Topical Administration of Tetrasodium-Mesotetraphenyl-Porphinesulfonate (TPPS): Correlation between Drug Penetration and Depth of Necrosis in Skin of Nude Mice following Red Light Irradiation

Penetration potency of topical applied delta-aminolevulinic acid for photodynamic therapy of basal cell carcinoma

Penetration potency of delta-aminolevulinic acid (ALA) was studied by examining fluorescence of endogenous protoporphyrin IX in different histological types of basal cell carcinoma. Ten basal cell carcinomas were coated with an ointment containing 10% ALA prior to excision; five served as controls. Tumors were excised either 4 h or 12 h after application of ALA using a modified Mohs' micrographic surgical technique. Horizontal sections were cut from deep dermis to tumor surface and examined under a fluorescence microscope. After 4 h of application, only skin appendages demonstrated fluorescence typical of protoporphyrin IX. After 12 h, fluorescence was detectable in tumor cells in deep dermis. The five controls revealed no fluorescence at any site. These results may confirm the high penetration potential of topically applied ALA and its usefulness in photodynamic therapy. For tumors penetrating to deep dermis, an application time of more than 4 h seems necessary, at least when hydrophilic solvents for ALA are used.

Endogenous protoporphyrin IX, a clinically useful photosensitizer for photodynamic therapy

The tissue photosensitizer protoporphyrin IX (PpIX) is an immediate precursor of heme in the biosynthetic pathway for heme. In certain types of cells and tissues, the rate of synthesis of PpIX is determined by the rate of synthesis of 5-aminolevulinic acid (ALA), which in turn is regulated via a feedback control mechanism governed by the concentration of free heme. The presence of exogenous ALA bypasses the feedback control, and thus may induce the intracellular accumulation of photosensitizing concentrations of PpIX. However, this occurs only in certain types of cells and tissues. The resulting tissue-specific photosensitization provides a basis for using ALA-induced PpIX for photodynamic therapy. The topical application of ALA to certain malignant and non-malignant lesions of the skin can induce a clinically useful degree of lesion-specific photosensitization. Superficial basal cell carcinomas showed a complete response rate of approximately 79% following a single exposure to light. Recent preclinical studies in experimental animals and human volunteers indicate that ALA can induce a localized tissue-specific photosensitization if administered by intradermal injection. A generalized but still quite tissue-specific photosensitization may be induced if ALA is administered by either subcutaneous or intraperitoneal injection or by mouth. This opens the possibility of using ALA-induced PpIX to treat tumors that are too thick or that lie too deep to be accessible to either topical or locally injected ALA.