Photodynamic therapy in China: Over 25 years of unique clinical experience

HiPorfin photodynamic therapy for vaginal high-grade squamous intraepithelial lesion

PURPOSE

We aimed to evaluate the efficacy and safety of HiPorfin-photodynamic therapy (PDT) in women with vaginal high-grade squamous intraepithelial Lesion (HSIL).

METHODS

Retrospective analysis of eighteen patients with vaginal HSIL received HiPorfin-PDT between June 2019 and May 2023. Illumination with a 630-nm laser light was applied to the lesions 48-72 h after intravenous injection of 2 mg/kg HiPorfin®. The light dose to the lesions was 150 J/cm2.

RESULTS

The mean age of the 18 patients was 45.8 years (range, 24 to 63). The complete response (CR) rate was 66.7% (12/18), 83.3% (15/18) and 83.3% (15/18) at 3, 6 and 12 months after PDT, respectively. Patients who achieved CR showed no signs of recurrence during long-term follow-up. There were three cases of persistent disease showing partial response (PR) and the lesion area was significantly reduced more than 50%. One patient with persistent disease then underwent thermocoagulation one time and subsequently showed no evidence of HSIL. Pre-treatment, 100% (18/18) patients were high-risk human papilloma virus (HR-HPV)-positive. HPV eradication rate was 16.7% (3/18), 22.2% (4/18) and 44.4% (8/18) after PDT at 3, 6 and 12 months, respectively. Before treatment, liquid-based cytology test ≥ atypical squamous cells of undetermined significance (ASCUS) was 94.4% (17/18). Negative conversion ratio of cytology was 47.1% (8/17), 52.9% (9/17) and 76.5% (13/17) at 3, 6 and 12 months, respectively. There were no serious adverse effects during and after PDT.

CONCLUSIONS

HiPorfin-PDT may be an effective alternative treatment for vaginal HSIL for organ-saving and sexual function protection.

Successful pregnancy and delivery after HiPorfin photodynamic therapy for cervical high-grade squamous intraepithelial lesion

OBJECTIVE

The study analyzed HiPorfin-Photodynamic therapy (PDT) for young women with cervial high-grade squamous intraepithelial lesion (HSIL) and evaluated the impact of PDT on their pregnancy and delivery.

METHODS

Retrospective analysis of 4 patients (21-33 years old) were treated with HiPorfin® (2 mg/kg) PDT in 2019-2022. 1 patient suffered from cervical intraepithelial neoplasia (CIN)Ⅱ and 3 patients from CIN Ⅲ. 630 nm laser light irradiated the cervical surface and endocervical canal with light dose of 150 J/cm2 and 100-120 J/cm2 respectively.

RESULTS

The median observation time period was 40.5 months. Cure rate, HPV eradication rate and negative conversion rate of cytology were all 100.0 % at 3, 6 and 12 months. All cervical canal lesions completely turned negative. No recurrence occurred during the long-term follow-up period. None of patients suffered from infertility. Three patients delivered vaginally and one delivered by C-section to healthy infants at term.

CONCLUSION

HiPorfin® PDT for cervical HSIL was proved to be a safe method without adverse effects on female fertility and allowing these women to have healthy, full-term children.

Photodynamic therapy with HiPorfin for cervical squamous intraepithelial lesion at childbearing age

OBJECTIVE

To evaluate the clinical efficacy and safety of HiPorfin® photodynamic therapy (PDT) in the treatment of young women at reproductive age with high-grade squamous intraepithelial lesion (HSIL) of the cervix.

METHODS

Prospective study of 41 patients aged 28.8 ± 4.6 years old with cervical intraepithelial neoplasia (CIN) Ⅱ-Ⅲ at Peking University Shenzhen Hospital from March 2019 to January 2023. HiPorfin® (2 mg/kg) was infused intravenously, and 48-72 h later, 630-nm laser irradiation was performed in cervical canal and cervical surface with an irradiation dose of 100-120 J/cm2 and 150 J/cm2 respectively.

RESULTS

All 41 patients with no recurrence had been observed at least 12 months follow-up period after PDT. The number of nulliparous women was 30 (30/41, 73.2 %). CIN Ⅱ were 22 cases (22/41,53.7 %) and CIN Ⅲ were 19 cases (19/41,46.3 %). Complete response (CR) was in 95.5 % (21/22) patients with CIN Ⅱ and 78.9 % (15/19) patients with CIN Ⅲ at 6 months follow-up. Meanwhile, CR rate was 100.0 % (22/22) and 84.2 % (16/19) in CIN Ⅱ and CIN Ⅲ group respectively at 12 months. Pre-treatment, all patients (41/41,100 %) were Human papilloma virus (HPV) positive. HPV eradication rate was 63.4 % (26/41), 73.2 % (30/41) and 92.7 % (38/41) at 3, 6 and 12 months after PDT respectively. Before treatment, cytology ≥ atypical squamous cells of undetermined significance (ASCUS) was 78.0 % (32/41). Negative conversion ratio of cytology was 75.0 % (24/32), 90.6 % (29/32) and 100.0 % (32/32) at 3, 6 and 12 months after PDT respectively. There were no serious adverse effects in patients during and after PDT.

CONCLUSION

HiPorfin-PDT is a promising and organ-saving approach for cervical HSIL, which also eradicates HPV infection effectively and can be a beacon of hope for the young women with fertility preservation requirement.

Bimodal photodynamic therapy for treatment of a 91-year-old patient with locally advanced cutaneous basal cell carcinoma and postoperative scar management

Locally advanced basal cell carcinoma (laBCC) is an uncommon cutaneous malignant tumor characterized by direct spread and extensive tissue destruction. The optimal therapy for laBCC remains a challenge, especially for elderly patients. Photodynamic therapy (PDT) has its advantage of better tumor selectivity, providing focal treatment for various non-melanoma carcinomas. We report that a new combination treatment of HiPorfin-photodynamic therapy (HiPorfin-PDT) and modified topical 5-aminolevulinic acid-photodynamic therapy (ALA-PDT), named bimodal PDT was successful to treat a 91-year-old patient with laBCC. As for side effects, hypertrophic scar and pain were observed. The symptoms were relieved after intralesional corticosteroid, 980 nm laser and 595 nm pulsed dye laser treatment in 3 months.

Effect of 532nm photodynamic therapy with hemoporfin on the expression of vascular endothelial growth factor in cultured human vascular endothelial cells

BACKGROUND

Photodynamic therapy (PDT) with hemoporfin (hematoporphyrinmonomethyl ether, HMME) and 532 nm continuous-wave lasers is effective for port-wine stains (PWS) and is considered as a promising treatment modality. The vascular endothelial growth factor (VEGF) is involved in the development of PWS. This study aimed to investigate the effect of 532 nm-HMME-PDT on the in vitro expression of VEGF in human umbilical vein endothelial cells (HUVECs) exposed to different power levels of 532 nm laser and different concentrations of HMME.

METHOD

The CCK-8 assay was performed to assess cell viability. Enzyme-linked immunosorbent assay (ELISA) was performed to measure VEGF secretion. VEGF and VEGF receptor (VEGFR) mRNA expression levels were detected by quantitative reverse transcription-polymerase chain reaction (qRT-PCR).

RESULTS

Within 72 h after HMME-PDT, cell viability was inhibited, secretion and expression of VEGF was decreased, and expression of VEGFR mRNA was significantly decreased with the increase of HMME concentration.

CONCLUSION

532 nm-HMME-PDT can downregulate the expression of VEGF and VEGFR mRNA. Future studies are necessary to examine the HMME doses to achieve better efficacy with fewer adverse effects.

Vascular-targeted photodynamic therapy of gastric antral vascular ectasia (GAVE)

BACKGROUND AND STUDY AIM

Vascular-targeted photodynamic therapy (V-PDT) has been used for several benign vascular diseases. The aim of this pilot study was to demonstrate the potential benefits of VPDT in the treatment of gastric antral vascular ectasia (GAVE).

PATIENTS AND METHODS

Data from patients with GAVE (n=5) who underwent endoscopic V-PDT were analyzed retrospectively. Pre- and post-V-PDT clinical and endoscopic features, hemoglobin levels, and transfusion requirement were compared.

RESULTS

The five GAVE patients received one to four sessions of V-PDT. The hemoglobin levels of all five patients increased steadily following V-PDT. Within 6-48months of follow-up, gastrointestinal bleeding and melena disappeared in all five patients and none of the patients needed a transfusion. Endoscopy examinations showed that the dilated vessels had disappeared without scar formation. No significant side effects or adverse reactions were reported.

CONCLUSION

This preliminary study indicates the good selectivity, safety, and efficacy of V-PDT in the treatment of patients with GAVE. Larger prospective studies are needed to further confirm the feasibility of using V-PDT to treat patients with GAVE.

A Surgical View of Photodynamic Therapy in Oncology: A Review

Clinical photodynamic therapy (PDT) has existed for over 30 years, and its scientific basis has been known and investigated for well over 100 years. The scientific foundation of PDT is solid and its application to cancer treatment for many common neoplastic lesions has been the subject of a huge number of clinical trials and observational studies. Yet its acceptance by many clinicians has suffered from its absence from the undergraduate and/or postgraduate education curricula of surgeons, physicians, and oncologists. Surgeons in a variety of specialties many with years of experience who are familiar with PDT bear witness in many thousands of publications to its safety and efficacy as well as to the unique role that it can play in the treatment of cancer with its targeting precision, its lack of collateral damage to healthy structures surrounding the treated lesions, and its usage within minimal access therapy. PDT is closely related to the fluorescence phenomenon used in photodiagnosis. This review aspires both to inform and to present the clinical aspect of PDT as seen by a surgeon.

Hiporfin-mediated photodynamic therapy in preclinical treatment of osteosarcoma

This study was carried out to investigate the anti-tumor effect and mechanism of hiporfin-mediated photodynamic therapy (hiporfin-PDT) in osteosarcoma. We found that hiporfin accumulated mainly in the cytoplasm of osteosarcoma cells in a time and concentration-dependent manner. Hiporfin-PDT inhibited the proliferation, induced apoptosis and produced cell cycle arrest at G2M in osteosarcoma cell lines. Hiporfin-PDT increased the expression of cleaved-caspase-3, cleaved PARP-1, Bax and RIP1 while it decreased the expression of Bcl-2; in addition, low concentration of hiporfin increased LC3 conversion. Furthermore, cell death caused by hiporfin-PDT could be rescued by Nec-1 but not by Z-VAD-FMK. Production of reactive oxygen species was increased after hiporfin-PDT. In vivo studies showed a significant decrease in tumor volume and weight after hiporfin-PDT in all three tumor mouse models investigated (subcutaneous and orthotopic). Histological analysis showed widespread cell apoptosis and necrosis after treatment. Immunohistochemistry also showed upregulation of cleaved-caspase-3 and downregulation of Bcl-2 after hiporfin-PDT. These results indicate that hiporfin-PDT exhibits a killing effect in osteosarcoma both in vitro and in vivo, which is associated with apoptosis and necroptosis, while autophagy plays a protective role. All these findings shed light on a potential future clinical use for hiporfin in the treatment of osteosarcoma.

A medical manipulator system with lasers in photodynamic therapy of port wine stains

Port wine stains (PWS) are a congenital malformation and dilation of the superficial dermal capillary. Photodynamic therapy (PDT) with lasers is an effective treatment of PWS with good results. However, because the laser density is uneven and nonuniform, the treatment is carried out manually by a doctor thus providing little accuracy. Additionally, since the treatment of a single lesion can take between 30 and 60 minutes, the doctor can become fatigued after only a few applications. To assist the medical staff with this treatment method, a medical manipulator system (MMS) was built to operate the lasers. The manipulator holds the laser fiber and, using a combination of active and passive joints, the fiber can be operated automatically. In addition to the control input from the doctor over a human-computer interface, information from a binocular vision system is used to guide and supervise the operation. Clinical results are compared in nonparametric values between treatments with and without the use of the MMS. The MMS, which can significantly reduce the workload of doctors and improve the uniformity of laser irradiation, was safely and helpfully applied in PDT treatment of PWS with good therapeutic results.

Crossed and linked histories of tetrapyrrolic macrocycles and their use for engineering pores within sol-gel matrices

The crossed and linked histories of tetrapyrrolic macrocycles, interwoven with new research discoveries, suggest that Nature has found in these structures a way to ensure the continuity of life. For diverse applications porphyrins or phthalocyanines must be trapped inside solid networks, but due to their nature, these compounds cannot be introduced by thermal diffusion; the sol-gel method makes possible this insertion through a soft chemical process. The methodologies for trapping or bonding macrocycles inside pristine or organo-modified silica or inside ZrO₂ xerogels were developed by using phthalocyanines and porphyrins as molecular probes. The sizes of the pores formed depend on the structure, the cation nature, and the identities and positions of peripheral substituents of the macrocycle. The interactions of the macrocyclic molecule and surface Si-OH groups inhibit the efficient displaying of the macrocycle properties and to avoid this undesirable event, strategies such as situating the macrocycle far from the pore walls or to exchange the Si-OH species by alkyl or aryl groups have been proposed. Spectroscopic properties are better preserved when long unions are established between the macrocycle and the pore walls, or when oligomeric macrocyclic species are trapped inside each pore. When macrocycles are trapped inside organo-modified silica, their properties result similar to those displayed in solution and their intensities depend on the length of the alkyl chain attached to the matrix. These results support the prospect of tuning up the pore size, surface area, and polarity inside the pore cavities in order to prepare efficient catalytic, optical, sensoring, and medical systems. The most important feature is that research would confirm again that tetrapyrrolic macrocycles can help in the development of the authentic pore engineering in materials science.

Liposomal photosensitizers: potential platforms for anticancer photodynamic therapy

Photodynamic therapy is a well-established and clinically approved treatment for several types of cancer. Antineoplastic photodynamic therapy is based on photosensitizers, i.e., drugs that absorb photons translating light energy into a chemical potential that damages tumor tissues. Despite the encouraging clinical results with the approved photosensitizers available today, the prolonged skin phototoxicity, poor selectivity for diseased tissues, hydrophobic nature, and extended retention in the host organism shown by these drugs have stimulated researchers to develop new formulations for photodynamic therapy. In this context, due to their amphiphilic characteristic (compatibility with both hydrophobic and hydrophilic substances), liposomes have proven to be suitable carriers for photosensitizers, improving the photophysical properties of the photosensitizers. Moreover, as nanostructured drug delivery systems, liposomes improve the efficiency and safety of antineoplastic photodynamic therapy, mainly by the classical phenomenon of extended permeation and retention. Therefore, the association of photosensitizers with liposomes has been extensively studied. In this review, both current knowledge and future perspectives on liposomal carriers for antineoplastic photodynamic therapy are critically discussed.

Research progress of Hemoporfin--part one: preclinical study

The second generation photosensitizer Hemoporfin (7(12)-(1-methoxyethyl) -12(7)-(1-hydroxyethyl)-3,8,13,17-tetramethyl-21H,23H-porphin-2,18-dipropionic acid) is a porphyrin derivative which processes a stable structure, high singlet oxygen yield, high photoactivity, low dark toxicity and fast clearance rate. Hemoporfin, also known as hematoporphyrin monomethyl ether (HMME) has been studied and used in photodynamic therapy (PDT) in China since 1989. This series of reports will provide an overview on the preclinical and clinical studies of this PDT photosensitizer. The first part of this series will highlight the results of preclinical studies that focused on the compound's optical characteristics, mechanism of the activities, pharmacological and toxicological properties.

A Convenient Synthesis of Haematoporphyrin Ester-Ethers under Ultrasound Irradiation

A convenient approach to the synthesis of haematoporphyrin ester-ethers from haemin under ultrasound irradiation has been developed. This method provides several advantages such as shorter reaction time, high yields and environmental friendliness.

Development and clinical evaluation of medical robot assisted photodynamic therapy of port wine stains

BACKGROUND

Port wine stains (PWS) are a kind of skin disease for which photodynamic therapy (PDT) has already achieved good results. With manual operation of clinical PDT, the laser density is uneven and laser irradiation of the lesion is arbitrary and non-uniform. In addition, lengthy manual operation tires doctors; thus a robot system has been developed to assist them.

METHODS

First, a novel medical manipulator consisting of five passive joints (robot arm) and two active joints (robot wrist) was developed to automatically improve the uniformity of laser irradiation. Second, image processing of the lesion was introduced. Third, kinematics and path planning of the robot were analysed, and safety precautions were introduced. Then, accuracy tests of the robot wrist and robot system were conducted separately before clinical application. Finally, a total of 50 PWS cases were treated using the robot system. The clinical outcomes and comparison of non-parametric values were employed to evaluate the robot system.

RESULTS

The accuracies of the robot wrist and robot system were shown to meet the requirements of clinical PDT treatment. The robot system performed successfully in 50 PWS cases. Doctors can devote more energy to clinical judgments during treatment with the assistance of the robot system. All the PWS have shown different degrees of improvement. The results show that the robot system is useful in assisting doctors for the PDT treatment of PWS.

CONCLUSIONS

The experiments show the feasibility and usefulness of the robot system in assisting doctors giving PDT treatment for PWS. The robot system can lighten the load on doctors and improve the therapeutic effect.

Intraperitoneal photodynamic therapy for an ovarian cancer ascite model in Fischer 344 rat using hematoporphyrin monomethyl ether

With limited treatment options, intraperitoneal spread of ovarian cancer is a common problem leading to high morbidity. Intraperitoneal photodynamic therapy combined with debulking surgery to treat residual disease is an alternative choice for clinicians. Hematoporphyrin monomethyl ether (HMME) is a promising second-generation photosensitizer developed in China. Our study was designed to investigate the phototoxicity of HMME on ovarian cancer. NuTu-19, a cell line derived from adenocarcinoma of Fischer 344 rat, and its allogeneic graft ascites tumor model was used in this study. HMME was confirmed to be localized in cytolysosome, and HMME-based photosensitization induced direct necrosis as well as mitochondria damage. The photocytotoxicity of HMME was both light- and drug dose-dependent and no significant dark cytotoxicity was observed in NuTu-19 cells. With the ascite tumor-bearing Fischer 344 rat model, HMME-based intraperitoneal photodynamic therapy was proved to be useful in improving the prognosis of ovarian cancer. Thus, this study provides evidence that HMME-based photodynamic therapy is an effective adjuvant therapy for ovarian cancer.

Photodynamic therapy combined with local chemotherapy for the treatment of advanced esophagocardiac carcinoma

BACKGROUND

Photodynamic therapy (PDT) is an effective palliative treatment for gastrointestinal tumors. The aim of this clinical study was to evaluate the efficacy of PDT combined with local chemotherapy for the treatment of advanced esophagocardiac cancer.

METHODS

A total of 140 patients with advanced esophagocardiac cancer were divided into two groups: 42 treated with PDT alone and 98 with combination of PDT and local injection of 5-fluorouracil (5-Fu). The light irradiation was carried out through a diffuser fiber at 24 and 48h after intravenous injection of a domestic photosensitizer PSD-007 (Photocarcinorin, 3-5mg/kg b.w.) at 200-400J/cm under endoscope guidance. Local chemotherapy group was carried out by local injection of 5-Fu (250-500mg) prior to PDT. Treatment was repeated 1-4 times. Short-term and long-term follow up were evaluated.

RESULTS

Short-term efficacy evaluation showed that the rate of significant remission in PDT combined with local chemotherapy group (41.8%) was significantly higher than that in PDT alone group (21.4%, P<0.05). Long-term follow up (up to 36 months) showed that the mean survival time of combined treatment group was longer than that of PDT group (P<0.01).

CONCLUSION

PDT is safe and effective for advanced esophagocardiac cancer. Its therapeutic effect can be further improved when combined with local chemotherapy.