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Ortiz-Rodríguez LA, Fang YG, Niogret G, Hadidi K, Hoehn SJ, Folkwein HJ, Jockusch S, Tor Y, Cui G, Levi L, Crespo-Hernández CE. Thieno[3,4- d]pyrimidin-4(3 H)-thione: an effective, oxygenation independent, heavy-atom-free photosensitizer for cancer cells. Chem Sci 2023; 14:8831-8841. [PMID: 37621444 PMCID: PMC10445467 DOI: 10.1039/d3sc02592f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
All-organic, heavy-atom-free photosensitizers based on thionation of nucleobases are receiving increased attention because they are easy to make, noncytotoxic, work both in the presence and absence of molecular oxygen, and can be readily incorporated into DNA and RNA. In this contribution, the DNA and RNA fluorescent probe, thieno[3,4-d]pyrimidin-4(1H)-one, has been thionated to develop thieno[3,4-d]pyrimidin-4(3H)-thione, which is nonfluorescent and absorbs near-visible radiation with about 60% higher efficiency. Steady-state absorption and emission spectra are combined with transient absorption spectroscopy and CASPT2 calculations to delineate the electronic relaxation mechanisms of both pyrimidine derivatives in aqueous and acetonitrile solutions. It is demonstrated that thieno[3,4-d]pyrimidin-4(3H)-thione efficiently populates the long-lived and reactive triplet state generating singlet oxygen with a quantum yield of about 80% independent of solvent. It is further shown that thieno[3,4-d]pyrimidin-4(3H)-thione exhibits high photodynamic efficacy against monolayer melanoma cells and cervical cancer cells both under normoxic and hypoxic conditions. Our combined spectroscopic, computational, and in vitro data demonstrate the excellent potential of thieno[3,4-d]pyrimidin-4(1H)-thione as a heavy-atom-free PDT agent and paves the way for further development of photosensitizers based on the thionation of thieno[3,4-d]pyrimidine derivatives. Collectively, the experimental and computational results demonstrate that thieno[3,4-d]pyrimidine-4(3H)-thione stands out as the most promising thiobase photosensitizer developed to this date.
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Affiliation(s)
| | - Ye-Guang Fang
- Key Lab of Theoretical and Computational Photochemistry, Ministry of Education, Chemistry College, Beijing Normal University Beijing 100875 China
| | - Germain Niogret
- Department of Chemistry and Biochemistry, University of California San Diego La Jolla CA 92093 USA
| | - Kaivin Hadidi
- Department of Chemistry and Biochemistry, University of California San Diego La Jolla CA 92093 USA
| | - Sean J Hoehn
- Department of Chemistry, Case Western Reserve University Cleveland OH 44106 USA
| | - Heather J Folkwein
- Department of Chemistry, Case Western Reserve University Cleveland OH 44106 USA
| | - Steffen Jockusch
- Center for Photochemical Sciences, Bowling Green State University Bowling Green Ohio 43403 USA
| | - Yitzhak Tor
- Department of Chemistry and Biochemistry, University of California San Diego La Jolla CA 92093 USA
| | - Ganglong Cui
- Key Lab of Theoretical and Computational Photochemistry, Ministry of Education, Chemistry College, Beijing Normal University Beijing 100875 China
| | - Liraz Levi
- Celloram Inc Cleveland OH 44106 USA
- Department of Pediatrics, Case Western Reserve University School of Medicine Cleveland Ohio 44106 USA
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Pourali SP, Gutierrez Y, Jones ME, Rajkumar JR, Kucharik AH, Armstrong AW. Are we contributing to the opioid epidemic? A systematic review on systemic opioid use in dermatology. Int J Dermatol 2022; 61:1056-1068. [PMID: 34870325 DOI: 10.1111/ijd.16011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 11/11/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although dermatologists treat many painful skin conditions and perform procedures that may require analgesic use, there is a lack of evidence synthesis on opioid use in dermatology. OBJECTIVE To conduct a systematic review of the evidence on the use of opioid analgesics in dermatology. METHODS We applied the PRISMA guidelines and systematically reviewed literature that examined opioid use in dermatology published between 1980 and 2020 in the PubMed, EMBASE, and Cochrane databases. This review was registered with PROSPERO (CRD42020204864). RESULTS We identified 24 studies that analyzed 52,705,201 patients and 13,099 dermatologists. Between 34% and 87.5% of patients received opioids following dermatologic procedures; however, many did not use the entirety of their prescriptions, and 35-69% did not use any of their prescription. Top opioid prescribers were more likely to be Mohs surgeons, male, and practice in the South. Variability exists in the current evidence for opioid prescribing for nonprocedural dermatologic disease. CONCLUSION While opioid prescribing in dermatology is low compared with other specialties, patients are not utilizing the entirety of their prescriptions. Opioid prescribing for nonprocedural dermatologic disease varies; treatments focused on targeting the pathogenesis of these diseases is important to minimize opioid use. Dermatologists should consider limiting opioid prescribing and utilizing nonnarcotic analgesics.
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Affiliation(s)
- Sarah P Pourali
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Yasmin Gutierrez
- University of California Riverside School of Medicine, Riverside, CA, USA
| | - Madison E Jones
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Alison H Kucharik
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - April W Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Wang L, Li G, Cao L, Shao K, Li Y, Zhang X, Zhao J, Zhao W. Novel Water-Soluble Chlorin-Based Photosensitizer for Low-Fluence Photodynamic Therapy. ACS Pharmacol Transl Sci 2022; 5:110-117. [PMID: 35187418 PMCID: PMC8844960 DOI: 10.1021/acsptsci.1c00249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Indexed: 01/23/2023]
Abstract
Photodynamic therapy (PDT), performed with low-fluence rates, can improve antitumor responses and prevent adverse effects. However, photosensitizers (PSs) for low-fluence PDT treatment are rarely reported. Herein, we exploited an amphiphilic chlorin-based PS, named DYSP-C34, which has a variety of beneficial biological properties, such as improved water solubility, better cellular permeability, specific localization and enhanced phototoxicity under low light dose irradiation. In addition, DYSP-C34 could effectively accumulate in a mouse subcutaneous xenograft tumor and exhibit substantial tumor regression after irradiation with an extremely low light fluence (6 J/cm2). Meanwhile, the excellent phototoxicity could stimulate the host immune system and lead to a strong inhibition of tumor growth synergistically. These results indicated the potential value of DYSP-C34 as a chlorin-type PS for low-fluence PDT application.
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Affiliation(s)
- Liu Wang
- State
Key Laboratory of Fine Chemicals, Department of Pharmaceutical Sciences,
School of Chemical Engineering, Dalian University
of Technology, Dalian 116024, China
| | - Guangzhe Li
- State
Key Laboratory of Fine Chemicals, Department of Pharmaceutical Sciences,
School of Chemical Engineering, Dalian University
of Technology, Dalian 116024, China,
| | - Lei Cao
- State
Key Laboratory of Fine Chemicals, Department of Pharmaceutical Sciences,
School of Chemical Engineering, Dalian University
of Technology, Dalian 116024, China
| | - Kun Shao
- State
Key Laboratory of Fine Chemicals, School of Chemical Engineering, Dalian University of Technology, Dalian 116024, China
| | - Yueqing Li
- State
Key Laboratory of Fine Chemicals, Department of Pharmaceutical Sciences,
School of Chemical Engineering, Dalian University
of Technology, Dalian 116024, China
| | - Xi Zhang
- State
Key Laboratory of Fine Chemicals, Department of Pharmaceutical Sciences,
School of Chemical Engineering, Dalian University
of Technology, Dalian 116024, China
| | - Jianzhang Zhao
- State
Key Laboratory of Fine Chemicals, School of Chemical Engineering, Dalian University of Technology, Dalian 116024, China
| | - Weijie Zhao
- State
Key Laboratory of Fine Chemicals, Department of Pharmaceutical Sciences,
School of Chemical Engineering, Dalian University
of Technology, Dalian 116024, China,
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4
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O'Mahoney P, Samuel IDW, Eadie E, Ibbotson S. Fluorescence and thermal imaging of non-melanoma skin cancers before and during photodynamic therapy. Photodiagnosis Photodyn Ther 2021; 34:102327. [PMID: 33962057 DOI: 10.1016/j.pdpdt.2021.102327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/19/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) has been shown to be less effective on the extremities. Protoporphyrin-IX (PpIX) fluorescence and skin surface temperature are variables that have been implicated in the differences in efficacy with body site, but objective studies have not been undertaken. OBJECTIVES To further investigate observations from our previous study that temperature and fluorescence during pro-drug incubation are correlated, through a prospective objective investigation of the relationships between fluorescence and skin surface temperature before and during PDT and relationships with body site and efficacy. METHODS Eighteen patients with Bowen's disease or basal cell carcinoma, who had been referred for PDT, were recruited to this study. PpIX fluorescence and thermal measurements were recorded at intervals during the pro-drug incubation and irradiation phases of PDT. Pain immediately after irradiation, and outcome at 3- and 12-months were recorded. RESULTS Temperature and PpIX fluorescence were higher on the trunk than lower leg immediately before treatment (median temperature 32.7 °C vs. 27.8 °C, p < 0.05 and median fluorescence 16.5 vs. 6.7, p < 0.05). Higher pain levels were reported during PDT on the extremities (median 5.7 vs. 2.2, p < 0.05). Clearance rates at 12-months were 80 %. CONCLUSIONS The study supports a correlation between temperature and PpIX fluorescence during PDT, providing robust objective data to support our previous hypothesis and observations. The higher pain levels, lower PpIX fluorescence on the lower leg, and the high efficacy rates at all body sites irrespective of temperature and fluorescence indicates that relationships between PDT treatment conditions and parameters is likely to be multifactorial.
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Affiliation(s)
- P O'Mahoney
- Photobiology Unit, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK; The Scottish Photodynamic Therapy Centre, Dundee, UK; School of Medicine, University of Dundee, Dundee, UK.
| | - I D W Samuel
- School of Physics and Astronomy, University of St. Andrews, St. Andrews, UK
| | - E Eadie
- Photobiology Unit, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK; The Scottish Photodynamic Therapy Centre, Dundee, UK
| | - S Ibbotson
- Photobiology Unit, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK; The Scottish Photodynamic Therapy Centre, Dundee, UK; School of Medicine, University of Dundee, Dundee, UK
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Ortiz-Rodríguez LA, Crespo-Hernández CE. Thionated organic compounds as emerging heavy-atom-free photodynamic therapy agents. Chem Sci 2020; 11:11113-11123. [PMID: 34094354 PMCID: PMC8162790 DOI: 10.1039/d0sc04747c] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/15/2020] [Indexed: 12/13/2022] Open
Abstract
This minireview focuses on recent progress in developing heavy-atom-free photosensitizers based on the thionation of nucleic acid derivatives and other biocompatible organic compounds for prospective applications in photodynamic therapy. Particular attention is given to the use of thionated nucleobase derivatives as "one-two punch" photodynamic agents. These versatile photosensitizers can act as "Trojan horses" upon metabolization into DNA and exposure to activating light. Their incorporation into cellular DNA increases their selectivity and photodynamic efficacy against highly proliferating skin cancer tumor cells, while simultaneously enabling the use of low irradiation doses both in the presence and in the absence of molecular oxygen. Also reviewed are their primary photochemical reactions, modes of action, and photosensitization mechanisms. New developments of emerging thionated organic photosensitizers absorbing visible and near-infrared radiation are highlighted. Future research directions, as well as, other prospective applications of heavy-atom-free, thionated photosensitizers are discussed.
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Ruiz AJ, LaRochelle EPM, Gunn JR, Hull SM, Hasan T, Chapman MS, Pogue BW. Smartphone fluorescence imager for quantitative dosimetry of protoporphyrin-IX-based photodynamic therapy in skin. JOURNAL OF BIOMEDICAL OPTICS 2019; 25:1-13. [PMID: 31820594 PMCID: PMC6901011 DOI: 10.1117/1.jbo.25.6.063802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/30/2019] [Indexed: 05/04/2023]
Abstract
Significance: While clinical treatment of actinic keratosis by photodynamic therapy (PDT) is widely practiced, there is a well-known variability in response, primarily caused by heterogeneous accumulation of the photosensitizer protoporphyrin IX (PpIX) between patients and between lesions, but measurement of this is rarely done. Aim: Develop a smartphone-based fluorescence imager for simple quantitative photography of the lesions and their PpIX levels that can be used in a new clinical workflow to guide the reliability of aminolevulinic acid (ALA) application for improved lesion clearance. Approach: The smartphone fluorescence imager uses an iPhone and a custom iOS application for image acquisition, a 3D-printed base for measurement standardization, an emission filter for PpIX fluorescence isolation, and a 405-nm LED ring for optical excitation. System performance was tested to ensure measurement reproducibility and the ability to capture photosensitizer accumulation and photobleaching in pre-clinical and clinical settings. Results: PpIX fluorescence signal from tissue-simulating phantoms showed linear sensitivity in the 0.01 to 2.0 μM range. Murine studies with Ameluz® aminolevulinic acid (ALA) gel and initial human testing with Levulan® ALA cream verified that in-vivo imaging was feasible, including that PpIX production over 1 h is easily captured and that photobleaching from the light treatment could be quantified. Conclusions: The presented device is the first quantitative wide-field fluorescence imaging system for PDT dosimetry designed for clinical skin use and for maximal ease of translation into clinical workflow. The results lay the foundation for using the system in clinical studies to establish treatment thresholds for the individualization of PDT treatment.
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Affiliation(s)
- Alberto J. Ruiz
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Address all correspondence to Alberto J. Ruiz, E-mail: ; Brian W. Pogue, E-mail:
| | | | - Jason R. Gunn
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Sally M. Hull
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Tayyaba Hasan
- Massachusetts General Hospital, Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts, United States
| | - M. Shane Chapman
- Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire, United States
- Address all correspondence to Alberto J. Ruiz, E-mail: ; Brian W. Pogue, E-mail:
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Dawe RS. Choice of topical prodrug in daylight photodynamic therapy for actinic keratoses. Br J Dermatol 2019; 181:246-247. [PMID: 31314130 DOI: 10.1111/bjd.18170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- R S Dawe
- Photobiology Unit, Department of Dermatology, Ninewells Hospital and Medical School, Dundee, U.K
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Ibbotson S, Wong T, Morton C, Collier N, Haylett A, McKenna K, Mallipeddi R, Moseley H, Rhodes L, Seukeran D, Ward K, Mohd Mustapa M, Exton L. Adverse effects of topical photodynamic therapy: a consensus review and approach to management. Br J Dermatol 2018; 180:715-729. [DOI: 10.1111/bjd.17131] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2018] [Indexed: 12/21/2022]
Affiliation(s)
- S.H. Ibbotson
- Photobiology Unit Department of Dermatology University of Dundee Ninewells Hospital and Medical School Dundee U.K
| | - T.H. Wong
- Stirling Community Hospital StirlingU.K
| | | | - N.J. Collier
- Photobiology Unit Dermatology Centre University of Manchester and Salford Royal NHS Foundation Trust ManchesterU.K
| | - A. Haylett
- Photobiology Unit Dermatology Centre University of Manchester and Salford Royal NHS Foundation Trust ManchesterU.K
| | - K.E. McKenna
- Department of Dermatology Belfast City Hospital BelfastU.K
| | - R. Mallipeddi
- St John's Institute of Dermatology Guy's and St Thomas’ NHS Foundation Trust London U.K
| | - H. Moseley
- Photobiology Unit Department of Dermatology University of Dundee Ninewells Hospital and Medical School Dundee U.K
| | - L.E. Rhodes
- Photobiology Unit Dermatology Centre University of Manchester and Salford Royal NHS Foundation Trust ManchesterU.K
| | | | | | | | - L.S. Exton
- British Association of Dermatologists London U.K
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9
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O'Mahoney P, Haigh N, Wood K, Brown CTA, Ibbotson S, Eadie E. A novel light source with tuneable uniformity of light distribution for artificial daylight photodynamic therapy. Photodiagnosis Photodyn Ther 2018; 23:144-150. [PMID: 29920346 DOI: 10.1016/j.pdpdt.2018.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Implementation of daylight photodynamic therapy (dPDT) is somewhat limited by variable weather conditions. Light sources have been employed to provide artificial dPDT indoors, with low irradiances and comparable treatment times to dPDT. Uniform light distribution across the target area is desirable in effective treatment planning, particularly for large areas. A novel light source is developed with tuneable direction of light emission in order to meet this challenge. METHODS Wavelength composition of the novel light source is controlled such that the protoporphyrin-IX (PpIX) weighted spectra of both the light source and daylight match. The uniformity of the light distribution is characterised on a flat surface, a model head and a model leg. For context, a typical conventional PDT light source is also characterised. Additionally, the wavelength uniformity across the treatment site is characterised. RESULTS The PpIX-weighted spectrum of the novel light source matches the PpIX-weighted daylight spectrum, with irradiance values within the bounds for effective dPDT. By tuning the direction of light emission, improvements are seen in the uniformity across large anatomical surfaces. Wavelength uniformity is discussed. CONCLUSIONS We have developed a light source that addresses the challenges in uniform, multiwavelength light distribution for large area artificial dPDT across curved anatomical surfaces.
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Affiliation(s)
- Paul O'Mahoney
- Photobiology Unit, NHS Tayside, Ninewells Hospital, Dundee, UK; The Scottish Photodynamic Therapy Centre, Dundee, UK; School of Medicine, University of Dundee, Dundee, UK.
| | | | - Kenny Wood
- SUPA, School of Physics and Astronomy, University of St. Andrews, St. Andrews, UK
| | - C Tom A Brown
- SUPA, School of Physics and Astronomy, University of St. Andrews, St. Andrews, UK
| | - Sally Ibbotson
- Photobiology Unit, NHS Tayside, Ninewells Hospital, Dundee, UK; The Scottish Photodynamic Therapy Centre, Dundee, UK; School of Medicine, University of Dundee, Dundee, UK
| | - Ewan Eadie
- Photobiology Unit, NHS Tayside, Ninewells Hospital, Dundee, UK; The Scottish Photodynamic Therapy Centre, Dundee, UK
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Novak B, Heesen L, Schary N, Lübbert H. The influence of different illumination parameters on protoporphyrin IX induced cell death in squamous cell carcinoma cells. Photodiagnosis Photodyn Ther 2018; 21:385-392. [PMID: 29427796 DOI: 10.1016/j.pdpdt.2018.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/20/2017] [Accepted: 02/06/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Topical photodynamic therapy (PDT) is a highly effective therapy especially for extended cancerized fields of the skin. Whenever extended fields are treated pain management is advisable. Light source mediated pain management can be performed by reducing fluence rates, as long as this does not compromise efficacy. METHODS Two squamous cell carcinoma cell lines (A431 and SCC-13) were subjected to in vitro PDT using two different ALA concentrations and synthesis intervals and protoporphyrin IX (PpIX) synthesis was assessed. Two total light doses (6 J/cm2 and 37 J/cm2) were applied at three different fluence rates and cell viability was measured using the MTS-test. RESULTS Both cell lines synthetized PpIX at different kinetics. A431 cells produced a maximum 28.6 nmol/l PpIX, while SCC-13 reached only a production of 8.7 nmol/l. Illumination reduced cell viability depending on PpIX content and light dose. When a lower light dose (6 J/cm2) was applied, only the combination with the highest PpIX content was effective in A431 cells and no effect could be detected in SCC-13 cells. With a light dose of 37 J/cm2, lower PpIX amounts became effective in A431 and cell death could be induced in SCC-13 cells. Light fluence rate had no differential effect in this setup. CONCLUSIONS In both, A431 and SCC-13 cells, total light dose is a key factor for photodynamic efficacy. Additionally, our results hint towards a threshold concentration of PpIX upon which a drastic loss of viability occurs. Light fluence rate in the analyzed range is not a limiting factor of photodynamic cytotoxicity. This may allow for the clinical implementation of low fluence rate protocols for pain management without compromising efficacy.
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Affiliation(s)
- B Novak
- Biofrontera Pharma GmbH, Hemmelrather Weg 201, 51377 Leverkusen, Germany; Department of Animal Physiology, Ruhr-University, Universitätsstraße 150, Bochum, Germany.
| | - L Heesen
- Department of Animal Physiology, Ruhr-University, Universitätsstraße 150, Bochum, Germany
| | - N Schary
- Department of Animal Physiology, Ruhr-University, Universitätsstraße 150, Bochum, Germany
| | - H Lübbert
- Biofrontera AG, Hemmelrather Weg 201, 51377 Leverkusen, Germany; Department of Animal Physiology, Ruhr-University, Universitätsstraße 150, Bochum, Germany
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Early and Late Onset Side Effects of Photodynamic Therapy. Biomedicines 2018; 6:biomedicines6010012. [PMID: 29382133 PMCID: PMC5874669 DOI: 10.3390/biomedicines6010012] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/20/2018] [Accepted: 01/25/2018] [Indexed: 01/06/2023] Open
Abstract
Photodynamic Therapy (PDT) is a non-invasive treatment successfully used for neoplastic, inflammatory and infectious skin diseases. One of its strengths is represented by the high safety profile, even in elderly and/or immuno-depressed subjects. PDT, however, may induce early and late onset side effects. Erythema, pain, burns, edema, itching, desquamation, and pustular formation, often in association with each other, are frequently observed in course of exposure to the light source and in the hours/days immediately after the therapy. In particular, pain is a clinically relevant short-term complication that also reduces long-term patient satisfaction. Rare complications are urticaria, contact dermatitis at the site of application of the photosensitizer, and erosive pustular dermatosis. Debated is the relationship between PDT and carcinogenesis: the eruptive appearance of squamous cell carcinoma (SCC) in previously treated areas has been correlated to a condition of local and/or systemic immunosuppression or to the selection of PDT-resistant SCC. Here we review the literature, with particular emphasis to the pathogenic hypotheses underlying these observations.
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Daeschlein G, Arnold A, Lutze S, Napp M, Aly F, von Podewils S, Sicher C, Juenger M. Treatment of recalcitrant actinic keratosis (AK) of the scalp by cold atmospheric plasma. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1412903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Georg Daeschlein
- Department of Dermatology, University Medicine Greifswald, Sauerbruchstrasse, 17475 Greifswald, Germany
| | - Andreas Arnold
- Department of Dermatology, University Medicine Greifswald, Sauerbruchstrasse, 17475 Greifswald, Germany
| | - Stine Lutze
- Department of Dermatology, University Medicine Greifswald, Sauerbruchstrasse, 17475 Greifswald, Germany
| | - Matthias Napp
- Department of Traumatology, University Medicine Greifswald, Greifswald, Germany
| | - Fatma Aly
- Department of Medical Applications of Laser, Cairo University, Cairo, Egypt
| | - Sebastian von Podewils
- Department of Dermatology, University Medicine Greifswald, Sauerbruchstrasse, 17475 Greifswald, Germany
| | - Claudia Sicher
- Department of Dermatology, University Medicine Greifswald, Sauerbruchstrasse, 17475 Greifswald, Germany
| | - Michael Juenger
- Department of Dermatology, University Medicine Greifswald, Sauerbruchstrasse, 17475 Greifswald, Germany
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de Souza ALR, LaRochelle E, Marra K, Gunn J, Davis SC, Samkoe KS, Chapman MS, Maytin EV, Hasan T, Pogue BW. Assessing daylight & low-dose rate photodynamic therapy efficacy, using biomarkers of photophysical, biochemical and biological damage metrics in situ. Photodiagnosis Photodyn Ther 2017; 20:227-233. [PMID: 29037911 DOI: 10.1016/j.pdpdt.2017.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 10/02/2017] [Accepted: 10/10/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Sunlight can activate photodynamic therapy (PDT), and this is a proven strategy to reduce pain caused byconventional PDT treatment, but assessment of this and other alternative low dose rate light sources, and their efficacy, has not been studied in an objective, controlled pre-clinical setting. This study used three objective assays to assess the efficacy of different PDT treatment regimens, using PpIX fluorescence as a photophysical measure, STAT3 cross-linking as a photochemical measure, and keratinocyte damage as a photobiological measure. METHODS Nude mouse skin was used along with in vivo measures of photosensitizer fluorescence, keratinocyte nucleus damage from pathology, and STAT3 cross-linking from Western blot analysis. Light sources compared included a low fluence rate red LED panel, compact fluorescent bulbs, halogen bulbs and direct sunlight, as compared to traditional PDT delivery with conventional and fractionated high fluence rate red LED light delivery. RESULTS Of the three biomarkers, two had strong correlation to the PpIX-weighted light dose, which is calculated as the product of the treatment light dose (J/cm2) and the normalized PpIX absorption spectra. Comparison of STAT3 cross-linking to PpIX-weighted light dose had an R=0.74, and comparison of keratinocyte nuclear damage R=0.70. There was little correlation to PpIX fluorescence. These assays indicate most of the low fluence rate treatment modalities were as effective as conventional PDT, while fractionated PDT showed the most damage. CONCLUSIONS Daylight or artificial light PDT provides an alternative schedule for delivery of drug-light treatment, and this pre-clinical assay demonstrated that in vivo assays of damage could be used to objectively predict a clinical outcome in this altered delivery process.
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Affiliation(s)
- Ana Luiza Ribeiro de Souza
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA; CAPES Foundation, Ministry of Education of Brazil, Brasilia 70040-020, Brazil
| | - Ethan LaRochelle
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Kayla Marra
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Jason Gunn
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Scott C Davis
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Kimberley S Samkoe
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA; Department of Surgery, Geisel School of Medicine, Dartmouth College, Lebanon, NH, 03756, USA
| | - M Shane Chapman
- Department of Surgery, Geisel School of Medicine, Dartmouth College, Lebanon, NH, 03756, USA
| | - Edward V Maytin
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA; Department of Surgery, Geisel School of Medicine, Dartmouth College, Lebanon, NH, 03756, USA.
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14
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Reinhold U. A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis. Future Oncol 2017; 13:2413-2428. [PMID: 28805092 DOI: 10.2217/fon-2017-0247] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BF-200 ALA is a combination of a nanoscale-lipid vesicle formulation and the prodrug 5-aminolevulinic acid (5-ALA). The nanoemulsion stabilizes the prodrug and enhances its penetration through the stratum corneum. It has shown excellent therapeutic results in both lesion and field-directed photodynamic therapy of actinic keratosis (AK). AK is an early form of epidermal neoplasia and a precursor of invasive cutaneous squamous cell carcinoma. It is characterized by the combination of visible neoplastic lesions and surrounding tissue also harboring tumorigenic UV-induced mutations: a concept called field cancerization. A selective, field-directed treatment is ideal to meet the requirements of field change. Here, we review the clinical data on BF-200 ALA for AK along with a summary of molecular mechanisms and future perspectives.
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Affiliation(s)
- Uwe Reinhold
- Dermatological Center Bonn Friedensplatz, Bonn, Germany
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15
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Wang B, Shi L, Zhang Y, Zhou Q, Zheng J, Szeimies R, Wang X. Gain with no pain? Pain management in dermatological photodynamic therapy. Br J Dermatol 2017; 177:656-665. [PMID: 28122416 DOI: 10.1111/bjd.15344] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 12/30/2022]
Affiliation(s)
- B. Wang
- Department of Dermatology Ruijin Hospital School of Medicine Shanghai Jiaotong University Shanghai China
| | - L. Shi
- Institute of Photomedicine Shanghai Skin Disease Hospital Tongji University School of Medicine 1278 Baode Road Shanghai 200443 China
| | - Y.F. Zhang
- Institute of Photomedicine Shanghai Skin Disease Hospital Tongji University School of Medicine 1278 Baode Road Shanghai 200443 China
| | - Q. Zhou
- Institute of Photomedicine Shanghai Skin Disease Hospital Tongji University School of Medicine 1278 Baode Road Shanghai 200443 China
| | - J. Zheng
- Department of Dermatology Ruijin Hospital School of Medicine Shanghai Jiaotong University Shanghai China
| | - R.M. Szeimies
- Department of Dermatology and Allergology Vest Clinic Recklinghausen Germany
| | - X.L. Wang
- Institute of Photomedicine Shanghai Skin Disease Hospital Tongji University School of Medicine 1278 Baode Road Shanghai 200443 China
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16
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Shao X, Wang F, Xu B. Two-step irradiance schedule versus single-dose cold compress for pain control during 5-aminolevulinic acid-based photodynamic therapy of condyloma acuminatum. Lasers Surg Med 2017. [PMID: 28640436 DOI: 10.1002/lsm.22699] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of two-step irradiance schedule in relieving pain during PDT of CA. METHODS The study was a prospective, controlled trial of 141 CA patients who were randomly divided into Group A (two-step irradiance schedule) and Group B (single-dose cold compress). The numeric rating scales (NRS) of patients' pain were recorded at 5, 10, 15, and 20 minutes during each PDT. RESULTS The efficacy of PDT and NRS scores of patients in the two groups were compared. There was no significant difference in gender, age, lesion site, and disease course between the two groups (P > 0.05). In addition, the cure rate of patients in the two groups was not significantly different (97.1% vs. 95.8%, χ2 = 0.000, P = 1.000). However, the NRS scores at different time points and number of PDT sessions were significantly different (F = 198.233 and 165.224, respectively, P < 0.05). The NRS scores of patients in Group A were significantly lower than those of patients in Group B (F = 82.762, P < 0.0001). Moreover, the NRS scores at different positions were significantly different (F = 28.286, P < 0.0001). The NRS scores of penis were significantly lower than those of the vulva and crissum (P < 0.05). CONCLUSIONS Compared with single-dose cold compress, two-step irradiance schedule could more significantly reduce the patients' pain degree during treatment, especially for vulva and crissum. Lasers Surg. Med. 49:908-912, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Xiaonan Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Fang Wang
- Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Bin Xu
- Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
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17
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García-Malinis AJ, Turrión-Merino L, Pérez-García B, Saceda-Corralo D, Harto-Castaño A, Gilaberte Y. Observational study of chondrodermatitis nodularis helicis treated with methyl aminolevulinate photodynamic therapy. J Am Acad Dermatol 2017; 76:1103-1108. [DOI: 10.1016/j.jaad.2016.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 12/06/2016] [Accepted: 12/08/2016] [Indexed: 11/30/2022]
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18
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Cordey H, Valentine R, Lesar A, Moseley H, Eadie E, Ibbotson S. Daylight photodynamic therapy in Scotland. Scott Med J 2017; 62:48-53. [PMID: 28511619 DOI: 10.1177/0036933017695156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic sun-induced dysplastic skin changes (actinic keratoses) are extremely common in fair-skinned people in Scotland. These changes are a major cause of morbidity and may develop into skin cancer. Actinic keratoses are often extensive and pose a therapeutic challenge as field-directed treatment is required for chronic disease management. One such treatment approach is hospital-based photodynamic therapy, which is a well-established treatment in Scotland for actinic keratoses, using a photosensitiser pro-drug and red LED light irradiation. However, photodynamic therapy using daylight as the activating light source is increasingly and effectively used in continental Europe, but had not been explored in Scotland until we initiated this in 2013. We report our experience of daylight photodynamic therapy in 64 patient-treatment courses and demonstrate that this can be an effective, well-tolerated treatment, which is liked by patients. Our most recent data show that most patients (73%) achieved clearance or at least a good response to treatment and had high levels of satisfaction with daylight photodynamic therapy. Daylight exposure measurements indicated that treatment is feasible in Scotland between April to September. Daylight photodynamic therapy is an important advancement in treatment options for Scottish patients with extensive pre-cancerous field changes and provides opportunities for home-based treatment and increased efficiency of photodynamic therapy services.
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Affiliation(s)
- Helen Cordey
- 1 Specialist Registrar in Dermatology, University of Dundee, Scotland
| | - Ronan Valentine
- 2 Post-doctoral Scientist Scottish PDT Centre, University of Dundee, Scotland
| | - Andrea Lesar
- 3 Clinical Technologist, University of Dundee, Scotland
| | - Harry Moseley
- 4 Honorary Consultant Clinical Scientist, University of Dundee, Scotland
| | - Ewan Eadie
- 5 Head of Scientific Services for Photobiology, University of Dundee, Scotland
| | - Sally Ibbotson
- 6 Professor of Photodermatology, Head of Photobiology Unit, Clinical Director Scottish PDT Centre
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19
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Cheng Y, Chang Y, Feng Y, Liu N, Sun X, Feng Y, Li X, Zhang H. Simulated Sunlight-Mediated Photodynamic Therapy for Melanoma Skin Cancer by Titanium-Dioxide-Nanoparticle-Gold-Nanocluster-Graphene Heterogeneous Nanocomposites. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2017; 13:1603935. [PMID: 28371113 DOI: 10.1002/smll.201603935] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/08/2017] [Indexed: 05/22/2023]
Abstract
Simulated sunlight has promise as a light source able to alleviate the severe pain associated with patients during photodynamic therapy (PDT); however, low sunlight utilization efficiency of traditional photosensitizers dramatically limits its application. Titanium-dioxide-nanoparticle-gold-nanocluster-graphene (TAG) heterogeneous nanocomposites are designed to efficiently utilize simulated sunlight for melanoma skin cancer PDT. The narrow band gap in gold nanoclusters (Au NCs), and staggered energy bands between Au NCs, titanium dioxide nanoparticles (TiO2 NPs), and graphene can result in efficient utilization of simulated sunlight and separation of electron-hole pairs, facilitating the production of abundant hydroxyl and superoxide radicals. Under irradiation of simulated sunlight, TAG nanocomposites can trigger a series of toxicological responses in mouse B16F1 melanoma cells, such as intracellular reactive oxygen species production, glutathione depletion, heme oxygenase-1 expression, and mitochondrial dysfunctions, resulting in severe cell death. Furthermore, intravenous or intratumoral administration of biocompatible TAG nanocomposites in B16F1-tumor-xenograft-bearing mice can significantly inhibit tumor growth and cause severe pathological tumor tissue changes. All of these results demonstrate prominent simulated sunlight-mediated PDT effects.
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Affiliation(s)
- Yan Cheng
- Laboratory of Chemical Biology, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, Jilin, 130022, P. R. China
| | - Yun Chang
- Laboratory of Chemical Biology, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, Jilin, 130022, P. R. China
- University of Chinese Academy of Sciences, Beijing, 100039, P. R. China
| | - Yanlin Feng
- Laboratory of Chemical Biology, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, Jilin, 130022, P. R. China
- University of Chinese Academy of Sciences, Beijing, 100039, P. R. China
| | - Ning Liu
- Laboratory of Chemical Biology, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, Jilin, 130022, P. R. China
| | - Xiujuan Sun
- Laboratory of Chemical Biology, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, Jilin, 130022, P. R. China
| | - Yuqing Feng
- School of Chemistry and Life Science, Changchun University of Technology, Changchun, Jilin, 130022, P. R. China
| | - Xi Li
- School of Chemistry and Life Science, Changchun University of Technology, Changchun, Jilin, 130022, P. R. China
| | - Haiyuan Zhang
- Laboratory of Chemical Biology, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, Jilin, 130022, P. R. China
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20
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O'Mahoney P, Khazova M, Higlett M, Lister T, Ibbotson S, Eadie E. Use of illuminance as a guide to effective light delivery during daylight photodynamic therapy in the U.K. Br J Dermatol 2017; 176:1607-1616. [DOI: 10.1111/bjd.15146] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2016] [Indexed: 01/06/2023]
Affiliation(s)
- P. O'Mahoney
- Photobiology Unit; NHS Tayside; Ninewells Hospital; Dundee U.K
- The Scottish Photodynamic Therapy Centre; Dundee U.K
- University of Dundee; Dundee U.K
| | | | | | - T. Lister
- Salisbury NHS Foundation Trust; Salisbury U.K
| | - S. Ibbotson
- Photobiology Unit; NHS Tayside; Ninewells Hospital; Dundee U.K
- The Scottish Photodynamic Therapy Centre; Dundee U.K
- University of Dundee; Dundee U.K
| | - E. Eadie
- Photobiology Unit; NHS Tayside; Ninewells Hospital; Dundee U.K
- The Scottish Photodynamic Therapy Centre; Dundee U.K
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21
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Wilkie R, Ibbotson S. Patient satisfaction in the photodynamic therapy clinic. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2015; 32:44-7. [DOI: 10.1111/phpp.12218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 01/07/2023]
Affiliation(s)
- Rachel Wilkie
- Photobiology Unit; Dermatology Department; Ninewells Hospital & Medical School; Dundee UK
| | - Sally Ibbotson
- Photobiology Unit; Dermatology Department; Ninewells Hospital & Medical School; Dundee UK
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22
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Combined Treatments with Photodynamic Therapy for Non-Melanoma Skin Cancer. Int J Mol Sci 2015; 16:25912-33. [PMID: 26516853 PMCID: PMC4632833 DOI: 10.3390/ijms161025912] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 09/28/2015] [Accepted: 10/20/2015] [Indexed: 12/11/2022] Open
Abstract
Non-melanoma skin cancer (NMSC) is the most common form of cancer in the Caucasian population. Among NMSC types, basal cell carcinoma (BCC) has the highest incidence and squamous cell carcinoma (SCC) is less common although it can metastasize, accounting for the majority of NMSC-related deaths. Treatment options for NMSC include both surgical and non-surgical modalities. Even though surgical approaches are most commonly used to treat these lesions, Photodynamic Therapy (PDT) has the advantage of being a non-invasive option, and capable of field treatment, providing optimum cosmetic outcomes. Numerous clinical research studies have shown the efficacy of PDT for treating pre-malignant and malignant NMSC. However, resistant or recurrent tumors appear and sometimes become more aggressive. In this sense, the enhancement of PDT effectiveness by combining it with other therapeutic modalities has become an interesting field in NMSC research. Depending on the characteristics and the type of tumor, PDT can be applied in combination with immunomodulatory (Imiquimod) and chemotherapeutic (5-fluorouracil, methotrexate, diclofenac, or ingenol mebutate) agents, inhibitors of some molecules implicated in the carcinogenic process (COX2 or MAPK), surgical techniques, or even radiotherapy. These new strategies open the way to a wider improvement of the prevention and eradication of skin cancer.
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23
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Kanick SC, Davis SC, Zhao Y, Sheehan KL, Hasan T, Maytin EV, Pogue BW, Chapman MS. Pre-treatment protoporphyrin IX concentration in actinic keratosis lesions may be a predictive biomarker of response to aminolevulinic-acid based photodynamic therapy. Photodiagnosis Photodyn Ther 2015; 12:561-6. [PMID: 26480810 DOI: 10.1016/j.pdpdt.2015.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/14/2015] [Accepted: 10/12/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Although aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) photodynamic therapy (PDT) is an effective FDA-approved therapy for actinic keratosis (AK), a substantial fraction of patients (up to 25%) do not respond to treatment. This study examined the feasibility of using pre-treatment measurements of PpIX concentration in AK lesions to predict response of ALA-PpIX PDT. METHODS A non-invasive fiber-optic fluorescence spectroscopy system was used to measure PpIX concentration in patients undergoing standard-of-care ALA-PDT for AK. All patients provided assessments of pain at the time of treatment (n=70), and a subset reported pain and erythema 48-76 h after treatment (n=13). RESULTS PpIX concentration was significantly higher in lesions of patients reporting high levels of pain (VAS score ≥5) immediately after treatment vs. patients reporting pain scores below VAS=5 (p<0.022) (n=70). However, pain was not an exclusive indicator of PpIX concentration as many patients with low PpIX concentration reported high pain. In a subpopulation of patients surveyed in the days after treatment (n=13), PpIX concentration measured on the day of treatment was uncorrelated with pain-reported immediately after treatment (r=0.17, p<0.57), but positive correlations were found between PpIX concentration and patient-reported pain (r=0.55, p<0.051) and erythema (r=0.58, p<0.039) in the 48-72 h following treatment. CONCLUSIONS These data suggest that in vivo optical measurements of PpIX concentration acquired before light delivery may be an objective predictor of response to ALA-PpIX PDT. Identification of non-responding patients on the day of treatment could facilitate the use of interventions that may improve outcomes.
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Affiliation(s)
- S C Kanick
- Thayer School of Engineering, Dartmouth College, Hanover, USA; Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon NH, USA.
| | - S C Davis
- Thayer School of Engineering, Dartmouth College, Hanover, USA; Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon NH, USA
| | - Y Zhao
- Thayer School of Engineering, Dartmouth College, Hanover, USA
| | - K L Sheehan
- Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, USA
| | - T Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, USA
| | - E V Maytin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, USA; Biomedical Engineering, Cleveland Clinic, Cleveland, USA
| | - B W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, USA; Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon NH, USA; Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, USA; Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, USA
| | - M S Chapman
- Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, USA
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24
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Affiliation(s)
- R.S. Dawe
- Photobiology Unit; Department of Dermatology; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
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25
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Kellner C, Bauriedl S, Hollstein S, Reinhold U. Simulated-daylight photodynamic therapy with BF-200 aminolaevulinic acid for actinic keratosis: assessment of the efficacy and tolerability in a retrospective study. Br J Dermatol 2015; 172:1146-8. [PMID: 25244353 DOI: 10.1111/bjd.13420] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- C Kellner
- Dermatology Center Bonn Friedensplatz, Bonn, Germany
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26
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A prospective study of pain control by a 2-step irradiance schedule during topical photodynamic therapy of nonmelanoma skin cancer. Dermatol Surg 2015; 40:1390-4. [PMID: 25393353 DOI: 10.1097/dss.0000000000000183] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Topical photodynamic therapy (PDT) for selected nonmelanoma skin cancer using 5-aminolevulinic acid (ALA) or methyl aminolevulinate (MAL) has yielded high long-term complete response rates with very good cosmesis. Pain during light activation of the photosensitizer can be a serious adverse event. A 2-step irradiance protocol has previously been shown to minimize ALA-PDT pain. OBJECTIVE To determine the irradiance-dependent pain threshold for MAL-PDT, to adapt the 2-step protocol to a light-emitting diode (LED) light source, and assess clinical response. METHODS In this prospective study, 25 superficial basal cell carcinoma (sBCC) received an initial irradiance by laser at 40 or 50 mW/cm², or LED at 35 mW/cm² followed by an irradiance at 70 mW/cm² for a total of 75 J/cm². Pain levels were recorded for both irradiance steps. Efficacy was assessed at 6, 12, or 24 months. RESULTS Pain was mild in the 40/70 mW/cm² laser cohort. Three instances of irradiance-limiting pain occurred at 50/70 mW/cm². Pain was minimal in the 35/70 mW/cm² LED cohort. Clinical response rates were 80% in the 50/70 mW/cm² laser cohort and 90% in the 35/70 mW/cm² LED cohort. CONCLUSION Topical PDT can be effectively delivered to sBCC with minimal treatment-related pain by a 2-step irradiance protocol.
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27
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Benov L. Photodynamic therapy: current status and future directions. Med Princ Pract 2015; 24 Suppl 1:14-28. [PMID: 24820409 PMCID: PMC6489067 DOI: 10.1159/000362416] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/24/2014] [Indexed: 12/19/2022] Open
Abstract
Photodynamic therapy (PDT) is a minimally invasive therapeutic modality used for the management of a variety of cancers and benign diseases. The destruction of unwanted cells and tissues in PDT is achieved by the use of visible or near-infrared radiation to activate a light-absorbing compound (a photosensitizer, PS), which, in the presence of molecular oxygen, leads to the production of singlet oxygen and other reactive oxygen species. These cytotoxic species damage and kill target cells. The development of new PSs with properties optimized for PDT applications is crucial for the improvement of the therapeutic outcome. This review outlines the principles of PDT and discusses the relationship between the structure and physicochemical properties of a PS, its cellular uptake and subcellular localization, and its effect on PDT outcome and efficacy.
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Affiliation(s)
- Ludmil Benov
- *Ludmil Benov, Department of Biochemistry, Faculty of Medicine, Kuwait University, PO Box 24923, Safat 13110 (Kuwait), E-Mail
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28
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Daylight-Mediated Photodynamic Therapy in Spain: Advantages and Disadvantages. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2014.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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29
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Pérez-Pérez L, García-Gavín J, Gilaberte Y. Terapia fotodinámica con luz de día en España: ventajas y limitaciones. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:663-74. [DOI: 10.1016/j.ad.2013.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/03/2013] [Accepted: 10/09/2013] [Indexed: 01/10/2023] Open
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30
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Huang N, Zeng J, Liang J, Qiu H, Wang Y, Gu Y. A randomized, double-blind, placebo-controlled study of oral oxycodone plus acetaminophen for the treatment of pain in photodynamic therapy on port wine stains. Photodiagnosis Photodyn Ther 2014; 11:134-40. [DOI: 10.1016/j.pdpdt.2014.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 03/01/2014] [Accepted: 03/05/2014] [Indexed: 01/28/2023]
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31
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Lu YG, Wang YY, Yang YD, Zhang XC, Gao Y, Yang Y, Zhang JB, Li GL. Efficacy of topical ALA-PDT combined with excision in the treatment of skin malignant tumor. Photodiagnosis Photodyn Ther 2014; 11:122-6. [DOI: 10.1016/j.pdpdt.2014.02.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 12/29/2013] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
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32
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Kanick SC, Davis SC, Zhao Y, Hasan T, Maytin EV, Pogue BW, Chapman MS. Dual-channel red/blue fluorescence dosimetry with broadband reflectance spectroscopic correction measures protoporphyrin IX production during photodynamic therapy of actinic keratosis. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:75002. [PMID: 24996661 PMCID: PMC4082494 DOI: 10.1117/1.jbo.19.7.075002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/27/2014] [Indexed: 05/10/2023]
Abstract
Dosimetry for aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) photodynamic therapy of actinic keratosis was examined with an optimized fluorescence dosimeter to measure PpIX during treatment. While insufficient PpIX generation may be an indicator of incomplete response, there exists no standardized method to quantitate PpIX production at depths in the skin during clinical treatments. In this study, a spectrometer-based point probe dosimeter system was used to sample PpIX fluorescence from superficial (blue wavelength excitation) and deeper (red wavelength excitation) tissue layers. Broadband white light spectroscopy (WLS) was used to monitor aspects of vascular physiology and inform a correction of fluorescence for the background optical properties. Measurements in tissue phantoms showed accurate recovery of blood volume fraction and reduced scattering coefficient from WLS, and a linear response of PpIX fluorescence versus concentration down to 1.95 and 250 nM for blue and red excitations, respectively. A pilot clinical study of 19 patients receiving 1-h ALA incubation before treatment showed high intrinsic variance in PpIX fluorescence with a standard deviation/mean ratio of > 0.9. PpIX fluorescence was significantly higher in patients reporting higher pain levels on a visual analog scale. These pilot data suggest that patient-specific PpIX quantitation may predict outcome response.
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Affiliation(s)
- Stephen Chad Kanick
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
- Address all correspondence to: Stephen Chad Kanick, E-mail:
| | - Scott C. Davis
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
| | - Yan Zhao
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114
| | | | - Brian W. Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114
- Department of Surgery, Section of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03766
| | - M. Shane Chapman
- Department of Surgery, Section of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03766
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Barge J, Glanzmann T, Zellweger M, Salomon D, van den Bergh H, Wagnières G. Correlations between photoactivable porphyrins' fluorescence, erythema and the pain induced by PDT on normal skin using ALA-derivatives. Photodiagnosis Photodyn Ther 2013; 10:683-93. [PMID: 24284128 DOI: 10.1016/j.pdpdt.2013.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 08/21/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) with precursors of photoactivable porphyrins is a well-established treatment modality for skin pathologies as well as hair removal. Pain is a major side effect thereof, and it affects the treatment compliance and acceptance. METHODS Five male subjects underwent a PDT procedure on normal skin, either with a diode laser (635 nm) or a lamp (405 nm), 3 or 6h after application of various precursors of photoactivable porphyrins (ALA 1M; Metvix(®) 1M; ALA-DGME 1M; ALA-DGME 3.66 M). Light doses ranged from 30 to 150 J/cm(2) and irradiances were 100 or 180 mW/cm(2). Fluorescence measurements were performed just before PDT, pain was quantified during PDT, and erythema was determined 24h afterwards. RESULTS Because precursor ALA-DGME was very selective for the pilosebaceous apparatus vs. the epidermis, we solely carried out the PDTs using this precursor. In the absence of light, no pain was reported. An increase in pain was observed when increasing the irradiance. A correlation was observed between the follicular fluorescence and the maximal pain score during PDT. A correlation was observed between follicular fluorescence and skin erythema, and between pain score and skin erythema. CONCLUSIONS With our well-controlled PDT parameters and homogenous subjects' conditions, we showed that pain could be reduced by reducing irradiance during PDT procedures. With the various correlations observed, we conclude that both pain and PaP fluorescence are useful tools to predict the post-PDT tissue effects (side effects and outcome). We suggest that A∂ nerve fibres would be the best candidate as first generators of PDT-induced pain.
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Affiliation(s)
- Jérôme Barge
- Photoderma SA, Ch. du Raffort 6, 1055 Froideville, Switzerland.
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Cai H, Wang YX, Sun P, Yang ZY, Tian R, Liu XY, Li Q, Qiao L, Liu W. Photodynamic therapy for facial actinic keratosis: A clinical and histological study in Chinese patients. Photodiagnosis Photodyn Ther 2013; 10:260-5. [DOI: 10.1016/j.pdpdt.2012.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 12/04/2012] [Accepted: 12/05/2012] [Indexed: 12/20/2022]
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Buinauskaite E, Zalinkevicius R, Buinauskiene J, Valiukeviciene S. Pain during topical photodynamic therapy of actinic keratoses with 5-aminolevulinic acid and red light source: randomized controlled trial. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2013; 29:173-81. [DOI: 10.1111/phpp.12044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Evelina Buinauskaite
- Department of Skin and Venereal Diseases; Lithuanian University of Health Sciences, Medical Academy; Kaunas; Lithuania
| | | | - Jurate Buinauskiene
- Medical Academy; Lithuanian University of Health Sciences; Kaunas; Lithuania
| | - Skaidra Valiukeviciene
- Department of Skin and Venereal Diseases; Lithuanian University of Health Sciences, Medical Academy; Kaunas; Lithuania
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Zeitouni NC, Paquette AD, Housel JP, Shi Y, Wilding GE, Foster TH, Henderson BW. A retrospective review of pain control by a two-step irradiance schedule during topical ALA-photodynamic therapy of non-melanoma skin cancer. Lasers Surg Med 2013; 45:89-94. [PMID: 23390058 DOI: 10.1002/lsm.22118] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Photodynamic therapy (PDT) with topical δ-aminolevulinic acid (ALA) of non-melanoma skin cancers is often associated with treatment-limiting pain. A previous study on basal cell carcinomas (BCCs) at Roswell Park Cancer Institute evaluated a two-step irradiance scheme as a means of minimizing pain, preserving outcomes, and limiting treatment time. We used an initial low irradiance until 90% of the protoporphyrin IX was photobleached, followed by a high irradiance interval until the prescribed fluence was delivered. Success of this pilot investigation motivated integration of the protocol into routine practice. Here, we present a retrospective review of recent clinical experience in a broad patient population. STUDY DESIGN/MATERIALS AND METHODS This was a retrospective review of an existing dermatology database. Fourteen caucasion patients-nine men and five women, ages 18-80, with a total of 51 superficial and 73 nodular BCCs, and three Bowen's disease lesions-were included. ALA was applied to each lesion for approximately 4 hours. Lesions received an initial irradiance of 30-50 mW/cm(2) for 20 J/cm(2) , followed by 150 mW/cm(2) for a total fluence of 200-300 J/cm(2) . Pain was assessed using a visual analog scale (VAS). Clinical outcome was determined at 6-12 months. RESULTS Median VAS scores were 1.0 for both irradiances. Five of 127 lesions required pain control with 1% xylocaine. Pain was strongly influenced by lesion location but not by lesion type, number, or size. Complete responses were achieved in 84.1% of BCCs, which compares favorably with reported results for single ALA-PDT treatments. Two of three Bowen's disease lesions showed a complete response. Complete responses for nodular BCCs were 37%, which are also within the range of reported outcomes. CONCLUSIONS A two-step irradiance protocol in ALA-PDT effectively minimizes pain, maintains excellent clinical outcomes in superficial lesions, and adds minimal treatment time.
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Affiliation(s)
- Nathalie C Zeitouni
- Department of Dermatology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Ibbotson SH, Valentine R, Hearn R. Is the pain of topical photodynamic therapy with methyl aminolevulinate any different from that with 5-aminolaevulinic acid? PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2013; 28:272-3. [PMID: 22971196 DOI: 10.1111/j.1600-0781.2012.00684.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Topical photodynamic therapy (PDT) using 5-aminolaevulinic acid (ALA) or methyl aminolevulinate (MAL) is widely used in dermatology. It is commonly stated that MAL PDT is less painful than ALA PDT, although published data are conflicting. We report our experience of the use of ALA (4-6 h) (n = 20) and MAL (3 h) (n = 20) in 40 consecutive patients with Bowen's disease or superficial basal cell carcinoma, treated with PDT using an identical irradiation regime. Although there was a trend to higher pain scores with ALA PDT [visual analogue scale (VAS)score, median 4.50], this was not significantly different from that of MAL PDT (VAS score, median 3.55; P = 0.98), nor considered to be clinically important. Importantly, both ALA and MAL PDT regimes were fairly well tolerated in this patient cohort, supporting the use of these prodrugs in dermatological PDT.
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Affiliation(s)
- Sally H Ibbotson
- Photobiology Unit, Department of Dermatology, Ninewells Hospital & Medical School, Dundee, UK.
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Reelfs O, Karran P, Young AR. 4-Thiothymidine sensitization of DNA to UVA offers potential for a novel photochemotherapy. Photochem Photobiol Sci 2012; 11:148-54. [PMID: 22044942 DOI: 10.1039/c1pp05188a] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 09/23/2011] [Indexed: 02/11/2024]
Abstract
Photochemotherapy, in which ultraviolet radiation (UVR: 280-400 nm) or visible light is combined with a photosensitizing drug to produce a therapeutic effect that neither drug or radiation can achieve alone, is a proven therapeutic strategy for a number of non-malignant hyperproliferative skin conditions and various cancers. Examples are psoralen plus UVA (320-400 nm) radiation (PUVA) and photodynamic therapy (PDT). All existing photochemotherapies have drawbacks - for example the association of PUVA with the development of skin cancer, and pain that is often associated with PDT treatment of skin lesions. There is a clear need to develop alternative approaches that involve lower radiation doses and/or improved selectivity for target cells. In this review, we explore the possibility to address this need by exploiting thionucleoside-mediated DNA photosensitisation to low, non toxic doses of UVA radiation.
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Affiliation(s)
- Olivier Reelfs
- King's College London, King's College London School of Medicine, Division of Genetics and Molecular Medicine, St John's Institute of Dermatology, London, UK SE19RT.
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