Effects of haematoporphyrin derivative and light in combination with hyperthermia on cells in culture

Design of dinuclear osmium complex doped antifouling cellulose nanoparticles for targeting and dual photodynamic/photothermal therapy under near infrared irradiation

Transition metal complexes has been explored in the treatment of tumors in photodynamic theray (PDT) or photothermal therapy (PTT) and Osmium complex attracts attentration due to its lower toxicity and longer absorption wavelength. However, there was no report about binuclear Os complex for combined therapy of PDT and PTT which could have a synergistic effect and improve the effectiveness. Herein, we synthesis of mono/dinuclear Os complexes (OsY1, OsY2) with dual PDT/PTT capabilities under a single near-infrared (NIR) excitation wavelength. These features arise from the large π-conjugated structure of our dinuclear Os complex coupled with efficient metal-to-ligand charge transfer, which bring in ultralow energy gaps of 0.733 eV and 0.308 eV for OsY1 and OsY2, respectively. Furthermore, we prepared the Osmium complex-doped, aptamer-conjugated cellulose NPs via the emulsion polymerization method. These NPs exhibit a notable ability to target mitochondria and posse a "protein corona-free" status, showing much higher efficiency in tumor ablation (76 %) than the commercialized indocyanine green (ICG) doped cellulose NPs (24 %) under 808 nm irradiation. Consequently, our designed mono/dinuclear Os complex, featuring a single-molecule dual PDT/PTT effect within doped antifouling NPs, holds promise for potential applications in cancer therapy.

Photodynamic therapy with NIR-II probes: review on state-of-the-art tools and strategies

In 2022 10% of the world's population was aged 65+, and by 2100 this segment is expected to hit 25%. These demographic changes place considerable pressure over healthcare systems worldwide, which results in an urgent need for accurate, inexpensive and non-invasive ways to treat cancers, a family of diseases correlated with age. Among the therapeutic tools that gained important attention in this context, photodynamic therapies (PDT), which use photosensitizers to produce cytotoxic substances for selectively destroying tumor cells and tissues under light irradiation, profile as important players for next-generation nanomedicine. However, the development of clinical applications is progressing at slow pace, due to still pending bottlenecks, such as the limited tissue penetration of the excitation light, and insufficient targeting performance of the therapeutic probes to fully avoid damage to normal cells and tissues. The penetration depth of long-wavelength near infrared (NIR) light is significantly higher than that of short-wavelength UV and visible light, and thus NIR light in the second window (NIR-II) is acknowledged as the preferred phototherapeutic means for eliminating deep-seated tumors, given the higher maximum permissible exposure, reduced phototoxicity and low autofluorescence, among others. Upon collective multidisciplinary efforts of experts in materials science, medicine and biology, multifunctional NIR-II inorganic or organic photosensitizers have been widely developed. This review overviews the current state-of-the art on NIR-II-activated photosensitizers and their applications for the treatment of deep tumors. We also place focus on recent efforts that combine NIR-II activated PDT with other complementary therapeutic routes such as photothermal therapy, chemotherapy, immunotherapy, starvation, and gas therapies. Finally, we discuss still pending challenges and problems of PDT and provide a series of perspectives that we find useful for further extending the state-of-the art on NIR-II-triggered PDT.

Photodynamic and Photothermal Therapies: Synergy Opportunities for Nanomedicine

Tumoricidal photodynamic (PDT) and photothermal (PTT) therapies harness light to eliminate cancer cells with spatiotemporal precision by either generating reactive oxygen species or increasing temperature. Great strides have been made in understanding biological effects of PDT and PTT at the cellular, vascular and tumor microenvironmental levels, as well as translating both modalities in the clinic. Emerging evidence suggests that PDT and PTT may synergize due to their different mechanisms of action, and their nonoverlapping toxicity profiles make such combination potentially efficacious. Moreover, PDT/PTT combinations have gained momentum in recent years due to the development of multimodal nanoplatforms that simultaneously incorporate photodynamically- and photothermally active agents. In this review, we discuss how combining PDT and PTT can address the limitations of each modality alone and enhance treatment safety and efficacy. We provide an overview of recent literature featuring dual PDT/PTT nanoparticles and analyze the strengths and limitations of various nanoparticle design strategies. We also detail how treatment sequence and dose may affect cellular states, tumor pathophysiology and drug delivery, ultimately shaping the treatment response. Lastly, we analyze common experimental design pitfalls that complicate preclinical assessment of PDT/PTT combinations and propose rational guidelines to elucidate the mechanisms underlying PDT/PTT interactions.

A Warp-Knitted Light-Emitting Fabric-Based Device for In Vitro Photodynamic Therapy: Description, Characterization, and Application on Human Cancer Cell Lines

Simple Summary

While photodynamic therapy appears to be a promising approach to treating cancers, the complexity of its parameters prevents wide acceptance. Accurate light dose measurement is one of the keys to photodynamic effect assessment, but it remains challenging when comparing different technologies. This work provides a complete demonstration of the technical performance of a homemade optical device, based on knitted light-emitting fabrics, called CELL-LEF. Thermal and optical distributions and related safeties are investigated. The results are discussed in relation to the requirements of photodynamic therapy. The usability of CELL-LEF is investigated on human cancer cell lines as a proof of concept. This study highlights that new light-emitting fabric-based technologies can be relevant light sources for in vitro photodynamic therapy studies of tomorrow.

Abstract

Photodynamic therapy (PDT) appears to be a promising strategy in biomedical applications. However, the complexity of its parameters prevents wide acceptance. This work presents and characterizes a novel optical device based on knitted light-emitting fabrics and dedicated to in vitro PDT involving low irradiance over a long illumination period. Technical characterization of this device, called CELL-LEF, is performed. A cytotoxic study of 5-ALA-mediated PDT on human cancer cell lines is provided as a proof of concept. The target of delivering an irradiance of 1 mW/cm² over 750 cm² is achieved (mean: 0.99 mW/cm²; standard deviation: 0.13 mW/cm²). The device can maintain a stable temperature with the mean thermal distribution of 35.1 °C (min: 30.7 °C; max: 38.4 °C). In vitro outcomes show that 5-ALA PDT using CELL-LEF consistently and effectively induced a decrease in tumor cell viability: Almost all the HepG2 cells died after 80 min of illumination, while less than 60% of U87 cell viability remained. CELL-LEF is suitable for in vitro PDT involving low irradiance over a long illumination period.

Photodynamic Therapy and Hyperthermia in Combination Treatment-Neglected Forces in the Fight against Cancer

Cancer is one of the leading causes of death in humans. Despite the progress in cancer treatment, and an increase in the effectiveness of diagnostic methods, cancer is still highly lethal and very difficult to treat in many cases. Combination therapy, in the context of cancer treatment, seems to be a promising option that may allow minimizing treatment side effects and may have a significant impact on the cure. It may also increase the effectiveness of anti-cancer therapies. Moreover, combination treatment can significantly increase delivery of drugs to cancerous tissues. Photodynamic therapy and hyperthermia seem to be ideal examples that prove the effectiveness of combination therapy. These two kinds of therapy can kill cancer cells through different mechanisms and activate various signaling pathways. Both PDT and hyperthermia play significant roles in the perfusion of a tumor and the network of blood vessels wrapped around it. The main goal of combination therapy is to combine separate mechanisms of action that will make cancer cells more sensitive to a given therapeutic agent. Such an approach in treatment may contribute toward increasing its effectiveness, optimizing the cancer treatment process in the future.

Macrophages as delivery vehicles for anticancer agents

The delivery of anticancer agents via passive approaches such as the enhanced permeability and retention effect is unlikely to achieve sufficient concentrations throughout the tumor volume for effective treatment. Cell-based delivery approaches using tumor tropic cells have the potential to overcome the limitations of passive approaches. Specifically, this review focuses on the use of monocytes/macrophages for the delivery of a variety of anticancer agents, including nanoparticles, chemotherapeutics and gene constructs. The efficacy of this delivery approach, both as monotherapy and in combination with light-based phototherapy modalities, has been demonstrated in numerous in vitro and animal studies, however, its clinical potential remains to be determined.

Combined concurrent photodynamic and gold nanoshell loaded macrophage-mediated photothermal therapies: an in vitro study on squamous cell head and neck carcinoma

BACKGROUND AND OBJECTIVE

Treatment modalities, such as hyperthermia and photodynamic therapy (PDT) have been used in the treatment of a variety of head and neck squamous cell carcinoma (HNSCC), either alone or as an adjuvant therapy. Macrophages loaded with gold nanoshells, which convert near-infrared light to heat, can be used as transport vectors for photothermal hyperthermia of tumors. The purpose of this study was to investigate the effects of combined macrophage mediated photothermal therapy (PTT) and PDT on HNSCC cells.

STUDY DESIGN/MATERIALS AND METHODS

Gold nanoshell loaded rat macrophages either alone or combined with human FaDu squamous cells in hybrid monolayers were subjected to PTT, PDT, or a simultaneous combination of the two light treatments. Therapies were given concurrently employing two laser light sources of λ = 670 nm (PDT) and λ = 810 nm (PTT), respectively.

RESULTS

Significant uptake of gold nanospheres (AuNS) by rat alveolar macrophages was observed thus providing the rationale for their use as delivery vectors. Viability of the AuNS-loaded Ma was reduced to 35 and 12% of control values at an irradiance of 14 or 28 W/cm(2) administered over a 5 minute period respectively. No significant cytotoxicity was observed for empty Ma for similar PTT exposure. AlPcS2a mediated PDT at a fluence level of 0.25 J/cm(2) and PTT at 14 W/cm(2) irradiance had little effect on cell viability for the FaDu/Ma (ratio 2:1) hybrid monolayers. In contrast, combined treatment reduced the cell viability to less than 40% at these same laser power settings.

CONCLUSIONS

The results of this study provide proof of concept for the use of macrophages as a delivery vector of AuNS for photothermal enhancement of the effects of PDT on squamous cell carcinoma. A significant synergy was demonstrated with combined PDT and PTT compared to each modality applied separately.

Enhanced cytotoxic effects of 5-aminolevulinic acid-mediated photodynamic therapy by concurrent hyperthermia in glioma spheroids

During photodynamic therapy (PDT) both normal and pathological brain tissue, in close proximity to the light source, can experience significant temperature increases. The purpose of this study was to investigate the anti-tumor effects of concurrent 5-aminolevulinic acid (ALA)-mediated PDT and hyperthermia (HT) in human and rat glioma spheroids. Human or rat glioma spheroids were subjected to PDT, HT, or a combination of the two treatments. Therapies were given concurrently to simulate the conditions that will occur during patient PDT. Predictions of diffusion theory suggest that brain tissue immediately adjacent to a spherical light applicator may experience temperature increases approaching 8 degrees C for laser input powers of 2 W. In the in vitro model employed here, HT had no effect on spheroid survival at temperatures below 49 degrees C, while sub-threshold fluence PDT results in only modest decrease in survival. HT (40-46 degrees C) and PDT interact in a synergistic manner if the two treatments are given concurrently. The degree of synergism increases with increasing temperature and light fluence. Apoptosis is the primary mode of cell death following both low-fluence rate PDT and combined HT + PDT.

Combined hyperthermia and chlorophyll-based photodynamic therapy: tumour growth and metabolic microenvironment

The effects of combined and simultaneously applied localised 43 degrees C hyperthermia (HT) and an antivascular bacteriochlorophyll-serine-based photodynamic therapy (Bchl-ser-PDT) on tumour growth and several microenvironmental parameters were examined. Rats bearing DS-sarcomas were allocated to treatment groups: (i) sham-treatment (control), (ii) Bchl-ser-PDT (20 mg kg(-1) i.v.), (iii) localised HT, (iv) Bchl-ser-PDT+HT. The light source used was an infrared-A irradiator, which, by use of appropriate filters, delivered the different ranges of wavelengths required. Following treatment, tumour volume was monitored. The greatest tumour growth inhibition was seen with Bchl-ser-PDT+HT, and subsequent experiments identified the pathophysiological basis for this effect. Red blood cell flux in tumour microvessels declined rapidly upon Bchl-ser-PDT+HT, reaching approximately 10% of initial values by the end of treatment. Similarly, tumour oxygenation worsened, reaching almost anoxic levels by the end of the treatment period. Assessment of metabolic parameters showed a pronounced increase in lactate levels and a decrease in ATP concentrations after combined treatment. The results presented suggest that vascular collapse and flow stasis resulting in a deterioration of tumour oxygenation and a switch from oxidative to glycolytic glucose turnover are key elements in the tumour eradication seen with this novel approach in which an antivascular PDT and HT are combined and simultaneously applied.

Enhanced effects of aminolaevulinic acid-based photodynamic therapy through local hyperthermia in rat tumours

The possibility of enhancing aminolaevulinic acid (ALA)-based photodynamic therapy (PDT) by simultaneous application of localised hyperthermia (HT) was evaluated. Treatments of rat DS-sarcomas included: (i) control, (ii) ALA administration (375 mg kg(-1), i.p.), no illumination, (iii) 'nonthermal' illumination, (iv) ALA-PDT: that is, ALA administration, 'nonthermal' illumination, (v) localised HT, 43 degrees C, 60 min (vi) ALA-PDT+HT: ALA administration with full spectrum irradiation resulting in ALA-PDT and HT. Tumour volume was monitored for 90 days or until a target volume (3.5 ml) was reached. No differences were seen between the first three groups, with all tumours reaching the target volume by 8-11 days. A total of 13 and 15% of tumours did not reach the target volume by day 90 following HT or ALA-PDT treatment, respectively. ALA-PDT+HT showed the greatest antitumour effect (P=0.0001), with 61% of the tumours not reaching the target volume. Viability and in vitro growth were also assessed in cells from tumours excised after treatment. ALA-PDT+HT reduced the fraction of viable tumour cells by 85%, and in vitro culture showed pronounced growth delay compared to control cells. These results demonstrate an enhanced antitumour effect upon ALA+HT, which appears to involve direct cell toxicity rather than solely vascular damage.

Postirradiation hyperthermia selectively potentiates the merocyanine 540-sensitized photoinactivation of small cell lung cancer cells

Lung cancer has long been considered a disease that might benefit from the dose escalation of radio/chemotherapy afforded by a stem cell transplant. However, the clinical experience with high-dose chemotherapy and autologous bone marrow transplantation in lung cancer has been disappointing, with most trials showing little or no improvement in long-term survival. Unfortunately, lung cancer has a tendency to metastasize to the bone marrow, and lung cancer cells are known to circulate in the peripheral blood. Therefore, there is concern that autologous stem cell grafts from lung cancer patients may reinoculate recipients with live tumor cells. Photochemical purging of stem cell grafts with Merocyanine 540 (MC540) is highly effective against a wide range of leukemia and lymphoma cells and is well tolerated by normal hematopoietic stem and progenitor cells. Most solid tumor cells (including lung cancer cells), however, are only moderately sensitive or refractory to MC540-mediated photodynamic therapy (PDT). We report here that postirradiation hyperthermia (< or = 42 degrees C, 3 h) potentiates the MC540-mediated photoinactivation of both wild-type (H69) and cisplatin-resistant mutant (H69/CDDP) small cell lung cancer cells by several orders of magnitude, while only minimally enhancing the depletion of normal human granulocyte/macrophage progenitor cells. Our data suggest that postirradiation hyperthermia provides a simple and effective means of extending the utility of MC540-PDT to the purging of stem cell grafts contaminated with lung cancer and possibly other solid tumor cells.

Water-filtered infrared-A radiation: a novel technique for localized hyperthermia in combination with bacteriochlorophyll-based photodynamic therapy

A novel application of an infrared-A (IR-A) radiation source equipped with a water-filter in the radiation path is described, which allows for tumour treatment with a simultaneous combination of localized hyperthermia (HT) and bacteriochlorophyll-serine (Bchl-ser) based photodynamic therapy (PDT). Using this system, the IR-A radiation was used to heat tumours to 43 degrees C for 60 min, while at the same time activating the Bchl-ser which was injected i.v. at a dose of 20 mg/kg, 10 min following commencement of HT. The growth of tumours undergoing this combined therapy was compared to that of tumours undergoing HT alone or sham-treated controls. Within the 90 day observation period, 100% of tumours in sham-treated animals, 80% in HT-treated animals and only 17% in HT + Bchlser-treated animals reached the end point target volume of 3.5 ml. Thus, the tumour growth inhibition effect of HT can be substantially enhanced by combination with Bchl-ser-PDT. This novel technique has proved to be well-tolerated, easy to apply and should be suitable for treatment of superficial malignancies, especially where hypoxic tumour areas are present.

Hyperthermic sensitization by hematoporphyrin on glioma cells

This study investigated: (1) the effect of Hp as a hyperthermic sensitizer on glioma cells; and (2) the possible mechanism of hyperthermic sensitization by Hp using an exogenous scavenger specific to a particular reactive oxygen species. Hp at nontoxic doses at 37 degrees C significantly enhanced thermal cell damage at 41.5 degrees C and above in a dose-dependent manner. Thermal cell damage enhancement by HP was effectively suppressed by the addition of beta-carotene, a singlet oxygen scavenger, or SOD, a superoxide scavenger, but not by the addition of mannitol or catalase. These results support the following hypothesis: The generation of superoxide is increased in cells treated with Hp in combination with hyperthermia. Thermal cell damage enhancement by Hp is probably mediated by singlet oxygen generated via superoxide in an alternative pathway different from that of photosensitization. Hp has potential as a hyperthermic sensitizer because of the following advantages: (1) its dose-dependent enhancement of thermal cell damage; and (2) the lack of toxicity at physiological temperature at doses of Hp required for hyperthermic sensitization of tumour cells.

Synergistic interaction of photodynamic treatment with the sensitizer aluminum phthalocyanine and hyperthermia on loss of clonogenicity of CHO cells

When CHO cells were exposed to hyperthermia and subsequently to photodynamic treatment, the combined effects were additive but in the reverse sequence the interaction was synergistic. The synergistic interaction comprised two quite different components: (1) photodynamically induced sensitization of cellular proteins and/or supramolecular structures for thermal inactivation and (2) a photodynamically induced inhibition of the cellular repair system for sublethal thermal damage. The first component of the synergistic interaction was reflected by a change of the Arrhenius parameters of thermal cell killing. A lowering of the activation energy of this process was responsible for the synergistic interactions, whereas a concomitant decrease of the frequency factor, opposing this effect, actually caused a much lower degree of synergism at higher temperatures. This component of the synergistic interaction did not respond to the insertion of an intermediate incubation period between the two treatments. The second component of the synergistic interaction, viz the interference with the ability of cells to survive sublethal thermal damage, was reversible, as an intermediate incubation between photodynamic treatment and hyperthermia resulted in its repair. The photodynamically induced inhibition of the ability of cells to survive sublethal thermal damage was not related to ATP or glutathione depletion, inhibition of de novo protein synthesis or impairment of degradation of damaged protein molecules. Restoration of the repair system for sublethal damage depended on a metabolic process and required free intracellular Ca2+, suggesting that a cell signaling pathway may be involved. Thus, in a practical sense the magnitude of the synergistic interaction between photodynamic treatment and hyperthermia depends on the length of the interval between the two treatments and on the temperature and duration of the subsequent thermal treatment. This may have significant consequences for the development of clinical protocols for the combined application of photodynamic therapy and hyperthermia in the treatment of tumors.

The use of porphyrins and non-ionizing radiation for treatment of cancer

Photodynamic therapy (PDT) is the treatment of malignant lesions with visible light following systemic or local administration of a photosensitizer or its precursor. Initially, hematoporphyrin derivative and a purified component called Photofrin II was used for clinical PDT. Later on interest has focused on new sensitizers with more favourable absorption as regards light transmission in tissues. Twenty years of clinical experience has revealed that PDT is best applied to early stage cancers. The present review discusses the basic components of PDT and its clinical use in treatment of cancer.

The effect of hypothermia and hyperthermia on photodynamic therapy of normal brain

The effect of whole body hyperthermia and hypothermia in conjunction with photodynamic therapy (PDT) was determined on normal rat brain. Hyperthermia animals (Group I, n = 18) were warmed until their core body temperature reached 40 degrees C, (brain temperature, 39.7 +/- 0.5 degree C) and maintained at 40 +/- 1 degree C for 30 minutes prior to and after PDT. Hypothermia (Group II, n = 31) animals were cooled to 30 +/- 1 degree C (brain temperature, 29.3 +/- 0.4 degree C) for 1 hour. PDT treatment was performed, and the body temperature of the animals was maintained at 30 degrees C for 2 hours post-PDT. A population of animals was subjected to PDT under normothermic (Group III, n = 16; body temperature, 37 +/- 1 degree C; brain temperature, 36.7 +/- 0.8 degree C) conditions and treated in a manner identical to that of hyperthermic animals. PDT was performed with 17 J/cm2, 35 J/cm2, or 70 J/cm2 (100 mW/cm2). Photofrin (Quadralogic Technologies Ltd., Vancouver, Canada) (12.5 mg/kg) was injected intraperitoneally 48 hours prior to laser treatment on all three groups. Wet-dry weight measurements were obtained on a separate set of all three groups of animals (n = 27). Cortical lesion depths were measured, and pathological evaluation was made at 24 hours post-PDT. No difference in the wet-dry weight measurements or histopathology was present between the three groups of animals. Lesion depths for Group I animals did not significantly differ from Group III animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Lasers in neurosurgery

Lasers have been used in neurosurgery for the past 25 years, undergoing modifications to suit the specific needs of this medical discipline. The present report reviews the current use of lasers in neurosurgical practice and examines the pros and cons of lasers in specific neurosurgical applications. In spite of their advantages, laser use is still not widespread in neurosurgery. One reason is the continued lack of complete control over real-time laser interactions with neural tissue. A greater acceptance and use of lasers by neurosurgeons will depend upon automated control over defined specific parameters for laser applications based upon the type of tissue, the desired effect on tissue, and application to the clinical situation without loss of precision and a lot of expense. This will require the integration of newer lasers, computers, robotics, stereotaxy, and concepts of minimally invasive surgery into the routine management of neurosurgical problems.

The response of normal and malignant cells to ultrasound in vitro

The effect of ultrasonic irradiation on the viability of normal and tumor cell cultures derived from human and mouse origins was investigated. The cells were irradiated with a frequency of 2 MHz and intensity of 0.33 W/cm2, up to 4 min and immediately tested for cell viability using four different parameters: vital staining for the determination of the rate of cell growth; [3H]-thymidine and [3H]-leucine incorporation as an indication of the rate of DNA and protein synthesis respectively; and cloning efficiency as a measurement of the cell ability to multiply. Two human normal cell lines used in our studies, FS11 foreskin fibroblasts and Wish cells, were relatively resistant to ultrasonic irradiation effect although the growth rate of the latter was somewhat affected, particularly after 2 or 4 min of irradiation. However, cells derived from either malignant melanoma or breast carcinoma were highly sensitive to irradiation as demonstrated by a reduction of 96% and 65%, respectively, in cloning efficiency even after irradiation for 1 min. A third tumor cell line derived from lung carcinoma was more resistant. Two normal clones derived from NIH/3T3 mouse fibroblasts were used. These clones revealed some degree of sensitivity, particularly after 4 min of irradiation. However, their murine-sarcoma-virus transformed counterparts were found to be even more sensitive at identical times of ultrasonic irradiation, although the differences are not as striking as demonstrated with cells from human origin.(ABSTRACT TRUNCATED AT 250 WORDS)

MTT assays allow quick and reliable measurement of the response of human tumour cells to photodynamic therapy

MCF-7 and HT-29 cell lines were selected as a reliable model to examine the possible parameters affecting the sensitivity of tumour cells to photodynamic therapy (PDT) using a dye-laser at 630 nm. The chemical composition of haematoporphyrin derivative (HPD) was determined by high-performance liquid chromatography (HPLC) analysis and was in agreement with reported values. MTT assays were performed to assess the time-dependency of PDT and the influence of the output power and light fluence. The results showed a maximal cytotoxicity 48 h after photoirradiation. The output power (1 or 2 W) did not significantly affect the cytotoxicity when the fluence was constant (20 J/cm2). However, an increase in fluence (10-40 J/cm2) led to a significant enhancement of cytotoxicity until maximal values were reached (30-40 J/cm2). A further increase in fluence (50 J/cm2) proved to induce a fall-off in cytotoxicity related to the intense photobleaching of HPD.

Potentiation of hyperthermia-induced haemolysis of human erythrocytes by photodynamic treatment. Evidence for the involvement of the anion transporter in this synergistic interaction

Heat treatment of human erythrocytes led to increased passive cation permeability, followed by haemolysis. K+ leakage was linear up to a loss of about 80% in the temperature range 46-54 degrees C. Kinetic analysis of the results revealed an activation energy of 246 kJ/mol, implicating a transition in the membrane as critical step. Pretreatment of erythrocytes with 4,4'-di-isothiocyano-2,2'-stilbenedisulphonate, chymotrypsin or chlorpromazine caused a potentiation of subsequent heat-induced K+ leakage. Photodynamic treatment of erythrocytes with Photofrin II, eosin isothiocyanate or a porphyrin-Cu2+ complex as sensitizer also induced an increase in passive cation permeability, ultimately resulting in colloid osmotic haemolysis. The combination of photodynamic treatment immediately followed by hyperthermia had a synergistic effect on K+ leakage. Analysis of the results by the Arrhenius equation revealed that both the activation energy and the frequency factor of heat-induced K+ leakage were decreased significantly by preceding photodynamic treatment, suggesting that hyperthermia and photodynamic treatment have a common target for the induction of K+ leakage. Several lines of reasoning indicate that this common target is band 3. A model is thus proposed for the observed potentiation of hyperthermically induced K+ leakage by photodynamic treatment, in which photo-oxidation of band 3 results in increased sensitivity to subsequent thermal denaturation. These phenomena may be of more general significance, as photodynamic treatment and hyperthermia interacted synergistically with respect to K+ leakage with L929 fibroblasts also.

Potentiation of thermal inactivation of glyceraldehyde-3-phosphate dehydrogenase by photodynamic treatment. A possible model for the synergistic interaction between photodynamic therapy and hyperthermia

Thermal inactivation of glyceraldehyde-3-phosphate dehydrogenase appeared to be caused by a conformational mechanism, without involvement of covalent reactions. On the other hand, photodynamic inactivation of the enzyme (induced by illumination in the presence of Photofrin II) was caused by photo-oxidation of the essential thiol group in the active centre. A short photodynamic treatment of the enzyme, leading to only a limited inactivation, caused a pronounced potentiation of subsequent thermal inactivation, as measured over the temperature range 40-50 degrees C. Analysis of the experimental results according to the Arrhenius equation revealed that both the activation energy of thermal inactivation and the frequency factor (the proportionality constant) were significantly decreased by the preceding photodynamic treatment. The experimental results indicate a mechanism in which limited photodynamic treatment induced a conformational change of the protein molecule. This conformational change did not contribute to photodynamic enzyme inhibition, but was responsible for the decreased frequency factor and activation energy of subsequent thermal inactivation of the enzyme. The opposing effects of decreased activation energy and decreased frequency factor resulted in potentiation of thermal inactivation of the enzyme over the temperature range 40-50 degrees C. With other proteins, different results were obtained. With amylase the combined photodynamic and thermal effects were not synergistic, but additive, and photodynamic treatment had no effect on the frequency factor and the activation energy of thermal inactivation. With respect to myoglobin denaturation, the photodynamic and thermal effects were antagonistic over the whole practically applicable temperature range. Limited photodynamic treatment protected the protein against heat-induced precipitation, concomitantly increasing both the frequency factor and the activation energy of the process. These results offer a model for one of the possible mechanisms of synergistic interaction between photodynamic therapy and hyperthermia in cancer treatment.

Temperature effects on photosensitized processes

The singlet-oxygen-mediated reaction of meso-tetraphenylporphine tetrasulphonate (TPPS4) with different chemical acceptors in buffered aqueous solution was studied as a function of temperature. Imidazole, tryptophan, dimethyl p-nitrosoaniline, (RNO) and furfuryl alcohol served as acceptors. The measurements were performed in real time by spectroscopic or electrochemical monitoring of the consumption of the various reagents, acceptors or dissolved oxygen as a function of the absorbed energy. The results show the following increases in the reaction rate over the temperature range 15-45 degrees C: tryptophan (86%), RNO (90%), furfuryl alcohol (150%) and imidazole (210%). The influence of temperature-correlated changes in the initial oxygen concentration and pH was investigated. Possible implications of the present results for the synergistic influence of hyperthermia and photodynamic therapy are discussed.

Combination studies of hyperthermia induced by the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser as an adjuvant to photodynamic therapy

Photodynamic therapy (PDT) and hyperthermia have been investigated as treatments for several types of tumors. Studies have been done to determine the efficacy of each modality individually and recently in combination with each other. In this study, 630-nm light was delivered by an argon-dye laser and hyperthermia was induced using an Nd:YAG laser. Both lasers offer the ability of delivering the beams through a quartz fiberoptic alone or simultaneously. This study examines the efficacy of the simultaneous administration of PDT and selective hyperthermia at 44.5 degrees C in tumor control in the spontaneous mammary tumor (SMT-F) in DBA mice. Hyperthermia alone (44.5 degrees C, 30 min) resulted in complete destruction of tumors, with no subsequent regrowth in 6.6% of the mice treated. PDT alone (5 mg/kg dihematoporphyrin ether; 135 J/cm) resulted in a cure rate of approximately 10%, and the simultaneous treatment of the modalities resulted in a 32.8% cure rate after 90 days. These values are indicative of a synergistic interaction.

Damaging action of photodynamic treatment in combination with hyperthermia on transmembrane transport in murine L929 fibroblasts

Photodynamic treatment of murine L929 fibroblasts with hematoporphyrin derivative caused inhibition of the 2-aminoisobutyric acid transport system. This was reflected by an increase in the apparent Km with a constant Vmax, indicating impairment of the carrier function rather than a decrease of the number of transport sites. Hyperthermic treatment of these cells resulted in a moderate decrease of the activity of the 2-aminoisobutyric acid transport system. Overall protein synthesis was severely inhibited both by photodynamic treatment and by hyperthermia. Hyperthermia subsequent to photodynamic treatment resulted in an additive inhibition of 2-aminoisobutyric acid transport and of protein synthesis. After photodynamic treatment both 2-aminoisobutyric acid transport and protein synthesis were repaired. The repair of 2-aminoisobutyric acid transport depended on protein synthesis, as shown by the virtually complete blockage of repair by anisomycin. After hyperthermia (either alone or subsequent to photodynamic treatment), no recovery of 2-aminoisobutyric acid transport was observed, although protein synthesis was restored to the initial level. Apparently, hyperthermia subsequent to photodynamic treatment blocks the repair of photodynamically induced damage of this transport system. The experimental results further indicate that protein synthesis is not the rate-determining step for the repair of 2-aminoisobutyric acid transport, although it is necessary in this process. Cell survival was decreased both by photodynamic treatment and by hyperthermia. The combined effects of these two treatments were additive. It is discussed that these results indicate that photodynamic inhibition of 2-aminoisobutyric acid transport is not causally related to loss of clonogenicity, contrary to earlier suggestions.

The effect of fractionation of light treatment on necrosis and vascular function of normal skin following photodynamic therapy

Sparing of normal tissue, mouse tail skin, by fractionation of light treatment in photodynamic therapy has been demonstrated in BDF1 mice injected with 2 mg tetrasodium-meso-tetra(4-sulphophenyl)porphine dodecahydrate i.v. When the time between 2 fractions of 67.5 J cm-2 and 90 J cm-2 was increased to 2 and 4 days respectively the incidence of necrosis fell to that expected after a single fraction. Blood flow in the tail skin 5 days after the second light fraction, as measured by the clearance of an intradermally injected solution of 133xenon in 0.9% saline, returned to control values when the time between 2 fractions was 2 days with 67.5 J cm-2 fractions, and 3 days with 90 J cm-2 fractions. The time course of recovery of normal mouse tail skin from photodynamic therapy, as shown by these split dose experiments, was found to be similar to the time course for the recovery of blood flow following a single light treatment.

Interstitial hyperthermia using 27 MHz wire antennas and interstitial photodynamic therapy in a rat rhabdomyosarcoma: phantom and animal studies

This paper deals with the interaction of interstitial hyperthermia (HT) and interstitial photodynamic therapy (PDT). Its main focus, however, is on a newly developed heating system; phantom studies as well as temperature-response data obtained from the in vivo experiments are presented. Heat was delivered by thin, flexible wire antennas operating at a frequency of 27 MHz. Measurements in muscle-equivalent phantom with infrared thermography were performed. Uniform heating over the inserted length of the antenna was obtained and impedance matching appears possible by simple variable air coils, thereby minimizing the reflected power to less than 20%. Light was obtained from an Argon-Dye laser system tuned to a wavelength of 625 nm at a dose rate of 75-100 mW per fiber to a total incident dose of 900 J from four linear light applicators. An experimental murine tumor (Rhabdomyosarcoma, type R-1) was transplanted in WAG/Rij rats and, after reaching an average diameter of 2 cm, the active component of haematoporphyrin derivative (HPD), Photofrin II, was injected intravenously. The tumors were subsequently implanted with four flexible catheters, through which either light or heat could be applied. Dose-response relationships for PDT alone, HT alone and PDT followed by HT were established with cure as endpoint. The animal experiments showed that with the use of low-frequency wires a good localized heat distribution in the tumors can be obtained. Moreover, this study showed that PDT and HT, in the proper sequence and only when optimal temperatures are reached, result in an augmented cytotoxicity on the tumor cells in vivo; i.e. a cure rate of 41% was obtained.

Histopathological changes in an intraocular retinoblastoma-like tumour following photodynamic therapy

The histopathological effect of photodynamic therapy (PDT) was investigated in an intraocular retinoblastoma-like tumour in vivo. Eighty-two tumours were studied by light microscopy and 8 by electron microscopy. Damage of the vascular endothelium with dilation of the organelles was evident 1 h after treatment, followed by leakage of the blood vessels, tissue hemorrhages, and vascular collapse. Histopathological examination showed an overall pattern of shrinkage of the cytoplasm and pycnosis of the nuclei in most of the tumour cells 3-5 days after treatment. The tumour recurrence often developed from the periphery of the tumours and in a few cases from small islets of viable tissue. Use of high doses of Photofrin II or light energy was associated with damage in the light irradiated area both to the conjunctiva or cornea in the form of leucocyte infiltration or ulcers, and to the retina, which often developed edema and appeared severely disorganized, with damage of the photoreceptors.

Interaction of interstitial photodynamic therapy and interstitial hyperthermia in a rat rhabdomyosarcoma--a pilot study

Photodynamic therapy (PDT) involves the activation of photosensitizing drugs by light of appropriate wavelength. The photosensitive agent Hematoporphyrin Derivative (HPD) appears to be preferentially retained in malignant tumors; irradiation of HPD-containing tissue by light of appropriate wavelength (625 nm) and dose leads to (tumor) tissue destruction. The aim of this study is to achieve maximum tumor control probability with minimum normal tissue photosensitivity. In previous work from our laboratory it has been demonstrated that PDT has its fundamental effects on the tumor and normal tissue microcirculation. As it is well established that hyperthermia (HT) has its major effects in less well vascularized areas of the tumor, the combined modality of HT and PDT might prove to be advantageous. Moreover, suppression of sublethal damage repair by HT has been observed. To overcome the problem of poor light penetration into tissues and the high rate of recurrences following PDT with external irradiation, the combined effects of interstitial PDT with interstitial hyperthermia in a new line of animal experiments were studied in our laboratory. An experimental murine tumor (Rhabdomyosarcoma, type R-1) was transplanted in WAG/Rij rats and, after reaching an average diameter of 2 cm, the active component of HPD, that is Photofrin II, was injected intravenously in different dose schedules (5 mg/kg, 10 mg/kg). After 24 or 48 hrs the tumors were implanted with four flexible catheters, through which either light or heat could be applied. Light was obtained from an Argon-Dye laser system tuned to a wavelength of 625 nm at a dose rate of 75-100 mW per fiber to a dose level of 900 Joule from four linear light applicators. Heat (44 degrees C/30') was delivered by four 27 MHz radiofrequency antennas. Dose response relationships for PDT alone, HT alone and PDT combined with HT were established with cure as endpoint. This study showed that these two modalities, in the proper sequence and spacing, result in an augmented cytotoxicity on the tumor cells in vivo. With the combined modality treatment a cure rate of 41% (90 days) was obtained. As the implantation of flexible catheters is a well-known technique in radiation therapy practice, the potentiating effects of interstitial HT combined with interstitial PDT in solid tumors is very promising and clinical studies are warranted.

Photodynamic therapy of C3H mouse mammary carcinoma with haematoporphyrin di-ethers as sensitizers

Haematoporphyrin di-ethers were synthesized and tested as sensitizers for photodynamic therapy of C3H/Tif mammary tumours in mice. Growth curves of the tumours were determined by measuring the tumour volume. The animals were given 25 mg porphyrins kg-1 body weight i.p. and 24 h later exposed to 135 J cm-2 of 630 nm light at a fluence rate of 150 mW cm-2. The sensitizing efficiency of the ethers was measured in terms of the increase in growth time of the treated tumours, as compared with that of untreated controls, needed to reach a volume 5 times larger than that at the time of the treatment. This sensitizing efficiency increased with decreasing polarity, i.e. in the order di-methyl ether, di-propyl ether, dibutyl ether and di-amyl ether. Haematoporphyrin di-amyl ether was more efficient than haematoporphyrin derivative and insignificantly less efficient than photofrin II (DHE). This was true for sensitization of both tumours and normal tissue.

Photochemotherapy mediated by hematoporphyrin derivative in gastroenterology

While results concerning photodynamic treatments of cancers in pneumology or dermatology have been published regularly, few works have been devoted to gastroenterology. Twenty-seven non-operable patients bearing various G.I. tumors of less than 40 mm dia. have been treated by PDT for palliative purpose to appreciate the local efficacy of a single treatment. Before July, 1985, the parameters of treatment were 2.5 mg/kg of HPD injected intravenously for theoretical power of delivered laser light (630 mm) 300 mW. After July, 1985, HPD was injected at the dose of 5 mg/kg and the laser dose was 400 mW. A normalization of grip biopsies was observed on 12 patients (6 squamous cell carcinomas, 6 adenocarcinomas), transient in 3 cases. Our main finding is that PDT seems able to destroy significant volumes of tumor by itself although subsequent biopsies proved negative in very few cases. This method remains to be compared to others less sophisticated than the YAG laser.

Hyperthermic potentiation of photodynamic therapy employing Photofrin I and II: comparison of results using three animal tumor models

Hyperthermia induced by a microwave source (2,450 MHz) was used alone and in combination with photodynamic therapy (PDT) to treat the SMT-F, EMT-6, and RIF animal tumors in vivo. PDT was administered using either Photofrin I or II as the photosensitizer and an argon-pumped tunable dye laser (630 nm) as the light source. Greater than additive increases in long-term tumor control were achieved when hyperthermia was given immediately post-PDT in the SMT-F and RIF tumor systems. Only additive (or independent) increases in tumor control were achieved when hyperthermia was given immediately before PDT in all these tumor systems and when heat was applied post-PDT using the EMT-6 tumor. In a series of experiments using the SMT-F tumor, it was observed that decreases in PDT drug or light doses could be offset (in terms of tumor control) by the addition of a subsequent heat treatment. This result, along with others presented, indicates the clinical potential of PDT and hyperthermia as adjuvant cancer modalities.

Hyperthermia from interstitial laser irradiation in normal rat brain

This study examined both the effect of variations in optical fiber tip and in light wavelength on laser-induced hyperthermia in rat brain. Normal rat brains were exposed to argon laser light (454-514.5 nm) delivered through an intracerebral end-emitting (bare-tipped) or a diffusion-emitting (sapphire-tipped) optical fiber probe. Interstitial thermistor probes recorded temperatures after thermal equilibration at varying distances from the emitting source. The end-emitting fiber produced significantly (P less than 0.05) higher elevations in tissue temperature than the diffusion-emitting fiber at the same laser power output. This is due to the smaller surface area (1.2 mm2 versus 7.8 mm2) of the end-emitting fiber, which results in a greater rate of energy delivery to tissue adjacent to the fiber tip. Changes in intracerebral temperature measurements were also recorded at similar distances from a diffusion-emitting fiber at a continuous total laser power output of 150 mW for light wavelengths of 454-514.5 nm, 700 nm, and 750 nm and at a total laser output of 1.1 W for 1,060 nm. Variations in brain tissue temperature with distance from the laser emission source were compared for each laser group with the tissue temperature profile generated by a radiofrequency (wavelength 600-625 m) interstitial probe. Similar temperature changes were found for all visible wavelengths near the probe, suggesting that the thermal response of brain adjacent to an interstitial laser fiber is primarily dependent upon the rate of energy delivery and not upon wavelength. The thermal profile versus distance from the light source depends mostly upon the level of temperature rise near the interstitial laser fiber tip and not the wavelength of laser light used. These results have important implications in interstitial applications of laser for hyperthermia and photochemotherapy.

A study on the possible involvement of nonlinear mechanism of light absorption by HpD with Nd:YAG laser

The purpose of this study was to investigate whether excitation of porphyrin could be related to nonlinear mechanisms of absorption of porphyrin itself or of the medium in which porphyrin is embedded. This possibility was proposed as an explanation for results of previous experiments where a Nd:YAG laser was used. An MS-2 sarcoma transplanted into the hind pad of BALB/c mice was used as the experimental tumor model. Mice were given HpD i.v. (25 mg/kg) 24 h before exposure to light delivered from an IR laser (1,060 nm). Since at dose-rates ranging between 600 and 1,200 mW/cm2 the thermal effect tended to mask the nonlinear effect, the temperature of the limb of mice was kept cold by running water. Irradiation performed under cooling conditions did not show any tumor growth inhibition. Experiments in vitro performed on HT-29 cells by a continuous wave (CW) or pulsed (Q-switch) Nd:YAG laser indicated no appreciable difference in DNA synthesis between irradiated and nonirradiated cells. Our results did not evidence nonlinear mechanisms of absorption by HpD with Nd:YAG laser both in CW and pulsed (nanosecond range) modes. Whether this effect should occur, in any case it is unlikely to be suitable to induce a photodynamic effect due to its low efficiency. Nd:YAG laser could induce a heating related effect, which can improve the therapeutic efficacy of PDT.

The expected effect of a combination of agents: the general solution

Interactions between agents (drugs, carcinogens, physiological stimuli, environmental pollutants, etc.) in producing their effects are of fundamental interest and practical importance in virtually every branch of biology and medicine. A combination of agents is said to show interaction when the magnitude of its effect is greater or smaller than expected, expectation being based on the dose-effect relations of the individual agents in the combination. The crux of the matter is to decide what is expected, and various rules have been proposed to this end (for example, that the expected effect is the sum of the effects of the individual constituents of the combination, or that it is the product of these effects, or that it may be calculated from the law of mass action). These rules are valid for combinations of agents with particular and rather restricted types of dose-effect relations, but they have no general validity. A general solution to this problem is given here, that enables the effects of non-interactive combinations to be calculated directly from the dose-effect relations of the individual agents (whether expressed algebraically or numerically), regardless of the particular types of dose-effect relations involved. This solution is based on the fact that, when an effect of particular magnitude is produced by a combination of n agents which do not interact to produce that effect, the point representing the combination in the n-dimensional space spanned by the dose-axes of the individual agents lies in the same (n-1)-dimensional hyperplane as those representing other combinations iso-effective with it and iso-effective amounts of the individual agents. Methods for calculating the effect of a non-interactive combination as the sum or product of the effects of its constituents, or from the law of mass action, each of which is correct in appropriate cases, may be deduced (without invoking mechanisms of action) by applying this general principle to particular types of dose-effect relations.

Photodynamic effects and hyperthermia in vitro

Cells from the established human line NHIK 3025 were labelled with hematoporphyrin derivative in vitro. Subsequently, the cells were treated with light and hyperthermia. The cells could be irradiated either before, during or after the incubation at a hyperthermic temperature. It was shown that hyperthermia given shortly after the light exposure gave a synergistic killing effect. In spite of some loss of porphyrins from the cells, the light sensitivity increased 20 min after a light irradiation. At later times, the cells apparently repaired some of the photodynamic damage at 37 degrees C. At higher temperatures, the repair was inhibited.

Potentiation of photodynamic therapy by heat: effect of sequence and time interval between treatments in vivo

Photodynamic therapy (PDT) utilizing hematoporphyrin derivative (Hpd) as photosensitizer and an argon-dye laser as the light source was used alone and in combination with a localized microwave hyperthermia treatment to treat the SMT-F mammary carcinoma in mice. A 30-min heat treatment at 44.5 degrees C was applied 0-8 hr before or after a standard photodynamic treatment (67.5 or 135 J/cm2, given 24 hr post-7.5 mg/kg Hpd). Potentiation of PDT by heat was found to be related to the sequence of the treatments and the time interval between them. When 44.5 degrees C for 30 min was applied immediately after a 15-min PDT treatment, significant potentiation was seen (58% long-term tumor control vs 3 and 10%, respectively, for PDT and heat alone). This potentiation decreased with increasing time between PDT and heat, with tumor control values decreasing to 36, 20, and 14%, when 2, 4, and 8 hr, respectively, were allowed between treatments. Only additive effects of the independent therapies were found when this heat treatment was applied 0-8 hr before PDT. In other experiments, mice were treated with single or fractionated 30-min PDT treatments (two 15-min treatments separated by 0-, 2-, 4- or 8-hr intervals). Decreases in tumor control were seen with increasing time interval; only minor differences in tumor control were seen when 4-8 hr was allowed between treatments compared to a single 15-min treatment.