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Georges JF, Valeri A, Wang H, Brooking A, Kakareka M, Cho SS, Al-Atrache Z, Bamimore M, Osman H, Ifrach J, Yu S, Li C, Appelt D, Lee JYK, Nakaji P, Brill K, Yocom S. Delta-Aminolevulinic Acid-Mediated Photodiagnoses in Surgical Oncology: A Historical Review of Clinical Trials. Front Surg 2019; 6:45. [PMID: 31555659 PMCID: PMC6737001 DOI: 10.3389/fsurg.2019.00045] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/17/2019] [Indexed: 12/11/2022] Open
Abstract
Fluorescence imaging is an emerging clinical technique for real-time intraoperative visualization of tumors and their boundaries. Though multiple fluorescent contrast agents are available in the basic sciences, few fluorescence agents are available for clinical use. Of the clinical fluorophores, delta aminolevulinic acid (5ALA) is unique for generating visible wavelength tumor-specific fluorescence. In 2017, 5ALA was FDA-approved for glioma surgery in the United States. Additionally, clinical studies suggest this agent may have utility in surgical subspecialties outside of neurosurgery. Data from dermatology, OB/GYN, urology, cardiothoracic surgery, and gastrointestinal surgery show 5ALA is helpful for intraoperative visualization of malignant tissues in multiple organ systems. This review summarizes data from English-language 5ALA clinical trials across surgical subspecialties. Imaging systems, routes of administration, dosing, efficacy, and related side effects are reviewed. We found that modified surgical microscopes and endoscopes are the preferred imaging devices. Systemic dosing across surgical specialties range between 5 and 30 mg/kg bodyweight. Multiple studies discussed potential for skin irritation with sun exposure, however this side effect is infrequently reported. Overall, 5ALA has shown high sensitivity for labeling malignant tissues and providing a means to visualize malignant tissue not apparent with standard operative light sources.
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Affiliation(s)
- Joseph F Georges
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States.,Department of Neurosurgery, Cooper University Healthcare, Philadelphia, PA, United States
| | - Amber Valeri
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States.,Department of Neurosurgery, Cooper University Healthcare, Philadelphia, PA, United States
| | - Huan Wang
- School of Medicine, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Aaron Brooking
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States.,Department of Neurosurgery, Cooper University Healthcare, Philadelphia, PA, United States
| | - Michael Kakareka
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States.,Department of Neurosurgery, Cooper University Healthcare, Philadelphia, PA, United States
| | - Steve S Cho
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Zein Al-Atrache
- School of Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States
| | - Michael Bamimore
- School of Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States
| | - Hany Osman
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, United States
| | - Joseph Ifrach
- School of Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States
| | - Si Yu
- School of Medicine, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Carrie Li
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Denah Appelt
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States
| | - John Y K Lee
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Peter Nakaji
- Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Kristin Brill
- Department of Surgery, MD Anderson Cancer Center at Cooper Health Systems, Camden, NJ, United States
| | - Steven Yocom
- Department of Neurosurgery, Cooper University Healthcare, Philadelphia, PA, United States
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Larisch P, Verwanger T, Linecker M, Krammer B. The interrelation between a pro-inflammatory milieu and fluorescence diagnosis or photodynamic therapy of human skin cell lines. Photodiagnosis Photodyn Ther 2014; 11:91-103. [DOI: 10.1016/j.pdpdt.2014.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 01/13/2014] [Accepted: 01/16/2014] [Indexed: 01/03/2023]
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In vitro analysis of photosensitizer accumulation for assessment of applicability of fluorescence diagnosis of squamous cell carcinoma of epidermolysis bullosa patients. BIOMED RESEARCH INTERNATIONAL 2012; 2013:521281. [PMID: 23509735 PMCID: PMC3591193 DOI: 10.1155/2013/521281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 08/28/2012] [Accepted: 08/28/2012] [Indexed: 01/04/2023]
Abstract
Epidermolysis bullosa (EB) is a group of inherited skin disorders characterized by blistering following mechanical trauma. Chronic wounds of EB patients often lead to tumors such as squamous cell carcinoma (SCC). Early diagnosis may prevent its invasive growth--frequently the reason of premature mortality of EB-patients. Early detection of tumors is achieved by fluorescence diagnosis (FD), where photosensitizers localize selectively in tumors and fluoresce upon illumination. Excessive accumulation of photosensitizers in inflamed areas, as occasionally found at chronic wounds and tumors due to inflammatory processes, leads to false-positive results in FD. This study analyzed accumulation kinetics of the photosensitizers hypericin and endogenous protoporphyrin IX (PpIX) in different skin cell lines including the three EB subtypes under normal and proinflammatory conditions (stimulated with TNF-alpha). The aim was to assess the applicability of FD of SCC in EB. All cell lines accumulate hypericin or PpIX mostly increasing with incubation time, but with different kinetics. SCC cells of recessive dystrophic EB (RDEB) accumulate less hypericin or PpIX than nonmalignant RDEB cells. Nevertheless, tumor selectivity in vivo might be existent. Non-EB cell lines are more active concerning photosensitizer enrichment. Proinflammatory conditions of skin cell lines seem to have no major influence on photosensitizer accumulation.
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Ishimura N, Amano Y, Appelman HD, Penagini R, Tenca A, Falk GW, Wong RK, Gerson LB, Ramirez FC, Horwhat JD, Lightdale CJ, DeVault KR, Freschi G, Taddei A, Bechi P, Ringressi MN, Castiglione F, Rossi Degl'Innocenti D, Wang HH, Huang Q, Bellizzi AM, Lisovsky M, Srivastava A, Riddell RH, Johnson LF, Saunders MD, Chuttani R. Barrett's esophagus: endoscopic diagnosis. Ann N Y Acad Sci 2011; 1232:53-75. [DOI: 10.1111/j.1749-6632.2011.06045.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ritz R, Feigl GC, Schuhmann MU, Ehrhardt A, Danz S, Noell S, Bornemann A, Tatagiba MS. Use of 5-ALA fluorescence guided endoscopic biopsy of a deep-seated primary malignant brain tumor. J Neurosurg 2011; 114:1410-3. [DOI: 10.3171/2010.11.jns10250] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The introduction of fluorescence-guided resection of primary malignant brain tumors was a milestone in neurosurgery. Deep-seated malignant brain tumors are often not approachable for microsurgical resection. For diagnosis and therapy, new strategies are recommended. The combination of endoscopy and 5-aminolevulinic acid–induced protoporphyrin IX (5-ALA-induced Pp IX) fluorescence–guided procedures supported by neuronavigation seems an interesting option. Here the authors report on a combined approach for 5-ALA fluorescence–guided biopsy in which they use an endoscopy system based on an Xe lamp (excitation approximately λ = 407 nm; dichroic filter system λ = 380–430 nm) to treat a malignant tumor of the thalamus and perform a ventriculostomy and septostomy. The excitation filter and emission filter are adapted to ensure that the remaining visible blue remission is sufficient to superimpose on or suppress the excited red fluorescence of the endogenous fluorochromes. The authors report that the lesion was easily detectable in the fluorescence mode and that biopsy led to histological diagnosis.
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Affiliation(s)
| | | | | | | | | | | | - Antje Bornemann
- 4Institute of Brain Research, University of Tübingen Medical Center, Tübingen; and
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6
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Celli JP, Spring BQ, Rizvi I, Evans CL, Samkoe KS, Verma S, Pogue BW, Hasan T. Imaging and photodynamic therapy: mechanisms, monitoring, and optimization. Chem Rev 2010; 110:2795-838. [PMID: 20353192 PMCID: PMC2896821 DOI: 10.1021/cr900300p] [Citation(s) in RCA: 1605] [Impact Index Per Article: 114.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Jonathan P Celli
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
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Pogue BW, Samkoe KS, Gibbs-Strauss SL, Davis SC. Fluorescent molecular imaging and dosimetry tools in photodynamic therapy. Methods Mol Biol 2010; 635:207-22. [PMID: 20552350 PMCID: PMC3787902 DOI: 10.1007/978-1-60761-697-9_15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Measurement of fluorescence and phosphorescence in vivo is readily used to quantify the concentration of specific species that are relevant to photodynamic therapy. However, the tools to make the data quantitatively accurate vary considerably between different applications. Sampling of the signal can be done with point samples, such as specialized fiber probes or from bulk regions with either imaging or sampling, and then in broad region image-guided manner. Each of these methods is described below, the application to imaging photosensitizer uptake is discussed, and developing methods to image molecular responses to therapy are outlined.
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Affiliation(s)
- Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
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Lee JH, Cho JY, Choi MG, Kim JS, Choi KD, Lee YC, Jang JY, Chun HJ, Seol SY. Usefulness of autofluorescence imaging for estimating the extent of gastric neoplastic lesions: a prospective multicenter study. Gut Liver 2008; 2:174-9. [PMID: 20485643 DOI: 10.5009/gnl.2008.2.3.174] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Accepted: 05/15/2008] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/AIMS The aim of this study was to determine whether the margin of early to be detected gastric cancer (EGC) and gastric adenoma is easier to be detected with autofluorescence imaging (AFI) than with white-light endoscopy (WLE). METHODS A total of 102 lesions (48 EGCs and 54 gastric adenomas) found in 98 patients were removed endoscopically or surgically. The measured length of each pathology specimen was compared with the lengths estimated using WLE, AFI, and chromoendoscopy. RESULTS The lesions could be discriminated from surrounding mucosa by AFI in 86 cases (84.3%). The detection rates were similar for elevated lesions (85.1%) and flat/depressed lesions (82.9%, p=0.770). In terms of histology, the detection rate was slightly higher for adenomas (90.7%) than for cancer (77.1%, p=0.058). The estimated length was shorter than the pathologic length in 31.4% of cases when using WLE and 22.1% of cases when using AFI (p=0.168). The resection range was larger for EMR than for AFI in 24 of 80 cases (30.0%). CONCLUSIONS WLE tends to underestimate the size of EGCs, whereas AFI tends to overestimate their size.
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Affiliation(s)
- Jun Haeng Lee
- Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
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Curvers WL, Kiesslich R, Bergman JJGHM. Novel imaging modalities in the detection of oesophageal neoplasia. Best Pract Res Clin Gastroenterol 2008; 22:687-720. [PMID: 18656825 DOI: 10.1016/j.bpg.2008.01.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The prognosis of oesophageal neoplasia is dependent on the stage of the disease at the time of detection. Early lesions have an excellent prognosis in contrast to more advanced stages that usually have a dismal prognosis. Therefore, the early detection of these lesions is of the utmost importance. In recent years, several new techniques have been introduced to improve the endoscopic detection of early lesions. The most important improvement, in general, has been the introduction of high-resolution/high-definition endoscopy into daily clinical practice. The value of superimposing techniques such as chromoendoscopy, narrow band imaging and computed virtual chromoendoscopy onto high-resolution/high-definition endoscopy will have to be proven in randomised cross-over trials comparing these techniques with standard techniques. Important future adjuncts to white-light endoscopy serving as 'red-flag' techniques for the detection of early neoplasia may be broad field functional imaging techniques such as video autofluorescence endoscopy. In addition, real-time histopathology during endoscopy has become possible with endocytoscopy and confocal endomicroscopy. The clinical value of these techniques needs to be ascertained in the coming years.
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Affiliation(s)
- W L Curvers
- Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
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Collaud S, Warloe T, Jordan O, Gurny R, Lange N. Clinical evaluation of bioadhesive hydrogels for topical delivery of hexylaminolevulinate to Barrett's esophagus. J Control Release 2007; 123:203-10. [PMID: 17884228 DOI: 10.1016/j.jconrel.2007.08.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 07/26/2007] [Accepted: 08/13/2007] [Indexed: 11/28/2022]
Abstract
Fluorescence diagnosis following oral administration of 5-aminolevulinic acid (5-ALA) has shown to enable the sensitive visualization of intestinal metaplasia, dysplasia and early carcinoma in Barrett's esophagus. Once being established, this technique will be a potential alternative to today's standard diagnosis, i.e. four-quadrant random biopsies which are taken every 1-2 cm of the esophagus for histopathological analysis. In order to further improve this methodology, topical application of lipophilic 5-ALA esters to the esophagus could be advantageous in terms of fluorescence contrast and fluorescence intensity in the target tissue, adverse side effects, as well as application time. Therefore, the aim of this study was to develop a bioadhesive formulation loaded with hexylaminolevulinate (HAL) targeting the esophageal lining. In the present study, different mucoadhesive gels including poloxamer 407, cross-linked polyacrylic acid, hydroxypropylmethylcellulose, sodium carboxymethylcellulose and chitosan have been evaluated with respect to bioadhesion to the esophagus using an ex vivo rat model and a clinical study on healthy volunteers. In order to visualize the mucoadhesive properties of the formulations, a blue dye was incorporated as contrast agent. Chitosan has shown the best esophageal adhesion both in vitro and in vivo. Furthermore, using the in vitro release profiles from chitosan loaded with 40 mM of HAL, one can estimate that after a residence time of 10 min on the esophageal wall, the amount of HAL delivered to the epithelium will be sufficient to perform fluorescence diagnosis of Barrett's esophagus following swallowing of this formulation.
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Affiliation(s)
- S Collaud
- Department of Pharmaceutics and Biopharmaceutics, School of Pharmaceutical Sciences, University of Geneva, Quai Ernest-Ansermet 30, 1211 Geneva 4, Switzerland
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Vázquez-Iglesias JL, Alonso-Aguirre P, Diz-Lois MT, Vázquez-Millán MA, Alvarez A, Lorenzo MJ. Acetic acid allows effective selection of areas for obtaining biopsy samples in Barrett's esophagus. Eur J Gastroenterol Hepatol 2007; 19:187-93. [PMID: 17301644 DOI: 10.1097/meg.0b013e3280102f5e] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether macroscopic changes resulting from acetic acid application on the surface of columnar-lined esophagus allow regular, nonmagnifying, endoscopic identification of areas presenting dysplasia and/or cancer in Barrett's esophagus. PATIENTS AND METHODS A total of 100 patients (mean age, 53 years; range, 27-86 years) under surveillance because of short-segment (n=71) and long-segment (n=29) Barrett's esophagus, with no alterations of columnar-lined esophagus on standard endoscopy, were enrolled. After endoscopic examination, 3% acetic acid was sprayed on columnar-lined esophagus. The subsequent appearance of the mucosa was classified as: (1) Normal pattern: uniform reticulum along the entire columnar-lined esophagus. (2) Abnormal pattern: reticulum presenting areas of rough or irregular appearance. Biopsy samples were obtained from areas of normal and abnormal patterns, and the results of the corresponding histological studies were compared. All endoscopies were performed by the same investigator. RESULTS The endoscopic appearance, after acetic acid application, corresponded to a normal pattern in 85% of cases and an abnormal pattern in 15%. The percentage of dysplasia and adenocarcinoma in biopsy specimens was significantly higher in patients with rough or irregular areas (86.7%) than in those with normal uniform reticulum (0%) (P< 0.001). Sensitivity for the identification of areas of dysplasia or adenocarcinoma was 100% (95% confidence interval: 71.7-100%). Specificity was 97.7% (95% confidence interval: 91.2-99.6%). CONCLUSIONS This prospective study shows that acetic acid test is useful for standard, nonmagnifying, endoscopic detection of dysplasia and cancer in Barrett's esophagus.
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Mordon S, Maunoury V, Bulois P, Rochon P, Desreumaux P, Colombel JF. [Fluorescent imaging in digestive endoscopy]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2006; 30:165-8. [PMID: 16514408 DOI: 10.1016/s0399-8320(06)73143-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Serge Mordon
- EA 2689 INSERM IFR 114, Pavillon Vancostenobel, CHRU, 59037 Lille Cedex.
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Fotinos N, Campo MA, Popowycz F, Gurny R, Lange N. 5-Aminolevulinic Acid Derivatives in Photomedicine: Characteristics, Application and Perspectives. Photochem Photobiol 2006; 82:994-1015. [PMID: 16542112 DOI: 10.1562/2006-02-03-ir-794] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The introduction of lipophilic derivatives of the naturally occurring heme precursor 5-aminolevulinic acid (5-ALA) into photomedicine has led to a true revival of this research area. 5-ALA-mediated photodynamic therapy (PDT) and fluorescence photodetection (FD) of neoplastic disease is probably one of the most selective cancer treatments currently known in oncology. To date, this method has been assessed experimentally for the treatment of various medical indications. However, the limited local bioavailability of 5-ALA has widely prevented its use in daily clinical practice. Although researchers were already aware of this drawback early during the development of 5-ALA-mediated PDT, only recently have well-established concepts in pharmaceutical science been adapted to investigate ways to overcome this drawback. Recently, two derivatives of 5-ALA, methylaminolevulinate (MAL) and hexylaminolevulinate (HAL), gained marketing authorization from the regulatory offices in Europe and Australia. MAL is marketed under the trade name Metvix for the treatment of actinic keratosis and difficult-to-treat basal cell carcinoma. HAL has recently been launched under the trade name Hexvix to improve the detection of superficial bladder cancer in Europe. This review will first present the fundamental concepts underlying the use of 5-ALA derivatives in PDT and FD from a chemical, biochemical and pharmaceutical point of view. Experimental evidences from preclinical data on the improvements and limits observed with 5-ALA derivatives will then be introduced. The state-of-the-art from clinical studies with 5-ALA esters will be discussed, with special emphasis placed on the process that led to the development of MAL in dermatology and to HAL in urology. Finally, we will discuss promising medical fields in which use of 5-ALA derivatives might potentially lead to further use of this methodology in photomedicine.
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Affiliation(s)
- Nicolas Fotinos
- Laboratory of Pharmaceutical Technology and Biopharmaceutics, Ecole de Pharmacie Genève-Lausanne, University of Geneva, Switzerland
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Dorward AM, Fancher KS, Duffy TM, Beamer WG, Walt H. Early neoplastic and metastatic mammary tumours of transgenic mice detected by 5-aminolevulinic acid-stimulated protoporphyrin IX accumulation. Br J Cancer 2005; 93:1137-43. [PMID: 16251872 PMCID: PMC2361508 DOI: 10.1038/sj.bjc.6602840] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
A photodynamic technique for human breast cancer detection founded upon the ability of tumour cells to rapidly accumulate the fluorescent product protoporphyrin IX (PpIX) has been applied to transgenic mouse models of mammary tumorigenesis. A major goal of this investigation was to determine whether mouse mammary tumours are reliable models of human disease in terms of PpIX accumulation, for future mechanistic and therapeutic studies. The haeme substrate 5-aminolevulinic acid (5-ALA) (200 mg kg−1) was administered to mouse strains that develop mammary tumours of various histological subtypes upon expression of the transgenic oncogenes HRAS, Polyoma Virus middle T antigen, or Simian Virus 40 large T antigen in the mammary gland. Early neoplastic lesions, primary tumours and metastases showed consistent and rapid PpIX accumulation compared to the normal surrounding tissues, as evidenced by red fluorescence (635 nm) when the tumours were directly illuminated with blue light (380–440 nm). Detection of mouse mammary tumours at the stage of ductal carcinomain situ by red fluorescence emissions suggests that enhanced PpIX synthesis is a good marker for early tumorigenic processes in the mammary gland. We propose the mouse models provide an ideal experimental system for further investigation of the early diagnostic and therapeutic potential of 5-ALA-stimulated PpIX accumulation in human breast cancer patients.
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Affiliation(s)
- A M Dorward
- The Jackson Laboratory, 600 Main St Bar Harbor, ME 04609, USA
| | - K S Fancher
- The Jackson Laboratory, 600 Main St Bar Harbor, ME 04609, USA
| | - T M Duffy
- The Jackson Laboratory, 600 Main St Bar Harbor, ME 04609, USA
| | - W G Beamer
- The Jackson Laboratory, 600 Main St Bar Harbor, ME 04609, USA
| | - H Walt
- Research Division of Gynecology, Department of Obstetrics and Gynecology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091 Zurich, Switzerland
- Research Division of Gynecology, Department of Obstetrics and Gynecology, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091 Zurich, Switzerland. E-mail:
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Abstract
The detection of early-stage neoplastic lesions in the upper GI tract is associated with improved survival and the potential for complete endoscopic resection that is minimally invasive and less morbid than surgery. Despite technological advances in standard white-light endoscopy, the ability of the endoscopist to reliably detect dysplastic and early cancerous changes in the upper GI tract remains limited. In conditions such as Barrett's oesophagus, practice guidelines recommend periodic endoscopic surveillance with multiple biopsies, a methodology that is hindered by random sampling error, inconsistent histopathological interpretation, and delay in diagnosis. Early detection may be enhanced by several promising diagnostic modalities such as chromoendoscopy, magnification endoscopy, and optical spectroscopic/imaging techniques, as these modalities offer the potential to identify in real-time lesions that are inconspicuous under conventional endoscopy. The combination of novel diagnostic techniques and local endoscopic therapies will provide the endoscopist with much needed tools that can considerably enhance the detection and management of early stage lesions in the upper GI tract.
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Affiliation(s)
- Louis-Michel Wong Kee Song
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street S.W., Rochester, MN 55905, USA.
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Dietze A, Berg K. ALA-induced porphyrin formation and fluorescence in synovitis tissue In-vitro and in vivo studies. Photodiagnosis Photodyn Ther 2005; 2:299-307. [PMID: 25048871 DOI: 10.1016/s1572-1000(05)00107-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Revised: 10/11/2005] [Accepted: 10/12/2005] [Indexed: 11/26/2022]
Abstract
The synovial inflammatory process in rheumatoid arthritis (RA) is accompanied by massive tumor-like proliferation and activation of the connective stroma. These abnormal cells actively invade and destroy the peri-articular bone and cartilage at the margins of joints where synovium and bone are attached. There is still a lack of minimally invasive synovectomy methods, which might be suitable for the smaller joints. Unfortunately, these joints are usually involved in the disease. Photodynamic therapy has been evaluated as a possible treatment modality for RA synovitis. The present study describes the differences of 5-aminolevulinic acid (5-ALA) and 5-ALA ester-induced protoporphyrin IX (PpIX) production in cell cultures obtained from patients with RA, osteoarthritis (OA) and human sarcoma cell line (HS 192.T) and in a collagen-induced arthritis model in rats. The incubation of cells with hexyl aminolevulinate (HAL) induced the same amount of fluorescence as 5-ALA and methyl aminolevulinate (MAL) at about a 100-fold lower concentration. Incubation with HAL-induced accumulation of at least twice as much porphyrins in RA- and HS 192.T-cells than 5-ALA and MAL in OA-cells. Similar levels of porphyrins were accumulated in RA and the malignant cells. In vivo, intra-articular application of 5-ALA induced a significant porphyrin accumulation in synovitis tissue as measured by in situ fluorescence spectroscopy. In contrast to our in vitro results and other reports, we could not detect enhanced fluorescence after application of up to 0.1mg HAL.
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Affiliation(s)
- Andreas Dietze
- Department of Orthopedic Surgery, National Hospital, Oslo, Norway; Department of Radiation Biology, The Norwegian Radium Hospital, Montebello, N-0310 Oslo, Norway
| | - Kristian Berg
- Department of Radiation Biology, The Norwegian Radium Hospital, Montebello, N-0310 Oslo, Norway
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Wong Kee Song LM, Wilson BC. Optical Detection of High-Grade Dysplasia in Barrett’s Esophagus. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2005. [DOI: 10.1016/j.tgie.2005.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
PURPOSE OF REVIEW The incidence of esophageal adenocarcinoma continues to rise in the Western world, with a mean 5-year survival of less than 20%. There has therefore been increasing interest in the precursor lesion, Barrett's esophagus. However, adenocarcinoma will not develop in most patients with Barrett's esophagus. This review summarizes the data on the management of Barrett's esophagus that have been published since January 2003. RECENT FINDINGS The control of reflux symptoms significantly improves quality of life, and surgical antireflux therapy may gradually cause regression of the Barrett segment compared with proton pump inhibitor therapy. The data substantiate the claim that the cancer risk in Barrett esophagus is lower than had hitherto been suggested. The risk factors for progression include increasing age and length of segment, macroscopic inflammatory changes, loss of heterozygosity over several genetic loci, and increased proliferation status. The extent of high-grade dysplasia may not accurately predict cancer development, and continued surveillance, rather than intervention, for such patients may decrease the chances of curative treatment. Long-term follow-up data are beginning to accumulate for nonsurgical treatment strategies. Chemoprevention trials are under way to evaluate the role of acid suppression and nonsteroidal anti-inflammatory drugs and their derivatives. SUMMARY At this time, endoscopic surveillance and surgical management remain the mainstay, but continued research efforts should enable risk stratification and cancer prevention in the future.
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Affiliation(s)
- R C Fitzgerald
- MRC Cancer Cell Unit, Hutchison-MRC Research Centre, Cambridge, UK.
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Endlicher E, Gelbmann CM, Knüchel R, Fürst A, Szeimies RM, Gölder SK, Schölmerich J, Lottner C, Messmann H. Hexaminolevulinate-induced fluorescence endoscopy in patients with rectal adenoma and cancer: a pilot study. Gastrointest Endosc 2004; 60:449-54. [PMID: 15332045 DOI: 10.1016/s0016-5107(04)01723-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Fluorescence endoscopy is a promising new method for detection and treatment of premalignant and malignant lesions. The aim of this pilot study was to investigate the feasibility of hexaminolevulinate-based photodetection of rectal adenoma and cancer, including safety, dose finding, and efficacy. METHODS Ten patients with known rectal adenoma or cancer were sensitized by instillation of 3.2 mM of hexaminolevulinate as an enema. Fluorescence endoscopy was performed after retention of the enema for 30 to 60 minutes, followed by a rest time of up to 30 minutes before endoscopy. Biopsy specimens were taken from fluorescent and non-fluorescent areas and fluorescence microscopy studies were performed to assess the distribution of protoporphyrin IX fluorescence in different tissue layers. Adverse events were reported by direct questioning of all patients; skin photosensitivity, changes in biochemical tests of liver function, blood pressure and heart rate, and the occurrence of GI symptoms (nausea, vomiting) were recorded for 5 patients. OBSERVATIONS Hexaminolevulinate-induced fluorescence endoscopy produced selective fluorescence of all rectal adenomas with intraepithelial neoplasia. For rectal cancer, there was only weak fluorescence or none at all. No hexaminolevulinate-induced side effect was observed. In two patients, fluorescence differentiated adenomas and hyperplastic polyps. CONCLUSIONS Hexaminolevulinate-based fluorescence endoscopy (3.2 mM administered as an enema) in patients with rectal cancer and adenoma was well tolerated and produced no significant skin sensitivity or other side effects. The optimal duration of application is 30 to 45 minutes, with a rest time of 30 minutes. Selective fluorescence of adenoma with intraepithelial neoplasia suggests that hexaminolevulinate-based fluorescence endoscopy may be useful for detection of premalignant lesions.
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Affiliation(s)
- Esther Endlicher
- Department of Internal Medicine I, Institute of Pathology, University of Regensburg, 93042 Regensburg, Germany
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Abstract
PURPOSE OF REVIEW Technology for detection and staging of esophageal cancer has made significant strides advances in the past 2 years. These advances have led to the enhanced selection of appropriate treatments for esophageal cancer. Cancers that are discovered at an early stage can be treated with endoscopic therapy, whereas advanced cancers are primarily treated with chemotherapy and radiation. RECENT FINDINGS Detection of esophageal cancer can be enhanced by two major mechanisms: one is by enhancing the lesion, which has typically been done using vital dyes and the other is by changing the method of imaging of the lesion, which has been accomplished by the use of several technologies including fluorescence and optical coherence tomography. Neither of these techniques has been proven, but some investigators have been able to use them to enhance cancer detection. Similar technologies have been applied to staging esophageal cancer. The optical imaging devices also have the potential to stage mucosa-based malignancy. The use of positron emission tomography has been the most recent development that may have application for advanced cancer. Endoscopic ultrasonography has also been improved in resolution and ability to perform fine needle aspiration. The most significant development for staging early cancers is mucosal resection. Finally, by using mucosal resection techniques, the depth of tumor invasion can be established by histology, which allows gastroenterologists to treat early cancers with greater confidence regarding rates of metastatic disease. SUMMARY Early detection of esophageal cancer can be enhanced by the use of vital dyes for mucosal staining, but the advancement of novel optical diagnostic strategies may be more suitable for clinical use. The primary advantage of these new staging methods is to clearly identify early stage cancer that potentially can be treated without traditional surgical resection techniques. More advanced cancers can be staged with positron emission tomography, but definitive studies demonstrating its role are still lacking.
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Affiliation(s)
- Kenneth K Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
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