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Schmidt-Erfurth U, Hasan T. Mechanisms of action of photodynamic therapy with verteporfin for the treatment of age-related macular degeneration. Surv Ophthalmol 2000; 45:195-214. [PMID: 11094244 DOI: 10.1016/s0039-6257(00)00158-2] [Citation(s) in RCA: 316] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Age-related macular degeneration, especially the neovascular form of the disease, is the leading cause of blindness in elderly people in developed countries. Thermal photocoagulation is still the preferred treatment for choroidal neovascularization that does not involve the fovea, but it is suitable for only a small number of patients and it can lead to immediate loss of visual acuity. Photodynamic therapy with use of photochemical light activation of verteporfin as a photosensitizer (verteporfin therapy) has been shown to be effective in treating vascularized tumors, and its potential to treat other conditions involving neovascularization has also been suggested. Preclinical and clinical studies have indicated that verteporfin therapy can be used to treat choroidal neovascularization secondary to age-related macular degeneration effectively and safely. Selective occlusion of choroidal neovasculature by this therapy causes minimal damage to the neurosensory retina and, therefore, does not induce loss of visual acuity. This benefit allows verteporfin therapy to be used in the large proportion of patients who are not eligible for treatment by laser photocoagulation. The mechanistic aspects of the mode of action of light-activated verteporfin are described in this review.
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52
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Guldi DM, Mody TD, Gerasimchuk NN, Magda D, Sessler JL. Influence of Large Metal Cations on the Photophysical Properties of Texaphyrin, a Rigid Aromatic Chromophore. J Am Chem Soc 2000. [DOI: 10.1021/ja001578b] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Dirk M. Guldi
- Contribution from the Radiation Laboratory, University of Notre Dame, Notre Dame, Indiana 46556, Pharmacyclics, Inc., 995 East Arques Avenue, Sunnyvale, California 94086, and Department of Chemistry and Biochemistry, University of Texas at Austin, Austin, Texas 78712
| | - Tarak D. Mody
- Contribution from the Radiation Laboratory, University of Notre Dame, Notre Dame, Indiana 46556, Pharmacyclics, Inc., 995 East Arques Avenue, Sunnyvale, California 94086, and Department of Chemistry and Biochemistry, University of Texas at Austin, Austin, Texas 78712
| | - Nikolay N. Gerasimchuk
- Contribution from the Radiation Laboratory, University of Notre Dame, Notre Dame, Indiana 46556, Pharmacyclics, Inc., 995 East Arques Avenue, Sunnyvale, California 94086, and Department of Chemistry and Biochemistry, University of Texas at Austin, Austin, Texas 78712
| | - Darren Magda
- Contribution from the Radiation Laboratory, University of Notre Dame, Notre Dame, Indiana 46556, Pharmacyclics, Inc., 995 East Arques Avenue, Sunnyvale, California 94086, and Department of Chemistry and Biochemistry, University of Texas at Austin, Austin, Texas 78712
| | - Jonathan L. Sessler
- Contribution from the Radiation Laboratory, University of Notre Dame, Notre Dame, Indiana 46556, Pharmacyclics, Inc., 995 East Arques Avenue, Sunnyvale, California 94086, and Department of Chemistry and Biochemistry, University of Texas at Austin, Austin, Texas 78712
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53
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Rockson SG, Lorenz DP, Cheong WF, Woodburn KW. Photoangioplasty: An emerging clinical cardiovascular role for photodynamic therapy. Circulation 2000; 102:591-6. [PMID: 10920074 DOI: 10.1161/01.cir.102.5.591] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Photodynamic therapy (PDT) has been studied and applied to various disease processes. The potential of PDT for selective destruction of target tissues is especially appealing in cardiovascular disease, in which other existing interventional tools are somewhat nonselective and carry substantial risk of damage to the normal arterial wall. Enthusiasm for photoangioplasty (PDT of vascular de novo atherosclerotic and, potentially, restenotic lesions) is fueled by more effective second-generation photosensitizers and technological advances in endovascular light delivery. This excitement revolves around at least 4 significant attributes of light-activated therapy: the putative selectivity and safety of photoangioplasty, the potential for atraumatic and effective debulking of atheromatous plaque through a biological mechanism, the postulated capability to reduce or inhibit restenosis, and the potential to treat long segments of abnormal vessel by simply using fibers with longer light-emitting regions. The available nonclinical data, coupled with the observations of a new phase I trial in human peripheral atherosclerosis, suggest a promising future for photoangioplasty in the treatment of primary atherosclerosis and prevention of restenosis.
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Affiliation(s)
- S G Rockson
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
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54
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Sibata CH, Colussi VC, Oleinick NL, Kinsella TJ. Photodynamic therapy: a new concept in medical treatment. Braz J Med Biol Res 2000; 33:869-80. [PMID: 11023333 DOI: 10.1590/s0100-879x2000000800002] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A new concept in the therapy of both neoplastic and non-neoplastic diseases is discussed in this article. Photodynamic therapy (PDT) involves light activation, in the presence of molecular oxygen, of certain dyes that are taken up by the target tissue. These dyes are termed photosensitizers. The mechanism of interaction of the photosensitizers and light is discussed, along with the effects produced in the target tissue. The present status of clinical PDT is discussed along with the newer photosensitizers being used and their clinical roles. Despite the promising results from earlier clinical trials of PDT, considerable additional work is needed to bring this new modality of treatment into modern clinical practice. Improvements in the area of light source delivery, light dosimetry and the computation of models of treatment are necessary to standardize treatments and ensure proper treatment delivery. Finally, quality assurance issues in the treatment process should be introduced.
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Affiliation(s)
- C H Sibata
- Department of Radiation Oncology, Case Western Reserve University School of Medicine, Cleveland, OH 44106-5000, USA.
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55
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Abstract
Conventional cardiovascular imaging, with a focus on identifying flow-limiting stenoses, does not directly image the atherosclerotic lesion. Recent clinical and pathobiologic data indicate that stenosis severity does not dictate cardiovascular risk and that there are functional, structural, and biologic features of atherosclerosis that are associated with cardiovascular events. Imaging technologies, such as ultrasound, light, x-ray, magnetic resonance, and targeted contrast agents, have been developed to characterize directly the atherosclerotic vessel wall. They provide promising approaches to predict cardiovascular risk and facilitate further study of the mechanisms of atherosclerosis progression and its response to therapy.
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Affiliation(s)
- M V McConnell
- Stanford University Medical Center, 300 Pasteur Drive, Room H-2157, Stanford, CA 94305-5233, USA.
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56
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Kim TK, Choi BI, Park SW, Lee W, Han JK, Han MC, Weinmann HJ. Gadolinium mesoporphyrin as an MR imaging contrast agent in the evaluation of tumors: an experimental model of VX2 carcinoma in rabbits. AJR Am J Roentgenol 2000; 175:227-34. [PMID: 10882277 DOI: 10.2214/ajr.175.1.1750227] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We determined the enhancement features of experimentally induced malignant tumors on MR imaging with the use of gadolinium mesoporphyrin, a recently developed MR contrast agent that may be necrosis-specific. MATERIALS AND METHODS VX2 carcinoma was inoculated into 24 rabbit thighs. T1-weighted contrast-enhanced MR imaging with IV gadopentetate dimeglumine (2-min delay) and gadolinium mesoporphyrin (20-hr delay) was performed 3-4 days (n = 6), 6-7 days (n = 6), 10-11 days (n = 5), and 13-14 days (n = 7) after the implantation of VX2 carcinoma. All tumors were sectioned along the same plane of MR images, and a detailed MR imaging-histopathologic correlation was performed. RESULTS Pathologically, areas enhanced with gadolinium mesoporphyrin included necrotic tissue, viable tumor, inflammatory granulation tissue, hemorrhage, and fibrosis. On gadopentetate dimeglumine-enhanced MR images, unenhanced areas of the tumor corresponded with intratumoral necrosis and hemorrhage. CONCLUSION Gadolinium mesoporphyrin enhances tumor necrosis on delayed phase MR imaging; however, it is impossible to specifically depict necrosis with gadolinium mesoporphyrin because it also enhances other parts of lesions, including viable tumor.
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Affiliation(s)
- T K Kim
- Department of Radiology, Seoul National University College of Medicine, Korea
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57
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Hunt DW, Chan AH. Influence of photodynamic therapy on immunological aspects of disease - an update. Expert Opin Investig Drugs 2000; 9:807-17. [PMID: 11060711 DOI: 10.1517/13543784.9.4.807] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Photodynamic therapy (PDT) utilises light-absorbing compounds combined with directed photo-irradiation to produce clinical effects. This review updates advances in the understanding of the biochemical pathways triggered by PDT within cells, its influence upon different immune parameters and progress in the use of PDT against human immune-mediated disease. Several works have further defined the notable capacity of PDT to foster anticancer immunity.
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Affiliation(s)
- D W Hunt
- QLT PhotoTherapeutics, Inc., 887 Great Northern Way, Vancouver, British Columbia V5T 4T5, Canada.
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58
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Sessler JL, Miller RA. Texaphyrins: new drugs with diverse clinical applications in radiation and photodynamic therapy. Biochem Pharmacol 2000; 59:733-9. [PMID: 10718331 DOI: 10.1016/s0006-2952(99)00314-7] [Citation(s) in RCA: 233] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The texaphyrins are quintessential metal-coordinating expanded porphyrins. They constitute a new series of synthetic porphyrin analogues that show promise as drugs for use in a range of medical therapies. Currently, two different water-solubilized lanthanide(III) texaphyrin complexes, namely the gadolinium(III) and lutetium(III) derivatives 1 and 2 (Gd-Tex and Lu-Tex, respectively), are being tested clinically. The first of these, XCYTRIN, is in a pivotal Phase III clinical trial as a potential enhancer of radiation therapy for patients with metastatic cancers to the brain receiving whole brain radiation therapy. The second, in various formulations, is being tested as a photosensitizer for use in: (i) the photodynamic treatment of recurrent breast cancer (LUTRIN; Phase II clinical trials complete), (ii) photoangioplastic reduction of atherosclerosis involving peripheral arteries (ANTRIN; now in Phase II testing), and (iii) light-based treatment of age-related macular degeneration (OPTRIN; currently in Phase I clinical trials), a vision-threatening disease of the retina. Taken in concert, these two metallotexaphyrins provide a powerful new class of experimental drugs whose diverse potential utility is abetted by a combination of well-optimized physical features, favorable tissue biolocalization characteristics, and novel mechanisms of action. Interestingly, these mechanisms may alter conventional wisdom regarding mechanisms of radiation therapy and the pathophysiology of atherosclerosis.
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Affiliation(s)
- J L Sessler
- Department of Chemistry & Biochemistry, University of Texas, Austin 78712, USA.
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59
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Abstract
UNLABELLED The combination of light and chemicals to treat skin diseases is widely practiced in dermatology. Within this broad use of light and drugs, in recent years the concept of photodynamic therapy (PDT) has emerged. PDT is a promising modality for the management of various tumors and nonmalignant diseases, based on the combination of a photosensitizer that is selectively localized in the target tissue and illumination of the lesion with visible light, resulting in photodamage and subsequent cell death. Moreover, the fluorescence of photosensitizing compounds is also utilized as a helpful diagnostic tool for the detection of neoplastic tissue. Intensive basic and clinical research culminated in the worldwide approval of PDT for bladder, esophageal, and lung cancer. The expanding use of this relatively new therapeutic modality in dermatology at many centers around the world has revealed its efficacy for the treatment of cutaneous precancer and cancer, as well as selected benign skin disorders. The following article summarizes the main principles of PDT considering the most recent developments and provides a comprehensive synopsis of the present status of the use of PDT in dermatology. (J Am Acad Dermatol 2000;42:389-413.) LEARNING OBJECTIVE At the conclusion of this learning activity, participants should be able to describe the basic concepts of PDT, including fundamental knowledge of the most relevant photosensitizers, the light sources, the mechanisms involved in PDT-mediated cell destruction, as well as the indications and limitations of photodynamic treatment of skin diseases.
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Affiliation(s)
- K Kalka
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
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60
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Abstract
Despite decades of targeted research, cancer remains a leading cause of death. Around one third of the population of Western Europe and North America will develop cancer in their lifetime and, virtually without exception, all of us will be affected by the disease, either directly as patients or by repercussions in family and friends. In certain specific cancers, advances in surgery, chemotherapy and radiotherapy have led to major achievements, but in many types of cancer there has been little or no improvement in long-term survival. In yet other cases, whilst there may be good initial responses to drug therapy, drug resistance develops and additional agents are required to induce further remission in these patients. There is therefore a clear need for new anticancer agents and novel therapies. It is in this context that photosensitising drugs may play a significant part.
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61
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Hammer-Wilson MJ, Akian L, Espinoza J, Kimel S, Berns MW. Photodynamic parameters in the chick chorioallantoic membrane (CAM) bioassay for topically applied photosensitizers. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 1999; 53:44-52. [PMID: 10672528 DOI: 10.1016/s1011-1344(99)00124-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The relative efficacy of Photofrin-based photodynamic therapy (PDT) has been compared with that of the second-generation photosensitizers 5-aminolevulinic acid (ALA), sulfonated chloro-aluminum phthalocyanine (AlPcSn), benzoporphyrin derivative monoacid ring A (BPD-MA), and lutetium texaphyrin (Lutex). PDT-induced vascular damage in the chick chorioallantoic membrane (CAM) is measured following topical application of the photosensitizers. In order to make meaningful comparisons, care is taken to keep treatment variables the same. These include light dose (5 and 10 J/cm2), power density (33 and 100 mW/cm2), and drug uptake time (30 and 90 min). The drug dose ranges from 0.1 microgram/cm2 for BPD to 5000 micrograms/cm2 for ALA. Results are also analyzed statistically according to CAM vessel type (arterioles versus venules), vessel diameter, and vessel development (embryonic age). For each photosensitizer, the order of importance for the various PDT parameters is found to be unique. The differences between the sensitizers are most likely due to variation in biophysical and biochemical characteristics, biodistribution, and uptake kinetics.
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Affiliation(s)
- M J Hammer-Wilson
- Beckman Laser Institute and Medical Clinic, University of California, Irvine 92612, USA
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62
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Rockson SG. Lutetium Texaphyrin: A New Therapeutic Tool for Human Atherosclerosis. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 1999; 1:199-202. [PMID: 11096484 DOI: 10.1007/s11936-999-0035-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- SG Rockson
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
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63
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Affiliation(s)
- H Ali
- MRC Group in the Radiation Sciences, Department of Nuclear Medicine and Radiobiology, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada J1H 5N4
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64
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Grossweiner LI, Bilgin MD, Berdusis P, Mody TD. Singlet Oxygen Generation by Metallotexaphyrins. Photochem Photobiol 1999. [DOI: 10.1111/j.1751-1097.1999.tb07981.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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65
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Woodburn KW, Fan Q, Kessel D, Luo Y, Young SW. Photodynamic therapy of B16F10 murine melanoma with lutetium texaphyrin. J Invest Dermatol 1998; 110:746-51. [PMID: 9579539 DOI: 10.1046/j.1523-1747.1998.00182.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Photodynamic therapy (PDT) of pigmented melanoma has generally been unsuccessful because of insufficient light penetration in such tissues. In this study, the responsiveness of the heavily pigmented B16F10 murine melanoma to lutetium texaphyrin (PCI-0123), a water-soluble sensitizer with strong absorbance in the near infrared (700-760 nm), was examined. These studies were carried out in both normal and ApoE deficient C57BL/6 mice. The latter strain exhibits a lipoprotein profile more like humans (low density lipoprotein > high density lipoprotein) than rodents (high density lipoprotein >> low density lipoprotein). Under optimal conditions of drug dose, light dose, and interval between drug administration and irradiation--the median survival time of C57BL/6 tumor bearing mice was approximately doubled (29 d) compared with tumor bearing control animals (13 d). The life-span of the ApoE knockout mice was greater (33 d) than the C57BL/6 animals (23 d) when irradiation occurred 3 h after administration of a 10 micromol per kg drug dose. The greater efficacy of PDT in the ApoE deficient mice was associated with more rapid clearance of drug from the blood, greater accumulation of sensitizer in tumor tissue, and substantially greater drug binding to the very low density lipoprotein/low density lipoprotein plasma fraction. Confocal laser scanning microscopy showed that the predominant subcellular site of photosensitizer binding was to melanosomes; costaining was performed with Mel-5. Melanosomes are susceptible to oxidative stress. Photo-oxidation, mediated by PCI-0123 PDT, could potentially overload an already highly oxidized stressed state leading to cell death. The good tissue penetration depth achieved by PCI-0213 mediated PDT and the activation of melanosomes makes PDT of pigmented melanoma, for the first time, clinically relevant.
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