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Okabe Y, Fukuhara Y, Matsuoka W, Nobuyuki N, Hiroshi M, Takeshi M, Naotaka G, Kosuke T, Tsubouchi K, Masahiro T, Chizuru N, Fumihiro Y, Haga N. Identification of Risk Factors Associated with Oral 5-Aminolevulinic Acid Induced Adverse Events in Photodynamic Diagnosis-Transurethral Resection of Bladder Tumor. Photodiagnosis Photodyn Ther 2024:104291. [PMID: 39059758 DOI: 10.1016/j.pdpdt.2024.104291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/04/2024] [Accepted: 07/22/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Oral 5-aminolevulinic acid for transurethral resection of bladder tumor reduces bladder cancer recurrence compared with standard white-light transurethral resection of bladder tumor. However, data regarding risks of adverse events with this drug are unclear. The aim of the present study was to identify risk factors associated with oral 5-aminolevulinic acid induced adverse events in photodynamic diagnosis-transurethral resection of bladder tumor. METHODS We studied 104 cases of 5-aminolevulinic acid-photodynamic diagnosis-transurethral resection of bladder tumor from October 2021 to April 2023, administering 20 mg/kg 5-aminolevulinic acid orally at least 2 hours pre-surgery. Four major adverse events associated with 5-aminolevulinic acid were selected to identify risk factors for their occurrence, including perioperative hypotension, nausea and/or vomiting, photosensitivity, and liver dysfunction. Univariate and multivariate analyses were conducted to identify the risk factors of those adverse events. RESULTS Perioperative hypotension (11.5%), nausea and/or vomiting (37.5%) photosensitivity (31.7%), and liver dysfunction (51.9%) were observed. Multivariate analyses revealed that spinal anesthesia was associated with hypotension (p=0.02), whereas advanced age (p<0.01) and higher body mass index (p<0.01) were associated with nausea and/or vomiting. Also, male sex (p<0.01) and longer operative time (p=0.01) were associated with photosensitivity, and renin-angiotensin system inhibitors use was associated with postoperative liver dysfunction (p<0.01). CONCLUSIONS For elderly male obese patients taking renin-angiotensin system inhibitors, particular attention is needed during the perioperative period of photodynamic diagnosis-transurethral resection of bladder tumor under spinal anesthesia due to the higher risk of onset of the adverse events involved in oral administration of 5-aminolevulinic acid.
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Affiliation(s)
- Yu Okabe
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yuichiro Fukuhara
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Wataru Matsuoka
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Nakamura Nobuyuki
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Matsuzaki Hiroshi
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Miyazaki Takeshi
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Gunge Naotaka
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Tominaga Kosuke
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kazuna Tsubouchi
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Tachibana Masahiro
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Nakagawa Chizuru
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yamazaki Fumihiro
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Nobuhiro Haga
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
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Christensen E, Foss OA, Holien T, Juzenas P, Peng Q. Application of Photodynamic Therapy with 5-Aminolevulinic Acid to Extracorporeal Photopheresis in the Treatment of Cutaneous T-Cell Lymphoma: A First-in-Human Phase I/II Study. Pharmaceutics 2024; 16:815. [PMID: 38931936 PMCID: PMC11207254 DOI: 10.3390/pharmaceutics16060815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/08/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Extracorporeal photopheresis (ECP) is a therapeutic modality used for T-cell-mediated disorders. This approach involves exposing isolated white blood cells to photoactivatable 8-methoxypsoralen (8-MOP) and UVA light, aiming to induce apoptosis in T-cells and thereby modulate immune responses. However, conventional 8-MOP-ECP lacks cell selectivity, killing both healthy and diseased cells, and has shown limited treatment efficacy. An alternative approach under investigation involves the use of 5-aminolevulinic acid (ALA) in conjunction with light, referred to as ALA-based photodynamic therapy. Our previous ex vivo studies suggest that ALA-ECP exhibits greater selectivity and efficiency in killing T-cells derived from patients with T-cell-mediated disorders compared to those treated with 8-MOP-ECP. We have conducted a clinical phase I-(II) study evaluating ALA-ECP safety and tolerability in cutaneous T-cell lymphoma (CTCL). Here, 20 ALA-ECP treatments were administered to one CTCL patient, revealing no significant changes in vital signs. Two adverse events were reported; both evaluated by the Internal Safety Review Committee as non-serious. In addition, five conceivable events with mainly mild symptoms took place. During the study period, a 53% reduction in skin involvement and a 50% reduction in pruritus was observed. In conclusion, the results indicate that ALA-ECP treatment is safe and well tolerated.
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Affiliation(s)
- Eidi Christensen
- Department of Dermatology, St. Olav’s Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, 0310 Oslo, Norway; (P.J.); (Q.P.)
| | - Olav Andreas Foss
- Department of Orthopaedic Surgery, Clinic of Orthopaedic, Rheumatology and Dermatology, St. Olav’s Hospital, Trondheim University Hospital, 7030 Trondheim, Norway;
| | - Toril Holien
- Department of Biomedical Laboratory Science, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway;
- Department of Immunology and Transfusion Medicine, St. Olav’s Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
| | - Petras Juzenas
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, 0310 Oslo, Norway; (P.J.); (Q.P.)
| | - Qian Peng
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, 0310 Oslo, Norway; (P.J.); (Q.P.)
- Department of Optical Science and Engineering, School of Information Science and Technology, Fudan University, Shanghai 200433, China
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Mui OOT, Murray DB, Walsh B, Crimmins DW, Caird JD. Spontaneous intracerebral haemorrhage secondary to 5-ALA-induced thrombocytopaenia in a paediatric patient: case report and literature review. Childs Nerv Syst 2023; 39:1051-1058. [PMID: 36662275 PMCID: PMC10160215 DOI: 10.1007/s00381-023-05846-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/10/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The primary objective of neurosurgical management of malignant gliomas is maximal safe resection of the tumour. One of the main obstacles in achieving this is the ability to accurately discriminate between tumour edges and the surrounding healthy brain tissue. The use of fluorescence-guided surgery utilising 5-aminolevulinic acid (5-ALA), first introduced more than 20 years ago, has become an invaluable adjunct in high-grade glioma surgery in adults. However, as 5-ALA is not licensed for use in paediatric patients, the safety profile for such use remains undetermined. CASE REPORT We describe the case of a 4-year-old boy who underwent 5-ALA-guided resection of a fourth ventricle anaplastic ependymoma. Although complete resection was achieved and the patient awoke from surgery well with no neurological deficits, the patient developed acute transaminitis, anaemia, thrombocytopaenia and coagulopathy postoperatively. The patient had a sudden neurological deterioration on postoperative day 2; imaging revealed that he had suffered a spontaneous right frontal intracerebral haemorrhage. The patient returned to theatre for surgical decompression and evacuation of the haematoma, and ultimately went on to make a full recovery. CONCLUSION The use of 5-ALA in paediatric patients can be helpful in maximising surgical resection, but the associated safety profile remains undefined. Further research is urgently warranted in order to characterise the efficacy and risk of the use of 5-ALA in the paediatric population.
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Affiliation(s)
- Olivia O T Mui
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. .,Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Daniel B Murray
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland.,Temple Street Children's University Hospital, Dublin, Ireland
| | - Bill Walsh
- Temple Street Children's University Hospital, Dublin, Ireland
| | - Darach W Crimmins
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland.,Temple Street Children's University Hospital, Dublin, Ireland
| | - John D Caird
- Royal College of Surgeons in Ireland, Dublin, Ireland.,Temple Street Children's University Hospital, Dublin, Ireland
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Fukunaga S, Ogata K, Eguchi A, Matsunaga K, Sakurai K, Abe J, Cohen SM, Asano H. Evaluation of the mode of action and human relevance of liver tumors in male mice treated with epyrifenacil. Regul Toxicol Pharmacol 2022; 136:105268. [DOI: 10.1016/j.yrtph.2022.105268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/15/2022] [Accepted: 10/01/2022] [Indexed: 11/13/2022]
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Li A, Fang R, Mao X, Sun Q. Photodynamic therapy in the treatment of rosacea: a systematic review. Photodiagnosis Photodyn Ther 2022; 38:102875. [DOI: 10.1016/j.pdpdt.2022.102875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
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Christensen E, Foss OA, Quist-Paulsen P, Staur I, Pettersen F, Holien T, Juzenas P, Peng Q. Application of Photodynamic Therapy with 5-Aminolevulinic Acid to Extracorporeal Photopheresis in the Treatment of Patients with Chronic Graft-versus-Host Disease: A First-in-Human Study. Pharmaceutics 2021; 13:pharmaceutics13101558. [PMID: 34683851 PMCID: PMC8538664 DOI: 10.3390/pharmaceutics13101558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 11/30/2022] Open
Abstract
Extracorporeal photopheresis (ECP), an immunomodulatory therapy for the treatment of chronic graft-versus-host disease (cGvHD), exposes isolated white blood cells to photoactivatable 8-methoxypsoralen (8-MOP) and UVA light to induce the apoptosis of T-cells and, hence, to modulate immune responses. However, 8-MOP-ECP kills diseased and healthy cells with no selectivity and has limited efficacy in many cases. The use of 5-aminolevulinic acid (ALA) and light (ALA-based photodynamic therapy) may be an alternative, as ex vivo investigations show that ALA-ECP kills T-cells from cGvHD patients more selectively and efficiently than those treated with 8-MOP-ECP. The purpose of this phase I-(II) study was to evaluate the safety and tolerability of ALA-ECP in cGvHD patients. The study included 82 treatments in five patients. One patient was discharged due to the progression of the haematological disease. No significant persistent changes in vital signs or laboratory values were detected. In total, 62 adverse events were reported. Two events were severe, 17 were moderate, and 43 were mild symptoms. None of the adverse events evaluated by the internal safety review committee were considered to be likely related to the study medication. The results indicate that ALA-ECP is safe and is mainly tolerated well by cGvHD patients.
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Affiliation(s)
- Eidi Christensen
- Department of Dermatology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway;
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, 0310 Oslo, Norway; (T.H.); (P.J.); (Q.P.)
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7030 Trondheim, Norway;
- Correspondence:
| | - Olav A. Foss
- Department of Orthopaedic Surgery, Clinic of Orthopaedy, Rheumatology and Dermatology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway;
- Department of Neuroscience and Movement Science, Norwegian University of Science and Technology, 7030 Trondheim, Norway
| | - Petter Quist-Paulsen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7030 Trondheim, Norway;
- Department of Haematology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
| | - Ingrid Staur
- Department of Dermatology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway;
| | - Frode Pettersen
- Department of Nephrology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway;
| | - Toril Holien
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, 0310 Oslo, Norway; (T.H.); (P.J.); (Q.P.)
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7030 Trondheim, Norway;
- Department of Haematology, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
| | - Petras Juzenas
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, 0310 Oslo, Norway; (T.H.); (P.J.); (Q.P.)
| | - Qian Peng
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, 0310 Oslo, Norway; (T.H.); (P.J.); (Q.P.)
- Department of Optical Science and Engineering, School of Information Science and Technology, Fudan University, Shanghai 200433, China
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Eguchi A, Fukunaga S, Ogata K, Kushida M, Asano H, Cohen SM, Sukata T. Chimeric Mouse With Humanized Liver Is an Appropriate Animal Model to Investigate Mode of Action for Porphyria-Mediated Hepatocytotoxicity. Toxicol Pathol 2021; 49:1243-1254. [PMID: 34238059 PMCID: PMC8521358 DOI: 10.1177/01926233211027474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Porphyrinogenic compounds are known to induce porphyria-mediated hepatocellular injury and subsequent regenerative proliferation in rodents, ultimately leading to hepatocellular tumor induction. However, an appropriate in vivo experimental model to evaluate an effect of porphyrinogenic compounds on human liver has not been fully established. Recently, the chimeric mouse with humanized liver (PXB mice) became widely used as a humanized model in which human hepatocytes are transplanted. In the present study, we examined the utility of PXB mice as an in vivo experimental model to evaluate the key events of the porphyria-mediated cytotoxicity mode of action (MOA) in humans. The treatment of PXB mice with 5-aminolevulinic acid, a representative porphyrinogenic compound, for 28 days caused protoporphyrin IX accumulation, followed by hepatocyte necrosis, increased mitosis, and an increase in replicative DNA synthesis in human hepatocytes, indicative of cellular injury and regenerative proliferation, similar to findings in patients with porphyria or experimental porphyria models and corresponding to the key events of the MOA for porphyria-mediated hepatocellular carcinogenesis. We conclude that the PXB mouse is a useful model to evaluate the key events of the porphyria-mediated cytotoxicity MOA in humans and suggest the utility of PXB mice for clarifying the human relevancy of findings in mice.
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Affiliation(s)
- Ayumi Eguchi
- Environmental Health Science Laboratory, Sumitomo Chemical Co, Ltd, Osaka, Japan
| | - Satoki Fukunaga
- Environmental Health Science Laboratory, Sumitomo Chemical Co, Ltd, Osaka, Japan
| | - Keiko Ogata
- Environmental Health Science Laboratory, Sumitomo Chemical Co, Ltd, Osaka, Japan
| | - Masahiko Kushida
- Environmental Health Science Laboratory, Sumitomo Chemical Co, Ltd, Osaka, Japan
| | - Hiroyuki Asano
- Environmental Health Science Laboratory, Sumitomo Chemical Co, Ltd, Osaka, Japan
| | - Samuel M Cohen
- Department of Pathology and Microbiology, Havlik-Wall Professor of Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tokuo Sukata
- Environmental Health Science Laboratory, Sumitomo Chemical Co, Ltd, Osaka, Japan
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Wen P, Wang L, Liu H, Gong L, Ji H, Wu H, Chu W. Risk factors for the severity of Guillain-Barré syndrome and predictors of short-term prognosis of severe Guillain-Barré syndrome. Sci Rep 2021; 11:11578. [PMID: 34079013 PMCID: PMC8172857 DOI: 10.1038/s41598-021-91132-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/17/2021] [Indexed: 01/28/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is a neurological disorder characterized by paralysis. Identifying the severity, appropriate therapeutic method, and prognosis of GBS at an early stage is highly important. This study aimed to investigate the modifiable risk factors for the severity of GBS and consequent need for mechanical ventilation (MV) and to identify clinical predictive factors for poor short-term outcomes of severe GBS. 155 GBS patients who were admitted to the Affiliated Yantai Yuhuangding Hospital of Qingdao University during 2014–2020 were enrolled. Demographic, clinical, therapeutic and evolutionary data were collected and were then analyzed using univariate and multivariate regression analyses. Our analytic data demonstrated that the significant clinical predictors of severe GBS were recent history of surgery, older age, cranial nerve impairment, and elevated levels of liver enzymes (p < 0.05). Furthermore, autonomic dysfunction, lower Medical Research Council (MRC) score at nadir, and elevated levels of liver enzymes were significantly associated with MV for severe GBS (p < 0.05), and lower MRC score at nadir and autonomic dysfunction remained significant predictors of MV in severe GBS (p < 0.05). Lastly, recent history of surgery, lower MRC score at admission and at nadir, requirement for MV, and pneumonia during hospitalization were significantly associated with the short-term outcome of severe GBS and that lower MRC score at admission and need for MV were confirmed to be predictors of poor short-term prognosis (p < 0.05). Of note, this study suggested that recent history of surgery is a predictor of severity in GBS patients and is associated with the poor short-term prognosis of severe GBS.
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Affiliation(s)
- Puyuan Wen
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China
| | - Lisha Wang
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China
| | - Hong Liu
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China
| | - Li Gong
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China
| | - Han Ji
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China
| | - Hongliang Wu
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China.
| | - Wenzheng Chu
- Department of Neurology, The affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong, People's Republic of China.
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