Is photodynamic therapy a good alternative to surgery and radiotherapy in the treatment of head and neck cancer?

Type 1 Phototherapeutic Agents. 2. Cancer Cell Viability and ESR Studies of Tricyclic Diarylamines

Type 1 phototherapeutic agents based on diarylamines were assessed for free radical generation and evaluated in vitro for cell death efficacy in the U937 leukemia cancer cell line. All of the compounds were found to produce copious free radicals upon photoexcitation with UV-A and/or UV-B light, as determined by electron spin resonance (ESR) spectroscopy. Among the diarylamines, the most potent compounds were acridan (4) and 9-phenylacridan (5), with IC50 values of 0.68 μM and 0.17 μM, respectively.

ROS-mediated killing efficiency with visible light of bacteria carrying different red fluorochrome proteins

Red fluorescent proteins can generate reactive oxygen species (ROS) if their fluorochrome is stimulated e.g. by visible light illumination. ROS compounds have very reactive, highly toxic properties leading to cell damage which results in cell killing. In this context, the toxicity of the various red fluorochromes KillerRed, DsRed2, mCherry, and mRFP expressed in Escherichia coli bacteria was tested after illumination with white light. The toxic effect was determined by measurement of the colony forming ability 24h after transfection and illumination. KillerRed was found to be the most harmful, followed by mRFP and DsRed2 while bacteria expressing mCherry and controls without fluorescent proteins survived after application of identical illumination doses. Their application and a possible bactericide role is discussed.

Temoporfin (Foscan®, 5,10,15,20-tetra(m-hydroxyphenyl)chlorin)--a second-generation photosensitizer

This review traces the development and study of the second-generation photosensitizer 5,10,15,20-tetra(m-hydroxyphenyl)chlorin through to its acceptance and clinical use in modern photodynamic (cancer) therapy. The literature has been covered up to early 2011.

Prospective evaluation of 110 patients following ultrasound-guided photodynamic therapy for deep seated pathologies

INTRODUCTION

Photodynamic therapy, the fourth oncological interventional modality has proved its success in the management of variety of pathologies involving the human body. Our aim in this prospective clinical study was to continue evaluating the outcome following ultrasound-guided interstitial PDT of pathologies involving the human body. Patients' reports on quality of life with clinical and radiological evaluation were the main end point parameters used to assess the outcome.

MATERIALS AND METHODS

One hundred and ten patients were referred to the UCLH Head and Neck Centre, London for treatment of various deep-seated pathologies. These included tumours in the head and neck as well as vascular anomalies of the limbs. After multidisciplinary discussion, all patients underwent interstitial photodynamic therapy (iPDT) under general anaesthesia, using 0.15mg/kg mTHPC as the photosensitising agent. Following treatment, patients were followed-up for a mean of 26 months.

RESULTS

Four out of five patients who presented with visual problems reported improvement after treatment. Also, 27/32 reported improvement of breathing. Improvement of swallowing was reported by 30/37 patients; while speech improvement was evident in 22/29 patients and 43/52 reported reduction in the disfigurement caused by their pathology. Seven out of nine patients with impeded limb function reported some degree of improvement. Clinical assessment showed that nearly half of the patients had "good response" to the treatment and 5 became disease free. Moderate clinical response was reported by 39 patients. Radiological assessment comparing radiological imaging 6-week post-PDT to the baseline showed moderate response in 45 patients and significant response in 32 patients.

CONCLUSION

This study on 110 patients with deep-seated pathologies undergoing interstitial photodynamic therapy provided further evidence that PDT is a useful modality in the management of these pathologies that are otherwise resistant to conventional treatments, and with minimal side effects.

Photoreaction pathways for the anticancer complex trans,trans,trans-[Pt(N3)2(OH)2(NH3)2]

The photodecomposition of the anticancer complex trans,trans,trans-[Pt(N(3))(2)(OH)(2)(NH(3))(2)] in acidic aqueous solution, as well as in phosphate-buffered saline (PBS), induced by UVA light (centred at λ = 365 nm) has been studied by multinuclear NMR spectroscopy. We show that the photoreaction pathway in PBS, which involves azide release, differs from that in acidic aqueous conditions, under which N(2) is a major product. In both cases, a number of trans-{N-Pt(II/IV)-NH(3)} species were also observed as photoproducts, as well as the evolution of O(2) and release of free ammonia with a subsequent increase in pH. The results from this study illustrate that photoinduced reactions of Pt(IV)-diazido derivatives can lead to novel reaction pathways, and therefore potentially to new cytotoxic mechanisms in cancer cells.

TP53 regulates human AlkB homologue 2 expression in glioma resistance to Photofrin-mediated photodynamic therapy

BACKGROUND

Photodynamic therapy (PDT) is a promising adjuvant therapy in cancer treatment. However, cancers resistant to PDT, mediated through the efflux of photosensitisers by means of P-glycoprotein or ATP-binding cassette transporter proteins, have been reported. The DNA repair has also been suggested to be responsible for PDT resistance, but little is known about the repair pathways and mechanisms involved. Therefore, this study aimed to investigate the possible function of six major DNA repair mechanisms in glioma cells resistant to Photofrin-mediated PDT (Ph-PDT).

METHODS

The U87 glioma cells relatively resistant to Ph-PDT were obtained by recovering the viable cells 3 h after PDT treatment. The mRNA and protein expression levels of DNA repair genes were evaluated by quantitative real-time reverse transcription-polymerase chain reaction and western blotting, respectively. Small-interfering RNA and chromatin-immunoprecipitation assays were used to further examine the relationship between AlkB, an alkylation repair homologue 2 (Escherichia coli) (ALKBH2) and Ph-PDT responsiveness, and transcription factors involved in ALKBH2 transcription.

RESULTS

The ALKBH2 of DNA damage reversal was significantly increased at both mRNA and protein levels from 30 min to 48 h post-treatment with Ph-PDT. Conversely, down-regulating ALKBH2 expression enhances Ph-PDT efficiency. Furthermore, our data clearly show for the first time that tumour protein (TP53) is directly involved by binding to the promoter of ALKBH2 in mediating Ph-PDT resistance.

CONCLUSION

C The DNA damage reversal mechanisms may have important functions in Ph-PDT resistance through the activation of ALKBH2 by TP53.

Photodynamic therapy of early stage oral cavity and oropharynx neoplasms: an outcome analysis of 170 patients

The indications of photodynamic therapy (PDT) of oral cavity and oropharynx neoplasms are not well defined. The main reason is that the success rates are not well established. The current paper analyzes our institutional experience of early stage oral cavity and oropharynx neoplasms (Tis-T2) to identify the success rates for each subgroup according to T stage, primary or non-primary treatment and subsites. In total, 170 patients with 226 lesions are treated with PDT. From these lesions, 95 are primary neoplasms, 131 were non-primaries (recurrences and multiple primaries). The overall response rate is 90.7% with a complete response rate of 70.8%. Subgroup analysis identified oral tongue, floor of mouth sites with more favorable outcome. PDT has more favorable results with certain subsites and with previously untreated lesions. However, PDT can find its place for treating lesions in previously treated areas with acceptable results.

Future of oncologic photodynamic therapy

Photodynamic therapy (PDT) is a tumor-ablative and function-sparing oncologic intervention. The relative simplicity of photosensitizer application followed by light activation resulting in the cytotoxic and vasculartoxic photodynamic reaction has allowed PDT to reach a worldwide audience. With several commercially available photosensitizing agents now on the market, numerous well designed clinical trials have demonstrated the efficacy of PDT on various cutaneous and deep tissue tumors. However, current photosensitizers and light sources still have a number of limitations. Future PDT will build on those findings to allow development and refinement of more optimal therapeutic agents and illumination devices. This article reviews the current state of the art and limitations of PDT, and highlight the progress being made towards the future of oncologic PDT.

Explicit dosimetry for photodynamic therapy: macroscopic singlet oxygen modeling

Singlet oxygen ((1)O(2)) is the major cytotoxic agent responsible for cell killing for type-II photodynamic therapy (PDT). An empirical four-parameter macroscopic model is proposed to calculate the "apparent reacted (1)O(2) concentration", [(1)O(2)](rx), as a clinical PDT dosimetry quantity. This model incorporates light diffusion equation and a set of PDT kinetics equations, which can be applied in any clinical treatment geometry. We demonstrate that by introducing a fitting quantity "apparent singlet oxygen threshold concentration" [(1)O(2)](rx, sd), it is feasible to determine the model parameters by fitting the computed [(1)O(2)](rx) to the Photofrin-mediated PDT-induced necrotic distance using interstitially-measured Photofrin concentration and optical properties within each mouse. After determining the model parameters and the [(1)O(2)](rx, sd), we expect to use this model as an explicit dosimetry to assess PDT treatment outcome for a specific photosensitizer in an in vivo environment. The results also provide evidence that the [(1)O(2)](rx), because it takes into account the oxygen consumption (or light fluence rate) effect, can be a better predictor of PDT outcome than the PDT dose defined as the energy absorbed by the photosensitizer, which is proportional to the product of photosensitizer concentration and light fluence.

Photocytotoxic trans-diam(m)ine platinum(IV) diazido complexes more potent than their cis isomers

The photocytotoxicity of a series of anticancer trans-dihydroxido [Pt(N(3))(2)(OH)(2)(NH(3))(X)] (X = alkyl or aryl amine) platinum(IV) diazido complexes has been examined, and the influence of cis-trans isomerism has been investigated. A series of photoactivatable Pt(IV)-azido complexes has been synthesized: The synthesis, characterization, and photocytotoxicity of six mixed-ligand ammine/amine Pt(IV) diazido complexes, cis,trans,cis-[Pt(N(3))(2)(OH)(2)(NH(3))(X)] where X = propylamine (4c), butylamine (5c), or pentylamine (6c) and aromatic complexes where X = pyridine (7c), 2-methylpyridine (8c), or 3-methylpyridine (9c) are reported. Six all-trans isomers have also been studied where X = methylamine (2t), ethylamine (3t), 2-methylpyridine (8t), 4-methylpyridine (10t), 3-methylpyridine (9t), and 2-bromo-3-methylpyridine (11t). All of the complexes exhibit intense azide-to-Pt(IV) LMCT bands (ca. 290 nm for trans and ca. 260 nm for cis). When irradiated with UVA light (365 nm), the Pt(IV) complexes undergo photoreduction to Pt(II) species, as monitored by UV-vis spectroscopy. The trans isomers of complexes containing aliphatic or aromatic amines were more photocytotoxic than their cis isomers. One of the cis complexes (9c) was nonphotocytotoxic despite undergoing photoreduction. Substitution of NH(3) ligands by MeNH(2) or EtNH(2) results in more potent photocytotoxicity for the all-trans complexes. The complexes were all nontoxic toward human keratinocytes (HaCaT) and A2780 human ovarian cancer cells in the dark, apart from the 3-methylpyridine (9t), 2-bromo-3-methylpyridine (11t), and 4-methylpyridine (10t) derivatives.

Contemporary management of cancer of the oral cavity

Oral cancer represents a common entity comprising a third of all head and neck malignant tumors. The options for curative treatment of oral cavity cancer have not changed significantly in the last three decades; however, the work up, the approach to surveillance, and the options for reconstruction have evolved significantly. Because of the profound functional and cosmetic importance of the oral cavity, management of oral cavity cancers requires a thorough understanding of disease progression, approaches to management and options for reconstruction. The purpose of this review is to discuss the most current management options for oral cavity cancers.

Fullerene–porphyrin nanostructures in photodynamic therapy

Photodynamic therapy represents an alternative treatment with great potential in some types of cancer and premalignant conditions. In the quest to improve this therapy, potential new nontetrapyrrole photosensitizers are currently under research. Hence, in the last few years fullerenes attracted an increased interest because they prove characteristics for nanotechnology’s biomedical applications. Fullerenes derivatization for biology application in general and in particular for photodynamic therapy, led to the idea of their association with porphyrins. Porphyrins, well-known players in this domain, could form in association with fullerenes, new compounds with unique properties, namely new photosensitizers with enhanced efficiency in terms of singlet oxygen generation and tumor cell penetration. This article is an attempt to underscore the enormous effort currently dedicated to an emerging field represented by these new nanostructures for biomedicine and in particular for photodynamic therapy.

Apoptotic mechanism of MCF-7 breast cells in vivo and in vitro induced by photodynamic therapy with C-phycocyanin

The aim of this study was to investigate the pro-apoptotic mechanism of C-phycocyanin (C-PC)-mediated photodynamic therapy (PDT) in a murine tumor model and cultured MCF-7 cells. The mice were divided into four groups: control, He-Ne laser radiation, C-PC treatment, and C-PC treatment + He-Ne laser radiation. The effects of C-PC and/or laser on immune organs, immunocyte proliferation, tumor genesis, and apoptosis-related proteins expressions were investigated by immunohistochemistry, in situ hybridization, MTT, electron microscope, western blot, and immunofluorescence assay. The results showed that He-Ne laser treatment alone showed marginal effects. In C-PC-treated mice, the weight of immune organs, proliferation of immunocytes, and expression of pro-apoptotic Fas protein were increased, whereas the tumor weight and the expressions of anti-apoptotic proteins (NF-kappaB and P53) and CD44 mRNA were comparatively decreased. In vitro, C-PC was able to inhibit MCF-7 cell proliferation and cause ultrastructural changes including microvilli loss, formation of membrane blebs, and chromatin condensation. Moreover, C-PC treatment could activate caspase-9 expression, induce cytochrome c release, and downregulate Bcl-2 expression. When combined with He-Ne laser irradiation, the effects of C-PC treatment were further enhanced. Facilitating the apoptosis signals transduction and finally leading to the apoptosis of MCF-7 cells may be the mechanism of the anti-tumor activities of C-PC-mediated PDT.