Photodynamic therapy: basic principles and potential uses for the veterinary ophthalmologist

Marginal resection and infracyanine green-mediated photodynamic therapy in the management of feline eyelid squamous cell carcinoma: Two cases

OBJECTIVE

Describe the presenting features, surgical procedure, and clinical outcomes of two cats managed with marginal resection and photodynamic therapy (PDT) for eyelid squamous cell carcinoma (SCC).

ANIMALS STUDIED

A 12-year-old female spayed domestic shorthair cat (case 1) and a 10-year-old female spayed domestic shorthair cat (case 2).

PROCEDURES

Following marginal resection of the eyelid neoplasm, hemostasis was achieved using a handheld cautery unit then 1 mL of infracyanine green was injected into the surgical wound bed. Photodynamic therapy was performed using an 810 nm diode laser in two consecutive steps: (i) six cycles at 500 mW for 30 s per cycle, using a rapid movement; then (ii) one (case 1) or two cycles (case 2) of 30 s at 2000 mW, using a slow deliberate movement to effect (charred surface).

RESULTS

Histopathology was consistent with SCC resected with incomplete margins in both cats. Follow-up duration was 416 and 161 days in case 1 and case 2, respectively. Consecutive exams and photo-documentation (in clinic or by owners) showed appropriate healing of the lower eyelid, with a smooth lid margin, and no evidence of tumor regrowth or ocular irritation. Subtle trichiasis was noted in case 1 on day 185, but not at the last follow-up.

CONCLUSIONS AND CLINICAL RELEVANCE

Marginal resection followed by PDT may be a valid alternative to complete surgical resection of periocular SCC in cats. The procedure was easy to perform, post-operative recovery was uncomplicated, and neither cat developed recurrent disease during the follow-up period.

Limbal Squamous Cell Carcinoma in a Black Baldy Cow: Case Report and Surgical Treatment

Objective

To document a case of limbal squamous cell carcinoma (SCC) in an adult Black Baldy cow treated with photodynamic therapy (PDT) as an adjunctive therapy following surgical excision. Animals Studied. One privately owned 8-year-old female, entire, Black Baldy cow. Procedures. A complete ophthalmic examination was performed on an adult Black Baldy cow for assessment of a mass affecting the left eye. Following a routine partial incision superficial lamellar keratectomy and conjunctivectomy under local analgesia using a Peterson retrobulbar block, photodynamic therapy was performed as an adjunctive treatment to lower the chance for recurrence and improve the prognosis for the globe.

Results

Histopathologic analysis of the limbal mass was reported to be consistent with a squamous cell carcinoma, removed with clean margins. The patient was comfortable and visual with no signs of tumor recurrence 11 months after surgery.

Conclusion

Superficial lamellar keratectomy and conjunctivectomy with adjunctive photodynamic therapy is an effective treatment for limbal squamous cell carcinoma and may be performed as an alternative to enucleation, exenteration, euthanasia, or slaughtering in cattle.

Current Therapeutics and Future Perspectives to Ocular Melanocytic Neoplasms in Dogs and Cats

Neoplasms of melanocytic origin are diseases relevant to dogs and cats' ophthalmic oncology due to their incidence, potential visual loss, and consequent decrease in life quality and expectancy. Despite its non-specific clinical presentation, melanocytic neoplasms can be histologically distinguished in melanocytomas, which present benign characteristics, and malignant melanomas. The diagnosis often occurs in advanced cases, limiting the therapeutic options. Surgery, cryotherapy, radiotherapy, photodynamic therapy (PDT), and laser are currently available therapeutic strategies. As no clinical guidelines are available, the treatment choice is primarily based on the clinician's preference, proficiency, and the owner's financial constraints. While surgery is curative in benign lesions, ocular melanomas present a variable response to treatments, besides the potential of tumour recurrences or metastatic disease. This review presents the currently available therapies for ocular melanocytic neoplasms in dogs and cats, describing the therapeutic, indications, and limitations. Additionally, new therapeutics being developed are presented and discussed, as they can improve the current treatment options.

Perspectives of photodynamic therapy in biotechnology

Photodynamic therapy (PDT) is a current and innovative technique that can be applied in different areas, such as medical, biotechnological, veterinary, among others, both for the treatment of different pathologies, as well as for diagnosis. It is based on the action of light to activate photosensitizers that will perform their activity on target tissues, presenting high sensitivity and less adverse effects. Therefore, knowing that biotechnology aims to use processes to develop products aimed at improving the quality of life of human and the environment, and optimizing therapeutic actions, researchers have been used PDT as a tool of choice. This review aims to identify the impacts and perspectives and challenges of PDT in different areas of biotechnology, such as health and agriculture and oncology. Our search demonstrated that PDT has an important impact around oncology, minimizing the adverse effects and resistance to chemotherapeutic to the current treatments available for cancer. Veterinary medicine is another area with continuous interest in this therapy, since studies have shown promising results for the treatment of different animal pathologies such as Bovine mastitis, Malassezia, cutaneous hemangiosarcoma, among others. In agriculture, PDT has been used, for example, to remove traces of antibiotics of milk. The challenges, in general, of PDT in the field of biotechnology are mainly the development of effective and non-toxic or less toxic photosensitizers for humans, animals and plants. We believe that there is a current and future potential for PDT in different fields of biotechnology due to the existing demand.

Clinical and genetic aspects of the TGFBI-associated corneal dystrophies

Corneal dystrophies are a group of inherited disorders localized to various layers of the cornea that affect corneal transparency and visual acuity. The deposition of insoluble protein materials in the form of extracellular deposits or intracellular cysts is pathognomic. Mutations in TGFBI are responsible for superficial and stromal corneal dystrophies. The gene product, transforming growth factor β induced protein (TGFBIp) accumulates as insoluble deposits in various forms. The severity, clinicopathogenic variations, age of the onset, and location of the deposits depend on the type of amino acid alterations in the protein. Until 2006, 38 different pathogenic mutants were reported for the TGFBI-associated corneal dystrophies. This number has increased to 63 mutants, reported in more than 30 countries. There is no effective treatment to prevent, halt, or reverse the deposition of TGFBIp. This review presents a complete mutation update, classification of phenotypes, comprehensive reported incidents of various mutations, and current treatment options and their shortcomings. Future research directions and possible approaches to inhibiting disease progression are discussed.

Destruction of amyloid fibrils of keratoepithelin peptides by laser irradiation coupled with amyloid-specific thioflavin T

Mutations in keratoepithelin are associated with blinding ocular diseases, including lattice corneal dystrophy type 1 and granular corneal dystrophy type 2. These diseases are characterized by deposits of amyloid fibrils and/or granular non-amyloid aggregates in the cornea. Removing the deposits in the cornea is important for treatment. Previously, we reported the destruction of amyloid fibrils of β(2)-microglobulin K3 fragments and amyloid β by laser irradiation coupled with the binding of an amyloid-specific thioflavin T. Here, we studied the effects of this combination on the amyloid fibrils of two 22-residue fragments of keratoepithelin. The direct observation of individual amyloid fibrils was performed in real time using total internal reflection fluorescence microscopy. Both types of amyloid fibrils were broken up by the laser irradiation, dependent on the laser power. The results suggest the laser-induced destruction of amyloid fibrils to be a useful strategy for the treatment of these corneal dystrophies.

Photodynamic therapy: Palliation and endoscopic technique in cholangiocarcinoma

Cholangiocarcinoma is the primary malignancy arising from the biliary epithelium. The disease is marked by jaundice, cholestasis, and cholangitis. Over 50 percent of patients present with advanced stage disease, precluding curative surgical resection as an option of treatment. Prognosis is poor, and survival has been limited even after biliary decompression. Palliative management has become the standard of care for unresectable disease and has evolved to include an endoscopic approach. Photodynamic therapy (PDT) consists of administration of a photosensitizer followed by local irradiation with laser therapy. Several studies conducted in Europe and the United States have shown a marked improvement in the symptoms of cholestasis, survival, and quality of life. This article summarizes the published experience regarding PDT for cholangiocarcinoma and the steps required to administer this therapy safely.

Equine periocular neoplasia: current concepts in aetiopathogenesis and emerging treatment modalities

Neoplastic adnexal disease represents one of the most frequently encountered and therapeutically challenging ophthalmic problems of horses. This paper reviews current concepts in equine periocular neoplasia. Specifically, a literature-based review of the aetiopathogenesis of the most common tumours to affect the equine eyelid (squamous cell carcinoma, sarcoid, melanoma and lymphosarcoma) is provided. Current and emerging treatment modalities, including photodynamic therapy, are reviewed.

Cellular localization of Visudyne as a function of time after local injection in an in vivo model of squamous cell carcinoma: an investigation into tumor cell death

OBJECTIVE

To evaluate the effects of time on cellular localization of Visudyne after local injection.

ANIMALS

Twenty athymic nude mice.

PROCEDURES

A squamous cell carcinoma (SCC) cell line (A-431) was injected into right and left dorsolumbar subcutaneous tissue of each mouse, representing treatment (T) and control (C) tumors. In experiment 1 (Exp 1; n = 10) and 2 (Exp 2; n = 10), the T tumors received a local injection of Visudyne (0.1 mg/cm(3)), and C tumors received an equal dose of 5% dextrose in water (D5W). Mice were randomly subdivided into two groups (A and B; n = 5 per group). Mice in Exp 1A and B were sacrificed 1 and 30 min after local injection, respectively. Experiment 1A and B tumors were evaluated by fluorescence microscopy to determine drug localization. Experiment 2A and B tumors were exposed to LED illumination 1 and 30 min after injection, respectively, and evaluated by transmission electron microscopy (TEM) to determine ultrastructural tumor cell damage.

RESULTS

Fluorescence was detected within the cytoplasm of T tumors in both Exp 1A and B. Significance was detected in fluorescence intensity between T1 min vs. T30 min (P = 0.03) and between T1 min and C1 min tumors (P = 0.01), respectively. Tumors in Exp 2A and B demonstrated evidence of apoptotic cell death.

CONCLUSIONS

Fluorescence microscopy demonstrated higher Visudyne concentration within SCC cytoplasm of 1 min compared with 30-min tumors. Transmission electron microscopy results revealed that tumors treated by photodynamic therapy (PDT) within 30 min of local injection undergo cellular apoptosis.

Laser-induced propagation and destruction of amyloid beta fibrils

The amyloid deposition of amyloid beta (Abeta) peptides is a critical pathological event in Alzheimer disease (AD). Preventing the formation of amyloid deposits and removing preformed fibrils in tissues are important therapeutic strategies against AD. Previously, we reported the destruction of amyloid fibrils of beta(2)-microglobulin K3 fragments by laser irradiation coupled with the binding of amyloid-specific thioflavin T. Here, we studied the effects of a laser beam on Abeta fibrils. As was the case for K3 fibrils, extensive irradiation destroyed the preformed Abeta fibrils. However, irradiation during spontaneous fibril formation resulted in only the partial destruction of growing fibrils and a subsequent explosive propagation of fibrils. The explosive propagation was caused by an increase in the number of active ends due to breakage. The results not only reveal a case of fragmentation-induced propagation of fibrils but also provide insights into therapeutic strategies for AD.

The effect of photodynamic therapy on squamous cell carcinoma in a murine model: evaluation of time between intralesional injection to laser irradiation

Successful treatment of naturally occurring periocular squamous cell carcinoma (SCC) in horses with photodynamic therapy (PDT) has been performed by injecting residual tumor with verteporfin and applying laser irradiation immediately following injection. This study used a murine model to evaluate the influence of time between intralesional injection of verteporfin to laser irradiation on tumor growth inhibition with PDT. Mice were randomized into six groups (n=10/group). Each tumor was injected with either 0.1mg/cm(3) of verteporfin (Tx) or 5% dextrose in water (C). Tx and C groups 1, 2, and 3 were irradiated at 1, 30, and 180min after injection. Wilcoxon-rank sum test (P< or =0.05) was performed to determine the relative change in tumor volume (RCTV) between groups. Statistical significance was demonstrated between treatment groups. Although verteporfin-PDT treated mice in Tx1 and Tx2 demonstrated a lower RCTV compared to C1 and C2 mice, the differences were not statistically significant.