.2 log cell
kill to 0.5 log cell kill. Dark toxicity of ALA (4 hr, 1 mM) was negligible and did not increase with HOT.
For non-dark toxic concentrations of MB or ALA, (0.05 mM and 1 mM respectively) HOT-PDT enhanced
the antimicrobial effect of MB against Staphylococcus aureus in culture by >1 and >2 logs of cell kill
(CFU/mL) at 5 and 10 J/cm2 light dose respectively as compared to PDT alone. HOT-PDT also increased
the anti-microbial effects of MB against Staphylococcus aureus biofilms compared to PDT, albeit less so (>
2 logs) following 10 J/cm2 light dose. Anti-microbial effects of PDT using ALA were not significant for
either strain with or without HOT. These data suggest that HOTPDT may be useful for improving the PDT
treatment of bacterial infections.
This study investigates whether low level light treatment (LLLT) can enhance the expression of Peripheral-type
mitochondrial benzodiazepine receptors (PBRs) on the glioma-derived tumour cell line, CNS-1, and
by doing so promote the synthesis of protoporphyrin IX (PpIX) and increase the photodynamic therapy
(PDT)-induced cell kill using 5-aminolevulinic acid (ALA). The endogenous photosensitizer, (PpIX) and
related metabolites including coproporphyrin III are known to traffic via the PBRs on the outer
mitochondrial membrane on their passage into or out of the mitochondria. Astrocyte-derived cells within
the brain express PBRs, while neurons express the central-type of benzodiazepine receptor. CNS-1 cells
were exposed to a range of differing low-level light protocols immediately prior to PDT. LLLT involved
using broad-spectrum light or monochromatic laser light specific to 635 or 905 nm wavelength. Cells
(5&mgr;105) were exposed to a range of LLLT doses (0, 1 or 5 J/cm2) using a fixed intensity of 10 mW/cm2 and
subsequently harvested for cell viability, immunofluorescence or western blot analysis of PBR expression.
The amount of PpIX within the cells was determined using chemical extraction techniques. Results confirm
the induction of PBR following LLLT is dependent on the dose and wavelength of light used. Broadspectrum
light provided the greatest cell kill following PDT, although LLLT with 635 nm or 905 nm also
increased cell kill as compared to PDT alone. All LLLT regimens increased PBR expression compared to
controls with corresponding increases in PpIX production. These data suggest that by selectively increasing
PBR expression in tumour cells, LLLT may facilitate enhanced cell kill using ALA-PDT without damaging
surrounding normal brain.
Epilepsy is surgically curable if the seizure focus can be localized and does not include areas of eloquent cortex. Because epileptic cells are indistinct from surrounding brain, resection typically includes normal tissue. Using the rat kindling model of epilepsy, we evaluated Photodynamic Therapy (PDT) as a super-selective lesioning technique. We present a series of pilot studies to evaluate: 1) Protoporphyrin IX (PpIX) fluorescence, 2) the efficacy of PDT to raise seizure thresholds, 3) the safety of PDT using behavioral studies, and 4) histologic results. Bipolar electrodes were chronically implanted into the cortex and animals received successive low-level stimulation generating seizures of increasing severity. Following 5-aminolevulinic acid (ALA) administration, fully kindled rats received electrical stimulation to induce a generalized seizure. Animals were irradiated with laser light focused onto a temporal craniectomy. Our results show: 1) an increase in PpIX fluorescence in the seizure group, 2) PDT treated animals failed to demonstrate seizure activity following repeat stimulation, 3) no statistically significant difference between treated and control animals were
observed on behavioral tests, 4) histology showed pyknotic hippocampal pyramidal cells in the CA3 region without areas of obvious necrosis. In conclusion, this is the first report of heightened PpIX-mediated fluorescence in epileptic brain. The selective accumulation of PpIX with laser PDT may provide a less invasive and more precise technique for obliteration of epileptic foci. PDT warrants additional research to determine if this technique may augment or replace existing procedures for the surgical management of epilepsy.
There have been numerous reports describing the phenomena of low-level light therapy (LLLT) within the clinic and its broad application to alleviate pain, enhance the rate of wound healing, including spinal cord injury, reduce inflammation, improve learning, bolster immunity and combat disease. Yet, despite the breadth of potential applications for which bio-stimulation may prove beneficial, there persists a dramatic ignorance in our understanding of the signal pathways that govern these effects. At the cellular level, there exist a variety of endogenous chromophores such as cytochrome C oxidase, NADPH, FAD, FMN and other factors intrinsic to the electron transport chain in mitochondria that absorb light of specific wavelength and will undoubtedly have their role in bio-stimulation, however the dose dependency of effect with regard to total light fluence and fluence rate, as well as the importance of specific subcellular targeting, remains elusive. Furthermore, the translation of cellular response(s) in vitro to in vivo needs to be expounded. Clearly, a rigorous examination of bio-stimulatory parameters as a function of cellular and tissue response is necessary if we are to attain optimized, reproducible protocols based on a true scientific rationale for using bio-stimulation as a therapeutic modality in clinic. This paper introduces a number of the challenges we now face for advancing the bio-stimulation phenomena into the scientific mainstream by highlighting our current knowledge in this field as well as some of the research that we are conducting using LLLT in combination with photodynamic therapy.
This study investigates the use of photodynamic therapy (PDT) in regulating bone development with a view to its potential role in treating Juvenile leg length discrepancy (LLD). Transgenic mice expressing the luciferase firefly gene upon activation of a promoter sequence specific to the vascular endothelial growth factor (VEGF) gene were subject to benzoporphyrin derivative monoacid (BPD-MA)-mediated PDT in the right, tibial epiphyseal growth plate at the age of 3 weeks. BPD-MA was administered intracardially (2mg/kg) followed 10 mins later by a laser light (690 +/- 5 nm) at a range of doses (5-27J, 50 mW output) delivered either as a single or repeat regimen (x2-3). Contra-lateral legs served as no-light controls. Further controls included animals that received light treatment in the absence of photosensitizer or no treatment. Mice were imaged for VEGF related bioluminescence (photons/sec/steradian) at t= 0, 24, 48, 72 h and 1-4 weeks post PDT. FaxitronTM x-ray images provided accurate assessment of bone morphometry. Upon sacrifice, the tibia and femur of the treated and untreated limbs were harvested, imaged and measured again and prepared for histology. A number of animals were sacrificed at 24 h post PDT to allow immunohistochemical staining for CD31, VEGF and hypoxia-inducible factor (HIF-1 alpha) within the bone. PDT-treated (10 J, x2) mice displayed enhanced bioluminescence at the treatment site (and ear nick) for up to 4 weeks post treatment while control mice were bioluminescent at the ear-nick site only. Repeat regimens provided greater shortening of the limb than the corresponding single treatment. PDT-treated limbs were shorter by 3-4 mm on average as compared to the contra lateral and light only controls (10 J, x2). Immunohistochemistry confirmed the enhanced expression VEGF and CD31 at 4 weeks post-treatment although no increase in HIF-1α was evident at either 24 h or 4 weeks post PDT treatment. Results confirm the utility of PDT to provide localized effects on bone development that may be applicable to other related skeletal deformities.
Objective: Photodynamic therapy (PDT) defines the oxygen-dependent reaction that occurs upon light-mediated activation of a photosensitizing compound, culminating in the generation of cytotoxic, reactive oxygen species, predominantly, singlet oxygen. We are investigating PDT treatment of diseased bone. Methods: Using a rat model of human breast cancer (MT-1)-derived bone metastasis we confirmed the efficacy of benzoporphyrin-derivative monoacid (BPD-MA)-PDT for treating metastatic lesions within vertebrae or long bones. Results: Light administration (150 J) 15 mins after BPDMA (2.5 mg/Kg, i.v.) into the lumbar (L3) vertebra of rats resulted in complete ablation of the tumour and surrounding bone marrow 48 hrs post-PDT without paralysis. Porcine vertebrae provided a model comparable to that of human for light propagation (at 150 J/cm) and PDT response (BPD-MA; 6 mg/m2, i.v.) in non-tumour vertebrae. Precise fibre placement was afforded by 3-D cone beam computed tomography. Average penetration depth of light was 0.16 ± 0.04 cm, however, the necrotic/non-necrotic interface extended 0.6 cm out from the treatment fiber with an average incident fluence rate of 4.3 mW/cm2. Non-necrotic tissue damage was evident 2 cm out from the treatment fiber. Current studies involving BPD-MA-PDT treatment of primary osteosarcomas in the forelimbs of dogs are very promising. Magnetic resonance imaging 24 hr post treatment reveal well circumscribed margins of treatment that encompass the entire 3-4 cm lesion. Finally, we are also interested in using 5-aminolevulinic acid (ALA) mediated PDT to treat osteomyelitis. Response to therapy was monitored as changes in bioluminescence signal of staphylococcus aureus (SA)-derived biofilms grown onto 0.5 cm lengths of wire and subjected to ALA-PDT either in vitro or in vivo upon implant into the intramedullary
space of rat tibia. Transcutaneous delivery of PDT (75 J/cm2) effectively eradicated SAbiofilms within bone. Conclusions: Results support the application of PDT to the
treatment of primary or metastatic lesions within bone. Secondly, that ALA-PDT may be useful as a treatment for osteomyelitis. Further studies aim to optimize the parameters of delivering PDT into bone and explore imaging technologies that can be used for clinical PDT.
This study represents the first reported use of photodynamic therapy (PDT) for metastatic bone lesions and specifically, as a treatment for spinal metastases. A model of bone metastasis in rat confirmed the efficacy of benzoporphyrin derivative-monoacid-mediated PDT for treating lesions within the spine and appendicular bone. Fluorimetry confirmed the selective accumulation of drug into the tumor(s) at 3 h post-injection. 48 h post-light delivery into the vertebral body of the rat spine loss of bioluminescent signal and histological analyses of sectioned spine confirmed MT-1 tumor cell kill in vivo as previously confirmed in vitro using an established cell viability assay. Porcine vertebrae provided a model comparable to that of human for light propagation and PDT response. Histological examination of vertebrae 48 h post-PDT revealed a necrotic radius of 0.6 cm with an average fluence rate of 4.3 mW/cm2. Non-necrotic tissue damage was evident up to 2 cm out from the treatment fiber. Results support the application of PDT to the treatment of primary or metastatic lesions within bone.
KEYWORDS: Photodynamic therapy, Bioluminescence, In vitro testing, Bone, In vivo imaging, Control systems, Light sources, Optical fibers, Imaging systems, Tissues
Osteomyelitis can lead to severe morbidity and even death resulting from an acute or chronic inflammation of the bone and contiguous structures due to fungal or bacterial infection. Incidence approximates 1 in 1,000 neonates and 1 in 5,000 children in the United States annually and increases up to 0.36% and 16% in adults with diabetes or sickle cell anaemia, respectively. Current regiments of treatment include antibiotics and/or surgery. However, the increasing number of antibiotic resistant pathogens suggests that alternate strategies are required. We are investigating photodynamic therapy (PDT) as one such alternate treatment for osteomyelitis using a bioluminescent strain of biofilm-producing staphylococcus aureus (SA) grown onto kirschner wires (K-wire). SA-coated K-wires were exposed to methylene blue (MB) or 5-aminolevulinic acid (ALA)-mediated PDT either in vitro or following implant into the tibial medullary cavity of Sprague-Dawley rats. The progression of SA biofilm was monitored non-invasively using bioluminescence and expressed as a percentage of the signal for each sample immediately prior to treatment. SA infections were subject to PDT 10 days post inoculation. Treatment comprised administration of ALA (300 mg/Kg) intraperitoneally followed 4 hr later by light (635 ± 10 nm; 38 or 75 J/cm2) delivered transcutaneously via an optical fiber placed onto the tibia. In vitro, MB and ALA displayed similar cell kill with ≥ 4log10 cell kill. In vivo, ALA-mediated PDT inhibited biofilm implants in bone. These results confirm that MB or ALA-mediated PDT have potential to treat SA cultures grown in vitro or in vivo using an animal model of osteomyelitis.
The ability to customize photodynamic therapy (PDT) parameters with regards to timing and dosing of administered drug and light can be beneficial in determining target specificity and mode of cell death. Sustained, low level PDT or metronomic PDT (mPDT) may afford enhanced apoptotic cell death. This is of particular importance when considering PDT for the treatment of brain tumors as unlike apoptosis, necrotic cell death often leads to inflammation with increased intracranial pressure. The ability, therefore, to 'fine tune' PDT in favour of apoptosis is paramount. We have studied both acute (one time treatment) PDT (aPDT) and mPDT delivery strategies in combination with nicotinamide (NA) in an attempt to maximize the number of tumor cells dieing by apoptosis. Using several different glioma cell lines (9L, U87-MG and CNS-1) we now confirm that NA provides a dose-dependent (0.1-0.5 mM) increase in apoptotic cells following d-aminolevulinic acid-mediated aPDT or mPDT. Furthermore, using the 9L cell line stably transfected with the luciferase gene, NA was shown to delay the depletion of bioluminscence signal in aPDT and mPDT treated cells, inferring that adenosine triphosphate levels are maintained for longer following NA treatment. NA has previously been reported as promoting neuronal and vascular cell survival in normal brain following a number of neurological insults in which reactive oxygen species are implicated including, stroke, Alzheimer's disease and toxin-induced lesions. It is likely that the effects of NA reflect its capacity as an antioxidant as well as its ability to inhibit poly (adenosine diphosphate-ribose) polymerase-mediated depletion of ATP. Our results indicate that NA may prove therapeutically advantageous when used in combination with PDT treatment of brain tumors.
This study represents the first reported use of photodynamic therapy in bone and specifically, as a treatment for spinal
metastases. A metastatic model in rat confirmed the efficacy of benzoporphyrin derivative-monoacid-mediated PDT for
treating lesions within the spine and appendicular bone. Fluorimetry confirmed the selective accumulation of drug into
the tumor(s) at 3 hours post-injection. 48 hrs post light delivery into the vertebral body of the rat spine loss of
bioluminescent signal and histological analyses of sectioned spine confirmed MT-1 tumor cell kill in vivo as previously
confirmed in vitro using an established cell viability assay. Porcine vertebrae provided a model comparable to that of
human for light propagation and PDT response. Light measurements were recorded at 2.5 mm increments as the detector
probe was retracted out of the vertebral body away from a diffusing fiber at 70-90° planar angle to it. At 30 minutes or
1hr post BPD-MA administration (6 mg/m2), light (648 J, 150 mW/cm, 690 nm) was delivered to vertebrae L1 and/or
L2. Vertebrae were harvested and sectioned for histology 48 hrs following PDT. Light propagation was plotted as
distance (μm) from the emitting source. Results support the application of PDT to the treatment of primary or metastatic
lesions within bone.
The concept of metronomic photodynamic therapy (mPDT) is presented, in which both the photosensitizer and light are deliverd continuously at low rates over extended periods in order to increase selective tumor cell kill through apoptosis. The focus of the present work is on mPDT treatment of malignant brain tumors, in which selectivity between damage to tumor cells versus normal brain tissue is critical. Previous studies have shown taht low-dose PDT using aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) can induce apoptosis in tumor cells within causing nectrosis in either tumor or normal brain tissue or apoptosis in teh latter. In order to produce enough tumor cell kill to be an effective therapy, multiple PDT treatments, such as hyperfractionation or metronomic delivery, are likely required, based on the levels of apoptosis achieved and model calculations of tumor growth rates. mPDT poses two substantial technical challenges: extended delivery of ALA and implantation of interstitial devices for extended light delivery while allowing free movement. In rat models ALAL administration via the drinking water has been accomplished at significant doesse (up to 10 times therapeutic dose) for up to 10 days, and ex vivo spectrofluorimetry of tumor, normal brain and other tissues post mortem demonstrates a 3-4 increase in the tumor-to-brain concentration of PpIX, without toxicity. Prototype light sources and delivery devices are also shown to be practical, either using laser diode or light emitting diode (LED) coupled to an implanted optical fiber in the case of the rat model or a directly-implanted LED in rabbits. The combined delivery of both drug and light over an extended period, with survival of the animls, is demonstrated. Preliminary evidence of selective aopotosis of tumor under these conditions is presented.
This study describes the development of novel, fluorescent-based actinometer encapsulates as a means of discerning volumetric Photodynamic therapy (PDT) dosimetry relative to the incident light and reactive oxygen species (ROS) production. PDT relies on three main ingredients; oxygen, light and photo-activatable commpounds, although, the PDT response is definately contingent on the site and level of ROS generation. Providing a localized, in situ measurement of luminance and ROS generation is therefore critical when deciphering targetd photodynamci therapy (PDT) protocols in vivo. Toward this end, alginate-poly-L-lysine-alginate encapsulates were made using ionotropic gelation of sodium alginate droplets ranging from 75 to 200 μm in diameter. Two candidate dyes, ADS680WS (ADS) and R-phycoerythrin (RPE) were chosen based on photochemistry, chemical stabilty and sensitivity to changing pH and oxygen environments. Alginate beads were constructed with ADS conjugated to the inside and RPE attached to the outside layer. The production of ROS was initiated either chemically using increasing concentrations of potassium perchromate or photochemically using tetra-sulphonated aluminium phosphorescence (AlPcS4). The generation of singlet oxygen was confirmed by the presence of a phosphorescence peak at 1270 nm. The resulting photodegradation and subsequent decrease in fluorescence of RPE was found to correlate very closely (p<0.001) with increasing perchromate or fluence respectively. This effect was independent of pH (6.5-8) and could be inhibited using sodium azide. RPA was not susceptible to photobleaching with light alone (675 nm; 150 J/cm2). Meanwhile, ADS680WS, which absorbs light at 670-690 nm, showed a direct correlation between diminished fluorescence (photobleaching) and incident fluence (675 nm; 0-100 J/cm2). This effect was independent of fluence rate (10-40 mW/cm2). We propose that actinometer encapsulates may prove useful for implanting into potential target areas such as the brain in order to determine the delivered dose of PDT at specific sites within that target area.
Metronomic photodynamic therapy (mPDT), a procedure in which both the photosensitizer and light are delivered continuously so that the individual doses overlap pharmacologically is introduced. The fundamental hypothesis in mPDT is that by providing therapy at low fluence over extended periods of time, there is potential for improved selectivity in tumor cell kill through non necrotic pathways. This is especially important in the treatment of malignant brain tumors, in which selectivity between damage to tumor cells versus normal brain tissue is critical. Previous studies have shown that low-dose PDT using aminolevulinic acid (ALA)-induced protoporphyrin IX (PiIX) can induce apoptosis in tumor cells without causing necrosis in either tumor or normal brain tissue nor apoptosis in the latter. However, in order to achieve tumor control, multiple PDT treatments, such as hyper fractionation or metronomic delivery, are required, where the frequency and duration of the treatment are determined by the levels of apoptosis achieved in relationship to tumor cell doubling times, mPDT poses two substantial technical challenges: extended delivery of ALA and implantation of interstitial devices for extended light delivery at a sufficiently high enough density to achieve low fluence exposure to the brain adjacent to tumor or the entire hemisphere. In a rat model we evaluated the feasibility of delivering sustained ALA administration via the drinking water for up to 10 days without loss of PPIX selectivity. Post mortem quantitative spectrofluorimetry of tumor, normal brain and other tissues demonstrates a 4 times higher PPIX concentration in the 9L gliosarcoma model without noticeable toxicity. Light sources and delivery devices based either on laser diode or light emitting diode (LED) coupled to an implanted optical fiber were shown to be feasible. The maximum permissible spacing of cylindrical isotropic emitters is determined using known apoptotic indices and the necrosis threshold value for white matter. Preliminary evidence of selective apoptosis of tumor under these conditions is presented.
Background: Currently clinical Doppler ultrasound cannot detect microvascular blood flow and it is difficult to provide depth discrimination using laser Doppler flowmetry. Doppler optical coherence tomography (DOCT) is a novel technique for noninvasive subsurface imaging of microcirculation and tissue structure. Aims: To design handheld and catheter-based DOCT probes for clinical cutaneous and endoscopic imaging. To develop signal processing techniques for real-time detection and quantification of microvascular blood flow. Methods: A DOCT system, with interchangeable cutaneous and catheter probes, was developed. The axial spatial resolution was 10 μm, and the velocity resolution was 20 μm/s, using a 1300 nm broadband infrared light. The system achieved real-time imaging with frame rates up to 32 Hz at 512 x 256 pixels per frame. We used the system to detect microcirculation in human skin and rat esophagus, and to monitor microvascular responses to photodynamic therapy (PDT) in a rat tumor model. Results: We present experimental results from in vivo DOCT imaging of microcirculation in human skin arterio-venous malformations (AVM), normal rat esophagus, and a rat gliosarcoma PDT model. In the PDT model, we followed microvascular responses to PDT and observed differences in the microcirculation during and after therapy, which can have important implications for PDT dosimetry and treatment optimization. Conclusions: To our knowledge, this is the first demonstration of endoscopic catheter-based DOCT detection of microcirculation in vivo. In addition, AVM can be detected using handheld cutaneous DOCT probes under clinical settings. DOCT may serve as a real-time monitoring tool for PDT dosimetry, especially for vascular targeting photosensitizers.
The concept of metronomic photodynamic therapy (mPDT) is presented, in which both the photosensitizer and light are delivered continuously at low rates over extended periods in order to increase selective tumor cell kill through apoptosis. The focus of the present work is on mPDT treatment of malignant brain tumors, in which selectivity between damage to tumor cells versus normal brain tissue is critical. Previous studies have shown that low-dose PDT using aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) can induce apoptosis in tumor cells without causing necrosis in either tumor or normal brain tissue or apoptosis in the latter. In order to produce enough tumor cell kill to be an effective therapy, multiple PDT treatments, such as hyperfractionation or metronomic delivery, are likely requried, based on the levels of apoptosis achieved and model calculations of tumor growth rates. mPDT poses two substantial technical challenges: extended delivery of ALA and implantation of interstitial devices for extended light delivery while allowing free movement. In rat models ALA administration via the drinking water has been accomplished at significant doses for up to 10 days, and ex vivo spectrofluorimetry of tumore, normal brain and other tissues post mortem demonstrates a 3-4 increase in the tumor-to-brain concentration of PpIX, without toxicity. Prototype light sources and delivery devices are also shown to be practical, either using a laser diode or light emitting diode (LED) coupled to an implanted optical fiber in the case of the rat model or a directly-implanted LED in rabbits. The combined delivery of both drug and light over an extended period, with survival of the animals, is demonstrated. Preliminary evidence of selective apoptosis of tumor under these conditions is presented.
Fluorescence-guided brain tumor resection may help the neurosurgeon to identify tumor margins that merge imperceptibly into the normal brain tissue and are difficult to identify under white light illumination even using an operating microscope. We compared the amount of residual tumor after white light resection using an operating microscope versus that after fluorescnece-guided resection of an intracranial VX2 tumor in a preclinical model using our previously developed co-axial fluorscence imaging and spectroscopy system, exciting and detecting PpIX fluorescence at 405nm and 635nm respectively. Preliminary results: No fluorescence was present in 3 non-tumor-bearing animals. Fluorescence was present in all 15 tumor-bearing animals after white light resection was completed. To date in 4 rabbits, a decrease in residual tumor was found when using additional fluorescence guided resection compared to white light resection only. Conclusions: ALA induced PpIX fluorescence detects tumor margins not seen under an operation microscope using while light. Using fluorescence imaging to guide tumor resection resulted in a 3-fold decrease in the amount of residual timor. However, these preliminary results indicate that also an additional amount of normal brain is resected, which will be further investigated.
Photodynamic Therapy (PDT) is a promising modality for tumor treatment that combines a photosensitizing agent and visible light resulting in the production of cytotoxic reactive oxygen species leading to cell death. Bioluminescence detection/imaging is a noninvasive technique that uses luciferase gene transfection together with administration of luciferin to generate detectable visible light. It can provide real-time assessment of tumor growth and therapeutic response. The aim of this study is to investigate the potential fo bioluminescence following animolevulinic acid (ALA)-mediated PDT. The in vitro results show a decrease of luminescence, with an excellent correlation to the number of viable cells. In vivo, the tumor growth was monitored using a cooled CCD camera, and ALA-PDT was performed 7-10 days post tumor implantation. The results show a decrease of the bioluminescence signal from the tumor that corresponds to a decrease of viable cells within the tumor, followed by re-growth at the sub-curative PDT doses used.
PDT included necrosis in brain tissue and an intracranial tumor has been quantified for various photosensitizers, and it has been shown to be dependent on the sub-cellular localization of these photosensitizers. In quantifying non- necrotic biological endpoints, such as PDT induced apoptosis, the expression and translation of apoptosis inhibiting or promoting genes is of considerable importance. We studied the susceptibility of two glioblastoma cell lines to under go apoptotic cell death following photodynamic treatment with either Photofrin or delta-aminolevulinic acid (delta) ALA) in vivo. Murine 9L Gliosarcoma cells or human U87 Glioblastoma cells were implanted into the cortex of rats, and following 12 or 14 days of growth respectively, subjected to either Photofrin-mediated PDT or ALA-mediated PDT. 9L gliosarcoma cells express the phosphatase Tensin homologue (PTEN) tumor suppressor gene while in U87 cells PTEN is mutated. Differences in the Photofrin mediated PDT induced apoptosis were noted between the two different cell lines in vivo, suggesting that Photofrin mediated PDT may be dependent on apoptotic pathways. ALA induced PPIX showed higher selectivity towards 9L than Photofrin mediated PDT. These studies suggests that PDT could be used as an effective treatment for intracranial neoplasm. Endogenous photosensitizers such as ALA could be used to promote apoptosis in tumor cells due to PDT treatment and thereby minimize the extent of necrotic infarction in the surrounding normal brain.
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