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Sharma KS, Dubey AK, Kumar C, Phadnis PP, Sudarsan V, Vatsa RK. Mesoporous Silica-Coated Upconversion Nanoparticles Assisted Photodynamic Therapy Using 5-Aminolevulinic Acid: Mechanistic and In Vivo Studies. ACS APPLIED BIO MATERIALS 2022; 5:583-597. [PMID: 35025194 DOI: 10.1021/acsabm.1c01074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Exclusively red-emitting upconversion nanoparticles (UCNPs) with the composition NaErF4:0.5%Tm as a core and NaYF4 as a shell were synthesized for performing photodynamic therapy (PDT). A possible mechanism was proposed for core-shell UCNPs formation. For loading a maximum amount of 5-aminolevulinic acid (5-ALA), mesoporous silica coating was performed on UCNPs. Studies under dark conditions confirmed the biocompatibility of 5-ALA-loaded UCNPs formulation (UCNPs-5-ALA) with MCF-7 cells. Meanwhile, studies under light-exposed conditions exhibited effective cytotoxicity against MCF-7 cells. Studies employing D2O-based cell cultured media and addition of DABCO in cell culture established that the cell death was due to oxidation of cellular components by reactive oxygen species (ROS) triggering the apoptosis. The formation of ROS was confirmed by DCF(H)DA-based ROS analysis via fluorescence microscopy to demonstrate the ROS production, which mediates the programmed cell death. Additionally, we have validated the apoptosis in MCF-7 cells with flow cytometry analyses. This was further confirmed by an electrophoretic mobility shift assay on nuclear extract and measurement of mitochondrial membrane potential. In the case of animal model studies, the formulation UCNPs-5-ALA without irradiation (980 nm) did not possess any in vivo cytotoxicity on tumor-induced SCID mice and there was a minimum migration of UCNPs-5-ALA to the vital organs but maximum retention at the tumor site only. Meanwhile, only the mice treated with UCNPs-5-ALA and irradiated on the tumor region with 980 nm laser (500 mW) for 20 min possessed a tumor with a size reduced to about 75% as compared with the corresponding control groups. To the best of our knowledge, this type of study was conducted for the first time employing exclusively red-emitting phosphors for effective PDT.
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Affiliation(s)
- K Shitaljit Sharma
- Chemistry Division, Bhabha Atomic Research Centre, Mumbai 400 085, India
| | - Akhil K Dubey
- Bio-Organic Division, Bhabha Atomic Research Centre, Mumbai 400 085, India
| | - Chandan Kumar
- Radiopharmaceuticals Division, Bhabha Atomic Research Centre, Mumbai 400 085, India
| | - Prasad P Phadnis
- Chemistry Division, Bhabha Atomic Research Centre, Mumbai 400 085, India.,Homi Bhabha National Institute, Anushaktinagar, Mumbai 400 094, India
| | | | - Rajesh K Vatsa
- Chemistry Division, Bhabha Atomic Research Centre, Mumbai 400 085, India.,Homi Bhabha National Institute, Anushaktinagar, Mumbai 400 094, India
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2
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In vivo photobleaching kinetics and epithelial biodistribution of hexylaminolevulinate-induced protoporphyrin IX in rat bladder cancer. Curr Urol 2021; 15:2-10. [PMID: 34084115 PMCID: PMC8137026 DOI: 10.1097/cu9.0000000000000004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/16/2019] [Indexed: 12/18/2022] Open
Abstract
In a previous paper, we showed that rat bladder instillations with 8 or 16 mM of hexyl aminolevulinate (hALA) result in diametrically opposed photodynamic therapy efficiency. Although the same fluorescent intensities were detected spectroscopically and by fluorescent microscopy in both conditions, while a given light dose resulted in tumor necrosis with an intact bladder wall after 8 mM hALA, bladders instilled with 16 mM showed total wall necrosis without impact on the tumor. The current study investigated the photobleaching and localization pattern of protoporphyrin IX (PpIX) after both hALA intravesical instillations in tumor-bearing rat bladders. The total PpIX content was evaluated by the extraction of postmortem whole bladders. Photobleaching was evaluated in vivo by fluorescent spectroscopy. Cryosections of bladders were subjected to fluorescent microscopy for cellular localization of the photosensitizer. PpIX extraction showed identical amounts of photosensitizer in tumor-bearing bladders at both concentrations. Photobleaching experiments revealed mono-exponential decay curves in both situations but with a two times faster decay constant in 16 mM bladders. Fluorescent microscopy showed an identical fluorescent pattern for normal bladders at both concentrations and tumor bladders at 8 mM with bright spots. Tumor bladders at 16 mM exhibited a more diffuse cytoplasmatic fluorescent distribution. The different response to photodynamic therapy with regard to the initial pro-drug concentration can thus be attributed to the different cellular localizations.
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3
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Kim HI, Wilson BC. Photodynamic Diagnosis and Therapy for Peritoneal Carcinomatosis from Gastrointestinal Cancers: Status, Opportunities, and Challenges. J Gastric Cancer 2020; 20:355-375. [PMID: 33425438 PMCID: PMC7781745 DOI: 10.5230/jgc.2020.20.e39] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/15/2020] [Indexed: 12/21/2022] Open
Abstract
Selective accumulation of a photosensitizer and the subsequent response in only the light-irradiated target are advantages of photodynamic diagnosis and therapy. The limited depth of the therapeutic effect is a positive characteristic when treating surface malignancies, such as peritoneal carcinomatosis. For photodynamic diagnosis (PDD), adjunctive use of aminolevulinic acid- protoporphyrin IX-guided fluorescence imaging detects cancer nodules, which would have been missed during assessment using white light visualization only. Furthermore, since few side effects have been reported, this has the potential to become a vital component of diagnostic laparoscopy. A variety of photosensitizers have been examined for photodynamic therapy (PDT), and treatment protocols are heterogeneous in terms of photosensitizer type and dose, photosensitizer-light time interval, and light source wavelength, dose, and dose rate. Although several studies have suggested that PDT has favorable effects in peritoneal carcinomatosis, clinical trials in more homogenous patient groups are required to identify the true benefits. In addition, major complications, such as bowel perforation and capillary leak syndrome, need to be reduced. In the long term, PDD and PDT are likely to be successful therapeutic options for patients with peritoneal carcinomatosis, with several options to optimize the photosensitizer and light delivery parameters to improve safety and efficacy.
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Affiliation(s)
- Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Seoul, Korea
- Open NBI Convergence Technology Research Laboratory, Severance Hospital, Seoul, Korea
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Brian C. Wilson
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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4
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Kerbage Y, Canlorbe G, Estevez JP, Grabarz A, Mordon S, Uzan C, Collinet P, Azaïs H. [Microscopic peritoneal metastases of epithelial ovarian cancers. Clinical relevance, diagnostic and therapeutic tools]. ACTA ACUST UNITED AC 2018; 46:497-502. [PMID: 29656069 DOI: 10.1016/j.gofs.2018.03.011] [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: 12/31/2017] [Indexed: 10/17/2022]
Abstract
Understanding the biology and progression mechanisms of peritoneal metastases in ovarian epithelial cancers (EOC) is important because peritoneal carcinomatosis is present or will occur during surveillance of a majority of patients. Despite the clinical remission achieved after complete macroscopic cytoreductive surgery and platinum-based chemotherapy, 60% of patients will develop peritoneal recurrence. This suggests that microscopic lesions, which are not eradicated by surgery may be present and may participate in the mechanisms leading to peritoneal recurrence. This paper discusses current available data on microscopic peritoneal metastases, their diagnosis and their treatment. We reviewed all publications dealing with microscopic peritoneal metastases of EOC between 1980 and 2017. The most recent and most relevant publications dealing with the treatment modalities of these metastases were selected. Peritoneal and epiploic microscopic localizations would occur in 1.2 to 15.1% of cases at early-stage and are not treated during conventional surgery. They could represent a potential therapeutic target. Local treatments (intraperitoneal chemotherapy, photodynamic therapy, fluorescence-guided surgery) seem to be necessary in addition to surgery and chemotherapy and may help reduce the risk of peritoneal recurrence. The place of these treatments in the management of EOC remains to be defined by subsequent researches.
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Affiliation(s)
- Y Kerbage
- Service de chirurgie gynécologique, CHU de Lille, 59000 Lille, France; Inserm, U1189, ONCO-THAI, thérapies laser assistées par l'imagerie, 59000 Lille, France
| | - G Canlorbe
- Service de chirurgie et oncologie gynécologique et mammaire, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, Pitié-Salpêtrière, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - J P Estevez
- Service de chirurgie gynécologique, CHU de Lille, 59000 Lille, France
| | - A Grabarz
- Service de chirurgie gynécologique, CHU de Lille, 59000 Lille, France; Inserm, U1189, ONCO-THAI, thérapies laser assistées par l'imagerie, 59000 Lille, France
| | - S Mordon
- Inserm, U1189, ONCO-THAI, thérapies laser assistées par l'imagerie, 59000 Lille, France
| | - C Uzan
- Service de chirurgie et oncologie gynécologique et mammaire, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, Pitié-Salpêtrière, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - P Collinet
- Service de chirurgie gynécologique, CHU de Lille, 59000 Lille, France; Inserm, U1189, ONCO-THAI, thérapies laser assistées par l'imagerie, 59000 Lille, France
| | - H Azaïs
- Inserm, U1189, ONCO-THAI, thérapies laser assistées par l'imagerie, 59000 Lille, France; Service de chirurgie et oncologie gynécologique et mammaire, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, Pitié-Salpêtrière, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France.
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Gheewala T, Skwor T, Munirathinam G. Photosensitizers in prostate cancer therapy. Oncotarget 2018; 8:30524-30538. [PMID: 28430624 PMCID: PMC5444762 DOI: 10.18632/oncotarget.15496] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 02/06/2017] [Indexed: 01/17/2023] Open
Abstract
The search for new therapeutics for the treatment of prostate cancer is ongoing with a focus on the balance between the harms and benefits of treatment. New therapies are being constantly developed to offer treatments similar to radical therapies, with limited side effects. Photodynamic therapy (PDT) is a promising strategy in delivering focal treatment in primary as well as post radiotherapy prostate cancer. PDT involves activation of a photosensitizer (PS) by appropriate wavelength of light, generating transient levels of reactive oxygen species (ROS). Several photosensitizers have been developed with a focus on treating prostate cancer like mTHPC, motexafin lutetium, padoporfin and so on. This article will review newly developed photosensitizers under clinical trials for the treatment of prostate cancer, along with the potential advantages and disadvantages in delivering focal therapy.
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Affiliation(s)
- Taher Gheewala
- Department of Biomedical Sciences, University of Illinois, College of Medicine, Rockford, IL, USA
| | - Troy Skwor
- Department of Chemical and Biological Sciences, Rockford University, Rockford, IL, USA
| | - Gnanasekar Munirathinam
- Department of Biomedical Sciences, University of Illinois, College of Medicine, Rockford, IL, USA
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6
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Azaïs H, Canlorbe G, Kerbage Y, Grabarz A, Collinet P, Mordon S. Image-guided surgery in gynecologic oncology. Future Oncol 2017; 13:2321-2328. [PMID: 29121779 DOI: 10.2217/fon-2017-0253] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Image-guided surgery is a relevant way to reduce surgical morbidity and maximize cytoreductive surgery approach especially in ovarian cancer. Sentinel lymph node detection is a promising approach to avoid radical lymph node dissection and is slightly becoming standard in daily practice in endometrial and cervical cancer surgery even if it needs to be evaluated more precisely. Regarding carcinomatosis of ovarian origin, detection and treatment of microscopic disease could be appropriate to avoid local recurrences. Photodiagnosis and photodynamic therapy are innovative techniques that allow to precise limits of excision (fluorescence-guided surgery) and to treat microscopic disease. Further developments of those strategies are necessary to become standard diagnosis tools and treatment options.
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Affiliation(s)
- Henri Azaïs
- Department of Gynecological & Breast Surgery & Oncology, AP-HP, Pitié-Salpêtrière, 83 Boulevard de l'Hôpital, 75013 Paris, France; Pierre et Marie Curie University, Paris 6, France.,INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
| | - Geoffroy Canlorbe
- Department of Gynecological & Breast Surgery & Oncology, AP-HP, Pitié-Salpêtrière, 83 Boulevard de l'Hôpital, 75013 Paris, France; Pierre et Marie Curie University, Paris 6, France
| | - Yohan Kerbage
- INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France.,Department of Gynecologic Surgery, CHU Lille, F-59000 Lille, France
| | - Anne Grabarz
- INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France.,Department of Gynecologic Surgery, CHU Lille, F-59000 Lille, France
| | - Pierre Collinet
- INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France.,Department of Gynecologic Surgery, CHU Lille, F-59000 Lille, France
| | - Serge Mordon
- INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
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7
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Azaïs H, Mordon S, Collinet P. [Intraperitoneal photodynamic therapy for peritoneal metastasis of epithelial ovarian cancer. Limits and future prospects]. ACTA ACUST UNITED AC 2017; 45:249-256. [PMID: 28373041 DOI: 10.1016/j.gofs.2017.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 02/10/2017] [Indexed: 01/29/2023]
Abstract
High peritoneal recurrence rate in advanced epithelial ovarian cancer after complete macroscopic cytoreductive surgery and platinum-based chemotherapy, raises the issue of peritoneal microscopic disease management and requires the development of additional locoregional treatment strategies. Photodynamic therapy is an effective treatment already applied in other medical and surgical indications. After administration of a photosensitizer which accumulates in cancer cells, illumination with a light of adequate wavelength may induce photochemical reaction between photosensitizer and tissue oxygen which lead to reactive oxygen species production and cytotoxic phenomenon. Photodynamic therapy's ability to treat superficial lesions disseminated on large area makes it an excellent candidate to insure destruction of microscopic peritoneal metastases in addition to macroscopic cytoreductive surgery in order to decrease peritoneal recurrence rate. Development of intraperitoneal photodynamic therapy has been limited by its poor tolerance related to the lack of specificity of photosensitizers and the location of the metastases in proximity to adjacent intraperitoneal organs. Our aim is to review clinical data concerning intraperitoneal photodynamic therapy and epithelial ovarian cancer to identify the limits of this strategy and to provide solutions which may be applied to solve these barriers and enable safe and effective treatment. Targeted photosensitizers and innovative illumination solutions are mandatory to continue research in this field and to consider the feasibility of clinical trials.
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Affiliation(s)
- H Azaïs
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpitaux universitaires Pitié Salpêtrière-Charles-Foix, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France; U1189-ONCO THAI-Image Assisted Laser Therapy for Oncology, Inserm, CHU de Lille, 59000 Lille, France.
| | - S Mordon
- U1189-ONCO THAI-Image Assisted Laser Therapy for Oncology, Inserm, CHU de Lille, 59000 Lille, France
| | - P Collinet
- U1189-ONCO THAI-Image Assisted Laser Therapy for Oncology, Inserm, CHU de Lille, 59000 Lille, France; Service de gynécologie medicochirurgicale, centre hospitalier régional et universitaire, 59000 Lille, France
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8
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Yonemura Y, Endo Y, Canbay E, Liu Y, Ishibashi H, Mizumoto A, Hirano M, Imazato Y, Takao N, Ichinose M, Noguchi K, Li Y, Wakama S, Yamada K, Hatano K, Shintani H, Yoshitake H, Ogura SI. Photodynamic Detection of Peritoneal Metastases Using 5-Aminolevulinic Acid (ALA). Cancers (Basel) 2017; 9:cancers9030023. [PMID: 28257041 PMCID: PMC5366818 DOI: 10.3390/cancers9030023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/08/2017] [Accepted: 02/16/2017] [Indexed: 12/14/2022] Open
Abstract
In the past, peritoneal metastasis (PM) was considered as a terminal stage of cancer. From the early 1990s, however, a new comprehensive treatment consisting of cytoreductive surgery and perioperative chemotherapy has been established to improve long-term survival for selected patients with PM. Among prognostic indicators after the treatment, completeness of cytoreduction is the most independent predictors of survival. However, peritoneal recurrence is a main cause of recurrence, even after complete cytoreduction. As a cause of peritoneal recurrence, small PM may be overlooked at the time of cytoreductive surgery (CRS), therefore, development of a new method to detect small PM is desired. Recently, photodynamic diagnosis (PDD) was developed for detection of PM. The objectives of this review were to evaluate whether PDD using 5-aminolevulinic acid (ALA) could improve detection of small PM.
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Affiliation(s)
- Yutaka Yonemura
- NPO Organization to support Peritoneal Surface Malignancy Treatment, 510 Fukushima-Cho, Shimogyou-Ku, Kyoto 600-8189, Japan.
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan.
- Department of General Surgery, Kusatsu General Hospital, 1660 Yabase, Kusatsu City, Shiga 525-8585, Japan.
| | - Yoshio Endo
- Central Research Resource Center, Cancer Research Institute, Kanazawa University, Kakuma-machi, Kanazawa 920-1192, Japan.
| | - Emel Canbay
- NPO HIPEC Istanbul, Guzelbahce Sokak No:15 Nisantasi, Istanbul 34367, Turkey.
| | - Yang Liu
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan.
| | - Haruaki Ishibashi
- NPO Organization to support Peritoneal Surface Malignancy Treatment, 510 Fukushima-Cho, Shimogyou-Ku, Kyoto 600-8189, Japan
| | - Akiyoshi Mizumoto
- Department of General Surgery, Kusatsu General Hospital, 1660 Yabase, Kusatsu City, Shiga 525-8585, Japan.
| | - Masamitu Hirano
- Department of General Surgery, Kusatsu General Hospital, 1660 Yabase, Kusatsu City, Shiga 525-8585, Japan.
| | - Yuuki Imazato
- Department of General Surgery, Kusatsu General Hospital, 1660 Yabase, Kusatsu City, Shiga 525-8585, Japan.
| | - Nobuyuki Takao
- Department of General Surgery, Kusatsu General Hospital, 1660 Yabase, Kusatsu City, Shiga 525-8585, Japan.
| | - Masumi Ichinose
- Department of General Surgery, Kusatsu General Hospital, 1660 Yabase, Kusatsu City, Shiga 525-8585, Japan.
| | - Kousuke Noguchi
- Department of General Surgery, Kusatsu General Hospital, 1660 Yabase, Kusatsu City, Shiga 525-8585, Japan.
| | - Yan Li
- Department of Peritoneal Surface Oncology, Beijing Shijitan Hospital of Capital Medical University, Beijing 100038, China.
| | - Satoshi Wakama
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan.
| | - Kazuhiro Yamada
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan.
| | - Koutarou Hatano
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan.
| | - Hiroshi Shintani
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan.
| | - Hiroyuki Yoshitake
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka 596-8522, Japan.
| | - Shun-Ichiro Ogura
- Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, 4259 Nagatsu-Cho, Midori-ku, Yokohama 226-8501, Japan.
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9
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Azaïs H, Estevez JP, Foucher P, Kerbage Y, Mordon S, Collinet P. Dealing with microscopic peritoneal metastases of epithelial ovarian cancer. A surgical challenge. Surg Oncol 2017; 26:46-52. [PMID: 28317584 DOI: 10.1016/j.suronc.2017.01.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/01/2017] [Accepted: 01/05/2017] [Indexed: 12/31/2022]
Abstract
Understanding biology and progression mechanisms of peritoneal metastases of epithelial ovarian cancer (EOC) is a cornerstone in the knowledge and the comprehensive management of the disease. Despite clinical remission after the association of complete cytoreductive surgery and platinum-based chemotherapy, peritoneal recurrence still occurs in 60% of patients. Eligible studies, published from 1980 to June 2016, were retrieved through ClinicalTrials.gov, MEDLINE, Cochrane databases and bibliography searches. We reviewed all publications that deals with microscopic peritoneal metastases of EOC in French and English. To discuss expected benefits of intraperitoneal (IP) chemotherapy, fluorescence-guided surgery or IP photodynamic therapy, we reviewed most recent and relevant studies. The final reference list was generated on the basis of originality and relevance to the broad scope of this review. Published data concerning early-stage ovarian cancer suggest that occult peritoneal or epiploic metastases are present in 1.2%-15.1% of cases. In the frequent case of advanced-stage disease, residual microscopic lesions are ignored by conventional surgery. We are convinced that microscopic peritoneal metastases are a relevant surgical therapeutic target. This article discusses existing data on microscopic peritoneal metastases, the treatment indications, the diagnostic and therapeutic surgical approaches to be developed and their expected benefits. A local therapeutic strategy to target microscopic lesions is needed in addition to complete macroscopic cytoreductive surgery to decrease the rate of peritoneal recurrence. Intraperitoneal chemotherapy, and targeted photodynamic therapy could play a role in this new paradigm. The roles of these different options must be defined by future researches.
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Affiliation(s)
- Henri Azaïs
- AP-HP, Pitié-Salpêtrière Hospital, Department of Gynecologic and Breast Surgery, F-75013 Paris, France; Univ. Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France.
| | | | - Périne Foucher
- CHU Lille, Department of Gynecology, F-59000 Lille, France
| | - Yohan Kerbage
- Univ. Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France; CHU Lille, Department of Gynecology, F-59000 Lille, France
| | - Serge Mordon
- Univ. Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
| | - Pierre Collinet
- Univ. Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France; CHU Lille, Department of Gynecology, F-59000 Lille, France
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10
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Ocakoglu K, Er O, Ersoz OA, Lambrecht FY, Ince M, Kayabasi C, Gunduz C. Evaluation of nuclear imaging potential and photodynamic therapy efficacy of symmetrical and asymmetrical zinc phthalocyanines. J Drug Deliv Sci Technol 2016. [DOI: 10.1016/j.jddst.2016.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Yurt Lambrecht F, Ocakoglu K, Er O, Ince M, Gunduz C, Kayabası C. Nuclear imaging potential andin vitrophotodynamic activity of symmetrical and asymmetrical zinc phthalocyanines. J Labelled Comp Radiopharm 2016; 59:221-7. [DOI: 10.1002/jlcr.3395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Fatma Yurt Lambrecht
- Department of Nuclear Applications, Institute of Nuclear Science; Ege University; Izmir Bornova 35100 Turkey
| | - Kasim Ocakoglu
- Advanced Technology Research and Application Center; Mersin University; Ciftlikkoy Campus Mersin Yenisehir TR-33343 Turkey
- Mersin University; Department of Energy Systems Engineering Faculty of Tarsus Technology; Mersin 33480 Turkey
| | - Ozge Er
- Department of Nuclear Applications, Institute of Nuclear Science; Ege University; Izmir Bornova 35100 Turkey
| | - Mine Ince
- Advanced Technology Research and Application Center; Mersin University; Ciftlikkoy Campus Mersin Yenisehir TR-33343 Turkey
- Mersin University; Department of Energy Systems Engineering Faculty of Tarsus Technology; Mersin 33480 Turkey
| | - Cumhur Gunduz
- Department of Medical Biology, Faculty of Medicine; Ege University; Izmir Bornova TR-35100 Turkey
| | - Cagla Kayabası
- Department of Medical Biology, Faculty of Medicine; Ege University; Izmir Bornova TR-35100 Turkey
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12
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Ince M, Er O, Ocakoglu K, Lambrecht FY, Colak SG, Soylu HM, Kayabasi C, Gunduz C. Investigation ofIn vitroPDT Activities andIn vivoBiopotential of Zinc Phthalocyanines Using131I Radioisotope. Chem Biol Drug Des 2015; 87:224-32. [DOI: 10.1111/cbdd.12659] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/29/2015] [Accepted: 08/09/2015] [Indexed: 01/25/2023]
Affiliation(s)
- Mine Ince
- Department of Energy Systems Engineering; Faculty of Technology; Mersin University; TR-33480 Tarsus, Mersin Turkey
- Advanced Technology Research & Application Center; Mersin University; Ciftlikkoy Campus TR-33343 Yenisehir, Mersin Turkey
| | - Ozge Er
- Department of Nuclear Applications; Institute of Nuclear Science; Ege University; Izmir Bornova 35100 Turkey
| | - Kasim Ocakoglu
- Department of Energy Systems Engineering; Faculty of Technology; Mersin University; TR-33480 Tarsus, Mersin Turkey
- Advanced Technology Research & Application Center; Mersin University; Ciftlikkoy Campus TR-33343 Yenisehir, Mersin Turkey
| | - Fatma Yurt Lambrecht
- Department of Nuclear Applications; Institute of Nuclear Science; Ege University; Izmir Bornova 35100 Turkey
| | - Suleyman Gokhan Colak
- Advanced Technology Research & Application Center; Mersin University; Ciftlikkoy Campus TR-33343 Yenisehir, Mersin Turkey
| | - Hale Melis Soylu
- Department of Biomedical Technology; Institute of Science; Ege University; Izmir Bornova 35100 Turkey
| | - Cagla Kayabasi
- Department of Medical Biology; Faculty of Medicine; Ege University; Izmir Bornova 35100 Turkey
| | - Cumhur Gunduz
- Department of Medical Biology; Faculty of Medicine; Ege University; Izmir Bornova 35100 Turkey
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Mallidi S, Spring BQ, Hasan T. Optical Imaging, Photodynamic Therapy and Optically Triggered Combination Treatments. Cancer J 2015; 21:194-205. [PMID: 26049699 PMCID: PMC4459538 DOI: 10.1097/ppo.0000000000000117] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Optical imaging is becoming increasingly promising for real-time image-guided resections, and combined with photodynamic therapy (PDT), a photochemistry-based treatment modality, optical approaches can be intrinsically "theranostic." Challenges in PDT include precise light delivery, dosimetry, and photosensitizer tumor localization to establish tumor selectivity, and like all other modalities, incomplete treatment and subsequent activation of molecular escape pathways are often attributable to tumor heterogeneity. Key advances in molecular imaging, target-activatable photosensitizers, and optically active nanoparticles that provide both cytotoxicity and a drug release mechanism have opened exciting avenues to meet these challenges. The focus of the review is optical imaging in the context of PDT, but the general principles presented are applicable to many of the conventional approaches to cancer management. We highlight the role of optical imaging in providing structural, functional, and molecular information regarding photodynamic mechanisms of action, thereby advancing PDT and PDT-based combination therapies of cancer. These advances represent a PDT renaissance with increasing applications of clinical PDT as a frontline cancer therapy working in concert with fluorescence-guided surgery, chemotherapy, and radiation.
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Affiliation(s)
- Srivalleesha Mallidi
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114
| | - Bryan Q. Spring
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114
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14
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Primary evaluation of a nickel-chlorophyll derivative as a multimodality agent for tumor imaging and photodynamic therapy. J Radioanal Nucl Chem 2015. [DOI: 10.1007/s10967-015-4081-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Almerie MQ, Gossedge G, Wright KE, Jayne DG. Photodynamic diagnosis for detection of peritoneal carcinomatosis. J Surg Res 2015; 195:175-87. [PMID: 25682189 DOI: 10.1016/j.jss.2015.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 12/11/2014] [Accepted: 01/08/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Peritoneal carcinomatosis is the dissemination of cancer in the peritoneal cavity secondary to abdominal or extra-abdominal malignancies. Accurate assessment of the disease's burden is a challenge because of the complexity of the peritoneal cavity and the small size of the metastatic nodules. Photodynamic diagnosis (PDD) is an emerging technology in tumor diagnosis. A photosensitizer is administered, which is preferentially taken up by cancer cells. The photosensitizer emits fluorescence when exposed to a light of a specific wavelength. This helps distinguish cancer from normal tissues. METHODS We systematically reviewed the evidence for using PDD in detecting peritoneal carcinomatosis in both animal and human literature. Both Medline and EMBASE databases were searched (November 2014). The titles and the abstracts of all retrieved citations were inspected, and the full articles of the relevant articles were obtained. RESULTS A total of 12 human and 18 animal studies were included. Clinical studies have shown PDD to be a safe modality with no significant adverse effects. It increases the detection of malignant peritoneal nodules by 21%-34% in comparison with white light alone. The sensitivity and specificity of PDD were reported at 83%-100% and 95%-100%, respectively. These findings were supported by multiple animal studies, which have shown an increase in the sensitivity of tumor detection when using PDD (72%-91%) in comparison with white light alone (39%). CONCLUSIONS PDD is a promising modality, which improves the detection of peritoneal carcinomatosis lesions. Further research, however, should investigate the impact of PDD on the patients' therapeutic management and final outcomes.
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Affiliation(s)
- Muhammad Qutayba Almerie
- Section of Translational Anaesthesia and Surgical Sciences, Leeds Institute of Biomedical & Clinical Sciences (LIBACS), St James's University Hospital, Leeds, United Kingdom.
| | - Gemma Gossedge
- Section of Translational Anaesthesia and Surgical Sciences, Leeds Institute of Biomedical & Clinical Sciences (LIBACS), St James's University Hospital, Leeds, United Kingdom
| | - Kathleen E Wright
- Section of Translational Anaesthesia and Surgical Sciences, Leeds Institute of Biomedical & Clinical Sciences (LIBACS), St James's University Hospital, Leeds, United Kingdom
| | - David G Jayne
- Section of Translational Anaesthesia and Surgical Sciences, Leeds Institute of Biomedical & Clinical Sciences (LIBACS), St James's University Hospital, Leeds, United Kingdom
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Successful in vivo tumor visualization using fluorescence laparoscopy in a mouse model of disseminated alveolar rhabdomyosarcoma. Surg Endosc 2014; 29:1105-14. [PMID: 25149634 DOI: 10.1007/s00464-014-3770-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 07/25/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Surgery for rhabdomyosarcoma is challenging due to a lack of clear delineation between tumor and surrounding tissue. Mutilating surgery can be necessary in difficult tumor localizations. Therefore, novel diagnostic and therapeutic modalities are required. The aim of this study was to evaluate the in vivo tumor detection of RMS using fluorescence laparoscopy and to analyze the efficacy of hypericin-induced photodynamic therapy in a mouse model. METHODS Seventeen NOD/LtSz-scid IL2Rγnull-mice were divided into four groups. In group 1, mCherry-expressing tumor cells and in group 2-4 non-transfected tumor cells were xenotransplanted. Three weeks later, one fluorochrome per group (ICG, ICG-cetuximab, hypericin) was injected. Fluorescence laparoscopy was carried out and tumors were resected using fluorescence guidance. In the hypericin group, photodynamic therapy was performed using blue light and apoptosis was evaluated by TUNEL test. RESULTS A clear discrimination between healthy and tumor tissue was feasible by fluorescending properties with mCherry expressing tumor cells and after injection of hypericin. No fluorescence was detected in mice injected with ICG and ICG-labeled cetuximab. Hypericin photodynamic therapy induced apoptosis of tumor cells after exposure to blue light. CONCLUSIONS Intraoperative photodynamic diagnosis was feasible using mCherry-transfected tumor cells or hypericin. Additionally, intraoperative photodynamic therapy was possible and effective.
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Spring BQ, Palanisami A, Hasan T. Microscale receiver operating characteristic analysis of micrometastasis recognition using activatable fluorescent probes indicates leukocyte imaging as a critical factor to enhance accuracy. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:066006. [PMID: 24919449 PMCID: PMC4053439 DOI: 10.1117/1.jbo.19.6.066006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/12/2014] [Accepted: 05/16/2014] [Indexed: 06/03/2023]
Abstract
Molecular-targeted probes are emerging with applications for optical biopsy of cancer. An underexplored potential clinical use of these probes is to monitor residual cancer micrometastases that escape cytoreductive surgery and chemotherapy. Here, we show that leukocytes, or white blood cells, residing in nontumor tissues--as well as those infiltrating micrometastatic lesions--uptake cancer cell-targeted, activatable immunoconjugates nonspecifically, which limits the accuracy and resolution of micrometastasis recognition using these probes. Receiver operating characteristic analysis of freshly excised tissues from a mouse model of peritoneal carcinomatosis suggests that dual-color imaging, adding an immunostain for leukocytes, offers promise for enabling accurate recognition of single cancer cells. Our results indicate that leukocyte identification improves micrometastasis recognition sensitivity and specificity from 92 to 93%--for multicellular metastases >20 to 30 μm in size--to 98 to 99.9% for resolving metastases as small as a single cell.
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Affiliation(s)
- Bryan Q. Spring
- Massachusetts General Hospital and Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts 02114
| | - Akilan Palanisami
- Massachusetts General Hospital and Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts 02114
| | - Tayyaba Hasan
- Massachusetts General Hospital and Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts 02114
- Massachusetts General Hospital, Department of Dermatology, Boston, Massachusetts 02114
- Harvard University and Massachusetts Institute of Technology, Division of Health Sciences and Technology, Cambridge, Massachusetts 02139
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18
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Selective treatment and monitoring of disseminated cancer micrometastases in vivo using dual-function, activatable immunoconjugates. Proc Natl Acad Sci U S A 2014; 111:E933-42. [PMID: 24572574 DOI: 10.1073/pnas.1319493111] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Drug-resistant micrometastases that escape standard therapies often go undetected until the emergence of lethal recurrent disease. Here, we show that it is possible to treat microscopic tumors selectively using an activatable immunoconjugate. The immunoconjugate is composed of self-quenching, near-infrared chromophores loaded onto a cancer cell-targeting antibody. Chromophore phototoxicity and fluorescence are activated by lysosomal proteolysis, and light, after cancer cell internalization, enabling tumor-confined photocytotoxicity and resolution of individual micrometastases. This unique approach not only introduces a therapeutic strategy to help destroy residual drug-resistant cells but also provides a sensitive imaging method to monitor micrometastatic disease in common sites of recurrence. Using fluorescence microendoscopy to monitor immunoconjugate activation and micrometastatic disease, we demonstrate these concepts of "tumor-targeted, activatable photoimmunotherapy" in a mouse model of peritoneal carcinomatosis. By introducing targeted activation to enhance tumor selectively in complex anatomical sites, this study offers prospects for catching early recurrent micrometastases and for treating occult disease.
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Josefsen LB, Boyle RW. Unique diagnostic and therapeutic roles of porphyrins and phthalocyanines in photodynamic therapy, imaging and theranostics. Theranostics 2012; 2:916-66. [PMID: 23082103 PMCID: PMC3475217 DOI: 10.7150/thno.4571] [Citation(s) in RCA: 379] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 08/10/2012] [Indexed: 02/07/2023] Open
Abstract
Porphyrinic molecules have a unique theranostic role in disease therapy; they have been used to image, detect and treat different forms of diseased tissue including age-related macular degeneration and a number of different cancer types. Current focus is on the clinical imaging of tumour tissue; targeted delivery of photosensitisers and the potential of photosensitisers in multimodal biomedical theranostic nanoplatforms. The roles of porphyrinic molecules in imaging and pdt, along with research into improving their selective uptake in diseased tissue and their utility in theranostic applications are highlighted in this Review.
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Shishkova N, Kuznetsova O, Berezov T. Photodynamic therapy for gynecological diseases and breast cancer. Cancer Biol Med 2012; 9:9-17. [PMID: 23691448 PMCID: PMC3643637 DOI: 10.3969/j.issn.2095-3941.2012.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 01/12/2012] [Indexed: 12/19/2022] Open
Abstract
Photodynamic therapy (PDT) is a minimally invasive and promising new method in cancer treatment. Cytotoxic reactive oxygen species (ROS) are generated by the tissue-localized non-toxic sensitizer upon illumination and in the presence of oxygen. Thus, selective destruction of a targeted tumor may be achieved. Compared with traditional cancer treatment, PDI has advantages including higher selectivity and lower rate of toxicity. The high degree of selectivity of the proposed method was applied to cancer diagnosis using fluorescence. This article reviews previous studies done on PDT treatment and photodetection of cervical intraepithelial neoplasia, vulvar intraepithelial neoplasia, ovarian and breast cancer, and PDT application in treating non-cancer lesions. The article also highlights the clinical responses to PDT, and discusses the possibility of enhancing treatment efficacy by combination with immunotherapy and targeted therapy.
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Affiliation(s)
- Natashis Shishkova
- Department of Biochemistry, School of Medicine, People's Friendship University of Russia, Moscow 117198, Russia
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21
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Image-enhanced laparoscopy: A promising technology for detection of peritoneal micrometastases. Surgery 2012; 151:345-50. [DOI: 10.1016/j.surg.2011.12.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 12/09/2011] [Indexed: 01/09/2023]
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22
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Guyon L, Ascencio M, Collinet P, Mordon S. Photodiagnosis and photodynamic therapy of peritoneal metastasis of ovarian cancer. Photodiagnosis Photodyn Ther 2012; 9:16-31. [DOI: 10.1016/j.pdpdt.2011.08.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 08/16/2011] [Accepted: 08/22/2011] [Indexed: 12/27/2022]
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Kato S, Kawamura J, Kawada K, Hasegawa S, Sakai Y. Fluorescence diagnosis of metastatic lymph nodes using 5-aminolevulinic acid (5-ALA) in a mouse model of colon cancer. J Surg Res 2011; 176:430-6. [PMID: 22221602 DOI: 10.1016/j.jss.2011.10.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 09/12/2011] [Accepted: 10/24/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND Lymph node metastasis is one of the most critical prognostic factors in patients with colorectal cancer. Although regional lymph nodes should be surgically resected and pathologically examined, techniques for the intraoperative diagnosis of lymph node metastasis remain to be well established. Fluorescence diagnosis using 5-aminolevulinic acid (5-ALA) is a promising technique for evaluating various malignancies. After exogenous administration of 5-ALA, protoporphyrin IX (PPIX) accumulates in malignant cells and can be detected as red fluorescence. In this study, we investigated the usefulness of fluorescence diagnosis using 5-ALA for the detection of lymph node metastasis in a mouse model of colon cancer. MATERIALS AND METHODS An orthotopic colon cancer model was prepared by inoculating the cecal wall of nude mice with HCA7, a human colon adenocarcinoma cell line. After 3 wk, 40 mg/kg of 5-ALA was administered intraperitoneally (IP) or orally (PO). Fluorescence diagnosis with a D-Light System (Karl Storz) was then performed after 3 or 6 h. RESULTS In the IP group, PPIX fluorescence was detected in metastatic lymph nodes as well as in other malignant lesions, including primary tumors and abdominal implantations, while non-metastatic nodes were fluorescence-negative. In contrast, no obvious fluorescence was detected in cancerous tissues in the PO group. CONCLUSIONS PPIX fluorescence induced by intraperitoneal injection of 5-ALA allows metastatic lymph nodes to be accurately diagnosed in this mouse model. This technique may facilitate the intraoperative diagnosis of lymph node metastases from colon cancer in a clinical setting.
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Affiliation(s)
- Shigeru Kato
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Celli JP, Spring BQ, Rizvi I, Evans CL, Samkoe KS, Verma S, Pogue BW, Hasan T. Imaging and photodynamic therapy: mechanisms, monitoring, and optimization. Chem Rev 2010; 110:2795-838. [PMID: 20353192 PMCID: PMC2896821 DOI: 10.1021/cr900300p] [Citation(s) in RCA: 1624] [Impact Index Per Article: 116.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Jonathan P Celli
- Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
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25
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Zhong W, Celli JP, Rizvi I, Mai Z, Spring BQ, Yun SH, Hasan T. In vivo high-resolution fluorescence microendoscopy for ovarian cancer detection and treatment monitoring. Br J Cancer 2009; 101:2015-22. [PMID: 19920823 PMCID: PMC2795438 DOI: 10.1038/sj.bjc.6605436] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: In patients with advanced ovarian cancer (OvCa), microscopic residual tumour nodules that remain after surgical debulking frequently escape detection by current treatment assessment methods and lead to disease recurrence. The aim of this study was to evaluate the use of high-resolution fibre-optic fluorescence imaging of the clinically approved photodynamic therapy (PDT) agent benzoporphyin-derivative monoacid ring A (BPD-MA) for detection of microscopic OvCa and for monitoring treatment response. Methods: Our fluorescence microendoscope consists of a flexible imaging fibre coupled to a custom epi-fluorescence system optimised for imaging BPD-MA, which, after a single administration, serves as both an imaging agent and a light-activated therapeutic agent. After characterisation in an in vitro OvCa 3D model, we used the flexible imaging fibre to minimally invasively image the peritoneal cavity of a disseminated OvCa murine model using BPD-MA administered intraperitoneally (i.p.). To evaluate longitudinal changes in response to treatment, we compared sets of images obtained before and after PDT with those from untreated mice imaged at the same time points. Results: By comparison with histopathology, we report an 86% sensitivity for tumour detection in vivo using the microendoscope. Using a custom routine to batch process-image data in the monitoring study, treated mice exhibited an average decrease of 58.8% in tumour volumes compared with an increase of 59.3% in untreated controls (P<0.05). Conclusions: Our findings indicate the potential of this approach as a reporter of treatment outcome that could aid in the rational design of strategies to mitigate recurrent OvCa.
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Affiliation(s)
- W Zhong
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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26
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Zeisser-Labouèbe M, Delie F, Gurny R, Lange N. Benefits of nanoencapsulation for the hypercin-mediated photodetection of ovarian micrometastases. Eur J Pharm Biopharm 2008; 71:207-13. [PMID: 18977296 DOI: 10.1016/j.ejpb.2008.10.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 09/29/2008] [Accepted: 10/02/2008] [Indexed: 11/28/2022]
Abstract
The high recurrence and lethality of ovarian cancer at advanced stages is problematic, especially due to the development of numerous micrometastases scattered throughout the abdominal cavity. Fluorescence photodetection (PD) used in combination with surgical resection of malignant tissues has been suggested to improve recovery. Based on promising in vivo results for the detection of bladder cancer, hypericin (Hy), a natural photosensitizer (PS), stands as a good candidate for the photodetection of ovarian cancer. However, due to its hydrophobicity, systemic administration of Hy is problematic. Polymeric nanoparticles (NPs) help to overcome these delivery and stability problems and enable intravenous administration of Hy. In this study, Hy-loaded NPs of polylactic acid were produced with the following properties: (i) mean size of 268 nm, (ii) negative zeta potential, (iii) low residual surfactant and (iv) drug loading of 3.7 % (w/w). The potential of hypericin-loaded nanoparticles for the fluorescence photodetection of ovarian metastases in Fischer 344 rats bearing ovarian tumours was compared to free drug. The selectivity of Hy administered with both formulations was assessed first by fluorescence endoscopy, and then quantified after tissue extraction. The results showed an improved selective accumulation of Hy in ovarian micrometastases when NPs were used.
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Affiliation(s)
- Magali Zeisser-Labouèbe
- Department of Pharmaceutics and Biopharmaceutics, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
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Ascencio M, Estevez JP, Delemer M, Farine MO, Collinet P, Mordon S. Comparison of continuous and fractionated illumination during hexaminolaevulinate-photodynamic therapy. Photodiagnosis Photodyn Ther 2008; 5:210-6. [DOI: 10.1016/j.pdpdt.2008.09.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 09/23/2008] [Accepted: 09/24/2008] [Indexed: 11/27/2022]
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28
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Regis C, Collinet P, Farine MO, Mordon S. Comparison of Aminolevulinic Acid– and Hexylester Aminolevulinate–Induced Protoporphyrin IX Fluorescence for the Detection of Ovarian Cancer in a Rat Model. Photomed Laser Surg 2007; 25:304-11. [PMID: 17803389 DOI: 10.1089/pho.2007.2057] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES This study set out to compare the photodetection of peritoneal micrometastases in an ovarian cancer model following administration of two precursors of protoporphyrin IX (PpIX): 5-aminolevulinic acid (ALA) and hexylester aminolevulinate (He-ALA). METHODS ALA or He-ALA (100 mg/kg) was injected into the peritoneal cavity of 16 rats with induced peritoneal metastases of ovarian cancer. Two hours later, the tumors were visualized laparoscopically using both white light for standard exploration and blue light for fluorescence. Peritoneal micrometastases were counted. Fluorescence intensities of tumoral and normal surrounding tissues were compared. The distribution of PpIX throughout the peritoneum was studied on frozen biopsies using fluorescence microscopy and correlated with pathological findings. RESULTS The number of micrometastases detected by the fluorescence blue mode was significantly higher (p < 0.05) than with standard white light for both ALA (235 versus 198) and He-ALA application (248 versus 199). The mean fluorescence intensity ratio between tumor and normal surrounding tissue was significantly (p < 0.05) higher for He-ALA (1.55 +/- 0.1) compared to ALA (1.45 +/- 0.1). Fluorescence microscopy confirmed that the PpIX fluorescence remained limited to cancer cells. Macroscopically fluorescing nodules were histopathologically confirmed as malignant. CONCLUSION He-ALA is an excellent precursor for PpIX synthesis, giving the highest PpIX fluorescence contrast between normal and tumoral peritoneal tissues. Imaging with He-ALA improves the detection of peritoneal metastases compared to ALA.
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Affiliation(s)
- Claudia Regis
- Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
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Collinet P, Sabban F, Cosson M, Farine MO, Villet R, Vinatier D, Mordon S. Laparoscopic Photodynamic Diagnosis of Ovarian Cancer Peritoneal Micro Metastasis: An Experimental Study. Photochem Photobiol 2007; 83:647-51. [PMID: 17117888 DOI: 10.1562/2006-04-13-ra-869] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The goal of this study was to assess the interest of photodynamic diagnosis (PDD) for laparoscopic detection of peritoneal micro metastasis in ovarian carcinoma. Using an experimental animal model, intraperitoneal injection of aminolevulinic acid (ALA) and hexylester of aminolevulinic acid (He-ALA) were compared in order to improve laparoscopic detection of ovarian peritoneal carcinomatosis. Twenty-one 344 Fischer female rats received an intra peritoneal injection of 106 NuTu-19 cells. At day 22, carcinomatosis with micro peritoneal metastasis was obtained. Rats were randomized in three groups concerning intra peritoneal injection before laparoscopic staging: 5-ALA hydrochloride, HE-ALA and sterile water. Using D Light system, laparoscopic peritoneal exploration was performed with white light (WL) first and then with blue light (BL). The main objective was to assess feasibility and sensibility of laparoscopic PDD for nonvisible peritoneal micro metastasis of ovarian cancer. The main parameter was the confirmation of neoplasic status of fluorescent foci by histology. Concerning PDD after intraperitoneal injection of 5-ALA, mean values of lesions seen is higher than without fluorescence (32 vs 20.7; P = 0.01). Using He-ALA, mean values of detected lesions is higher than without fluorescence (42.9 vs 33.6; P < 0.001). Neoplasic status of fluorescent foci was confirmed in 92.8% of cases (39/42). Using 5-ALA, fluorescence of cancerous tissue is significantly higher than that of normal tissue in all the rats (ratio 1.17) (P = 0.01). With He-ALA, intensity of fluorescence is significantly higher in cancerous tissue compared to normal tissue, irrespective of the rat studied (ratio 1.22; P < 0.001).
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Affiliation(s)
- Pierre Collinet
- Gynaecologic Surgery Department, Jeanne de Flandre Hospital, Lille University Hospital-CHRU, Lille Cedex, France
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Zeisser-Labouèbe M, Lange N, Gurny R, Delie F. Hypericin-loaded nanoparticles for the photodynamic treatment of ovarian cancer. Int J Pharm 2006; 326:174-81. [PMID: 16930882 DOI: 10.1016/j.ijpharm.2006.07.012] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Revised: 07/06/2006] [Accepted: 07/07/2006] [Indexed: 10/24/2022]
Abstract
A photodynamic approach has been suggested to improve diagnosis and therapy of ovarian cancer. As Hypericin (Hy), a natural photosensitizer (PS) extracted from Hypericum perforatum, has been shown to be efficient in vitro and in vivo for the detection or treatment of other cancers, Hy could also be a potent tool for the treatment and detection of ovarian cancer. Due to its hydrophobicity, systemic administration of Hy is problematic. Thus, polymeric nanoparticles (NPs) of polylactic acid (PLA) or polylactic-co-glycolic acid (PLGA) were used as a drug delivery system. Hy-loaded NPs were produced with the following characteristics: (i) size in the 200-300 nm range, (ii) negative zeta potential, (iii) low residual PVAL and (iv) drug loading from 0.03 to 0.15% (w/w). Their in vitro photoactivity was investigated on the NuTu-19 ovarian cancer cell model derived from Fischer 344 rats and compared to free drug. Hy-loaded PLA NPs exhibited a higher photoactivity than free drug. Increasing light dose or incubation time with cells induced an enhanced activity of Hy-loaded PLA NPs. Increased NP drug loading had a negative effect on their photoactivity on NuTu-19 cells: at the same Hy concentration, the higher was the drug loading, the lower was the phototoxic effect. The influence of NP drug loading on the Hy release from NPs was also investigated.
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Affiliation(s)
- Magali Zeisser-Labouèbe
- Department of Pharmaceutics and Biopharmaceutics, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, 30 Quai E. Ansermet, CH-1211 Geneva 4, Switzerland
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Till H, Bergmann F, Metzger R, Haeberle B, von Schweinitz D, Prosst R. Laparoscopic fluorescence diagnosis of peritoneal metastases from human hepatoblastoma in nude rats. J Pediatr Surg 2006; 41:1357-60. [PMID: 16863837 DOI: 10.1016/j.jpedsurg.2006.04.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM Fluorescence diagnosis is gaining clinical importance for the detection of malignancies in various medical disciplines. The technique relies on the specific metabolic capacity of a lesion to produce a fluorescent compound. It is still unknown whether pediatric solid tumors like hepatoblastoma (HB) are susceptible to this technique as well. METHODS Human HB (3 x 10(6)) cells were laparoscopically injected (4 mm scope, 18-G needle) underneath the peritoneum of 7 nude rats (mean weight, 198 g). Tumor growth was allowed for 7 weeks. Photosensitization was induced by peritoneal lavage with aminolevulinic acid (3%). After 3 hours, the animals were investigated with white light laparoscopy (WL) and laparoscopic fluorescence diagnosis (LFD), applying the Storz PDD system. Every suspicious lesion was analyzed by spectrometry and harvested for histology. RESULTS Every tumor seen in WL also demonstrated strong fluorescence during LFD (100%). One micrometastasis, almost invisible in WL, was obviously illuminating in LFD. Spectrometry demonstrated the specific peak of the aminolevulinic acid metabolite protoporphyrin IX at 635 nm and a 6.34-fold increase of the fluorescence intensity. Histology revealed HB in all specimens. CONCLUSION Human HB can be detected with LFD in a rat model. This finding opens a wide spectrum of experimental and clinical investigations to evaluate the impact of fluorescence diagnosis for pediatric oncology.
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Affiliation(s)
- Holger Till
- Department of Pediatric Surgery, University of Leipzig, 04317 Leipzig, Germany
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Di Venosa G, Fukuda H, Batlle A, Macrobert A, Casas A. Photodynamic therapy: regulation of porphyrin synthesis and hydrolysis from ALA esters. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2006; 83:129-36. [PMID: 16480890 DOI: 10.1016/j.jphotobiol.2006.01.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2005] [Revised: 12/16/2005] [Accepted: 01/03/2006] [Indexed: 11/29/2022]
Abstract
Photodynamic therapy (PDT) is a tool for the treatment of certain cancerous and pre-cancerous conditions. The natural precursor of porphyrins 5-aminolevulinic acid (ALA) has been extensively used as a pro-photosensitiser in PDT. ALA's poor permeability has been enhanced by chemical esterification with aliphatic alcohols. Some of the ALA esters proved to be more efficient than ALA for porphyrin synthesis. In the present work we studied the nature of porphyrin synthesis regulation from the ALA esters Hexyl-ALA (He-ALA) and R,S-ALA-2-(hydroxymethyl)tetrahydropyranyl ester (THP-ALA) in an adenocarcinoma cell line. We found that He-ALA is incorporated into the cells at a higher rate, followed by THP-ALA and ALA, whereas ALA and ALA esters efflux at the same rate mediated by passive diffusion. Although ALA entrance to the cell might be regulatory at low concentrations, ALA derivative uptake is not a limiting factor. At high concentrations, the regulation of ALA conversion into porphyrins is driven by the enzyme porphobilinogenase, whereas ALA esters hydrolysis is regulated by esterases. The key conclusion of this contribution is that the use of ALA esters has to be limited to low concentrations where no regulation on porphyrin synthesis takes place.
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Affiliation(s)
- Gabriela Di Venosa
- Centro de Investigaciones sobre Porfirinas y Porfirias (CIPYP), CONICET and Hospital de Clínicas José de San Martín, University of Buenos Aires, Córdoba 2351 1er subsuelo, Ciudad de Buenos Aires, CP 1120AAF, Argentina
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Fotinos N, Campo MA, Popowycz F, Gurny R, Lange N. 5-Aminolevulinic Acid Derivatives in Photomedicine: Characteristics, Application and Perspectives. Photochem Photobiol 2006; 82:994-1015. [PMID: 16542112 DOI: 10.1562/2006-02-03-ir-794] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The introduction of lipophilic derivatives of the naturally occurring heme precursor 5-aminolevulinic acid (5-ALA) into photomedicine has led to a true revival of this research area. 5-ALA-mediated photodynamic therapy (PDT) and fluorescence photodetection (FD) of neoplastic disease is probably one of the most selective cancer treatments currently known in oncology. To date, this method has been assessed experimentally for the treatment of various medical indications. However, the limited local bioavailability of 5-ALA has widely prevented its use in daily clinical practice. Although researchers were already aware of this drawback early during the development of 5-ALA-mediated PDT, only recently have well-established concepts in pharmaceutical science been adapted to investigate ways to overcome this drawback. Recently, two derivatives of 5-ALA, methylaminolevulinate (MAL) and hexylaminolevulinate (HAL), gained marketing authorization from the regulatory offices in Europe and Australia. MAL is marketed under the trade name Metvix for the treatment of actinic keratosis and difficult-to-treat basal cell carcinoma. HAL has recently been launched under the trade name Hexvix to improve the detection of superficial bladder cancer in Europe. This review will first present the fundamental concepts underlying the use of 5-ALA derivatives in PDT and FD from a chemical, biochemical and pharmaceutical point of view. Experimental evidences from preclinical data on the improvements and limits observed with 5-ALA derivatives will then be introduced. The state-of-the-art from clinical studies with 5-ALA esters will be discussed, with special emphasis placed on the process that led to the development of MAL in dermatology and to HAL in urology. Finally, we will discuss promising medical fields in which use of 5-ALA derivatives might potentially lead to further use of this methodology in photomedicine.
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Affiliation(s)
- Nicolas Fotinos
- Laboratory of Pharmaceutical Technology and Biopharmaceutics, Ecole de Pharmacie Genève-Lausanne, University of Geneva, Switzerland
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Till H, Bergmann F, Metzger R, Haeberle B, Schaeffer K, von Schweinitz D, Prosst RL. Videoscopic fluorescence diagnosis of peritoneal and thoracic metastases from human hepatoblastoma in nude rats. Surg Endosc 2005; 19:1483-6. [PMID: 16206006 DOI: 10.1007/s00464-005-0316-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2005] [Accepted: 06/12/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Various medical disciplines are employing photodynamic diagnosis (PDD) when searching for malignancies. It is still unknown whether pediatric solid tumors such as hepatoblastoma are susceptible to this technique as well. METHODS Human hepatoblastoma cells were injected into the abdomen or right thoracic cavity of nude rats. Tumor growth was allowed for 7 weeks. Then, photosensitization was induced by peritoneal lavage with 5-aminolevulinic acid (ALA). Applying the Storz PDD system and one 4-mm scope, all animals were investigated by videoscopic white light diagnosis (WD) and PDD. Suspicious lesions were marked and analyzed by spectrometry and histology. RESULTS Positive fluorescence was documented for every tumor seen by WD in the abdomen or right thoracic cavity. Spectrometry of lesions showed a 6.34-fold increased fluorescence intensity. Histology revealed hepatoblastoma in all specimens. CONCLUSIONS Human hepatoblastoma can be detected by PDD in a rat model. Considering the clinical success of this method in other specialties, our findings indicate that further investigations to evaluate the benefit of PDD for children with hepatoblastoma should be performed.
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Affiliation(s)
- H Till
- Department of Pediatric Surgery, Dr. V. Hauner Children's Hospital, University of Munich, Lindwurmstrasse 4, 80337 München, Germany.
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Sabban F, Collinet P, Cosson M, Mordon S. Technique d’imagerie par fluorescence : intérêt diagnostique et thérapeutique en gynécologie. ACTA ACUST UNITED AC 2004; 33:734-8. [PMID: 15687945 DOI: 10.1016/s0368-2315(04)96635-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Fluorescence techniques are presently used by several medical and surgical disciplines (dermatology, pneumology, urology, gastrointestinal surgery) for the diagnosis of pre-cancerous and cancerous lesions. The technique is based on the application of 5-aminolevulinic acid (5-ALA) which induces the production of an endogen photosensitizer: protoporphyrin IX (PpIX). Fluorescence detection of the infraclinical dysplasia lesion is based on the contrast between fluorescent pathological tissue and non-fluorescent healthy tissue. Moreover, there is a correlation between the degree of tissue dysplasia and fluorescence intensity. Fluorescence imaging could allow easier detection of infraclinical lesions enabling more well-targeted treatment. In gynecology, many experimental and clinical studies have been conducted on the detection and treatment of cervical dysplasia and the diagnosis and treatment of vaginal and vulvar diseases as well as the diagnosis of peritoneal micrometastasis from ovarian cancer, the diagnosis and treatment of endometrial alterations, and the treatment of locoregional recurrent skin breast cancer. The aim of this work is to present the fundamental principles of fluorescence imaging technical and to expose the diagnostic and therapeutic prospects in gynecology.
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Affiliation(s)
- F Sabban
- Maternité Jeanne de Flandre, avenue Eugène-Avinée, 59037 Lille Cedex
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Andrejevic-Blant S, Major A, Lüdicke F, Ballini JP, Wagnières G, van den Bergh H, Pelte MF. Time-dependent hexaminolaevulinate induced protoporphyrin IX distribution after topical application in patients with cervical intraepithelial neoplasia: A fluorescence microscopy study. Lasers Surg Med 2004; 35:276-83. [PMID: 15493027 DOI: 10.1002/lsm.20095] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Compared to the conventional management of cervical intraepithelial neoplasia (CIN) the potential advantage of photodynamic therapy (PDT) for the treatment of cervical human papilloma virus (HPV)-related disease encompasses a minimal invasive procedure with reduced risk of profuse bleeding as a consequence of conization, and possibly more favorable long-term results avoiding cervical stenosis. At present little is known about the precise time-dependent distribution and histological localization of hexaminolaevulinate (HAL) induced protoporphyrin IX (PPIX) fluorescence in healthy tissue and in CIN. The aim of this study was to use ex vivo fluorescence microscopy to determine whether PPIX is selectively induced by neoplastic cells of the cervical epithelium at various times after topical application. STUDY DESIGN/MATERIALS AND METHODS Cold cream containing 0.5% HAL was applied by means of cervical cap over various periods of time. We analyzed 52 healthy cervical mucosa and 84 CINs. RESULTS At time delay 100 (+/-10) minutes, high epithelial fluorescence and a significant selectivity between epithelium and underlying lamina propria was found. By contrast, no significant difference between healthy and neoplastic tissues, or between low and high-grade epithelial dysplasia (P > or = 0.05), was observed at any time point. CONCLUSIONS Application of HAL 0.5% cream to the cervix induced selective fluorescence in epithelial cells. The optimal ratio with a homogeneous PPIX distribution was obtained after 100 ( +/- 10) minutes cream application, which should be evaluated further for PDT.
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