Quinolone antibacterials: a new class of photochemical carcinogens

Photosensitization Reactions of Biomolecules: Definition, Targets and Mechanisms

Photosensitization reactions have been demonstrated to be largely responsible for the deleterious biological effects of UV and visible radiation, as well as for the curative actions of photomedicine. A large number of endogenous and exogenous photosensitizers, biological targets and mechanisms have been reported in the past few decades. Evolving from the original definitions of the type I and type II photosensitized oxidations, we now provide physicochemical frameworks, classifications and key examples of these mechanisms in order to organize, interpret and understand the vast information available in the literature and the new reports, which are in vigorous growth. This review surveys in an extended manner all identified photosensitization mechanisms of the major biomolecule groups such as nucleic acids, proteins, lipids bridging the gap with the subsequent biological processes. Also described are the effects of photosensitization in cells in which UVA and UVB irradiation triggers enzyme activation with the subsequent delayed generation of superoxide anion radical and nitric oxide. Definitions of photosensitized reactions are identified in biomolecules with key insights into cells and tissues.

The frequency of photosensitizing drug dispensings in Austria and Germany: a correlation with their photosensitizing potential based on published literature

Background

Drug‐induced photosensitivity refers to the development of cutaneous adverse events due to interaction between a pharmaceutical compound and sunlight. Although photosensitivity is a very commonly listed side‐effect of systemic drugs, reliable data on its actual incidence are lacking so far.

Objectives

A possible approach to evaluate the real‐life extent of drug‐induced photosensitivity would be an analysis of the frequency of exposure to a given photosensitizing drug combined with an indicator of its photosensitizing potential. This could serve as a basis for developing a pharmaceutical ‘heatmap’ of photosensitivity.

Methods

The present study investigated the number of reimbursed dispensed packages of potentially photosensitizing drugs in Germany (DE) and Austria (AT) between 2010 and 2017 based on nationwide health insurance‐based databases. In addition, an indicator for the photosensitizing potential was established for each drug based on the number of reports on photosensitivity in the literature.

Results

This analysis includes means of 632 826 944 (+/−14 894 918) drug dispensings per year in DE and 113 270 754 (+/−1 964 690) in AT. Out of these, the mean percentage of drugs that enlist photosensitivity as a potential side‐effect was 49.5% (±0.7) in DE and 48.2% (±1.2) in AT. When plotting the number of reimbursed dispensed packages vs. the number of reports on photosensitivity, two categories of drugs show high numbers for both parameters, that is diuretics and non‐steroidal anti‐inflammatory drugs (NSAIDs).

Conclusions

Diuretics and NSAIDs appear to be responsible for the greatest part of exposure to photosensitizing drugs with potential implication on public health.

A calix[4]arene-based ternary supramolecular nanoassembly with improved fluoroquinolone photostability and enhanced NO photorelease

Micellar-like nanoassemblies of a sulfonate amphiphilic calix[4]arene (1) are able to effectively co-entrap the fluoroquinolone antibacterial norfloxacin (2) and a hydrophobic nitric oxide (NO) photodonor (3), leading to a ternary supramolecular complex having a diameter of ca. 150 nm and a zeta potential of -48 mV. Outstanding photochemical stabilization of the otherwise photolabile fluoroquinolone 2 is observed under UVA excitation. Besides, visible light excitation leads to a remarkable enhancement of the NO photorelease efficiency of 3. Both the results can be explained on the basis of a "cage effect" of the micellar host that, in the case of 2, hinders the formation of the precursor complex responsible for the photodegradation, whereas in the case of 3 it provides a low polarity environment and easily abstractable hydrogens, which facilitate the radical-mediated mechanism involved in NO photorelease. Therefore, this supramolecular ternary nanoassembly simultaneously overcomes the main limitations of the free individual guests such as photolability and low photoreactivity. In view of the well-known antibacterial properties of the NO radical and the biocompatibility of the calixarene host, this nanoassembly represents a suitable bimodal system to be tested in antibacterial research.

Drug and chemical induced photosensitivity from a clinical perspective

Drug photosensitivity is a relatively common occurrence and a range of mechanisms may be involved. Some of these mechanisms will be discussed, including the most common, that of drug phototoxicity. Different types of photosensitivity are addressed with respect to clinical presentation, mechanisms and additionally the contribution to our understanding through clinically directed investigations and regulatory requirements. Repeated controlled therapeutic use of drug phototoxicity, with psoralen-UVA (PUVA) photochemotherapy and photodynamic therapy (PDT) will also be discussed. Finally, the potential for drug-induced photocarcinogenesis will also be covered.

Natural extracellular nanovesicles and photodynamic molecules: is there a future for drug delivery?

Photodynamic molecules represent an alternative approach for cancer therapy for their property (i) to be photo-reactive; (ii) to be not-toxic for target cells in absence of light; (iii) to accumulate specifically into tumour tissues; (iv) to be activable by a light beam only at the tumour site and (v) to exert cytotoxic activity against tumour cells. However, to date their clinical use is limited by the side effects elicited by systemic administration. Extracellular vesicles are endogenous nanosized-carriers that have been recently introduced as a natural delivery system for therapeutic molecules. We have recently shown the ability of human exosomes to deliver photodynamic molecules. Therefore, this review focussed on extracellular vesicles as a novel strategy for the delivery of photodynamic molecules at cancer sites. This completely new approach may enhance the delivery and decrease the toxicity of photodynamic molecules, therefore, represent the future for photodynamic therapy for cancer treatment.

Oxidatively-generated damage to DNA and proteins mediated by photosensitized UVA

UVA accounts for about 95% of the solar ultraviolet (UV) radiation that reaches Earth and most likely contributes to human skin cancer risk. In contrast to UVB, which comprises the remaining 5% and is absorbed by DNA nucleobases to cause direct photodamage, UVA damages DNA indirectly. It does this largely through its interactions with cellular chromophores that act as photosensitisers to generate reactive oxygen species. Exogenously supplied chemicals, including some widely-prescribed medicines, may also act as photosensitisers and these drugs are associated with an increased risk of sun-related cancer. Because they amplify the effects of UVA on cells, they provide a means to investigate the mechanisms and effects of UVA-induced photodamage. Here, we describe some of the major lesions induced by two groups of UVA photosensitisers, the DNA thionucleotides and the fluoroquinolone antibiotics. In thionucleotides, replacement of the oxygen atoms of canonical nucleobases by sulfur converts them into strong UVA chromophores that can be incorporated into DNA. The fluoroquinolones are also UVA chromophores. They are not incorporated into DNA and induce a different range of DNA damages. We also draw attention to the potentially important contribution of photochemical protein damage to the cellular effects of photosensitised UVA. Proteins targeted for oxidation damage include DNA repair factors and we suggest that UVA-mediated protein damage may contribute to sunlight-induced cancer risk.

Time-Resolved Spectroscopic Study of the Defluorination and Cyclization Reactions of Lomefloxacin in Water

The mechanism of the defluorination reaction(s) of lomefloxacin (LF) upon light illumination was investigated by using ultrafast laser flash photolysis combined with transient resonance Raman spectroscopy in near neutral water solution. The zwitterionic configuration of LF was determined to be the main species present in the near neutral water solution and was the species that was photoexcited to initiate the photochemical reaction. Femtosecond transient absorption revealed that the first excited singlet state (S₁) of LF did not appreciably undergo intersystem crossing (ISC), and instead partially decayed to the ground state via fluorescence emission, and there was partial cleavage of the carbon-fluorine bond at position 8 to produce a singlet LF aryl cation intermediate. The transient resonance Raman results provided a direct observation and vibrational spectral characterization of the singlet LF aryl cation species. Subsequently, the transformation from the singlet LF aryl cation to a triplet carbene via an ISC process was seen in nanosecond transient absorption spectra. Finally, the triplet carbene experienced a cyclization reaction with the N-ethyl chain to form a tricyclic product.

Does Photosensitivity Predict Photococarcinogenicity?

Assessment of short-term and long-term effects of light (pho—totesting) is part of the safety evaluation of drugs. Results are incorporated into drug package inserts to advise patients and health care providers about the use of drug products on sun—exposed skin. We undertook an exhaustive literature search and a search of archived studies at the Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), in order to evaluate the potential of short—term photoassays to predict long—term effects of drugs used in sunlight (280–700 nm). The correlation between the findings from the photococarcinogenicity assays in mice that used exposure to simulated sunlight and those from photogenotoxicity and photosensitivity studies was examined. Results indicated that photosensitivity and photogenotoxicity assays did not necessarily predict effects in photococarcinogenicity studies in mice. Effects of drugs on skin that are not due to photoactivation of drug can be important factors in enhancement of UV—induced skin carcinogenesis.

Assays for Photocarcinogenesis: Relevance of Animal Models

In the three and a half decades since the first published reports of squamous cell carcinomas in the skin of hairless mice exposed to ultraviolet radiation, this animal model has been developed and utilized extensively in basic and applied photobiology. Quantitative aspects of photocarcinogenesis had been investigated initially in haired mice; subsequently, the discipline of photoimmunology has developed largely on the basis of information derived from haired animals. Classical selective breeding methods, a few fortuitous mutations along the way, and the advent of genetic engineering have all enhanced the utility of the laboratory animal models. The benefits have included advances in our understanding of many influences on photocarcinogenesis such as genetic diversity, animal age, epidermal DNA damage and repair, wavelength dependency (action spectrum), ultraviolet radiation dose and its delivery, interactions with chemicals, and nutrition. As in other fields of basic and biomedical research, photobiological data have not been considered journalistically newsworthy or particularly contentious until they acquired potential economic impact. Thus, photocarcinogenesis became a more familiar word (at least along the Washington Beltway) when stratospheric ozone first appeared to be threatened by chlorofluorocarbons, and trends in photocarcinogenesis seemed less arcane when it appeared that the trends might be modified by consumer products and pharmaceuticals. The greatest challenge has not been in finding imaginative ways to exploit the models and to push the frontiers of science, but rather has been the uncertainty about quantitatively extrapolating the findings to humans. Research models would hardly be useful if they were not different from people (i.e., smaller, quicker to respond, shorter lived), and that fact encompasses differences in anatomy, physiology, metabolism, surface-to-weight ratios, etc. Selected examples from photomedicine (e.g., chronic solar damage, occupational exposure to tar, psoriasis phototherapy) tend to confirm that several basic principles about photocarcinogenesis are shared by man and mouse; other risk assessments await development and refinement, or remain to be corrected by experience.

DNA repair inhibition by UVA photoactivated fluoroquinolones and vemurafenib

Cutaneous photosensitization is a common side effect of drug treatment and can be associated with an increased skin cancer risk. The immunosuppressant azathioprine, the fluoroquinolone antibiotics and vemurafenib—a BRAF inhibitor used to treat metastatic melanoma—are all recognized clinical photosensitizers. We have compared the effects of UVA radiation on cultured human cells treated with 6-thioguanine (6-TG, a DNA-embedded azathioprine surrogate), the fluoroquinolones ciprofloxacin and ofloxacin and vemurafenib. Despite widely different structures and modes of action, each of these drugs potentiated UVA cytotoxicity. UVA photoactivation of 6-TG, ciprofloxacin and ofloxacin was associated with the generation of singlet oxygen that caused extensive protein oxidation. In particular, these treatments were associated with damage to DNA repair proteins that reduced the efficiency of nucleotide excision repair. Although vemurafenib was also highly phototoxic to cultured cells, its effects were less dependent on singlet oxygen. Highly toxic combinations of vemurafenib and UVA caused little protein carbonylation but were nevertheless inhibitory to nucleotide excision repair. Thus, for three different classes of drugs, photosensitization by at least two distinct mechanisms is associated with reduced protection against potentially mutagenic and carcinogenic DNA damage.

Voriconazole-induced photosensitivity: photobiological assessment of a case series of 12 patients

BACKGROUND

Voriconazole, a broad-spectrum triazole antifungal agent increasingly used to treat aspergillosis, has been linked with acute photosensitivity and skin carcinogenesis. The action spectrum of the photosensitivity is unknown, while an indirect retinol effect secondary to the antifungal's impact on CYP450 enzymes has been proposed to contribute to the underlying mechanism.

OBJECTIVES

To perform a detailed photobiological assessment of the photosensitivity presenting in a series of 12 patients treated with voriconazole.

METHODS

Minimal erythemal dose thresholds (MED) to narrow wavebands of ultraviolet (UV) A, UVB and visible light were determined. Provocation testing was performed to broadband UVA (310-400 nm) and to solar-simulated radiation (SSR) (290-400 nm). Patients underwent routine photopatch testing and laboratory investigations including serum vitamin A (retinol).

RESULTS

Patients (eight men, four women; median age 54years, range 40-63) experienced moderate-severe cutaneous erythema (n = 12), burning pain (n=5), itching (n=3), scaling (n=5), vesiculation (n=5) and oedema (n=1) following sunlight exposure; increased lentigines (n=4) and actinic cheilitis (n = 4) were also observed. While the majority (n=8) of patients showed normal MED thresholds to monochromator phototesting to UVB, UVA and visible light, a low MED to UVA was observed in four patients. Repeated provocation testing with broadband UVA and SSR provoked an abnormal erythema in eight and 10 patients, respectively. Serum retinol levels were mildly elevated in two patients but normal in the majority.

CONCLUSION

 UVA sensitivity is the predominant finding in acute voriconazole-induced photosensitivity. We found little evidence of elevated circulating retinol as the causal factor. Patients with voriconazole-induced photosensitivity require education in appropriate UVA protective measures in addition to consideration of skin surveillance for malignant sequelae.

Photochemical properties and phototoxicity of Pazufloxacin: a stable and transient study

Photochemical properties and phototoxicity of Pazufloxacin (PAX) were systematically investigated in aqueous solutions using UV-Vis, fluorescence, laser flash photolysis, pulse radiolysis and SDS-PAGE gel electrophoresis techniques. PAX triplet-state ((3)PAX(*)) absorption spectra (λ(max)=570 nm) was determined. (3)PAX(*) was quenched by PAX and O(2), with rate constants of 6.9×10(8) and 3.2×10(8) dm(3) mol(-1) s(-1), respectively. The pK(a) values (5.7 and 8.6) for the protonation equilibrium were determined by UV-Vis and fluorescence techniques. The PAX triplet energy (E(T)=260.3 kJ/mol) was obtained using energy transfer method. The reaction of electron transfer from tryptophan (TrpH) and dGMP to (3)PAX(*) was found with rate constants of 8.8×10(7) and 8.7×10(6) dm(3) mol(-1) s(-1), respectively. The rate constants for reactions of ()OH, SO(4)(-) and hydrated electron with PAX were found to be 5.8×10(8), 2.1×10(9) and 9×10(9)d m(3) mol(-1) s(-1), respectively. Based on the results obtained, a rational scheme for dGMP, TrpH and lysozyme photodamage induced by PAX was proposed.

Ciprofloxacin photosensitized oxidation of 2'-deoxyguanosine-5'-monophosphate in neutral aqueous solution

Laser flash photolysis studies have been carried out to investigate the reactions of ciprofloxacin (CPX) with 2'-deoxyguanosine-5'-monophosphate (dGMP), N, N, N', N'-tetramethyl-p-phenylenediamine (TMPD) and ferulic acid (FCA) in neutral aqueous solutions, respectively. CPX triplet state ((3)CPX*) can be quenched by TMPD, FCA and dGMP, with rate constants of 1.8 × 10(9), 1.5 × 10(9) and 5.8 × 10(7) dm(3) mol(-1) s(-1), respectively. TMPD radical cation (TMPD(·+)) and FCA radical cation (FCA(·+)) were observed directly. The formation rate of CPX radical anion (CPX(·-)) was determined to be 1.5 × 10(9) dm(3) mol(-1) s(-1). Redox reaction of dGMP was investigated through competing reactions using TMPD and FCA as probe. The triplet energy of CPX was determined to be 262 kJ mol(-1). Electron transfer from TMPD, FCA and dGMP to (3)CPX* was proposed.

UVA1 induces cyclobutane pyrimidine dimers but not 6-4 photoproducts in human skin in vivo

UVB readily induces cyclobutane pyrimidine dimers, mainly thymine dimers (TTs), and pyrimidine (6-4) pyrimidone photoproducts (6-4PPs) in DNA. These lesions result in "UVB signature mutations" found in skin cancers. We have investigated the induction of TTs and 6-4PPs in human skin in vivo by broadband UVA1, and have compared this with comparable erythemal doses of monochromatic UVB (300 nm). In vitro and ex vivo studies have shown the production of TTs, without 6-4PPs, by UVA1. We show that UVA1 induces TTs, without 6-4PPs, in the epidermis of healthy volunteers in vivo, whereas UVB induced both photoproducts. UVB induced more TTs than UVA1 for the same level of erythema. The level of UVA1-induced TTs increased with epidermal depth in contrast to a decrease that was seen with UVB. UVA1- and UVB-induced TTs were repaired in epidermal cells at a similar rate. The mechanism by which UVA1 induces TTs is unknown, but a lack of intra-individual correlation between our subjects' UVB and UVA1 minimal erythema doses implies that UVA1 and UVB erythema occur by different mechanisms. Our data suggest that UVA1 may be more carcinogenic than has previously been thought.

Photosensitization induced by the antibacterial fluoroquinolone Rufloxacin leads to mutagenesis in yeast

Rufloxacin (RFX) is an antibacterial fluoroquinolone that exhibits UVA photosensitization properties. Photosensitization reactions lead to the formation of oxidative damage, mainly via singlet oxygen. Here we explore the phototoxic and photomutagenic potency of RFX using a panel of yeast (Saccharomyces cerevisiae) mutants affected in different DNA repair pathways. Yeast mutants provide a sensitive tool to identify the photodamage and the DNA repair pathways that cope with it. Cell viability test at increasing dose of UVA shows that both the DNA repair deficient and wild type cells are equally sensitive to RFX-induced photosensitization, demonstrating that phototoxic effect is not due to DNA injury. Photomutagenicity of RFX is evaluated by measuring the frequency of forward Can(R) mutations. The mutation induction is low in wild type cells. A high increase in mutation frequency is observed in strains affected in Ogg1 gene, compared to wild type and other base excision repair deficient strains. The mutation spectrum photomediated by RFX in wild type cells reveals a bias in favour of GC>TA transversions, whereas transition and frameshift mutations are less represented. Altogether data demonstrates that 8-oxo-7,8-dihydroguanine (8-oxoGua) is by far the major DNA damage produced by RFX photosensitization, leading to mutagenesis. We also explore the role played by DNA mismatch repair, translesion synthesis and post-replication repair in the prevention of mutagenic effects due to RFX exposure. In addition, we show that most of RFX photodegradation products are not mutagenic. This study defines the phototoxic and photomutagenic properties of antibacterial RFX and point out possible unwanted side effects in skin under sunlight.

Cyclobutane pyrimidine dimers are photosensitised by carprofen plus UVA in human HaCaT cells

Every year in the UK about 75,000 cases of non-melanoma skin cancer (NMSC) are registered, and about 9500 people are diagnosed with cutaneous melanoma (CM). The main risk factor for these cancers is exposure to sunlight. The effects of light on skin are wavelength dependent, with wavelengths in the UVB waveband (280-315 nm) being the most carcinogenic. UVB is directly absorbed by DNA, producing dimeric pyrimidine photoproducts including cyclobutane pyrimidine dimers (CPD) and pyrimidine (6-4) pyrimodone photoproducts (6-4PP). However UVA (315-400 nm) can also produce CPD, induce skin tumours in mice, and has been shown to be mutagenic in cell culture. Although the precise role of UVA in human skin cancer remains to be elucidated, it comprises the major portion of solar UV radiation, transmits through window glass and can be delivered in high doses from tanning lamps. Non-steroidal anti-inflammatory drugs (NSAIDs), in particular the 2-aryl propionic acid derivatives, are a well-documented group of photosensitising chemicals producing clinical phototoxic and photoallergic reactions. We have used carprofen, a model compound from this group to see if it could amplify the effects of UVA and contribute to the formation of CPD by UVA. Preliminary work has shown that carprofen combined with low doses of UVA (lambda(max): 365 nm; 5 J/cm(2)) can produce both strand breaks (SB) and CPD in human skin or blood cells. CPD were detected indirectly by both an immunofluorescence method and as T4 endonuclease V sensitive sites in the comet assay. These findings show that compounds other than fluoroquinolones and psoralen derivatives may contribute to CPD formation in skin cells in combination with UVA.

Use of centromeric and telomeric DNA probes in in situ hybridization for differentiation of micronuclei induced by lomefloxacin

Classification of micronuclei induced by lomefloxacin, a difluorinated quinolone bactericidal agent, in mouse bone marrow was performed by fluorescence in situ hybridization using DNA probes for the centromere repeated minor satellite DNA and the telomeric hexamer repeat (5'-TTAGGG-3'). Colchicine and mitomycin C were used as a positive control aneugen and clastogen, respectively, and these compounds produced the expected responses. Single doses of 40, 80, 160, or 320 mg/kg lomefloxacin were given via oral intubations and bone marrow was sampled at 24 and 48 hr after treatment. The micronuclei showed significant increases in both sampling times after doses of 320 mg/kg. A statistically significant increase of micronuclei frequency was also detected for 160 mg/kg lomefloxacin at 48 hr after treatment. The responses were directly correlated with bone-marrow cytotoxicity. Following treatment with 160 and 320 mg/kg lomefloxacin, 48.2 and 50.0% of the induced micronuclei, respectively, showed double labeling with centromeric signals and several telomeric signals, indicating that the induced micronuclei were composed of whole chromosomes. Similarly, 51.8 and 50.0% of the induced micronuclei, respectively, were centromere-negative, demonstrating that lomefloxacin not only induces chromosome loss but also chromosome breakage. The results also showed that chromosomes can be enclosed in a micronucleus before and after centromere separation. Overall, this study provides the first evidence of the potential of lomefloxacin to induce aneugenic effect in mice. However, given the high doses used in this study, the clinical significance of this finding is uncertain.

Photosensitized DNA damage: the case of fluoroquinolones

This review focuses on DNA damage photosensitized by the fluoroquinolone (FQ) antibacterial drugs. The in vivo evidence for photocarcinogenesis mediated by FQs is presented in the introduction. The different methods employed for detection of DNA-photodamage mediated by FQs are then summarized, including gel electrophoresis (with whole cells, with isolated DNA and with oligonucleotides) and chromatographic analysis (especially HPLC with electrochemical and MS/MS detection). The chemical mechanisms involved in the formation of the reported lesions are discussed on the basis of product studies and transient spectroscopic evidence. In general, the literature coverage is limited to the last decade, although some earlier citations are also included.

The photo comet assay—A fast screening assay for the determination of photogenotoxicity in vitro

Different classes of chemicals can induce a phototoxic effect by absorbing light energy within the wavelength range of sunlight. The assessment of photo-safety is therefore an obligatory part of the development of new drugs. Ten UV-vis (280-800nm)-absorbing compounds (ketoprofen, promazine, chlorpromazine, dacarbazine, acridine, lomefloxacin, 8-methoxypsoralen, chlorhexidine, titanium dioxide, octylmethoxycinnamate) were tested for their photogenotoxic potential in the alkaline comet assay in the presence and absence of UV-vis. In order to establish an easy and timesaving protocol for a photo comet assay screening test, the application of 96-well plates was essential. The use of mouse lymphoma L5178Y cells, a cell line growing in suspension, allowed the determination of photocytotoxicity with the Alamar Blue assay and of photogenotoxicity with the alkaline comet assay in parallel. L5178Y cells were incubated with the test compounds for 20min and irradiated with simulated sunlight in the wavelength range from 280 to 800nm. The applied UV dose was 600mJ/cm(2) UV-A and 30mJ/cm(2) UV-B. After a post-incubation of 10min, the Alamar Blue assay and the alkaline comet assay were performed. All of the compounds which are known to be photogenotoxic (8-methoxypsoralen, acridine, chlorpromazine, dacarbazine, ketoprofen, lomefloxacin) showed a positive effect under our assay conditions. Furthermore, four UV-vis absorbing chemicals which are known to be not photogenotoxic (promazine, chlorhexidine, titanium dioxide, octylmethoxycinnamate) were analysed. For none of them an increase of the DNA damage following irradiation was observed in this study. In conclusion, all of the chemical compounds tested were classified in agreement with published data. From the data presented it is concluded that the photo comet assay with L5178Y mouse lymphoma cells is a reliable model to assess photochemical genotoxicity in vitro.

Pharmacokinetic and Molecular Biological Approaches to Achieve the Safety and Effective Management of Drug Therapies

To prevent medical errors, especially drug-related ones, clinical pharmacists have to play an important role in multidisciplinary team care. We have investigated the pharmacokinetics, pharmacodynamics, and molecular biology of several drugs and have applied the findings obtained in our studies to therapeutic drug monitoring. The first finding is that achieving vancomycin (VCM) concentrations at an appropriate concentration contributes to a decreased incidence of VCM-induced nephrotoxicity and a decreased duration of VCM therapy. From this result, we have constructed a system to provided recommendations for VCM doses to attending medical staff as soon as possible. The second finding is that we clarified the risk factors for steroid-induced diabetes in patients with neurologic diseases, indicating a close relationship among postprandial hyperglycemia, advanced age, and hypercholesterolemia in these patients. We also determined that monitoring plasma glucose concentrations 2 hours after lunch could be useful to detect diabetes in these patients. Finally, we identified the mechanism of 3'-azido-3'-deoxythymidine and dacarbazine photogenotoxicity, including the specific site of DNA damage. These findings may provide useful information to prevent phototoxicity of drugs and to develop new photodynamic therapies.

Photosensitized DNA Damage and its Protection via a Novel Mechanism†

UVA, which accounts for approximately 95% of solar UV radiation, can cause mutations and skin cancer. Based mainly on the results of our study, this paper summarizes the mechanisms of UVA-induced DNA damage in the presence of various photosensitizers, and also proposes a new mechanism for its chemoprevention. UVA radiation induces DNA damage at the 5'-G of 5'-GG-3' sequence in double-stranded DNA through Type I mechanism, which involves electron transfer from guanine to activated photosensitizers. Endogenous sensitizers such as riboflavin and pterin derivatives and an exogenous sensitizer nalidixic acid mediate DNA photodamage via this mechanism. The major Type II mechanism involves the generation of singlet oxygen from photoactivated sensitizers, including hematoporphyrin and a fluoroquinolone antibacterial lomefloxacin, resulting in damage to guanines without preference for consecutive guanines. UVA also produces superoxide anion radical by an electron transfer from photoexcited sensitizers to oxygen (minor Type II mechanism), and DNA damage is induced by reactive species generated through the interaction of hydrogen peroxide with metal ions. The involvement of these mechanisms in UVA carcinogenesis is discussed. In addition, we found that xanthone derivatives inhibited DNA damage caused by photoexcited riboflavin via the quenching of its excited triplet state. It is thus considered that naturally occurring quenchers including xanthone derivatives may act as novel chemopreventive agents against photocarcinogenesis.