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Caccavale S, Boccellino MP, Brancaccio G, Alfano R, Argenziano G. Keratolytics can replace curettage in daylight photodynamic therapy for actinic keratosis on the face/scalp: A randomized clinical trial. J Eur Acad Dermatol Venereol 2024; 38:594-601. [PMID: 38071596 DOI: 10.1111/jdv.19687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/23/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Methyl aminolevulinate (MAL) photodynamic therapy (PDT) is commonly used for field treatment of actinic keratoses (AKs). In standard natural daylight PDT (n-DL-PDT) the first step, after the application of chemical solar filter, is removal of crusts and scales by curettage, followed by the application of MAL cream. Some patients experience intense pain during curettage and stinging after application of the photosensitizer to just curettaged skin. OBJECTIVES To evaluate whether n-DL-PDT without curettage, but preceded by application of keratolytics, would maintain a similar efficacy, based on clinical, dermoscopic, reflectance confocal microscopy (RCM) assessments, safety and patient satisfaction as standard n-DL-PDT with curettage. METHODS Forty patients with multiple AKs on the face and/or scalp were enrolled in this study. Patients were randomized into two groups of treatment as follows: (i) MAL n-DL-PDT without previous curettage, preceded by skin preparation at home with keratolytics (30% urea cream, twice a day for 7 days; -Cur group) and (ii) MAL n-DL-PDT preceded by skin preparation at the hospital with curettage (+Cur group). RESULTS Thirty-nine participants completed the study. Four hundred and twenty-one AKs in -Cur group and 337 AKs in +Cur group were treated. The mean reduction in the number of AK lesions 3 months after the treatment was 10.7 (-54.7%) in the -Cur and 10.4 (-58.7%) in the +Cur group. We found that the differences in terms of efficacy and patient satisfaction comparing the two treatment regimens were not statistically significant. The pain score reported during and after daylight exposure was similar and low in both groups. Moreover, no unexpected adverse events occurred during the trial period. CONCLUSIONS According to our results, curettage is not necessary to obtain the full treatment effect of n-DL-PDT. We experienced in a real-life setting that n-DL-PDT protocol could be changed by replacing curettage with keratolytics.
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Affiliation(s)
- Stefano Caccavale
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Maria Pia Boccellino
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Gabriella Brancaccio
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Roberto Alfano
- Department of Anesthesiology, Surgery and Emergency, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppe Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
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Ruiz AJ, Allen R, Giallorenzi MK, Samkoe KS, Shane Chapman M, Pogue BW. Smartphone-based dual radiometric fluorescence and white-light imager for quantification of protoporphyrin IX in skin. JOURNAL OF BIOMEDICAL OPTICS 2023; 28:086003. [PMID: 37638107 PMCID: PMC10460113 DOI: 10.1117/1.jbo.28.8.086003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/02/2023] [Accepted: 07/06/2023] [Indexed: 08/29/2023]
Abstract
Significance The quantification of protoporphyrin IX (PpIX) in skin can be used to study photodynamic therapy (PDT) treatments, understand porphyrin mechanisms, and enhance preoperative mapping of non-melanoma skin cancers. Aim We aim to develop a smartphone-based imager for performing simultaneous radiometric fluorescence (FL) and white light (WL) imaging to study the baseline levels, accumulation, and photobleaching of PpIX in skin. Approach A smartphone-based dual FL and WL imager (sDUO) is introduced alongside new radiometric calibration methods for providing SI-units of measurements in both pre-clinical and clinical settings. These radiometric measurements and corresponding PpIX concentration estimations are applied to clinical measurements to understand mechanistic differences between PDT treatments, accumulation differences between normal tissue and actinic keratosis lesions, and the correlation of photosensitizer concentrations to treatment outcomes. Results The sDUO alongside the developed methods provided radiometric FL measurements (nW / cm 2 ) with a demonstrated sub nanomolar PpIX sensitivity in 1% intralipid phantoms. Patients undergoing PDT treatment of actinic keratosis (AK) lesions were imaged, capturing the increase and subsequent decrease in FL associated with the incubation and irradiation timepoints of lamp-based PDT. Furthermore, the clinical measurements showed mechanistic differences in new daylight-based treatment modalities alongside the selective accumulation of PpIX within AK lesions. The use of the radiometric calibration enabled the reporting of detected PpIX FL in units of nW / cm 2 with the use of liquid phantom measurements allowing for the estimation of in-vivo molar concentrations of skin PpIX. Conclusions The phantom, pre-clinical, and clinical measurements demonstrated the capability of the sDUO to provide quantitative measurements of PpIX FL. The results demonstrate the use of the sDUO for the quantification of PpIX accumulation and photobleaching in a clinical setting, with implications for improving the diagnosis and treatment of various skin conditions.
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Affiliation(s)
- Alberto J. Ruiz
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- QUEL Imaging, LLC, White River Junction, Vermont, United States
| | - Richard Allen
- QUEL Imaging, LLC, White River Junction, Vermont, United States
| | - Mia K. Giallorenzi
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Kimberley S. Samkoe
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - M. Shane Chapman
- Dartmouth Health, Department of Dermatology, Lebanon, New Hampshire, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- University of Wisconsin–Madison, Department of Medical Physics, Madison, Wisconsin, United States
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Kirillin M, Khilov A, Kurakina D, Orlova A, Perekatova V, Shishkova V, Malygina A, Mironycheva A, Shlivko I, Gamayunov S, Turchin I, Sergeeva E. Dual-Wavelength Fluorescence Monitoring of Photodynamic Therapy: From Analytical Models to Clinical Studies. Cancers (Basel) 2021; 13:cancers13225807. [PMID: 34830963 PMCID: PMC8616416 DOI: 10.3390/cancers13225807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Fluorescence imaging is an efficient tool in monitoring photodynamic therapy procedures allowing us to track accumulation and photobleaching of a photosensitizer (PS). Chlorin-based PSs feature high absorption in the red and blue bands of visible spectrum. Due to spectral dispersion of light penetration depth in biotissues, fluorescence signals registered upon excitation by red or blue light are formed in different measurement volumes. We present analytical and numerical models of dual-wavelength fluorescence imaging for evaluation of PS localization depth in the cases of topical administration and intravenous injection. The results of analytical and numerical simulations are in good agreement with the phantom experiments, and are translated to the in vivo imaging, which allows to interpret experimental observations in animal trials, human volunteers, and clinical studies. The proposed approach allows us to noninvasively estimate typical accumulation depths of PS localization which are consistent with the morphologically expected values. Abstract Fluorescence imaging modalities are currently a routine tool for the assessment of marker distribution within biological tissues, including monitoring of fluorescent photosensitizers (PSs) in photodynamic therapy (PDT). Conventional fluorescence imaging techniques provide en-face two-dimensional images, while depth-resolved techniques require complicated tomographic modalities. In this paper, we report on a cost-effective approach for the estimation of fluorophore localization depth based on dual-wavelength probing. Owing to significant difference in optical properties of superficial biotissues for red and blue ranges of optical spectra, simultaneous detection of fluorescence excited at different wavelengths provides complementary information from different measurement volumes. Here, we report analytical and numerical models of the dual-wavelength fluorescence imaging of PS-containing biotissues considering topical and intravenous PS administration, and demonstrate the feasibility of this approach for evaluation of the PS localization depth based on the fluorescence signal ratio. The results of analytical and numerical simulations, as well as phantom experiments, were translated to the in vivo imaging to interpret experimental observations in animal experiments, human volunteers, and clinical studies. The proposed approach allowed us to estimate typical accumulation depths of PS localization which are consistent with the morphologically expected values for both topical PS administration and intravenous injection.
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Affiliation(s)
- Mikhail Kirillin
- Institute of Applied Physics RAS, 46 Ulyanov St., 603950 Nizhny Novgorod, Russia
| | - Aleksandr Khilov
- Institute of Applied Physics RAS, 46 Ulyanov St., 603950 Nizhny Novgorod, Russia
| | - Daria Kurakina
- Institute of Applied Physics RAS, 46 Ulyanov St., 603950 Nizhny Novgorod, Russia
| | - Anna Orlova
- Institute of Applied Physics RAS, 46 Ulyanov St., 603950 Nizhny Novgorod, Russia
| | - Valeriya Perekatova
- Institute of Applied Physics RAS, 46 Ulyanov St., 603950 Nizhny Novgorod, Russia
| | - Veronika Shishkova
- Institute of Applied Physics RAS, 46 Ulyanov St., 603950 Nizhny Novgorod, Russia
- Institute of Information Technology, Mathematics and Mechanics, Lobachevsky State University of Nizhny Novgorod, 23 Gagarin Avenue, 603022 Nizhny Novgorod, Russia
| | - Alfia Malygina
- Center for Skin Tumor Diagnostics and Treatment, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603005 Nizhny Novgorod, Russia
| | - Anna Mironycheva
- Institute of Applied Physics RAS, 46 Ulyanov St., 603950 Nizhny Novgorod, Russia
- Center for Skin Tumor Diagnostics and Treatment, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603005 Nizhny Novgorod, Russia
| | - Irena Shlivko
- Center for Skin Tumor Diagnostics and Treatment, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603005 Nizhny Novgorod, Russia
| | - Sergey Gamayunov
- Institute of Applied Physics RAS, 46 Ulyanov St., 603950 Nizhny Novgorod, Russia
- Nizhny Novgorod Regional Oncological Hospital, Delovaya 11/1, 603126 Nizhny Novgorod, Russia
| | - Ilya Turchin
- Institute of Applied Physics RAS, 46 Ulyanov St., 603950 Nizhny Novgorod, Russia
| | - Ekaterina Sergeeva
- Institute of Applied Physics RAS, 46 Ulyanov St., 603950 Nizhny Novgorod, Russia
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Er O, Ag S, Ha M, Mb R, Mmc M, Mr G, Lpf A. RANDOMIZED CONTROLLED TRIAL FOR EVALUATION OF EFFICACY AND PAIN DURING PHOTODYNAMIC THERAPY FOR ACTINIC KERATOSIS OF FACE AND SCALP COMPARING TWO IRRADIATION PROTOCOLS. Photodiagnosis Photodyn Ther 2021; 37:102623. [PMID: 34775065 DOI: 10.1016/j.pdpdt.2021.102623] [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: 08/14/2021] [Revised: 10/24/2021] [Accepted: 11/08/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pain is a frequent adverse event during photodynamic therapy, which can limit treatment acceptance. This study aimed to evaluate the efficacy and pain during photodynamic therapy with two irradiation protocols in patients with actinic keratosis on the face and scalp. METHODS In this intra-patient randomized controlled trial, participants were randomly allocated to receive photodynamic therapy with methyl aminolevulinate and red light on the right or left side with protocol 1 (irradiation device in contact with the skin) and protocol 2 (device 3 cm away from the skin). There was a 15-day interval between the protocols. The primary outcome was the frequency of mean intensity of moderate or severe pain during photodynamic therapy. Secondary outcomes were actinic keratosis clearance rate, protoporphyrin IX consumption, participant preference, skin appearance, and adverse events. RESULTS Forty-one participants were included, yielding 47 and 50 randomized sites for protocols 1 and 2. There was no difference in the frequency of moderate and severe pain, with a relative risk of 1.09 (95% CI 0.70-1.70), p>0.05. An actinic keratosis count reduction >60% was observed in both protocols (p<0.01), with no difference between them. There was no difference in protoporphyrin IX consumption. Most treated sites were of good to excellent quality. There was a greater patient preference for protocol 2 (p<0.01). CONCLUSIONS The pain intensity was similar between the protocols, and the protocols were equally effective for actinic keratosis clearance, protoporphyrin IX consumption, and improvement in the quality of the treated areas. Both protocols can be considered safe.
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Affiliation(s)
- Oliveira Er
- Skin Department of Amaral Carvalho Hospital, Jahu, SP, Brazil
| | - Salvio Ag
- Skin Department of Amaral Carvalho Hospital, Jahu, SP, Brazil
| | - Miot Ha
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Requena Mb
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Medeiros Mmc
- Skin Department of Amaral Carvalho Hospital, Jahu, SP, Brazil
| | - Garcia Mr
- Sao Carlos Institute of Physics, University of Sao Paulo, São Carlos, SP, Brazil
| | - Abbade Lpf
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, SP, Brazil.
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Stimulation and homogenization of the protoporphyrin IX endogenous production by photobiomodulation to increase the potency of photodynamic therapy. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2021; 225:112347. [PMID: 34736068 DOI: 10.1016/j.jphotobiol.2021.112347] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 12/20/2022]
Abstract
Protoporphyrin IX (PpIX) is produced in the mitochondria and used as fluorescent contrast agent or photosensitizer after exogenous 5-aminolevulinic acid (ALA) delivery in cancer photodynamic detection and therapy (PDT). Although routinely used in the clinics, the stimulated production of PpIX is often insufficient and/or heterogeneous within the lesions, thereby limiting the PDT performances. Since photobiomodulation, which is based on the illumination of the tissues with sub-thermal radiometric conditions in the red or near-infrared, is known to stimulate the cell metabolism, we have optimized these conditions in vitro. Some of them lead to the homogenization and strong stimulation of the PpIX endogenous production. Interestingly, combined sequentially, PBM enhanced significantly the potency of PpIX-based PDT in vitro and in vivo in tumors grown on the chicken embryo chorioallantoic membrane. These results are in excellent agreement with other assays based on measurements of the cell survival/death, the production of reactive oxygen species, including singlet oxygen, and the mitochondrial membrane potential.
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Ubbink R, Prens EP, Mik EG. Quantitative intracellular oxygen availability before and after 5-aminolevulinic acid skin photodynamic therapy. Photodiagnosis Photodyn Ther 2021; 36:102599. [PMID: 34699980 DOI: 10.1016/j.pdpdt.2021.102599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/01/2021] [Accepted: 10/18/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND During photodynamic therapy (PDT) oxygen is transformed into reactive oxygen species (ROS) to induce cellular apoptosis in (pre)malignant cells. Real time oxygen availability measurement is clinically available with the Cellular Oxygen Metabolism (COMET) monitor. METHODS Primary objective is to show that mitochondrial oxygen availability (mitoPO2) measurement is possible during clinical ALA-PDT. The secondary aim was to determine the pain sensation, because it is the most commonly reported side effect of PDT. Before and after the two fraction PDT treatment, with a 2-hour dark period, mitoPO2 was measured and reported pain was documented with a visual analog scale (VAS) 0-100. RESULTS Nine patients were included. Before the first PDT session the median signal quality was [IQR] 55.0% [34.2-68.0], which decreased after session one to 0% [0.0-10.0]. MitoPO2 was 40.0 [17.7-53.8] mmHg and increased afterwards to 61.8 [38.2-64.8] mmHg. This likely the result of the delay time between the illumination stop and the mitoPO2 measurements in a vasodilated, visibly red lesion. Before session two signal quality was 10.4% [0-20.15], 40% lower than at the start. In 5 patients the signal quality after session 2 was too low because of photobleaching and insufficient regeneration of PpIX, median 0% [0-10]. Subjects reported low median VAS scores, all below 3, directly after the mitoPO2 measurements. CONCLUSION With COMET we were able to reliably measure mitochondrial oxygen concentrations during photodynamic therapy. Signal quality drastically decreases after a PDT session because of PpIX deterioration during the illumination phase.
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Affiliation(s)
- R Ubbink
- Erasmus Medical Center, Anesthesiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
| | - E P Prens
- Erasmus Medical Center, Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - E G Mik
- Erasmus Medical Center, Anesthesiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Assikar S, Labrunie A, Kerob D, Couraud A, Bédane C. Daylight photodynamic therapy with methyl aminolevulinate cream is as effective as conventional photodynamic therapy with blue light in the treatment of actinic keratosis: a controlled randomized intra-individual study. J Eur Acad Dermatol Venereol 2020; 34:1730-1735. [PMID: 31955461 DOI: 10.1111/jdv.16208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/17/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND We know the efficacy of daylight phototherapy dynamic (DL-PDT) in the treatment of actinic keratosis (AK). But the almost studies have compared daylight with red light using methyl aminolevulinate cream and not with blue light. PDT with blue light is another conventional PDT that is effective in the treatment of AKs. OBJECTIVES The aim of this study is to assess the efficacy and the safety of DL-PDT vs. PDT in blue light in the treatment of AKs. METHODS This randomized, controlled, intra-individual efficacy and safety study enrolled 26 subjects. AKs on the face/scalp were treated once, with DL-PDT on one side and c-PDT on the contralateral side. Primary endpoints for DL-PDT at week 12 were efficacy with clearance of AKs and safety with assessment of pain. Lesions with complete response 12 weeks after one treatment session were followed until week 24. RESULTS More than 1000 AK were studied. At week 12, the raw number of disappeared AK lesions at 3-month follow-up was 19.6 (±6.0) for DL-PDT and 20.0 (±6.9) for c-PDT with P = 0.8460 (90.5% vs. 94.2% of AK disappearance, respectively). The response was maintained at 6 months (90.0% and 94.6% of AK reduction, respectively). DL-PDT was nearly painless than c-PDT with light blue: 1.2 vs. 5.1, respectively (P < 0.0001). CONCLUSIONS Daylight-PDT seems as effective as c-PDT with light blue and DL-PDT is less painful. The response of DL-PDT was sustainable until 6 months.
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Affiliation(s)
- S Assikar
- Department of Dermatology, CHU Dupuytren, Limoges, France
| | - A Labrunie
- Centre d'Epidémiologie, de BIostatistique et de MEthodologie de la Recherche (CEBIMER), CHU Dupuytren, Limoges, France
| | - D Kerob
- Galderma International, Paris, France
| | - A Couraud
- Department of Dermatology, CHU Dupuytren, Limoges, France
| | - C Bédane
- Department of Dermatology, CHU Dupuytren, Limoges, France
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Ruiz AJ, LaRochelle EPM, Gunn JR, Hull SM, Hasan T, Chapman MS, Pogue BW. Smartphone fluorescence imager for quantitative dosimetry of protoporphyrin-IX-based photodynamic therapy in skin. JOURNAL OF BIOMEDICAL OPTICS 2019; 25:1-13. [PMID: 31820594 PMCID: PMC6901011 DOI: 10.1117/1.jbo.25.6.063802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/30/2019] [Indexed: 05/04/2023]
Abstract
Significance: While clinical treatment of actinic keratosis by photodynamic therapy (PDT) is widely practiced, there is a well-known variability in response, primarily caused by heterogeneous accumulation of the photosensitizer protoporphyrin IX (PpIX) between patients and between lesions, but measurement of this is rarely done. Aim: Develop a smartphone-based fluorescence imager for simple quantitative photography of the lesions and their PpIX levels that can be used in a new clinical workflow to guide the reliability of aminolevulinic acid (ALA) application for improved lesion clearance. Approach: The smartphone fluorescence imager uses an iPhone and a custom iOS application for image acquisition, a 3D-printed base for measurement standardization, an emission filter for PpIX fluorescence isolation, and a 405-nm LED ring for optical excitation. System performance was tested to ensure measurement reproducibility and the ability to capture photosensitizer accumulation and photobleaching in pre-clinical and clinical settings. Results: PpIX fluorescence signal from tissue-simulating phantoms showed linear sensitivity in the 0.01 to 2.0 μM range. Murine studies with Ameluz® aminolevulinic acid (ALA) gel and initial human testing with Levulan® ALA cream verified that in-vivo imaging was feasible, including that PpIX production over 1 h is easily captured and that photobleaching from the light treatment could be quantified. Conclusions: The presented device is the first quantitative wide-field fluorescence imaging system for PDT dosimetry designed for clinical skin use and for maximal ease of translation into clinical workflow. The results lay the foundation for using the system in clinical studies to establish treatment thresholds for the individualization of PDT treatment.
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Affiliation(s)
- Alberto J. Ruiz
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Address all correspondence to Alberto J. Ruiz, E-mail: ; Brian W. Pogue, E-mail:
| | | | - Jason R. Gunn
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Sally M. Hull
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Tayyaba Hasan
- Massachusetts General Hospital, Harvard Medical School, Wellman Center for Photomedicine, Boston, Massachusetts, United States
| | - M. Shane Chapman
- Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire, United States
- Address all correspondence to Alberto J. Ruiz, E-mail: ; Brian W. Pogue, E-mail:
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Joniová J, Kažiková V, Gerelli E, Bánó G, Wagnières G. Measurements of the optical coefficients of the protoporphyrin IX endogenously producing yeast-based model in the visible and NIR. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-5. [PMID: 29981223 DOI: 10.1117/1.jbo.23.7.075001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/13/2018] [Indexed: 06/08/2023]
Abstract
Models mimicking the endogenous production of protoporphyrin IX (PpIX), as well as its fluorescence, are of high interest for applied and fundamental studies in the fields of cancer detection by fluorescence imaging, photodynamic therapy (PDT), and photobiomodulation (PBM). Here, we present and describe optical properties of the yeast-based models able to produce PpIX endogenously after the administration of 5-aminolevulinic acid (ALA) and/or 2,2'-bipyridyl. As their optical properties have an important impact on the spatial distribution of the fluence rate in these liquid models, their absorption and reduced scattering coefficients were determined to be between 400 and 808 nm for two yeast solutions previously described by our group. These coefficients were derived from measurements of the total reflectance and light penetration depth using a dedicated Monte Carlo simulation. We observed that absorption and scattering coefficients were smaller than those of soft tissues at all wavelengths. This work will enable the production of a low-cost optical phantom loaded with appropriate amounts of light-absorbing and -scattering particles to mimic tumors containing PpIX, offering a useful tool to optimize the spectral and radiometric design of certain cancer photodetection setups.
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Affiliation(s)
| | | | | | - Gregor Bánó
- Pavol Jozef Šafárik Univ. in Košice, Slovakia
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10
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Marra K, LaRochelle EP, Chapman MS, Hoopes PJ, Lukovits K, Maytin EV, Hasan T, Pogue BW. Comparison of Blue and White Lamp Light with Sunlight for Daylight-Mediated, 5-ALA Photodynamic Therapy, in vivo. Photochem Photobiol 2018; 94:1049-1057. [PMID: 29663426 DOI: 10.1111/php.12923] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/02/2018] [Indexed: 12/24/2022]
Abstract
Daylight-mediated photodynamic therapy (d-PDT) as a treatment for actinic keratosis (AK) is an increasingly common technique due to a significant reduction in pain, leading to better patient tolerability. While past studies have looked at different light sources and delivery methods, this study strives to provide equivalent PpIX-weighted light doses with the hypothesis that artificial light sources could be equally as effective as natural sunlight if their PpIX-weighted fluences were equalized. Normal mouse skin was used as the model to compare blue LED light, metal halide white light and natural sunlight, with minimal incubation time between topical ALA application and the onset of light delivery. A total PpIX-weighted fluence of 20 Jeff cm-2 was delivered over 2 h, and the efficacy of response was quantified using three acute bioassays for PDT damage: PpIX photobleaching, Stat3 crosslinking and quantitative histopathology. These bioassays indicated blue light was slightly inferior to both sunlight and white light, but that the latter two were not significantly different. The results suggest that metal halide white light could be a reasonable alternative to daylight PDT, which should allow a more controlled treatment that is independent of weather and yet should have similar response rates with limited pain during treatment.
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Affiliation(s)
- Kayla Marra
- Thayer School of Engineering, Dartmouth College, Hanover, NH
| | | | - M Shane Chapman
- Department of Surgery, Geisel School of Medicine, Hanover, NH
| | - P Jack Hoopes
- Department of Surgery, Geisel School of Medicine, Hanover, NH
| | - Karina Lukovits
- Thayer School of Engineering, Dartmouth College, Hanover, NH
| | - Edward V Maytin
- Department of Biomedical Engineering, Learner Research Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH.,Department of Surgery, Geisel School of Medicine, Hanover, NH
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Heerfordt IM, Bieliauskiene G, Wulf HC. Protoporphyrin IX formation after application of methyl aminolevulinate on the face and scalp with and without prior curettage. Photodiagnosis Photodyn Ther 2018; 22:155-157. [PMID: 29601904 DOI: 10.1016/j.pdpdt.2018.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/23/2018] [Accepted: 03/26/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Pulse photodynamic therapy (PDT) is carried out as classical PDT except that methyl aminolaevulinate (MAL) is removed after 30 min. Protoporphyrin IX (PpIX) accumulation becomes lower after 3 h in pulse-PDT than in classical PDT, but pulse-PDT still has full treatment effect on actinic keratosis (AK). The present study aimed to investigate when PpIX formation in classical PDT without curettage reaches the PpIX level in pulse-PDT with curettage in the skin of the face and scalp. METHODS Fourteen patients with AKs in the face and scalp were included in this pilot study. Each patient had two fields randomly allocated to two different regimes: (i) continuing MAL incubation without prior curettage (-Cur) and (ii) 30 min MAL incubation after curettage (+Cur). The PpIX level in each field was measured with a hand-held fluorescence photometer every 30 min for 6 h after MAL application. No illumination was performed. RESULTS The median PpIX level in the +Cur field after 3 h was 22 arbitrary units (AU), which represents the amount of PpIX that could have been photobleached after pulse-PDT with maximal treatment effect. After 3 h the median PpIX level in the -Cur field was 20 AU, which was not significantly different from the level in the +Cur field (p = 0.9). CONCLUSIONS We propose PDT without curettage as follows: 3 h of MAL incubation and subsequently sufficient illumination. The treatment effect of this regime should be tested to verify if curettage of the face and scalp area may be omitted in PDT.
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Affiliation(s)
- Ida M Heerfordt
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark.
| | - Giedre Bieliauskiene
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - Hans Christian Wulf
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark
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12
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Early and Late Onset Side Effects of Photodynamic Therapy. Biomedicines 2018; 6:biomedicines6010012. [PMID: 29382133 PMCID: PMC5874669 DOI: 10.3390/biomedicines6010012] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/20/2018] [Accepted: 01/25/2018] [Indexed: 01/06/2023] Open
Abstract
Photodynamic Therapy (PDT) is a non-invasive treatment successfully used for neoplastic, inflammatory and infectious skin diseases. One of its strengths is represented by the high safety profile, even in elderly and/or immuno-depressed subjects. PDT, however, may induce early and late onset side effects. Erythema, pain, burns, edema, itching, desquamation, and pustular formation, often in association with each other, are frequently observed in course of exposure to the light source and in the hours/days immediately after the therapy. In particular, pain is a clinically relevant short-term complication that also reduces long-term patient satisfaction. Rare complications are urticaria, contact dermatitis at the site of application of the photosensitizer, and erosive pustular dermatosis. Debated is the relationship between PDT and carcinogenesis: the eruptive appearance of squamous cell carcinoma (SCC) in previously treated areas has been correlated to a condition of local and/or systemic immunosuppression or to the selection of PDT-resistant SCC. Here we review the literature, with particular emphasis to the pathogenic hypotheses underlying these observations.
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13
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Wang B, Shi L, Zhang Y, Zhou Q, Zheng J, Szeimies R, Wang X. Gain with no pain? Pain management in dermatological photodynamic therapy. Br J Dermatol 2017; 177:656-665. [PMID: 28122416 DOI: 10.1111/bjd.15344] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 12/30/2022]
Affiliation(s)
- B. Wang
- Department of Dermatology Ruijin Hospital School of Medicine Shanghai Jiaotong University Shanghai China
| | - L. Shi
- Institute of Photomedicine Shanghai Skin Disease Hospital Tongji University School of Medicine 1278 Baode Road Shanghai 200443 China
| | - Y.F. Zhang
- Institute of Photomedicine Shanghai Skin Disease Hospital Tongji University School of Medicine 1278 Baode Road Shanghai 200443 China
| | - Q. Zhou
- Institute of Photomedicine Shanghai Skin Disease Hospital Tongji University School of Medicine 1278 Baode Road Shanghai 200443 China
| | - J. Zheng
- Department of Dermatology Ruijin Hospital School of Medicine Shanghai Jiaotong University Shanghai China
| | - R.M. Szeimies
- Department of Dermatology and Allergology Vest Clinic Recklinghausen Germany
| | - X.L. Wang
- Institute of Photomedicine Shanghai Skin Disease Hospital Tongji University School of Medicine 1278 Baode Road Shanghai 200443 China
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14
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Yeast as a model organism for endogenous Protoporphyrin IX production. Photodiagnosis Photodyn Ther 2017. [DOI: 10.1016/j.pdpdt.2017.01.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Fanchiotti BG, Machado MPZ, de Paula LC, Durmuş M, Nyokong T, da Silva Gonçalves A, da Silva AR. The photobleaching of the free and encapsulated metallic phthalocyanine and its effect on the photooxidation of simple molecules. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2016; 165:10-23. [PMID: 27755995 DOI: 10.1016/j.jphotobiol.2016.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 09/06/2016] [Accepted: 10/10/2016] [Indexed: 11/25/2022]
Abstract
The photobleaching of an unsubstituted phthalocyanine (gallium(III) phthalocyanine chloride (GaPc)) and a substituted phthalocyanine (1,4-(tetrakis[4-(benzyloxy)phenoxy]phthalocyaninato) indium(III) chloride (InTBPPc)) was monitored for the free photosensitizers and for the phthalocyanines encapsulated into nanoparticles of PEGylated poly(D,L-lactide-co-glycolide) (PLGA-PEG). Phosphate-buffered solutions (PBS) and organic solutions of the free GaPc or the free InTBPPc, and suspensions of each encapsulated photosensitizer (2-15μmol/L) were irradiated using a laser diode of 665nm with a power of 1-104mW and a light dose of 7.5J/cm2. The relative absorbance (RA) of the free GaPc dissolved in 1-methyl-2-pyrrolidone (MP) decreased 8.4 times when the laser power increased from 1mW to 104mW. However, the free or encapsulated GaPc did not suffer the photobleaching in PBS solution. The RA values decreased 2.4 times and 22.2 times for the free InTBPPc dissolved in PBS solution and in dimethylformamide (DMF), respectively, but the encapsulated InTBPPc was only photobleached when the laser power was 104mW at 8μmol/L. The increase of the free GaPc concentration favored the photobleaching in MP until 8μmol/L while the increase from 2μmol/L to 5μmol/L reduced the photodegradation in PBS solution. However, the photobleaching of the free InTBPPc in DMF or in PBS solution, and of each encapsulated photosensitizer was not influenced by increasing the concentration. The influence of the photobleaching on the capability of the free and encapsulated GaPc and InTBPPc to photooxidate the simple molecules was investigated monitoring the fluorescence of dimethylanthracene (DMA) and the tryptophan (Trp). Free InTBPPc was 2.0 and 1.8 times faster to photooxidate the DMA and Trp than it was the free GaPc, but the encapsulated GaPc was 3.4 times more efficient to photooxidize the Trp than it was the encapsulated InTBPPc due to the photodegradation suffered by the encapsulated InTBPPc. The participation of the singlet oxygen was confirmed with the sodium azide in the photobleaching of all free and encapsulated photosensitizer, and in the photooxidation of the DMA and Trp. The asymmetry of InTBPPc increased the solubility of the free compound, decreasing the aggregation state of the photosensitizer and favoring the photobleaching process. The encapsulation shows capability in decreasing the photobleaching of both photosensitizers but the confocal micrographs showed that the increase of the solubility favored the InTBPPc photobleaching during the acquisition of optical cross section.
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Affiliation(s)
| | | | | | - Mahmut Durmuş
- Gebze Technical University, Department of Chemistry, PO Box 141, Gebze 41400, Turkey
| | - Tebello Nyokong
- Rhodes University, Department of Chemistry, PO Box 94, Grahamstown 6140, South Africa
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16
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Nissen CV, Wiegell SR, Philipsen PA, Wulf HC. Short-term chemical pretreatment cannot replace curettage in photodynamic therapy. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2016; 32:146-52. [DOI: 10.1111/phpp.12236] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/07/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Christoffer V. Nissen
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen NV Denmark
| | - Stine Regin Wiegell
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen NV Denmark
| | - Peter Alshede Philipsen
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen NV Denmark
| | - Hans Christian Wulf
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen NV Denmark
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17
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Marois M, Bravo J, Davis SC, Kanick SC. Characterization and standardization of tissue-simulating protoporphyrin IX optical phantoms. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:35003. [PMID: 26968385 PMCID: PMC5994807 DOI: 10.1117/1.jbo.21.3.035003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/19/2016] [Indexed: 05/04/2023]
Abstract
Optical devices for measuring protoporphryin IX (PpIX) fluorescence in tissue are routinely validated by measurements in optical phantoms. Yet there exists limited data to form a consensus on the recipe for phantoms that both mimic the optical properties found in tissue and yield a reliable and stable relationship between PpIX concentration and the fluorescence remission intensity. This study characterizes the influence of multiple phantom components on PpIX fluorescence emission intensity, using Intralipid as the scattering source, bovine whole blood as the background absorber, and Tween as a surfactant to prevent PpIX aggregation. Optical measurements showed a linear proportionality (r > 0.99) between fluorescence intensity and PpIX concentration (0.1 to 10 μg/mL) over a range of Intralipid (1 to 2%) and whole blood (0.5 to 3%) for phantoms containing low surfactant (≤ 0.1%), with fluorescence intensities and scattering and absorption properties stable for 5 h after mixing. The role of surfactant in PpIX phantoms was found to be complex, as aggregation was evident in aqueous nonturbid phantoms with no surfactant (0% Tween), and avoided in phantoms containing Intralipid as the scattering source with no additional or low amounts of added surfactant (≤ 0.1% Tween). Conversely, phantoms containing higher surfactant content (>0.1% Tween) and whole blood showed interactions that distorted the fluorescence emissions.
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Affiliation(s)
- Mikael Marois
- Polytechnique Montreal, 2500 Chemin de Polytechnique, Montreal, Quebec H3T 1J4, Canada
- Dartmouth College, 14 Engineering Drive, Hanover, New Hampshire 03755, United States
| | - Jaime Bravo
- Polytechnique Montreal, 2500 Chemin de Polytechnique, Montreal, Quebec H3T 1J4, Canada
| | - Scott C. Davis
- Dartmouth College, 14 Engineering Drive, Hanover, New Hampshire 03755, United States
- Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, New Hampshire 03766, United States
| | - Stephen Chad Kanick
- Dartmouth College, 14 Engineering Drive, Hanover, New Hampshire 03755, United States
- Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, New Hampshire 03766, United States
- Address all correspondence to: Stephen Chad Kanick,
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18
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Bay C, Togsverd-Bo K, Lerche CM, Haedersdal M. Skin tumor development after UV irradiation and photodynamic therapy is unaffected by short-term pretreatment with 5-fluorouracil, imiquimod and calcipotriol. An experimental hairless mouse study. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2015; 154:34-9. [PMID: 26678673 DOI: 10.1016/j.jphotobiol.2015.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/24/2015] [Accepted: 11/27/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) delays ultraviolet (UV) radiation-induced squamous cell carcinomas (SCCs) in hairless mice. Efficacy may be enhanced by combining PDT with antineoplastic or pro-differentiating agents. We investigated if pretreatment with 5-fluorouracil (5FU), imiquimod (IMIQ) or calcipotriol (CAL) before PDT further delays tumor onset. METHODS Hairless mice (n=224) were exposed 3 times weekly to 3 standard erythema doses (SED) of UV radiation. Methyl-aminolevulinate (MAL)-PDT sessions were given on days 45 and 90 before SCC development. Three applications of topical 5FU, IMIQ or CAL were given before each PDT session. Fluorescence photography quantified protoporphyrin IX (PpIX) formation. RESULTS PDT delayed UV-induced SCC development by 59 days (212 days UV-MAL-PDT vs. 153 days UV-control, P<0.001). Pretreatment with 5FU, IMIQ or CAL before PDT did not further delay SCC onset compared to PDT alone (207 days UV-5FU-MAL-PDT, 215 days UV-IMIQ-MAL-PDT, 206 days UV-CAL-MAL-PDT vs. 212 days UV-MAL-PDT, P=ns). PpIX fluorescence intensified by 5FU-pretreatment (median 21,392 au UV-5FU-MAL-PDT, P=0.011), decreased after IMIQ-pretreatment (12,452 au UV-IMIQ-MAL-PDT, P<0.001), and was unaffected by CAL-pretreatment (19,567 au UV-CAL-MAL-PDT, P=ns) compared to MAL alone (18,083 au UV-MAL-PDT). CONCLUSIONS Short-term three-day pretreatment with 5FU, IMIQ and CAL before PDT does not further delay tumor onset in UV-exposed hairless mice.
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Affiliation(s)
- Christiane Bay
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Katrine Togsverd-Bo
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Catharina M Lerche
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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19
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Kanick SC, Davis SC, Zhao Y, Sheehan KL, Hasan T, Maytin EV, Pogue BW, Chapman MS. Pre-treatment protoporphyrin IX concentration in actinic keratosis lesions may be a predictive biomarker of response to aminolevulinic-acid based photodynamic therapy. Photodiagnosis Photodyn Ther 2015; 12:561-6. [PMID: 26480810 DOI: 10.1016/j.pdpdt.2015.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/14/2015] [Accepted: 10/12/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Although aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) photodynamic therapy (PDT) is an effective FDA-approved therapy for actinic keratosis (AK), a substantial fraction of patients (up to 25%) do not respond to treatment. This study examined the feasibility of using pre-treatment measurements of PpIX concentration in AK lesions to predict response of ALA-PpIX PDT. METHODS A non-invasive fiber-optic fluorescence spectroscopy system was used to measure PpIX concentration in patients undergoing standard-of-care ALA-PDT for AK. All patients provided assessments of pain at the time of treatment (n=70), and a subset reported pain and erythema 48-76 h after treatment (n=13). RESULTS PpIX concentration was significantly higher in lesions of patients reporting high levels of pain (VAS score ≥5) immediately after treatment vs. patients reporting pain scores below VAS=5 (p<0.022) (n=70). However, pain was not an exclusive indicator of PpIX concentration as many patients with low PpIX concentration reported high pain. In a subpopulation of patients surveyed in the days after treatment (n=13), PpIX concentration measured on the day of treatment was uncorrelated with pain-reported immediately after treatment (r=0.17, p<0.57), but positive correlations were found between PpIX concentration and patient-reported pain (r=0.55, p<0.051) and erythema (r=0.58, p<0.039) in the 48-72 h following treatment. CONCLUSIONS These data suggest that in vivo optical measurements of PpIX concentration acquired before light delivery may be an objective predictor of response to ALA-PpIX PDT. Identification of non-responding patients on the day of treatment could facilitate the use of interventions that may improve outcomes.
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Affiliation(s)
- S C Kanick
- Thayer School of Engineering, Dartmouth College, Hanover, USA; Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon NH, USA.
| | - S C Davis
- Thayer School of Engineering, Dartmouth College, Hanover, USA; Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon NH, USA
| | - Y Zhao
- Thayer School of Engineering, Dartmouth College, Hanover, USA
| | - K L Sheehan
- Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, USA
| | - T Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, USA
| | - E V Maytin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, USA; Biomedical Engineering, Cleveland Clinic, Cleveland, USA
| | - B W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, USA; Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon NH, USA; Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, USA; Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, USA
| | - M S Chapman
- Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, USA
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20
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Fink C, Enk A, Gholam P. Photodynamic therapy--aspects of pain management. J Dtsch Dermatol Ges 2015; 13:15-22. [PMID: 25640485 DOI: 10.1111/ddg.12546] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Topical photodynamic therapy (PDT) is a highly effective and safe treatment method for actinic keratoses with an excellent cosmetic outcome and is commonly used for the therapy of large areas of photodamaged skin with multiple clinically manifest and subclinical lesions. However, the major drawback of photodynamic therapy is the pain experienced during the treatment that can be intense and sometimes even intolerable for patients, requiring interruption or termination of the process. Several strategies for controlling pain during photodynamic therapy have been studied but few effective methods are currently available. Therefore, this review puts the spotlight on predictors on pain intensity and aspects of pain management during photodynamic therapy.
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Affiliation(s)
- Christine Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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21
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Rollakanti KR, Anand S, Davis SC, Pogue BW, Maytin EV. Noninvasive Optical Imaging of UV-Induced Squamous Cell Carcinoma in Murine Skin: Studies of Early Tumor Development and Vitamin D Enhancement of Protoporphyrin IX Production. Photochem Photobiol 2015. [PMID: 26223149 DOI: 10.1111/php.12503] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Better noninvasive techniques are needed to monitor protoporphyrin IX (PpIX) levels before and during photodynamic therapy (PDT) of squamous cell carcinoma (SCC) of the skin. Our aim was to evaluate (1) multispectral fluorescent imaging of ultraviolet light (UV)-induced cancer and precancer in a mouse model of SCC and (2) multispectral imaging and probe-based fluorescence detection as a tool to study vitamin D (VD) effects on aminolevulinic acid (ALA)-induced PpIX synthesis. Dorsal skin of hairless mice was imaged weekly during a 24-week UV carcinogenesis protocol. Hot spots of PpIX fluorescence were detectable by multispectral imaging beginning at 14 weeks of UV exposure. Many hot spots disappeared after cessation of UV at week 20, but others persisted or became visible after week 20, and corresponded to tumors that eventually became visible by eye. In SCC-bearing mice pretreated with topical VD before ALA application, our optical techniques confirmed that VD preconditioning induces a tumor-selective increase in PpIX levels. Fluorescence-based optical imaging of PpIX is a promising tool for detecting early SCC lesions of the skin. Pretreatment with VD can increase the ability to detect early tumors, providing a potential new way to improve efficacy of ALA-PDT.
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Affiliation(s)
- Kishore R Rollakanti
- Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH.,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH
| | - Sanjay Anand
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH.,Department of Dermatology, Cleveland Clinic, Cleveland, OH
| | - Scott C Davis
- Thayer School of Engineering, Dartmouth College, Hanover, NH
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH
| | - Edward V Maytin
- Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH.,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH.,Department of Dermatology, Cleveland Clinic, Cleveland, OH
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22
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Topical PDT in the Treatment of Benign Skin Diseases: Principles and New Applications. Int J Mol Sci 2015; 16:23259-78. [PMID: 26404243 PMCID: PMC4632697 DOI: 10.3390/ijms161023259] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 02/04/2023] Open
Abstract
Photodynamic therapy (PDT) uses a photosensitizer, light energy, and molecular oxygen to cause cell damage. Cells exposed to the photosensitizer are susceptible to destruction upon light absorption because excitation of the photosensitizing agents leads to the production of reactive oxygen species and, subsequently, direct cytotoxicity. Using the intrinsic cellular heme biosynthetic pathway, topical PDT selectively targets abnormal cells, while preserving normal surrounding tissues. This selective cytotoxic effect is the basis for the use of PDT in antitumor treatment. Clinically, PDT is a widely used therapeutic regimen for oncologic skin conditions such as actinic keratosis, squamous cell carcinoma in situ, and basal cell carcinoma. PDT has been shown, under certain circumstances, to stimulate the immune system and produce antibacterial, and/or regenerative effects while protecting cell viability. Thus, it may be useful for treating benign skin conditions. An increasing number of studies support the idea that PDT may be effective for treating acne vulgaris and several other inflammatory/infective skin diseases, including psoriasis, rosacea, viral warts, and aging-related changes. This review provides an overview of the clinical investigations of PDT and discusses each of the essential aspects of the sequence: its mechanism of action, common photosensitizers, light sources, and clinical applications in dermatology. Of the numerous clinical trials of PDT in dermatology, this review focuses on those studies that have reported remarkable therapeutic benefits following topical PDT for benign skin conditions such as acne vulgaris, viral warts, and photorejuvenation without causing severe side effects.
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23
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Lerche CM, Fabricius S, Philipsen PA, Wulf HC. Correlation between treatment time, photobleaching, inflammation and pain after photodynamic therapy with methyl aminolevulinate on tape-stripped skin in healthy volunteers. Photochem Photobiol Sci 2015; 14:875-82. [DOI: 10.1039/c5pp00069f] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A shorter incubation time with methyl aminolevulinate in healthy volunteers results in decreased photobleaching and also less inflammation and pain.
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Affiliation(s)
| | - Susanne Fabricius
- Department of Dermatology
- Copenhagen University Hospital
- Copenhagen
- Denmark
| | - Peter A. Philipsen
- Department of Dermatology
- Copenhagen University Hospital
- Copenhagen
- Denmark
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24
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Fink C, Enk A, Gholam P. Aspekte der Schmerztherapie bei der photodynamischen Therapie. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12546_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Kanick SC, Davis SC, Zhao Y, Hasan T, Maytin EV, Pogue BW, Chapman MS. Dual-channel red/blue fluorescence dosimetry with broadband reflectance spectroscopic correction measures protoporphyrin IX production during photodynamic therapy of actinic keratosis. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:75002. [PMID: 24996661 PMCID: PMC4082494 DOI: 10.1117/1.jbo.19.7.075002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/27/2014] [Indexed: 05/10/2023]
Abstract
Dosimetry for aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) photodynamic therapy of actinic keratosis was examined with an optimized fluorescence dosimeter to measure PpIX during treatment. While insufficient PpIX generation may be an indicator of incomplete response, there exists no standardized method to quantitate PpIX production at depths in the skin during clinical treatments. In this study, a spectrometer-based point probe dosimeter system was used to sample PpIX fluorescence from superficial (blue wavelength excitation) and deeper (red wavelength excitation) tissue layers. Broadband white light spectroscopy (WLS) was used to monitor aspects of vascular physiology and inform a correction of fluorescence for the background optical properties. Measurements in tissue phantoms showed accurate recovery of blood volume fraction and reduced scattering coefficient from WLS, and a linear response of PpIX fluorescence versus concentration down to 1.95 and 250 nM for blue and red excitations, respectively. A pilot clinical study of 19 patients receiving 1-h ALA incubation before treatment showed high intrinsic variance in PpIX fluorescence with a standard deviation/mean ratio of > 0.9. PpIX fluorescence was significantly higher in patients reporting higher pain levels on a visual analog scale. These pilot data suggest that patient-specific PpIX quantitation may predict outcome response.
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Affiliation(s)
- Stephen Chad Kanick
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
- Address all correspondence to: Stephen Chad Kanick, E-mail:
| | - Scott C. Davis
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
| | - Yan Zhao
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
| | - Tayyaba Hasan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114
| | | | - Brian W. Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114
- Department of Surgery, Section of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03766
| | - M. Shane Chapman
- Department of Surgery, Section of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03766
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